Women's pain, medicine's shame

Issue 

Pain & Prejudice: A Call to Arms for Women & Their Bodies
By Gabrielle Jackson
Allen and Unwin, 2019 
360 pp, $29.99

Women’s health and chronic pain has been ignored throughout medical history, writes Gabrielle Jackson. Pain, more specifically, pelvic pain, has been seen as an intrinsic part of womanhood.

Jackson’s research began when she was diagnosed with endometriosis 14 years ago. As a senior writer with The Guardian, she was able to tell her story.

That caused a huge response from other women suffering physical pain and the pain of an insensitive medical system. The revelations that women have been, and still are, under-served by the system led to Jackson writing this book.

This prejudice has deep historical roots and still lingers in contemporary government attitudes, she says.

Jackson says from antiquity until today, medicine has defined the female and male bodies as distinct but not equal. Effectively, Jackson says: "In medicine, man is the default human being. Any deviation is atypical, abnormal, deficient."  

Her analysis of medical texts throughout history reveals the male body to be constructed as superior and the template against which bodies are judged.

Hippocrates, the inventor of the doctor’s oath to do no harm to patients, originated the idea of the "wandering womb". Many women’s medical afflictions were the fault of the uterus dislodging itself and wandering freely around the body. 

An ideologically construct developed of a volatile, slightly unhinged woman, repeatedly presenting with pain to her doctor. After failing to get relief, she would be diagnosed with "hysteria". 

While hysteria is named after the Greek word for uterus, the logic of the diagnosis is of women being lesser than men, not to be believed and prevented from competing in a male-controlled world.

Any aspect of the female body that differed from the male (exemplified by the uterus) was viewed as evidence of deviation or "fault". The template for women appeared with a smaller head and wider hips by comparison to men.

Medical discourse associated women with child bearing and the body, while males were associated with the mind. This built a particular medical explanatory model of female disease and illness: a woman’s failure to accept her "biological destiny" incites all manner of ailments.

This thinking has fed into how doctors relate to female pain. Many horrors have flowed from this attitude.

United States physician Dr J Marion Sims earned his reputation as the "Father of Modern Gynaecology". He operated without anaesthesia on enslaved African-American women in Alabama between 1845 and 1849 to perfect his technique.

A 1927 US Supreme Court decision protected states’ right to compulsorily sterilise ‘unfit’ women.

In 1975, the Chicago Committee to End Sterilisation Abuse reported the acting director of Obstetrics and Gynaecology at a New York hospital as saying: "In most major teaching hospitals in New York City, it is the unwritten policy to do elective hysterectomies on poor, Black and Puerto Rican women with minimal indications."

Australia has no better record, with Indigenous women experiencing discrimination when seeking health care.

Congress of Aboriginal and Torres Strait Islander Nurses and Midwives CEO Janine Mohamed said there is a preconception that Indigenous women are not interested in their health care, because they’re not turning up.

The opposite is true. When women are asked, the answer is always: "Give us culturally safe and respectful services."

Women are still suffering due to this entrenched patriarchal system and male-centred medical research — but are fighting back and winning small victories.

The Australian government convened a National Pain Summit in 2010, which declared that pain is the world’s largest “undiscovered” health priority. It found that less than 10% of people with non-cancer pain gain access to effective treatment.

But figures from The National Health and Medicine Research Council between the years 2013–17 show zero spending for chronic pelvic pain affecting about 2.4 million Australian women. Compare this to asthma, which affects the same number of people, but which received $13 million in funding.

In 2018 and 2019, $15 million in funding was awarded for research into endometriosis. The credit goes to many people, mostly women, who have advocated over years for endometriosis patients.

Recently, on Australian Story, ABC broadcaster Jill Emberson discussed her public fight for equity in funding for ovarian cancer. She is seen meeting with health minister Greg Hunt where he announces $15 million funding for targeted reproductive cancer clinical trials, including ovarian cancer.

However, the Pelvic Pain Report notes chronic pelvic pain is still being overlooked. The estimated 176 million women worldwide between ages 15–49 suffering endometriosis outnumber the people affected by breast cancer, prostate cancer, AIDS and type 1 and type 2 diabetes.

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