The Gendered Side of Pain

I had always had a fear of standardized testing, but I never thought it would manifest like this.

Like many high schoolers, I had to pass exams to graduate high school. Despite my fear of exams, these state tests were a breeze for me. You know, the type you would finish before everyone else but wonder if you did something wrong. It was during one of these tests when I experienced one of the worst pains I had ever felt in my life. As I plugged away at math problems at my desk, I felt as though someone was stabbing me in the abdomen. I hunched over, unsure of what was going on. The whole perverted side of the story was I tried desperately to save face. The state I lived in had a rule about the entire class having to retake the test if someone interrupted it.

And if I made kids sit for another round of tests, well then that spelled the social end for me.

The social end came from another source. I felt my intestines twist with that unmistakable feeling that I needed to run to the bathroom. Fast. I got up and sprinted down the hallway, my leaky gut taking it’s name too literally in the moment. Yes, I pooped in my pants at the age of 16 and had to ask my mom to pick me up. It was enough social suicide for one day.

When I was little, my mom had always joked that I had “an iron stomach.” , I just refused to throw up. However, after I finished taking Accutane for my acne when I was 14, this all changed. I constantly felt a dull throbbing pain, occasionally accented by short stabbing pains, in my abdomen. I was always nauseated. It usually was never enough for me to think I needed to stay home from school, and, to be honest, I just ignored the symptoms. Even though I was subconsciously concerned about my health, I was in denial about something being explicitly wrong with me. When I told the school nurse that I was nauseated, my stomach hurt, or I was throwing up unexplainably, she told me it was all in my head, that I was making myself so anxious that I was getting sick. I followed her lead, and just assumed I was overreacting to “gas,” and causing myself to feel worse. This was just how it was going to be for me. This was my normal.

It was not until the throwing up started that I became truly alarmed. I remember having a dish of dal with my friends at my favorite New York Indian restaurant. In the middle of dinner, I felt a sudden gurgle in my throat. I sprinted to the bathroom before anyone saw. The burn of the spices seethed in my throat, the tears from the sheer pain of my stomach turning inside out came in streams. That incident shook me. Food, my greatest love, had betrayed me.

In that moment in the bathroom, I felt so alone and afraid, like I had a secret disease that I did not want anyone to know about. I started making excuses to try and avoid experiencing another embarrassing episode. I refused to go out with my friends for meals, telling them I was busy on any date they selected. If we did go out, I made sure to inspect the menu beforehand to see if there was something I could eat. On holidays, I would guard the dish I prepared myself, knowing that it probably was the only “safe” thing that would not make my stomach turn.  I became so isolated and had such a fear of going out for anything other than salads or raw fruits and vegetables. With no mystery ingredients in or on them, they became my solace.

There is and always has been two aspects to food for humans. First is the primal desire for calories. We are hungry for the nutrition food provides. What defines us as human is the desire for the consumption of food to be centered around growing community. How many times have you tried to get together with someone, and you both suggest grabbing dinner or lunch? And, usually, any family gathering, be it Christmas or Thanksgiving, is centered around a meal. The fear of feeling in pain not only stole my love of food from me. Although I would cook for my friends at my apartment, I would inevitably spend a lot of nights alone, with the food I knew had nothing “wrong” on it. However, while I was safe from pain, it robbed me of the social joy.

It was not until I started seeing a dietician and a GI doctor during college that I realized just how blind I was about my health condition. After running tests, including an endoscopy, I was diagnosed with several types of sugar intolerances (lactose, fructose) and a fat intolerance from avoiding fat for so long (you know, a diet circa the 1980s). When I followed my doctors’ advice to remove certain foods, then slowly introduce them, it was an awakening. I had severe abdominal pain from the time I was 14 years old. There were so many times I remember feeling these sharp, stabbing pains in my stomach and chest. I did not know why I was feeling this way, why I was always doubled over the couch two or three times a week.  Until I was diagnosed with several types of intolerances when I was 20, I carried these pains with me. That is two whole decades!

Speaking particularly as a female, we need to be better attuned to our own personal pain levels. I realize we, as patients, need to be better advocates for ourselves and our health. Leslie Jamison’s essay “Grand Unified Theory of Female Pain” examines ways that different forms of female suffering are minimized, mocked, coaxed into silence. In her essay, Jamison refers back to “The Girl Who Cried Pain,” a study identifying ways gender bias tends to play out in clinical pain management. Women are  “more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients,’” the study concludes. Nationwide, men wait an average of 49 minutes before receiving an analgesic for acute abdominal pain. Women wait an average of 65 minutes for the same thing. If men are in pain, they are experiencing physical pain. For women, that pain is viewed as emotional or psychological.

This is especially important to remember as new studies come out about the differences in how men and women experience pain. In a study published by the  Journal of Neuroscience, researchers at Georgia State University found when microglia cells in the brain were blocked, the female rats responded better to opioid pain medication and matched the levels of pain relief normally seen in males. However, when the cells were not blocked,  females require almost twice as much morphine as males to produce comparable pain relief. So, yes, females process pain different then men do, but their pain tends to be written off by some healthcare professionals. I am not saying that every doctor or nurse in this country does this (and trust me,   even if society is telling us the pain we are experiencing is  “in our heads” we must take action to assure we are receiving the best possible care.

Pain is not normal. From an early age, we are taught to observe certain social cues. Be polite. Ask nicely. And even when we are feeling in pain or sick, we do not want to be the ones who break that social code. When I had my dal “incident”, I pretending everything was ok, wiping the tears and spew from my face and walking calmly into the dining room. I did not want to upset my dining companions. My situation was not normal. I had let the pain take over my life. Instead of sitting idly by and accepting our fate, we must be forward when we truly believe something is wrong. We must make sure we get testing done, to see if our pain has a medical cause. While many GI issues do stem from the stress in our life, the refusal to accept the pain as just in our heads could do far worse damage. By taking ownership of our medical care and becoming advocates for ourselves, we can take back our health. And by taking back our health, we can take back our lives.

One comment

  1. Hi Sarah! Thank you SO much for sharing this. I myself had a similar experience, however it was shortly after starting my career and I hadn't struggled with the issue growing up so I did not even know where to begin to address it. Thank you so much for sharing your story. I think it can be so hard to advocate for ourselves sometimes because we learn to accept discomfort as the norm. I hope many people realize this so they can begin to address their health.

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