Applying a Feminist Lens to Nociception

In recent years, there has been a push for gender-inclusivity in all aspects of science, including clinical diagnosis and treatment. Unfortunately, decades of sexism in the treatment of women cannot be easily undone, but there is hope. Applying a feminist lens to neuroscience and nociception can assist in reducing sexism at the clinical level regarding ailments such as chronic pain, dysmenorrhea, and more.

A study from Hellman et al. (2020) investigated the connection between dysmenorrhea and chronic pelvic pain through quantitative sensory testing that measured each woman’s pain threshold. Researchers hypothesized that dysmenorrheal women with comorbid bladder pain sensitivity would have lower bodily pain pressure thresholds, as well as impaired conditioned pain modulation. Ultimately, results showed that provoked bladder pain hypersensitivity was strongly related to multiple pelvic pain symptoms, including poor conditioned pain modulation and increased pelvic and external body site mechanical sensitivity. Since dysmenorrhea often precedes bladder pain sensitivity, the authors conclude that further work may investigate the potential for women with dysmenorrhea to develop chronic pain since their target group met estimates for chronic pain conditions.

Although this study offers promising results and clarity on prior research in uterine pain and suggests that hormonal and surgical interventions may alleviate other visceral pain conditions, there is still another aspect of pain to consider: recognition and treatment of pain. A study from Zhang et al. (in press) investigated the actual estimation of others’ pain and how gender bias effects that. The authors hypothesized that at equivalent levels of pain facial expression and self-reported pain, male patients would be perceived to be in more pain than female patients, as well as more likely to be given pain medicine in higher dosages. Further, the authors predicted that female patients would be prescribed psychotherapy instead of medication, and that gender bias and stereotypes would influence pain treatment. 

Unfortunately, Zhang et al. (in press) found that women’s pain was underestimated compared to men’s, and that female patients would benefit more from psychotherapy. Further, a perceiver’s pain-related stereotypes influenced their pain estimation, even in controlled conditions for pain facial expression and self-reported pain. Although there is a limitation in the number of participants, there is potential for further studies to expand on the method of the present research to increase generalization to other populations. The authors conclude that sex bias has an influence on the recognition and treatment of pain, with women’s pain often underestimated and undertreated.

Looking at the results of these studies combined, it is evident that there is a lack of literature expanding on nociception regarding conditions associated with women, as well as a broader understanding of how the initial acknowledgement of pain influences subsequent treatment. Studies such as the one from Hellman et al. (2020) show promise in expanding research in this area, but Zhang et al.’s (in press) work reveals that there is still a long road ahead for true gender equality at a clinical level. Applying feminism to neuroscience--specifically in nociception--allows for increased awareness about gender bias and draws attention to the concerning lack of literature on neurological issues that center women’s pain.