Understanding the Gender Pain Gap

Although women are disproportionately affected by pain, navigating everything from endometriosis to chronic migraines, their experiences are often trivialised and overlooked (1). This is down to a troubling trend known as the 'Gender Pain Gap'.

Despite advancements in medicine, pain management remains a woefully neglected area of women’s health, leaving gaps in both the scientific literature and our collective knowledge. The misconception that women's pain is 'normal' only compounds the issue, perpetuating a frustrating cycle of neglect.

The implications of the Gender Pain Gap are catastrophic: unconscious medical discrimination, dismissal of symptoms, misdiagnosis, and a continued lack of research. Consequently, women often endure years of suffering despite living longer than their male counterparts.

Below, we take a look at this long-ignored aspect of healthcare, exploring why the Gender Pain Gap exists and strategies for dismantling it.

The Gender Pain Gap refers to the phenomenon where women’s pain is misunderstood and mistreated due to widely held, unconscious biases.

In a recent report commissioned by Nurofen in 2023, which surveyed over 5,000 individuals, it found women experience pain more frequently and intensely than men. Shockingly, the data revealed that 1 in 2 women feel their pain has been disregarded simply because of their gender. Even more alarming, 1 in 6 women face severe pain on a daily basis (2).

The report also highlighted a concerning trend: there has been an 11% increase in the proportion of women who believe their pain has been dismissed, compared to just 7% in 2022, indicating the Gender Pain Gap is only getting bigger.

Unfortunately, women who live in pain without proper medical treatment are more likely to experience sleep issues, challenges exercising, and dips in their mental health, highlighting the all-encompassing nature of the issue.

The Gender Pain Gap has its roots in a patriarchal bias, stemming from a health care system that was built by men for men. Consequently, there has been – and continues to be – a lack of funding to study women’s health and bodies.

The ‘male by default’ perspective is widespread across clinical research. Most pain studies are conducted on male rodents or men. As a result we know less about how pain impacts men and women differently, as well as the pain conditions that mainly affect women.

Although women make up 51 per cent of the population, scientific findings are rarely disaggregated by sex, missing the vital opportunity to expand our knowledge of women’s health and experiences of pain.

For instance, there has been more scientific research on erectile dysfunction, which affects 19 per cent of men, than on premenstrual syndrome, which impacts almost 90 per cent of women (3).

Without sufficient funding, data, and statistics, a significant gap remains, hindering efforts to acknowledge and treat women’s pain effectively.

Besides the ‘male as default’ approach, the Gender Pain Gap can also be attributed to a number of erroneous beliefs and stereotypes.

Firstly, there’s the idea that women can naturally endure pain because they experience menstruation and childbirth. One study revealed that 51 per cent of women and 52 per cent of men think period pain is something women ‘have to deal with’ (4).

The notion that women are ‘emotional’ or more likely to exaggerate pain for ‘attention’ also perpetuates the Gender Pain Gap, as does the misconception that female pain is simply ‘psychological’.

A 2018 review of 77 pain studies globally reported that healthcare professionals were more likely to view men in pain as ‘brave’ and women in pain as ‘hysterical’ (5). For context, the word ‘hysteria’ derives from the Greek word for uterus. Historically, doctors thought a woman’s uterus could lead to mental health disorders – a belief that, perhaps, still lingers today.

The Gender Pain Gap can be even more detrimental for women of colour, who face additional discrimination regarding pain tolerance due to their race.

These stereotypes, coupled with the ‘male as default’ approach in medicine, fail to give female pain the gravitas it deserves, leaving women undiagnosed and untreated for years.

While the Women’s Health Strategy for England in 2022 promises to address the Gender Pain Gap in research and trials, systemic change takes time (6).

That said, there are still many ways to advocate for yourself at a grassroots level, break down stigma, and bring women’s pain to the fore.

Consulting healthcare professionals about pain can often be a frustrating and emotionally draining endeavour, particularly when you sense your concerns aren't being fully heard. With that in mind, here are some practical tips to get better treatment.

Come with a loved one: Bringing a close family member, partner, or friend to medical appointments can offer valuable support. They can ask questions, speak up on your behalf, and witness your experience.

Have your notes ready: Keeping an account of your symptoms can help you get straight to the point and maximise your appointment. These notes could also outline what you’ve already done to manage your pain, as well as your family history.

