Pelvic pain is common in women, and it comes with an added challenge: being dismissed or gaslit. From migraines during periods to pain during sex, women often don’t get the help they need, causing unfair differences in care. Gender biases in medicine still exist today and deeply affect women’s health.
However, Clinical Assistant Professor Dr. Kristen MacKenzie believes the cultural tide is beginning to turn. We spoke to her about why women’s pain isn’t taken seriously, how to avoid medical gaslighting, and when to seek care for pelvic pain.
Why Women’s Pain is Still Invalidated
The tendency to normalize women’s pain is deeply rooted in history. For centuries, explanations such as "hysteria" or the notion of a "wandering womb" dominated medical thinking, offering little in the way of solutions. These old beliefs made people think women’s pain was “normal” or “just in their heads.” This idea still causes many women to have their pain dismissed in today’s healthcare.
One common myth is that pain is just a natural part of being a woman, whether from periods, childbirth, or menopause. This belief makes it harder for women to get the care they need.
“Women are expected to have some type of pain,” says Dr. MacKenzie, citing experiences like periods, childbirth, and menopause. “For a long time, medicine didn’t have any sort of answers, so women were told things like, ‘You must be hormonal’ or ‘That’s just your lot in life.’”
Medical training didn’t offer solutions for chronic pain, which kept this mindset alive. Doctors are taught to focus on stopping illness and saving lives, not on treating long-term pain, especially if it’s not life-threatening.
“We aren’t taught how to make someone suffer less if the issue isn’t life-threatening.”
“We aren’t taught how to make someone suffer less if the issue isn’t life-threatening,” MacKenzie explains, whose clinical interests are in pelvic pain and women’s health. “So it leads to this pattern of telling patients ‘Sorry, we don’t have anything for you, but don’t worry–this won’t kill you. You just have to find a way to deal with it.
What to do about medical gaslighting
Picture this: You come into your doctor’s office, complaining of period cramps, painful sex, and unpleasant bowel movements. You’re worried you may have endometriosis, and ask for a scan. Your provider says that all sounds normal, and moves on to discuss your blood pressure.
This hypothetical scenario shows what medical gaslighting looks like. You shared concerns and told your doctor what you wanted, but your doctor simply says you’re fine. You’re offered no explanation for why they’re not concerned or why you weren’t offered a diagnostic test.
“Medical gaslighting really means that a provider is dismissing you, but they're also not giving you an explanation for why they're dismissing you.”
“Medical gaslighting really means that a provider is dismissing you, but they're also not giving you an explanation for why they're dismissing you,” Dr. MacKenzie explains.
In contrast, a validating interaction with a provider should be rich with:
- Active listening
- Education
- An actionable path forward
A supportive provider might ask, “Is this unusual for you?” or “How might imaging help?” Even if the proposed diagnostic tests are unnecessary, they explain why. They may also offer alternatives, monitor symptoms, and say, “Here’s when to return for the next step.”
“At that point, they can also offer the patient the first line treatments for endometriosis and explain how they could start you on them today,” MacKenzie says. “Or you could go home and read about them and come back and see me. So then there's a full plan laid out, the patient feels heard, supported. They understand what's being offered and why, and then they have choices to make around that.”
How to Advocate for Yourself at the Doctor
Many women are unaware of treatments for pelvic discomfort, in part because some options aren’t offered often. For instance, discomfort during an IUD insertion may be managed with premedication, relaxation strategies, topical anesthetic, and cervical blocks (injections of numbing medicine)- though many are unaware of these solutions.
Society's discomfort with pelvic pain makes it hard for women to ask for care. Many lack the words or confidence to discuss it and fear painful exams. This leads many to hide their pain, delay care, or avoid seeking help.
“You might feel comfortable calling your boss and saying, ‘My back pain really flared up and I can’t make it in,’ and you’d likely get a supportive answer,” she says. “But if you call in and say ‘my vagina is on fire today,’ would it be considered appropriate? Generally, that information would be considered private, so people don’t talk about it. People may even worry about telling their provider.”
When to See a Doctor About Pelvic Pain
Ever wondered, “Is my pelvic pain serious?” Pain is a normal part of life, but pain that disrupts your daily life isn’t, says MacKenzie. If you’re unsure about treatment, ask yourself:
- Does the pain scare or upset you, or do you feel neutral about it, like soreness after a marathon?
- How much does the pain interfere with your daily activities?
- How much suffering does the pain cause?
Hope in the Gender Pain Gap
Although old biases still exist, awareness of the problem is growing. Social media has become a strong tool for sharing experiences and highlighting issues like pain during IUD insertion, which recently led to changes in clinical guidelines. “Women deserve to be told the truth,” Dr. MacKenzie notes. “They might experience pain, and we need to try our best to address it.”
To improve women’s pain management, MacKenzie says it’s important to stand by patients. Even if a clinician doesn’t have an answer yet, asking more questions and problem-solving helps patients feel supported. “We may not always have perfect answers,” Dr. MacKenzie acknowledges, “but women deserve to be heard, supported, and offered the best care possible.”
