We hear that women would tolerate pain better than men considered cozier, that they would always be in pain somewhere while men would have an unfortunate tendency to be on the verge of death for a runny nose.

As proof: the English expression " man flu "  entered the Oxford Dictionary and defined as "a cold or a similar minor illness that a man catches and treats as if it were the flu or something more serious."

What if we tried to go beyond these clichés to understand the impacts they can have on medical treatments?

In the reflection on gender-related determinisms, pain is the subject of numerous scientific studies. Indeed, in pain management, the quality of care and the caregiver/patient relationship requires a precise understanding of pain, particularly from non-verbal signals.

However, pain, like other feelings, can be subject to systematic biases, including gender-based biases. Ignoring the existence of these biases means taking the risk of underestimating the pain and therefore not treating it properly.

According to a recent study published on March 5, 2021 in the Journal of Pain, conducted in Colorado, women are taken less seriously than men when both sexes express a similar intensity of pain. This study identifies biases related to gender stereotypes that lead to a systematic underestimation of pain in patients.

What are the modalities of the " Gender Biases in Pain " study?

To reach this conclusion, the researchers conducted two experiments.

The first brought together 50 participants, women and men combined, between 18 and 53 years old, who do not work in the medical field. Various videos of female and male patients suffering from shoulder pain were shown to them. 

For Elizabeth Losin, professor of psychology, director of the neuroscience laboratory at the University of Miami and co-author of this study: " One of the advantages of using these videos of patients who are actually suffering from an injury is that we have patients' evaluations of their own pain, not actors who imitate pain. […] ".

The patients' facial expressions were then analysed using an anatomy-based computer system, which made it possible to obtain an objective score of the intensity of their pain. By viewing the videos, the participants were then asked to rate the intensity of the patients' pain on a scale of zero to 100 :  zero to mean no pain, 100 to illustrate the strongest pain.

In the second experiment, 200 participants were asked to assess the intensity of the patients' pain, by watching the patients' facial expressions on video for 6 seconds. To do this, they had to answer questions such as: " How sensitive is a woman's to pain ? His endurance to pain ? His desire to point out this pain?" and at the same time, " What is man's sensitivity to pain ? Its endurance of pain. His willingness to report pain?" 

Finding 1: Gender stereotypes affect pain estimation

When faced with equivalent pain, participants underestimated women's pain compared to actual self-reported pain, while overestimating men's pain compared to their self-report.

The entire study shows that women are perceived as suffering less than male patients. It is also noted that when both the facial expressiveness of pain and self-reported pain by patients are taken into account, the majority of participants felt that women suffered less than men.

Even more interesting, the study reveals the power of the belief that women are desperate to express their pain to be reassured, to attract compassion, whereas men are better equipped and able to " suffer in silence ".

This gendered divergence is not confined to the pain of adult individuals alone. It also permeates our view of children's pain. "As adults, we rate boys' pain as more intense than girls', all other things being equal (facial expression, verbal utterance, etc.), even when it is the same child, presented as a boy in one case and a girl in the other," says Amrit K. Dhariwal, a pediatric psychologist at the British Columbia Children's Hospital and a researcher at the University of British Columbia in Vancouver, referring to a recent study.

But that's not all. The study also reports that these pain-related gender stereotypes have consequences for the treatments chosen by the participants.

Finding 2 : Different treatments linked to gender stereotypes

Observers were asked to prescribe, as if they were real caregivers, the treatment that they thought would be most useful for each patient. On the prescription to be filled, 3 questions:

• If you had to prescribe a medication, what dose would you prescribe to this patient?

• If you were to prescribe psychotherapy to this patient, how many sessions would you prescribe?

• In your opinion, which would be more suitable for this patient between analgesics and psychotherapy?

The results of these questions are convincing ! The prescription of analgesics was almost systematically preferred to psychotherapy, both for women (58 %) and men (62 %). However, when comparing treatment preference among male and female patients, the study found that psychotherapy was the most useful treatment for a higher proportion of female patients (42 %).

In another study conducted by the University of Pennsylvania, we learn that women wait an average of 16 minutes longer than men to receive painkillers when they go to the emergency room. This once again attests to our tendency to presuppose that the origin of women's pain is essentially psychological, whereas caregivers are rather inclined to look for objective physiological causes in men, directing them to additional examinations to objectify (and therefore legitimize) their pain.

In conclusion, the underestimation of pain and psychologization in the treatment of women's pain could have harmful effects on the health of patients, whether related to a delay in diagnosis, or the fact of inadequate treatment. In any case, it seems urgent to carry out real educational work at all levels and to constantly communicate on the biases to which our brains are subject when making decisions, which can range from the most trivial to the most consequential for a human life. Knowing is already acting !