What Women Endure – The New York Times

In medical settings, it is common for women’s pain to be ignored or dismissed. In other cases, it is not properly treated.

This phenomenon is particularly agonizing for women in some of their most vulnerable moments.

If you have been a gynecological patient, maybe you have felt unprepared for the pain of a procedure like an IUD insertion. Wondered why you were not offered a better option to control your pain before the HSG, a pelvic X-ray in which dye is shot into your uterus. Or been told, in any number of situations, that “you will feel pressure,” or “this will pinch,” or “take Tylenol.”

“To be honest, evidence suggests that Tylenol doesn’t likely work, even Advil doesn’t likely work, in many of those settings,” says Sara Whetstone, an obstetrician and gynecologist at the University of California, San Francisco. “So are we lying when we tell people ‘it’s just a cramp’?”

The pain that women experience in medical settings is common, often preventable and routinely ignored. I explored some of this in “The Retrievals,” a podcast series about recent events at the Yale Fertility Center.

The women I reported on experienced an extreme version of procedure pain. They underwent egg retrievals at a clinic where a nurse was stealing the fentanyl they should have been administered to manage the pain of the surgeries. Their pain control was missing entirely. Some of the women screamed out that they felt everything during their retrievals, in which a long needle is inserted through the vaginal wall and into the ovary.

For months, patient after patient complained about pain, and they say the clinic dismissed their complaints. One reason their complaints did not raise more alarm is that members of the medical staff expected that patients could feel pain with this procedure. Under the drug protocol the clinic had offered for years, some patients felt even severe pain. Pain had been normalized.

Not believing a patient is one way of dismissing pain. Offering inadequate pain control is another way of dismissing pain — another way of saying, this doesn’t matter.

Whetstone told me that she realized early in her career that pain control would be important in building trust with her patients, who include many women of color. Patients often tell her about past procedures in which their pain was not properly treated — and nobody listened to them. It’s a double trauma: pain being considered unworthy of adequate treatment in the first place, and then dismissed.

Why wouldn’t a doctor listen to a patient who complains about procedure pain? Whetstone had a reflective response. “I sometimes wonder if people internalize it as a failing that they as a provider did,” she told me. “That’s how I internalize it. When people have more pain than I want them to, I feel like I haven’t done a good job as the provider. So I wonder if not really engaging allows people to emotionally separate from their failure to control pain.”

Just because pain is acute also doesn’t mean it’s only a short-term problem. It can change health outcomes — alter the course of your life. You might avoid going back to the doctor for birth control. You might not get that endometrial biopsy. Or, like a patient I interviewed and others I have heard from since the series began, you might not go back for another egg retrieval and lose a chance to have a child.

All of the women in “The Retrievals” suffered lasting effects from their inadequately treated and unacknowledged pain. One of the most profound is a loss of trust in the medical system. One patient, Esha, who, for privacy, requested to be identified by only her first name, became pregnant with twins during her fertility treatment. She went into labor eight weeks early, and at the hospital, when it became clear that delivery was imminent, a provider approached Esha to talk about anesthesia.

Up until that moment, Esha had been calm. “The minute he said ‘anesthesia,’” she said, it was “pure panic.” Now the word raised a trauma. Esha looked at her husband and started crying.

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Alok Vaid-Menon is a gender-nonconforming activist and a prominent voice on issues of gender and sexuality. I spoke to them about new ways to think about transgender debates.

You write, “There is a shocking disconnect between the way the government and the media speak about gender-nonconforming people and the reality of our lives.” Tell me more.

There are no such thing as trans issues. There are issues that nontrans people have with themselves that they’re taking out on trans people. A great example is when they talk about our “agenda.” “The transgender agenda: It’s recruiting people.” My agenda is the ability to exist in public without the fear of being assaulted.

I think a lot of people have a sense that there is a true self inside them that gets boxed in by other people’s expectations. Do you have advice for people who might feel that way about how to be their true selves?

You’re pointing to exactly what’s behind all the anti-trans sentiment. The fundamental root of our problems is people living versions of who they’ve been told they should be, not who they are. The resentment that people have toward me and my community is because they’re looking at us saying, “What do you mean that we get to be free?”

But you don’t think people’s resentment is about their struggling to adapt to change more than feeling a comparative lack of freedom?

Of course. Things that are new are often jarring at first, but I want to tell you about the internet. I want to tell you about iPhones. These inventions fundamentally restructured how we related to one another, our self-conceptions, and there were not millions of people saying: “Abolish this! We are committed to our routine.”

Read more of the interview here.

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