Disclaimer: We appreciate that many people who have vaginas do not identify as female and are using “women” and “female” to encompass anyone who may experience this gender bias.
Vaginas are taboo. Despite efforts to normalise talking about vaginas, a long history of societal refusal to do so has its own consequences. The stigma around vaginas means that many people have little idea of what is ‘normal’ and so often symptoms to various conditions go unchecked and unaddressed. Hence, vaginismus, a condition where the vagina involuntarily contracts on contact, often making penetration painful, and estimated to affect between 5% and 17% of women, is still an unfamiliar term to so many of us.
However, it is not just the word vagina that has been shunned. Women’s health – and in particular, reproductive health – has been greatly neglected in medical research.
In the US, it was not made mandatory by the National Institute of Health for clinical trials to include women until 1993. In defence of running single sex trials for pharmaceuticals deemed suitable for people regardless of sex, it was claimed that the female body is more complex than the male, therefore, women would make unreliable test subjects. This is a glaring gender bias as whilst it it is true that hormones fluctuate to a greater extent in the female body, if anything this would only heighten the importance of ensuring the product is tested on women as well.
This feeble excuse was only made to try to explain away why research and trials have always focused on cis-gender men. In a society that prioritises its cis-male citizens, why would they waste funding and resources on making their trials span second class citizens? People of colour still suffer due to this; a 2009 paper revealed that US based genome-wide association studies were 96% white.
Therefore, women are missing out on decades of medical research. Had there been more female researchers, undoubtedly this would not be the case but the gender bias that pervades STEM fields has exacerbated the fact that women attending university was not normalised until the 1930’s. Hence, many of the research groups were likely mostly – if not totally – male.
Even now, the research carried out is still biased, swayed likely by the patriarchal nature of the funding given out. 90% of women suffer from premenstrual syndrome (PMS), and yet there is five times more research into erectile dysfunction, which affects 19% of men.
So it is no surprise that so many common conditions affecting the vagina and vulva are unheard of. In fact, so often they are not recognised by the medical community as well. Premenstrual dysphoric disorder (PMDD), a more serious version of PMS, was only adopted into the Diagnostic and Statistical Manual of Mental Disorders in 2013. Until then, it was not classified as an official disorder, despite being thought to affect 5% of women.
The argument against doing so was that PMDD is a social constructed disorder. There are convincing cases for this specific instance but the fact that the medical community would so readily dismiss it, even before carrying out research, as simply an emotional state reflects a gender bias with a wider tendency to disregard the severity of women’s symptoms and pain.
For example, University of Washington researcher Kathleen Lustyk revealed to ResearchGate that grant reviewers had rejected her grant applications for research into PMS on the grounds that they did not believe it to exist. They think it’s in the women’s head.
So often this is the case. The gender pain gap stems from the fact that our understanding of pain is informed mostly by studies done on male physiology. Women are believed to feel pain less severely and to have a lower tolerance. Consequently, our pain is far more likely to be attributed to psychological factors and so we are treated for those first instead. Men, on the other hand, get to skip that step and are far more likely to get treated with actual pain medication. A study showed that in ER in the US, men wait an average of 49 minutes before receiving pain medication for acute abdominal pain. Women in an identical position wait for 65 minutes.
But this is not just an uncomfortable reality – it’s a dangerous one. Pain is so often an important symptom, and yet ours is so frequently dismissed. For example, endometriosis, thought to affect 10% of women of childbearing age, has few outward signs. The patient’s pain is the main symptom, so the consulted doctor usually has to make their decisions solely off of that. This is complicated by the fact that so many women are used to having painful menstrual cycles anyway. The invalidation of our pain means that even we might not recognise it as something to be concerned about.
As for vaginismus, often cases are dismissed as standard discomfort, due to the myth that a women’s first experience of sexual intercourse is supposed to hurt. A 2013 US study found that 35% of women suffering from vestibulodynia, a chronic vaginal and vulvar pain, had visited doctors’ offices more than 15 times before getting a diagnosis.
Women are sent home from appointments armed with nothing other than a bit of questionable advice, often ‘have a glass of wine before’. Since when did that become a valid treatment of a medical condition?
The reluctance to take female pain seriously complicates diagnoses, not just because it ignores symptoms. It also often leaves the women embarrassed and confused. Invalidating their symptoms evokes shame, making them less likely to return.
In the UK, within the space of a year 31% of women had experienced severe reproductive health issues. However, less than half of them had sought help. This illustrates the strong influence of taboos surrounding the subject, as well as a lack of confidence in the system.
Of course, people with vaginas is not a homogenous category. How our bodies work varies greatly with factors such as race and if we are a member of the LGBTQ+ community, and it is indisputable that more research must be carried into that (a 2019 study showed that black women were 5 times more likely to die from childbirth than white woman in the UK). However, it is difficult to analyse the differences amongst us when there is not even a full groundwork.
Furthermore, the pattern of unnecessarily delayed diagnoses causes a further strain on already over burdened resources; proper reproductive health education for both physicians and women would mean that their health issues are identified quicker, making the system more efficient. For example, PMS is often misdiagnosed and treated as a mental illness, despite the fact that our mental health services are already stretched too thinly.
We are told not to self diagnose but many people are left with no choice. There is a gender bias in clinical research in it is endangering people. Women are less likely to be able to identify their own symptoms, less likely to have the confidence to go to a medical appointment, and less likely to come out of one with a correct diagnosis. We cannot allow reproductive health issues to remain taboo – not when we already have so much catching up to do.
Words by Isabella Ward
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