Use pain words: Describing pain can be difficult, but it’s important to convey the severity accurately. Using terms like stabbing, burning, cramping, sharp, aching, dull, pinching, tingling, gnawing, pulsing, and sporadic can help communicate with your doctor effectively.

Consider how pain affects your daily life: Explaining your everyday experience of pain helps healthcare professionals better understand your situation. Use a scale ranging from 1 (minimal pain) to 5 (severe pain) to articulate the intensity of your discomfort If you’re a number 3, this may suggest that you’re struggling more than usual and need help from others. If, however, you’re a number 5, this could indicate you’re unable to carry out your normal tasks altogether.

Get a second opinion: Remember, your pain is valid and you’re entitled to ask for help. If you feel your concerns have been dismissed based on your gender, don’t hesitate to request a second opinion.

Educating yourself on pain management can empower you in the face of the Gender Pain Gap. This may involve delving deeply into your condition, conducting your own research, and becoming somewhat of an 'expert'.

Of course, as mentioned, finding adequate scientific research on women’s pain can be a challenge. However, you can still glean valuable insights from forums, many of which have been set up by fellow women in response to gender pain discrimination. Besides education, these online spaces can provide a sense of solidarity and validation, which can be equally helpful.

Charities can also offer plenty of information and guidance on navigating your pain management journey.

While you can’t dismantle the Gender Pain Gap overnight, you have the power to improve your situation through lifestyle changes. Tweaking your daily habits means you can take matters into your own hands, buffer against pain, and support your overall health.

Following a plant-centred diet – rich in fruits, vegetables, whole grains, legumes, nuts, seeds, herbs and spices – can be extremely effective for pain management as it promises to reduce inflammation.

Inflammation is a natural response by the body to protect itself from harmful stimuli and begin the healing process. However, when inflammation becomes chronic and low-grade, it can contribute to various health issues, including pain (7).

Firstly, a plant-based diet reduces animal-based products, like butter, cheese, and milk – foods that may otherwise cause inflammation.

Plants are also packed with powerful antioxidants, phytochemicals (plant chemicals), and omega-3 fatty acids, which are known to lower inflammatory markers in the body and sustain general health.

Finally, a plant-focused diet is high in fibre. Fibre not only promotes healthy digestion but also nurtures the gut microbiome - a bustling ecosystem in your digestive tract crucial for modulating inflammation and supporting immune function.

The connection between the gut and the brain, also known as the gut-brain axis, further highlights how a healthy gut can positively influence pain perception and overall wellbeing.

If you live with pain, it can be tempting to avoid all movement to prevent further injury. However, studies suggest inactivity can often exacerbate pain (8). Gentle exercise reminds your body that movement is safe, normal, and nothing to be feared.

Exercise also releases feel-good hormones called endorphins, which are known to block pain signals from reaching the brain (9).

With this in mind, try to keep moving as much as possible, even if it’s a gentle walk around the block.

Psychological stress and anxiety can aggravate and even cause pain, so taking the time to decompress can help manage symptoms. There are many ways to reduce stress – from walks in nature to journaling to connecting with loved ones.

Mind-body practices like meditation can be particularly useful. In a 2018 study, researchers found that a long-term meditation practice changed the cortical thickness in some areas of the brain, which can make you less pain-sensitive (10).

Deep breathing can also quickly downregulate the stress response. Deep belly breathing activates the parasympathetic nervous system, responsible for the ‘rest and digest’ state. Spending a few minutes consciously breathing will communicate to your body that it’s safe, and this will positively impact your experience of pain.

When you’re stuck in the pain-fear cycle – experiencing pain, worrying about pain, and feeling more pain – it can be easy to get frustrated with yourself. But this only keeps the cycle going.

Practising self-compassion enhances your ability to self-soothe and reduce the threat response triggered by pain. Here are some simple ways to incorporate more of it into your daily life.

Talk to yourself gently, as you would to a small child or loved one. You could even use diminutives, like “darling” or “sweetheart”

Ask yourself: “What would I do if this was a friend?”

Use soft self-touch, such as giving yourself a massage or gently placing a hand on top of the painful area

According to environmental research, spending time in nature and green spaces can improve pain outcomes (11).

There are many reasons for this: exposure to sunlight, physical exercise, social interactions, and the sights and sounds of nature, all of which downregulate the nervous system and support wellbeing.

