果冻影院

When a man consults a doctor about pain, he will hope to be taken seriously: to convince the doctor that the pain is real, and a problem that needs addressing. The experience is different for women, who may suspect that gender stereotypes could lead their doctor to conclude they鈥檙e not in as much pain as they say they are.

Unfortunately, this suspicion is valid. Evidence suggests that healthcare staff routinely underestimate patients鈥� pain, and particularly women鈥檚 pain, based on a number of biases and beliefs that have little to do with their actual testimony.

Now, a new study has found gender stereotypes are particularly decisive in the estimation of patients鈥� pain. Because of the false belief that women are oversensitive to pain, and express or exaggerate it more easily, healthcare staff, both men and women, often discount women鈥檚 verbal reports and nonverbal behaviour expressing pain.

Not only do they tend to underestimate women鈥檚 pain but, on the basis of their underestimate, they often under-treat pain 鈥� and even recommend psychological rather than analgesic treatment to women.

Gendered pain

The new study ingeniously separates potential sources of observer bias in underestimating women鈥檚 pain: beliefs about women鈥檚 sensitivity to pain (鈥減ain threshold鈥�), about their willingness to report it, and their capacity to endure it (鈥減ain tolerance鈥�) 鈥� all, of course, compared to men as the norm or ideal.

Researchers used brief video clips of real patients undergoing painful examinations, with supporting information about patients鈥� ratings of their own pain, and a quantification of their pain expression.

Male and female lay participants watched a selection of these videos and, after each, recorded the patient鈥檚 sex, estimated their pain on a numerical scale, and rated their pain expressiveness too.

Compared with the patient鈥檚 own rating of their pain, observers of both genders consistently underestimated women鈥檚 pain and overestimated men鈥檚 pain. When men and women showed exactly the same amount of pain in their facial expression, women were thought to be in less pain than men.

An additional experiment showed that stereotypes drove these judgements: men鈥檚 pain was estimated higher by those who believed that the typical man endured pain better than the typical woman, and women鈥檚 pain was estimated lower by those who thought that women were more willing to report pain than men.

Consistent findings

The gender effect in pain estimation is surprisingly strong. In 2016, a study in my lab examined whether clinicians鈥� pain estimations were affected by patients鈥� depression history and their 鈥渢rustworthiness鈥� 鈥� an automatic judgement we make of other people鈥檚 faces.

What emerged was a strong underestimation of women鈥檚 pain, again by participants of both sexes. If women were perceived to be untrustworthy, this further disadvantaged them 鈥� but untrustworthiness had little effect on estimates of men鈥檚 pain.

These stereotypes do not necessarily help men, and serious studies of men鈥檚 pain are rare. While men鈥檚 pain may be estimated by clinicians closer to their pain self-ratings, being less than stoical can attract adverse judgements of being unmanly or weak, while the expectation of stoicism may encourage men to present symptoms to medical scrutiny later than they should.

Judging pain

Pain expression is complex: though partly hard-wired by evolution, it is affected by many personal factors, including your personal history of pain and your social context. The observer鈥檚 task of interpreting pain expression is also complex, modulated by their personal qualities, by social context, and by broader factors, such as gender, age and cultural norms.

Several studies of young children show that while boys and girls playing together have similar numbers of accidents (falls, collisions, conflicts) that might cause pain, and express their distress largely similarly, girls may be offered more physical comfort than boys.

Although findings are not entirely consistent, and may be mediated by girls expressing distress more vocally, they do demonstrate that gender stereotypes about pain may take root early in our lives. And in these cases, differences in judgement may lie more in observers鈥� responses to the children than in any differences in behaviour from the children themselves.

The gender bias effect even holds when observers are watching the same expression of pain. In one simple experiment, observers watched a video of a five year old having blood drawn from a finger, expressing pain. Observers for whom the child was described as 鈥淪amuel鈥� rated the child鈥檚 pain higher than those for whom the same child was described as 鈥淪amantha鈥�.

Further, participants believed that girls were more sensitive to pain, and were more willing to show it. Given how frequent minor painful incidents are for small children, as is the parental or other adult response, this is a surprisingly neglected area of enquiry.

Pain bias

Unfortunately, the pain expression database upon which many pain experiments are conducted consists mainly of middle-aged Canadian Caucasians. This provides little opportunity to explore another very consistent bias in pain assessment and treatment: discounting of the pain of black and Asian or other non-white patients, leading, in research studies, to shocking shortcomings in treatment.

There is much to be done by clinicians to abolish the inequalities in pain care 鈥� and many more inequalities, based on false stereotypes, to be unearthed through research. But this latest study, confirming that gender stereotypes inform our estimation of others鈥� pain, should help healthcare staff reflect on the social and personal bias they may bring to their practice.

This article originally appeared in on 8 April 2021.

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• Original article in
• 果冻影院 Department of Clinical, Education & Health Psychology
• 果冻影院 Division of Psychology & Language Sciences
• 果冻影院 Faculty of Brain Sciences