Women’s pain

International Women’s Day occurred on 8 March this year, and our good friend Sonia Grover was inclined to think and write about pain on the day. Here is what she shared with us. As always, our sincere thanks and appreciation for Sonia’s contribution.

Why talk and write about pain today?

So I ask myself – why do I feel inclined to talk and write about pain on International Women’s Day ?

I suppose there are a number of reasons – but largely it relates to the evidence that some sorts of pains that primarily affects women are often not discussed, or the pain is trivialised or ignored, and research in this field has not been valued as an important area.

Some of this pain affects only women, but in this pain conversation, we also need to include transmen as they too own body parts that like their cis-women counterparts generate specific pain relating to the pelvis.

Period pain

The obvious first example is period pain in women and young women which is  frequently trivialised or “normalised” and thus disregarded. This is despite the evidence that adolescent girls and women are missing substantial amounts of school, work, social and physical activities. We know that up to 90% of teenagers experience period pain, and we know that 20% of them regularly miss 1 to 2 days of school every month due to period pain. We know they do not know how to optimally use non steroidal medications to prevent and manage their pain. When they do attend doctors, they are often told that this is natural or normal. Although much period pain is physiological, that does not mean that it should be allowed to continue to impact on their lives. The problem with ignoring all period pain is that there is mounting evidence that repeated pain may predispose to  chronic pain – which we all know is far harder to manage.

Transmen, a group we can’t ignore

We are also seeing increasing numbers of transmen with pelvic pain, so despite this being some ponderings written on International Women’s Day, I cannot ignore this group of people who also have significant pelvic pain. It is very unclear what the origin of the pelvic pain that is experienced by transmen, whether it is uterine, pelvic floor muscles, or abdominal wall. Nor do we know how best to treat it – yet.

It can take years to be taken seriously

Repeated studies have shown that it takes years before someone takes the report of period and pelvic pain seriously – although the outcome of the being taken seriously  results in surgery – which may not always be the best road to travel –  but that is where the need for more research comes in. Could it be possible that like arthroscopies and back surgery, that pelvic pain may not always require surgery and that there may be other more or equally effective approaches?

Pain and sexual activity

With regards to pain with sexual activity, the international population data reports say that 50% of cis-women report having had some pain with sexual activity, but the number drops to 10% of women having pain with sexual activity that is distressing or that impacts on quality of life. The rate of 50% was confirmed in a Melbourne study. This study was undertaken with women referred to a public gynaecology service, where women were recruited into the study if any pelvic pain was mentioned in the referral. Never the less, of the women seen in the clinics, only 20% of these women had pain with sexual activity recorded in their medical notes suggesting that many were not actually asked about pain with sexual activity. But it also suggests that many women did not volunteer this information.  So if we don’t ask the questions we won’t even know if there is a problem.

Enormous potential for research

There is an enormous potential for more research to be done in this area. Yes – there is  research done in women’s health. But if I think about the academic departments in women’s health, in obstetrics and gynaecology, the vast majority of the research is in relation to fertility and infertility, childbirth and its complications, and cancer. If I think about the teaching that is done to medical students about period and pelvic pain, a common problem affecting so many – then the proportion of time allocated to this is tiny. Although I am not as well informed about physiotherapy – the similar biases within women health appear to occur with the emphasis on pregnancy and post partum – and omitting the enormous impact of pelvic pain and the role of pelvic floor and abdominal wall muscles, bowels, bladders and vulval dysaesthesia in causing these pains – and the tremendous opportunity for more effective interventions.

– Sonia Grover

Professor Sonia Grover has extensive experience in paediatric and adolescent gynaecology having worked in this field for over 20 years. She has been instrumental in establishing this subspecialty in Australia as well as in Asia and internationally. Professor Grover’s clinical interests include all aspects of young women’s’ reproductive health – including menstrual problems (excessive bleeding and/or pain), amenorrhoea, ovarian problems, congenital anomalies affecting the reproductive tract and reproductive hormones and the cyclic exacerbation of ‘non-gynaecological symptoms’ including cyclic seizures, asthma, and chronic fatigue. Professor Grover’s ResearchGate profile here.