Two major developments in women’s health have made headlines recently: less invasive alternatives to the Pap smear – long considered an “unpleasant but necessary evil” in cervical cancer screening – and new guidelines for managing pain during IUD insertion, a highly effective contraceptive that many women say is painful when inserted into the uterus to prevent pregnancy.

It is no secret that women suffer disproportionately from pain in the healthcare system. Studies suggest that they experience more pain on average and that it occurs more frequently than men. Yet women’s symptoms are undertreated and often ignored. Women with pain are more likely than men to be prescribed sedatives rather than painkillers. One study found that women undergoing bypass surgery were only half as likely to be prescribed painkillers as men undergoing the same procedure.

Why has the suffering of women been ignored for so long?

Women’s pain and discomfort in healthcare settings has long been ignored and misunderstood, largely because of a misunderstanding of women’s bodies and health – a history that stretches back to the third century BC philosopher Aristotle. Aristotle believed the female body was the opposite of the male, with its “genitals turned outwards”. As a result, the way women have traditionally been treated as patients often reflects old prejudices.

“The origin of the term hysterectomy goes back to the belief that ‘hysteria,’ a mental disorder characterized by uncontrollable emotions, occurs only in women and has its roots in the uterus,” Beth Darnall, a clinical pain psychologist at Stanford University, tells Yahoo Life.

Even today, medicine tends to blame women’s pain on emotions. The Washington Post reported on a study that found that “middle-aged women with chest pain and other symptoms of heart disease were twice as likely to have a mental illness as men with the same symptoms.”

David Thomas, special advisor to the director of the Office of Research on Women’s Health, tells Yahoo Life, “Women are more likely than men to be given anti-anxiety medications for pain, where pain is dismissed as an emotional response. And unfortunately, the lack of listening in clinical settings goes well beyond women reporting pain.”

Dr. Kristen MacKenzie, assistant professor of anesthesiology at Stanford University, explains that mainstream culture has historically accepted that certain aspects of being a woman – such as menstruation, childbirth and menopause – are inherently unpleasant and that women have simply “dealt with it” for centuries.

“This creates the impression that if you complain about it, the problem is with your pain tolerance and not the physical situation,” MacKenzie tells Yahoo Life.

Medicine also has a long history of not including women in trials to better understand their health. For example, under a 1977 policy (repealed in 1993), the Food and Drug Administration banned women of childbearing age from participating in early clinical trials—even if they were using contraception or their husbands had had vasectomies. The goal was to prevent fetuses from being exposed to experimental drugs, but the result was a lack of data on how these drugs affect women.

“Historically, women’s healthcare has received less attention, research and funding, and that has implications for women’s health outcomes today — including the way pain is measured, researched and treated,” Irene Aninye, chief scientific officer of the Society for Women’s Health Research (SWHR), tells Yahoo Life. “For a long time, women were not viewed as much different from small men in terms of their health” — that is, their pain was viewed as a “smaller version” of men’s pain — “so conclusions drawn in men were viewed as applicable to women as well. Today we know that’s wrong. There are important gender differences when it comes to health and pain.”

How things are changing

In some ways, little has changed in women’s health. The speculum has barely been modernized in 170 years, and the forceps often used to insert IUDs and perform cervical exams, for example, were invented 135 years ago by French surgeon Samuel Pozzi, the so-called father of modern gynecology – and were inspired by a bullet puller from the American Civil War era.

However, experts say they are seeing improvement when women’s symptoms and pain are taken more seriously.

“There is a greater awareness of bias in general, including gender bias, and a cultural movement toward equality,” says Darnall. “For example, the National Institutes of Health requires researchers to consider gender as a biological variable in studies to ensure we are gathering evidence about women and understanding how to best meet their specific needs.”

She adds: “Greater representation of female doctors could also make a difference. Last year, 55% of medical students were women.”

Aninye says conditions that specifically affect women (such as endometriosis and menopause), as well as conditions that disproportionately affect women (such as migraines, which are twice as common in women as men, and autoimmune diseases, 80% of which are diagnosed in women), are getting more and more attention. But “there’s still a lot of work to be done to bring these issues into the mainstream,” she says.

One challenge, experts say, is that pain is subjective and personal. Thomas says one area of ​​research the NIH is focusing on is finding “objective measures of pain” to reduce bias in treatment and diagnosis.

“We hope that objective measures of pain, not just things like a 0 to 10 scale, can confirm that people are in pain, what kind of pain they are in, and suggest possible treatments,” says Thomas. “While the patient’s voice is too often ignored or dismissed, we hope that it will be impossible to ignore hard scientific data.”

What can women do to be heard?

Experts offer the following tips if you want to talk to a healthcare professional about pain or discomfort or address other health concerns.

• Find a doctor you trust. Seek medical advice and treatment from someone you feel is compassionate and understands your concerns. “Patients need to find a doctor they trust—either because of their own experience with that doctor or because of trusted recommendations,” says Paula Castaño, M.D., associate professor of reproductive health at Columbia University.

• Ask questions. MacKenzie says it’s helpful to bring a list of specific questions to doctor’s appointments and let your doctor know in advance that you want to go over that list with them. “Many patients are concerned about a specific, undiagnosed diagnosis and should feel encouraged to bring that up with their doctor so they can get a clear solution or referral to a specialist,” she says. And if you’re considering a medical procedure, ask the doctor about potential pain and available pain treatments.

• Bring a lawyer with you. “Because doctor visits can be intimidating or overwhelming, I also encourage patients to bring a trusted friend or family member to help answer questions and advocate for them,” says Castaño.

• Keep calm. If your concerns are dismissed, be persistent. “Feeling dismissed can be frustrating,” says Darnall. “The best thing to do is to remain calm and restate your main question or concern. Ask for more information so you understand the treatment plan and your options.”

• Get a second opinion. If your current provider isn’t answering your questions or giving you the information you need, find one who will listen to your concerns. “As a patient, you are entitled to as much information as you need to feel comfortable with your health care decisions,” Aninye says. “Unfortunately, it’s not uncommon for many women to need to see multiple (providers) before they can receive an accurate diagnosis or work out an effective treatment plan for their condition.”

• Share your story. MacKenzie says women sharing their experiences on social media are raising awareness among both the general public and healthcare professionals and are already leading to change. “Women deserve to have these conversations with their doctor without the expectation that they have to suffer just because women before them have suffered these symptoms,” she says. Aninye agrees: “Sharing firsthand accounts can lead to powerful connections and provide real momentum for change in healthcare, research and policy. Women should share their health stories where and when they feel comfortable. Speaking out can raise awareness about women’s health and even influence research and funding decisions.”