For over a dozen years, studies have shown that women experience more pain than men.
But until recently, their pain has often gone overlooked.
“There's been sort of a grin and bear it attitude towards women's reported pain, which I think in part springs out of the fact that women are responsible for childbirth," says Emma C. Martenis-Robiner, MSN, WHP, who was part of an Obstetrics & Gynecology subcommittee that introduced the option for women to receive moderate sedation during gynecological procedures at Dartmouth Hitchcock Medical Center (DHMC).
“The view was that if they can tolerate childbirth, they should be able to tolerate other sorts of gynecological procedures. There's also not been a lot of funding for research around women's healthcare. And so we haven't really known for a long time what the best option is for controlling pain during office gynecological procedures,” she says.
But now, says Martenis-Robiner, thanks to new findings and women speaking out, women are finally being heard and getting offered the pain medication they’ve long deserved, including during gynecological procedures.
How women express and experience pain
More women than men suffer from chronic pain, and they have greater pain after a painful stimulus, reports the International Association for the Study of Pain (IASP).
Most of their chronic pain also remains undiagnosed and untreated, says the report.
In addition, clinically and in research, women express pain differently from men, showing greater pain sensitivity and a higher prevalence of many painful conditions.
“So, we see this paradox where they experience more pain but receive less treatment,” explains Martenis-Robiner.
Why women's pain has gone overlooked
Part of the reason women's pain has been overlooked is that they were long excluded from research.
“With concern about the risk that new drugs might have on an undiagnosed pregnancy, the US Food and Drug Administration recommended in 1977 that all women who were capable of becoming pregnant be excluded from drug trials. The presumption was that pain research in men would be applicable to both genders,” notes the IASP.
Psychosocial factors have also played a role in the lack of attention given to women's pain.
“Women are socialized to be attuned to bodily changes and to talk about pain, but they are also penalized for ‘complaining,’ which can shape how and when they speak up,” explains Martenis-Robiner.
Structural factors, like less inclusion of women in clinical trials and limited funding for women’s health research, have impacted pain management for women, too, particularly in gynecological care.
“Studies point to unconscious biases, a lack of gender-specific clinical protocols, and prevailing cultural stereotypes as contributors to the undertreatment of pain in women during procedures such as intrauterine device insertion and diagnostic hysteroscopy,” says this 2025 literature review.
In fact, says Martenis-Robiner, women’s pain has a long history of being perceived as almost endemic to the female condition, which has led to an assumed martyrdom for women. “One of the most striking patterns we saw (when developing the moderate sedation program) was how often women pre‑emptively minimized their pain—apologizing, worrying about being difficult,” she says.
This minimization of women’s pain, she adds, both by the medical community and women themselves, can be traced all the way back to the Greek word hystera, meaning uterus, which is linked to the word hysteria, which means exaggerated or uncontrollable emotion or excitement.
“That's sort of the basis of how medicine has viewed women historically,” she says.
Why women may experience pain differently
Less understood is why women can experience pain differently.
Some suggest that pain specifically associated with women, such as menstrual pain, may predispose women to feeling pain more acutely.
Women’s brains also reportedly produce less endorphin (which inhibits pain) following a pain stimulus than men.
“Biology does matter,” says Martenis-Robiner. “Sex hormones, immune mechanisms, and genetic factors all influence how pain is processed, and these systems operate differently in women than in men.”
Pain tolerance varies not just between women and men
All that said, variations in how people experience pain are not limited to gender.
Research has shown, for example, that people with red hair perceive pain differently from others. They may be more sensitive to certain types of pain, though their general pain tolerance may be higher.
People who have experienced trauma or have high levels of anxiety can be more prone to pain. “The same is true of people who have chronic pain,” says Martenis-Robener.
Katrina S. Hacker, PhD, a clinical psychologist in the Walter and Carole Young Center for Digestive Health who helped develop their GI (gastrointestinal) procedure support program, points to some of these variations she sees in their practice.
“When we originally conceptualized our in-person program that also has bedside support from psychologists, we were definitely thinking about the impact on pain, as patients with histories of trauma and higher levels of anxiety often have more difficulty tolerating the physical and emotional aspects of colonoscopies and endoscopies, even with moderate sedation. Past trauma can not only increase pain sensitivity but also a patient's sense of vulnerability when undergoing a medical procedure,” she says.
While Hacker notes that the pain management aspect is now less relevant in her department, as all endoscopic procedures are done with a higher level of sedation (monitored anesthesia care), the need for emotional and psychological support and preventing traumatization remains, she says.
What DHMC’s OB/GYN department is doing to address pain
For Martenis-Robiner, it is important that all patients are able to talk about their pain and whether they need support in managing it.
“Men experience pain, children experience pain. Our job as healthcare providers is to validate that pain and to treat it in a safe and controlled environment so that people are able to get the healthcare they need. We all deserve adequate pain control,” she says.
And it is because of what Martenis-Robiner describes as a disconnect between what their patients were telling them and what options have traditionally been offered, that their department has established standardized, safe, and equitable access to sedation, including for procedures labelled minor, but that can still be painful and anxiety-provoking.
“Part of the work that we did in developing our program was to sort of standardize how we talk about pain and how we communicate options for pain management. I think, historically, pain management has been very subjective, but now we bring the same options to every patient, every time, for equitable care," she says.
For Martenis-Robiner, the benefits have been measurable.
“When we take time to validate women’s experience and offer a spectrum of pain management options—including sedation when appropriate—the physical and emotional relief is clear,” she says.
Now, anyone who's interested in having an IUD replaced or who may need a biopsy done has their options presented by the caregiving team.
“Those options start with doing nothing, to topical numbing medicine, to injecting a numbing medicine, to oral medications, to moderate sedation and then in the OR, to general anesthesia. We lay these out in a stepwise approach,” she says. “And what we've noticed is that women respond so positively to being given the option and being allowed to decide.”
The future of pain management
Thankfully, Dartmouth Health is not alone in recognizing the need to address women’s pain.
Recently, for example, the CDC updated recommendations for pain management around IUD insertion.
And as the academic medical nonprofit AAMC last year reported, both the medical community and many women (often on social media) are now speaking out about the pain of certain procedures and about conditions like fibromyalgia (which is characterized by general pain, fatigue, and cognitive problems and mostly in women) and endometriosis (when the uterine lining grows outside the uterus and can go undetected for seven to 10 years, leading to years of unnecessary pain).
“[Historically, endometriosis was] probably most commonly described as female hysteria,” Jocelyn Fitzgerald, MD, a urogynecologist, pelvic-reconstruction surgeon, and assistant professor at the University of Pittsburgh School of Medicine, said in the AAMC report.
But now, at last, greater awareness has emerged around women's pain and its impact.
“Undiagnosed and under-treated pain, we know, can lead to depression, anxiety, and poor outcomes not only for women but for their children and families as well,” says Martenis-Robiner.
“We would hope that any person would get to decide what their pain management level should be, and patients just feel so empowered by being given that option, and that immediately builds trust, which in turn decreases the amount of pain and anxiety, too.”
