Pain & Prejudice: Inside The Rise (And Rise) Of Medical Misogyny
In the 2022 short film This Is Endometriosis, black-and-white photographs dance across the screen, showing filmmaker Georgie Wileman doubled over in pain. ‘I was misdiagnosed with chronic fatigue syndrome, ulcerative colitis, IBS and depression,’ she says in the 19-minute-long film that was exhibited at The National Portrait Gallery. Wileman, who started suffering from symptoms at 13, was referred to a child psychologist who told her there was nothing to worry about. ‘It was insinuated that I was making it up for attention,’ she says.
It took fourteen years before Wileman received a diagnosis of endometriosis in 2014 at the age of 26. By that point she was bed bound because of chronic pain: ‘I needed 24-hour care,’ she says. ‘I was propped up and barely conscious throughout the day because of the pain medication.’ Her experience inspired her to make the short film which has been part of a growing conversation and visibility around endometriosis, helped by high profile celebrities, including Lena Dunham and Florence Pugh, sharing their own stories. But despite this greater transparency, and the fact that endometriosis affects around 190 million women globally, the condition is still plagued by stigma: it takes an average of ten years to diagnose and there is currently no known cause or cure.
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This practice of pain and prejudice isn’t limited to endometriosis; it extends to the entire spectrum of women’s reproductive health issues and is one of the main causes of a widening health gap in the UK, which, as of 2022, is the 12th largest globally. It was also the subject of a December 2024 inquiry by the House of Commons Women and Equalities Committee, which found that some clinicians have an ‘ingrained belief’ that women, particularly those from ethnic minority groups, are exaggerating their symptoms, meaning that conditions, like Wileman’s, are left undiagnosed. The committee, which heard evidence from a range of witnesses, including medical organisations, ministers, and charities, identified a ‘clear lack of awareness and understanding of women’s reproductive health conditions’ among GPs, particularly concerning younger women and girls.
It’s not only gender biases that are distorting medicine, but racial, class, age and sexual orientation, too. Black women are four times more likely to die during pregnancy and childbirth than white women, with one in five Black women admitting in a 2022 survey that they had been treated unfairly by a health care provider because of their racial identity. When Abimbola Wingate-Saul went to hospital to have an elected caesarean with the birth of her second child, she was given just one tablet of Codeine. Despite asking midwives for more pain relief, it didn’t arrive. ‘I had to phone my husband to ask him to get me some paracetamol because I wasn’t mobile, and it’s quite shocking that despite having major abdominal surgery, I couldn’t get a simple painkiller,’ she explains. ‘Everybody assumes that because you're a woman and you're “supposed” to give birth that you’re supposed to manage the pain, because it's viewed as being like part of the menstrual cycle.’
Divina Johnson also experienced trauma with the birth of her three children. When Johnson expressed the intense pain she was experiencing before undergoing her third caesarean, her midwife told her: ‘I expect you to be stronger than that. I expect your people to be stronger than that.’
‘We’re not talking about ancient times,’ Johnson says. ‘This was 2021, and this is what doctors, midwives and the medical establishment thinks of Black women.’ Johnson has since parlayed her experience to become a birth trauma recovery coach.
Alongside this backdrop of pain discrimination, a large, money-making market is emerging which is tapping into women’s insecurity around their health. According to McKinsey’s latest Future of Wellness study, women spend more on products related to menopause and pregnancy than on other health products, with the menopause wellness market alone expected to grow from $17.66 billion (£21.4 billion) in 2024 to $27.63 billion (£33.5 billion) by 2033. ‘There’s a gap in knowledge of women’s health within medicine, which means there’s a gap in what doctors can actually prescribe women so in that space brands are jumping in and making women feel like they’re being listened to,’ health journalist and author of 'Rebel Bodies, A Guide To The Gender Health Gap', Sarah Graham says. ‘It's a huge problem, and a lot of it feels very exploitative…You see it across the board from as soon as somebody starts their period, all the way through to menopause and beyond.’
