“Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain

Abstract

Background Despite the large body of research on sex differences in pain, there is a lack of knowledge about the influence of gender in the patient-provider encounter. The purpose of this study was to review literature on gendered norms about men and women with pain and gender bias in the treatment of pain. The second aim was to analyze the results guided by the theoretical concepts of hegemonic masculinity and andronormativity. Methods A literature search of databases was conducted. A total of 77 articles met the inclusion criteria. The included articles were analyzed qualitatively, with an integrative approach. Results The included studies demonstrated a variety of gendered norms about men's and women's experience and expression of pain, their identity, lifestyle, and coping style. Gender bias in pain treatment was identified, as part of the patient-provider encounter and the professional's treatment decisions. It was discussed how gendered norms are consolidated by hegemonic masculinity and andronormativity. Conclusions Awareness about gendered norms is important, both in research and clinical practice, in order to counteract gender bias in health care and to support health-care professionals in providing more equitable care that is more capable to meet the need of all patients, men and women.

Exploring thoughts about pain and pain management: Interviews with South Asian community members in the UK

“…Gender differences in perceptions, expressions and approaches to coping with chronic pain are common, and embedded within gendered social norms (Samulowitz, Gremyr, Eriksson, & Hensing, ). Across ethnic groups, women have been shown to be more receptive to, and receive more, benefit from multimodal pain treatment programmes than men (Pieh et al, ).…”

“…Gender differences in perceptions, expressions and approaches to coping with chronic pain are common, and embedded within gendered social norms (Samulowitz, Gremyr, Eriksson, & Hensing, 2018).…”

Transvaginal mesh, gender and the ethics of clinical innovation

“…With this understanding of vulnerability in mind, it is clear that women have long been susceptible to harm in the context of medical practice and research . In clinical practice, men are more likely to receive comprehensive investigation and treatment, including for hypercholesterolaemia, ischaemic heart disease, heart failure, cardiorespiratory arrest, atrial fibrillation, rheumatoid arthritis, end‐stage renal disease and dementia . Women are also more likely to have their illness disregarded and their pain pathologised, or ignored .…”

“…In clinical practice, men are more likely to receive comprehensive investigation and treatment, including for hypercholesterolaemia, ischaemic heart disease, heart failure, cardiorespiratory arrest, atrial fibrillation, rheumatoid arthritis, end‐stage renal disease and dementia . Women are also more likely to have their illness disregarded and their pain pathologised, or ignored . This in turn, has not only physical but also psychological consequences for women, who feel that their pain is downplayed or dismissed by medical professionals (and who may already be at higher risk of mental ill‐health, depression and self‐harm) …”

“…Women, particularly those of reproductive age, have also been systematically discriminated against in research . Early clinical trials were often performed in male populations, with the results used to inform the development of treatment for men and women, irrespective of important biological and gender differences . While more recent exclusions have been justified on the basis that they protect women and foetuses from harm, this has led to significant knowledge gaps regarding the prevention and treatment of disease in women …”