‘Medical gaslighting’ exists – if you’re a woman

Another day, another NHS crisis meting out its effects on women’s physical and emotional health.

Latest studies suggest that there are 110,000 jobs unfilled inside the health service, and the Royal College of Nursing now says the staffing situation is jeopardising safe care for patients. Staff shortages are already rendering pregnant women vulnerable and some labours dangerous, it says, as NHS trusts struggle to employ enough trained midwives to meet demand, while more choose to leave the profession every day. And now another survey has emerged, highlighting how the lack of resources on the NHS front line is literally causing women pain.

According to patient safety campaigners, hundreds of women have been forced to endure “barbaric” pain while undergoing hysteroscopy tests after being denied pain relief options and anaesthetists were not available. The Health Service Journal reports that campaigners have identified at least 240 women who underwent the procedure without being told they were entitled to a general anaesthetic to manage the pain of the invasive test.

Guidance for doctors says pain relief should always be discussed. Instead, these women were found to be underinformed about their own rights and expected to simply endure what can be an incredibly painful process of internal investigation. Just because some women report only minimal or no discomfort, that does not mean this is a painless procedure; for those who do suffer, the experience can be very traumatic.

Pain is not an objective thing. It is subjective and very personal. Whether staff shortages are to blame or not (and patients responding to this story were certainly sceptical of that claim), the subliminal message to those women whose pain went ignored and untreated is that their misery is not legitimate. It also suggests that women’s pain is exaggerated – not sufficiently relevant to qualify for treatment at a moment of extreme pressure – and that their expressions of it are hysterical, a loaded term given the context of the particular test in question.

To say these women did not need and could not be provided with a choice of anaesthetic or other analgesic is a form of medical gaslighting. Like the form of emotional abuse it is named after, medical gaslighting like this is a form of sexism and misogyny, albeit mostly institutional rather than personal (although if you take a look at the compelling thread #shitmydoctorsays you’ll find endless examples of that too).

It’s not just to be found within this upsetting survey and among the devastating reports of out of labour wards with sparse midwifery care. It is everywhere and it is entrenched. At the beginning of the year, research work from academics based in Canada even exposed how women who are operated on by a male doctor are 32 per cent more likely to die after that procedure. These thought processes that dismiss female pain are deep-rooted within the entire western health system.

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Every woman has been told that smear tests don’t – or shouldn’t – hurt, but they can and they do. For women with a retroverted cervix, it can be one of the most unpleasant “routine” medical experiences imaginable. Pregnant women are repeatedly told that breastfeeding shouldn’t hurt if you’re doing it correctly. Luckily, there is a large community of breastfeeding mothers on social media to explode that myth, but why aren’t we able to talk of our bodily pain around this in a clinical setting?

The average length of time it takes a woman to secure a diagnosis of endometriosis – a condition that identifying initially relies on the reporting of experiences of pelvic and menstrual pain – is between six and 10 years. Women are talking about their pain and they are not being heard (incidentally, this sense of being separated from their own reality also extends to much of the language used around femininity in medical terms. Does any new parent really consider herself a “geriatric mother”, or in possession of an “old womb”?)

Yes, medical services are under acute pressure, but there can no longer be any excuse that healthcare professionals simply didn’t know how to address the issue of female pain and discomfort. The guidelines around all these issues – from cervical procedures to the right to anaesthetic for traumatic testing – are all in place; the problem is, they are not being followed.

Fixing that will involve asking a bigger question of every part of the health service: why? The answer might be uncomfortable.