Gender Bias: Why Gynecological Pain Is Often Dismissed

By Elizabeth Hintz and Marlene Berke

For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people – most of whom identify as women – sexual intercourse and routine pelvic exams are unbearable.

Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women.

Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain.

We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions.

We’ve consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training.

‘It’s All In Your Head’

A 2024 study of patients who went to a clinic for vulvovaginal pain – pain experienced in the external female genitals and vagina – found that 45% of these patients had been told that they “just needed to relax more” and 39% were made to feel that they were “crazy”. A staggering 55% had considered giving up on seeking care.

These results echo what one of us – Elizabeth Hintz – found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this “It’s all in your head” response from doctors.

Another study followed patients in two different major U.S. cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information.

These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care?

“Let me describe the pain that would drive me to try so many different doctors, tests and treatments,” a patient with vulvovaginal pain said to her doctor. For her, sex “is like taking your most sensitive area and trying to rip it apart.”

“I can now wear any pants or underwear that I want with no pain,” said another patient after successful treatment. “I never realized how much of a toll the pain took on my body every day until it was gone.”

Medical Gaslighting

Many patients worldwide experience medical gaslighting – a social phenomenon where a patient’s health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright.

Medical gaslighting is rooted in centuries of gender bias in medicine.

Women’s reproductive health issues have long been dismissed as psychological or “hysterical.” Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy.

These historical views help shed light on why these symptoms are still not taken seriously today.

In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity.

This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed.

Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist.

Disparities in Funding and Care

Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January 2025 report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men.

This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women’s health has actually declined over the past decade. Despite these known disparities, in April 2025 the Trump administration threatened to end funding for the Women’s Health Initiative, a long-running women’s health research program, further worsening the problem.

Without sustained federal funding for women’s health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded.

As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race.

One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients’ pain and offered them less accurate treatment recommendations.

Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men.

Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine.

These lingering erroneous beliefs about gender and race are key reasons patients’ pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death.

Learning and Listening

Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients’ lived experiences and admit when an answer isn’t known.

In the meantime, people navigating the health care system can take practical steps when encountering dismissive care.

They can educate themselves about chronic gynecological pain conditions by reading books like “When Sex Hurts: Understanding and Healing Pelvic Pain” or educational information from trusted sources like the International Society for the Study of Women’s Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease.

Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting.

If someone you know has experienced medical gaslighting and would like support, there are resources available.

Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information – like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.

Elizabeth Hintz, PhD, is an Assistant Professor in the Department of Communication at the University of Connecticut.

Marlene Berke recently completed her PhD in Philosophy at the Computational Social Cognition Lab at Yale University.

This article originally appeared in The Conversation and is republished with permission.

Genetics May Explain Why Women Are More Likely to Have Chronic Pain

By Pat Anson, PNN Editor

It’s no secret that women are far more likely than men to experience fibromyalgia, migraine, osteoarthritis and other chronic pain conditions. Why that is has been linked to everything from gender bias in healthcare to childhood trauma to women “catastrophizing” about their pain.  

A new study published by UK researchers in PLOS Genetics suggests that part of the reason is genetic differences between men and women.

In the largest genetic study of its kind, researchers at the University of Glasgow looked for genetic variants associated with chronic pain in over 209,000 women and 178,000 men who donated their medical and genetic data to the UK Biobank.

The researchers also investigated whether the activity of those genes was turned up or down in tissues commonly involved with chronic pain.

They found that 37 genes in men and 30 genes in women were active in the dorsal root ganglion, a cluster of nerves in the spinal cord that transmit pain signals from the body to the brain.

The findings support previous work by the same research team, which found that chronic pain originates to a large extent in the brain, and to a lesser degree in parts of the body where people “feel” pain. The study also suggests genetic differences between men and women may affect the immune system and how the two sexes respond to medication.

“Overall, our findings indicate the existence of potential sex differences in chronic pain at multiple levels… and the results support theories of strong nervous system and immune involvement in chronic pain in both sexes,” wrote lead author Keira Johnston of the University of Glasgow. "Our study highlights the importance of considering sex as a biological variable and showed subtle but interesting sex differences in the genetics of chronic pain."

Gender Bias

While genetic differences may partially explain why women are more likely to feel pain than men, gender biases may explain why they are treated differently, according to another study recently published in the Journal of Pain.

Researchers at the University of Miami found that when volunteers observed male and female patients expressing the same amount of pain, they had a tendency to view female patients' pain as less intense and more likely to benefit from psychotherapy.

The study consisted of two experiments in which adult volunteers were asked to view videos of men and women who suffered from shoulder pain. The videos came from a database of real patients experiencing different degrees of pain, and included their self-reported pain levels when moving their shoulders in a series of exercises.

The volunteer observers were asked to gauge the amount of pain they thought the patients in the videos experienced. They were also asked how much pain medication and psychotherapy they would prescribe to each patient, and which of the treatments they thought would be more effective.

The study found that female patients were perceived to be in less pain than the male patients — even when they reported and exhibited the same pain levels. Researchers believe those perceptions were partially explained by gender-based stereotypes.

"If the stereotype is to think women are more expressive than men, perhaps 'overly' expressive, then the tendency will be to discount women's pain behaviors," said co-author Elizabeth Losin, PhD, assistant professor of psychology at the University of Miami.

"The flip side of this stereotype is that men are perceived to be stoic, so when a man makes an intense pain facial expression, you think, 'Oh my, he must be dying!' The result of this gender stereotype about pain expression is that each unit of increased pain expression from a man is thought to represent a higher increase in his pain experience than that same increase in pain expression by a woman."

The volunteer observers were also more likely to choose psychotherapy as a treatment than pain medication for the female patients.

Interestingly, the gender of the observers did not influence pain estimation. Both men and women interpreted women's pain to be less intense.

"I think one critical piece of information that could be conveyed in medical curricula is that people, even those with medical training in other studies, have been found to have consistent demographic biases in how they assess the pain of male and female patients and that these biases impact treatment decisions," said Losin.

"Critically, our results demonstrate that these gender biases are not necessarily accurate. Women are not necessarily more expressive than men, and thus their pain expression should not be discounted."