And while we might see many more products being marketed to us, the problems around research into women’s health, or lack thereof, persist. ‘Those who experience menopause are being frozen out of the research picture,' explains writer Emma Szewczak whose book ‘The Stitch Up: How Medical Misogyny Harms Us All’ is out in May. 'Approximately half of the UK population may experience menopause, but only 0.3% of the National Institute for Health Research’s budget in 2023 went towards menopause studies. And the situation doesn’t look any better globally, either. A 2024 review in the journal Nature Ageing found that 99% of all preclinical studies into ageing did not include menopausal patients.’
Indeed, most of the advances we have seen in medicine have come from the study of male biology. ‘The entire research ecosystem and its gatekeepers is male-dominated, and so those conscious and subconscious values influence and perpetuate again and again,’ explains Dr. Shirin Heidari, the founding president of GENDRO, an organisation whose mission it is to advance research into women’s health.
According to Dr Heidari, women’s exclusion from research dates back to the thalidomide trials which began in 1955. Thalidomide was then a widely used drug used to treat nausea in pregnant women, before it was discovered in the 1960s to have caused severe birth defects in thousands of children. ‘After that, the medical establishment took the simplistic approach of excluding women from trials to protect foetuses,’ Dr. Heidari adds. ‘The more women started being excluded from research and studies, the bigger the gaps in our understanding of women's health became.’ For context, there is five times more research into erectile dysfunction, which affects 19% of men, than into premenstrual syndrome, which affects 90% of women. According to Imperial College London, less than 2% of medical research funding is spent on pregnancy, childbirth and female reproductive health.
Despite the outlawing of ‘hysteria’, a word fittingly derived from the Greek word for ‘uterus’, as a medical diagnosis in 1980, its sentiment has stuck, and women have found themselves being misdiagnosed with mental health problems as their physical symptoms are ignored. Studies have found that depression may be misdiagnosed in as many as 30–50% of female patients. The irony is that negative doctor-patient interactions can themselves have a detrimental impact on mental health, while depression and anxiety might not only be misdiagnosed but may also be symptoms of other diseases, as is often the case.
Before the July 2024 election, Graham was at a press briefing with Wes Streeting, the now-Secretary of State for Health and Social Care. ‘He was saying all the right things you’d expect him to say before the election, but it’s been radio silence since,’ she says. Despite the previous government announcing a £25 million investment to support the establishment or expansion of women's health hubs across England — awarding an additional £1.97 million to support women experiencing reproductive health issues, such as pregnancy loss or menopause — at the time of writing, Labour has yet to announce its own agenda for women’s health. ‘When women are not listened to, they come to harm,’ Dr. Henrietta Hughes OBE, who was appointed England’s first Patient Safety Commissioner in 2022, explains. ‘We need to change this so that all women receive the right diagnosis and the right treatment, and we keep people safe.’
Increased government funding could certainly help redress the polarities between male and female-focussed research, but Dr. Minhas is conscious that the phrasing of 'women’s health' is so expansive, that it’s not quite specific enough: ‘Women's health is massive, it’s not just one condition; it's obstetrics, gynaecology, premenstrual health, mental health, and post-menopausal care as well,’ she says. ‘It’s all good and well releasing studies, but words are just words and really this is an issue where we need to see action.’
Three years after her first endometriosis diagnosis — sixteen years after she first started experiencing symptoms — at the age of 29, Wileman had a hysterectomy. ‘I'm still trying to come to the terms for the idea of life without having children of my own,’ she says with clear emotion. ‘It’s really hard, but I also would be so nervous to pass this down if I had a girl.'
Women are suffering because they’re being failed by the systems that are in place to protect them. The current reality for women is that until our bodies are studied, scrutinised and ultimately better understood, our health hangs in the balance. But the fight for equity in healthcare and research is underway and although results may be incremental, they are starting to shape the future. ‘What we are pushing for is research into women’s health to be the rule, not the exception, but change is happening,' Dr. Heidari concedes. 'It’s slow, but it’s happening, and there is no way to go back now. We just have to keep looking forward.'
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