Even just 10 minutes spent in a natural setting can help alleviate the physical and emotional stress often associated with pain (12)

Women who experience chronic pain often find themselves in a self-perpetuating cycle of anxiety, low mood, pain, and insomnia (13). Fortunately, there are plenty of ways to break this negative feedback loop and optimise your sleep hygiene.

Ensure your bedroom is cool, quiet, and dark

Invest in a comfortable mattress, pillow, and bedding

Get plenty of natural morning light to calibrate your 24-hour circadian rhythm

Enjoy a relaxing wind-down routine one hour before bed

Avoid drinking caffeine after midday

Disconnect from your electronic devices before bed or, even better, leave them outside your bedroom

Have tools to help you get back to sleep if you wake in the middle of the night

Consider supplementing with magnesium, theanine and lemon balm, and tart cherry juice

Read more tips on improving sleep on our dedicated Sleep Health Hub.

Besides adjusting your diet and lifestyle, the following formulas can provide targeted support for physical discomfort.

Designed with healthy nerves in mind, NEURO-B contains relevant amounts of vitamin B1 for the nervous system, vitamin B6 (as PSP) for normal red blood cell formation, and B12 for normal neurological and psychological formation, making it a great choice.

A member of the N-acylethanolamine (NAE) family, PEA is found in almost every cell and is vital for chemical signalling in the body. PEA is a popular alternative to CBD and helps tackle any discomfort that might hold you back.

It’s easy to feel powerless in the face of the Gender Pain Gap. However, there are still many ways to advocate for yourself, including speaking up at doctors’ appointments, self-education, and making changes to your diet and lifestyle to reduce symptoms.

For more guidance and advice, please reach out to our team of expert Nutrition Advisors, who are on hand to provide free, confidential advice.

www.cdc.gov. (2020). Chronic Pain and High-impact Chronic Pain Among U.S. Adults, 2019. [online] Available at: https://www.cdc.gov/nchs/products/databriefs/db390.htm.

www.nurofen.co.uk. (2023). Nurofen | See My Pain. [online] Available at: https://www.nurofen.co.uk/see-my-pain/

The Independent. (2016). One in five men have erectile dysfunction. 90% of women experience PMS. Guess which one researchers study more? [online] Available at: https://www.independent.co.uk/news/science/pms-erectile-dysfunction-studies-penis-problems-period-pre-menstrual-pains-science-disparity-a7198681.html.

Bodyform Global V Taboo Tracker: https://libresse-images.essity.com/images-c5/592/309592/original/gvttfinal.pdf

Samulowitz, A., Gremyr, I., Eriksson, E. and Hensing, G. (2018). ‘Brave Men’ and ‘Emotional Women’: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Research and Management. [online] 2018(1), 1-14.

GOV.UK (2022). Women’s Health Strategy for England. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/womens-health-strategy-for-england.

Fang XX, Zhai MN, Zhu M, He C, Wang H, Wang J, Zhang ZJ. (2023) Inflammation in pathogenesis of chronic pain: Foe and friend. Mol Pain.

Anders Pedersen Årnes, Christopher Sivert Nielsen, Audun Stubhaug, Mats Kirkeby Fjeld, Johansen, A., Morseth, B., Bjørn Heine Strand, Wilsgaard, T. and Ólöf Anna Steingrímsdóttir (2023). Longitudinal relationships between habitual physical activity and pain tolerance in the general population. PLOS ONE. 18(5), e0285041–e0285041.

Pilozzi A, Carro C, Huang X. (2020) Roles of β-Endorphin in Stress, Behavior, Neuroinflammation, and Brain Energy Metabolism. Int J Mol Sci.22(1):338.

St. Marie R, et al. (2018). Neurological evidence of a mind-body connection: Mindfulness and pain control. Psychiatry. 13, 4: 205.

White MP. et al., (2019) Spending at least 120 minutes a week in nature is associated with good health and wellbeing. Sci Rep. 9,7730.

Psychology Today. (2022). Fun with Fractals? Available online: https://www.psychologytoday.com/gb/blog/codes-joy/201209/fun-fractals

Tang NK, Goodchild CE, Sanborn AN, Howard J, Salkovskis PM. (2012) Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study. Sleep. 1;35(5):675-87A.