Disbelief as Diagnosis

When I was 18, I went to the hospital with severe abdominal pain, a fever, and non-stop vomiting. I waited an hour to be admitted, and then 5 more for a diagnosis: I had an ovarian cyst that was strangling the surrounding tissue, cutting off the blood supply to my left ovary, and killing it. I needed emergency surgery to remove the cyst and restore blood flow. The goal was to save the ovary. The risk was losing far more.

When I woke from surgery, my doctor told me, “Good news: we removed the cyst. Bad news: we had to remove the ovary, too.” He explained that the cyst matched my ovary in size, making it large enough to cause the torsion. He couldn’t say how long the ovary had been dead, but said the cyst had likely been growing for years. Apparently, it was a wonder that it hadn’t been spotted before. 

Only, it had – two years earlier. It had shown itself repeatedly — in episodes of excruciating pain that sometimes lasted two full days. Each time, the pain was minimized. Each time, no further action was taken. The consequence was irreversible.

Stories like mine are disturbingly common.

In today’s healthcare system, it is women who pay the price of untreated pain. A quick scroll through Reddit’s forums “twoxchromosomes,” “womenshealth,” or “medical malpractice” reveals hundreds of women’s stories of doctors that don’t listen, of the belittling, harmful experience of being disregarded and left untreated. A common thread runs through these narratives: debilitating pain dismissed as PMS or an overreaction to “normal” pains, mistreatment if any treatment at all, and irreversible consequences. 

The phenomenon is so widespread that it has warranted a name: The Gender Pain Gap. Coined in 2001 by Diane Hoffmann, the term describes the unconscious bias in pain treatment that distorts women’s diagnoses and care. Despite over 20 years having passed since we put a name to the injustice, today the gap is as wide as ever– with 81% of women between the ages of 18-24 reporting to have their pain ignored or dismissed completely by healthcare professionals as of 2024.

The consequences of this bias reverberate through Western society. Women are forced to defend their autonomy while repeatedly proving their credibility, fighting to be heard in rooms where belief remains conditional.

The Medical Invention of Female Irrationality

The Pain Gap is not only pervasive; its roots run deep into the foundations of Western medicine and culture.

The roots of this bias reach back to ancient Greek and Egyptian medical thought, which attributed a wide range of women’s physical and psychological conditions to the womb. Though the explanations shifted over time, the central dogma remained intact for centuries.

In 1880, Jean-Martin Charcot formalized this belief by coining the term hysteria — derived from the Greek hystera, meaning uterus — as a medical diagnosis for a so-called “sex-selective disorder” affecting only women.

Sigmund Freud later reframed hysteria as psychological rather than physical, attributing it to what he called a woman’s “traumatic realization” that she lacked a penis. The theory borders on the absurd. Still, the diagnosis persisted for nearly a century more.

Over time, “hysteria” became a catch-all diagnosis for any behavior deemed unmanageable, overly emotional, or irrational in women. The prescribed treatments were telling: marriage, regular marital sex, and childbirth — all institutions historically tied to women’s subordination. The term wasn’t removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders until 1980.

Its legacy, however, did not leave with it. Today, when we call someone “hysterical,” we typically mean a woman that is “overly emotional” or out of control. And this idea bleeds into an unconscious bias against women’s ability to properly assess their own experiences, feelings, and bodies.

In medicine, that bias translates directly into delayed or denied care.

“It’s All in Your Head”

Oliva Jerge was diagnosed with POTS– an autonomic nervous system disorder that affects primarily AFAB individuals– in 2018, but her symptoms first began two years earlier, at the age of 15. She experienced brain fog, nausea, lack of feeling in extremities, extreme tiredness and fatigue, chronic migraines, and heightened sensitivity throughout. But before she saw a single doctor, she waited – months – because she was "internalizing the pain" and "validating" it to herself first.

It's worth pausing on that. Olivia had already absorbed, at 15, the unspoken cultural lesson that her pain needed to be justified before it could be brought to someone else. She had pre-emptively done the work of convincing herself she was worth believing. The medical system hadn't dismissed her yet. She had gotten there first.

Olivia, though struggling physically and emotionally, looked on the outside like the picture of health: she was a standout player on her varsity soccer team and a top student. Doctors told her directly: "When we look at you, nothing is wrong with you." This pattern is not incidental. A 2022 study analyzed five earlier studies in which clinicians had assessed women's attractiveness as an informal proxy for health, inadvertently suggesting that patient care should be shaped by appearance — a perpetuation of what researchers call the "beauty myth." In practice, this means something simple and devastating: a woman who looks healthy is less likely to be tested further. Her appearance becomes its own diagnosis.

Over the next two years, Olivia saw 14 different doctors. She was told repeatedly she was "in the prime time of becoming a woman" and that her symptoms were likely hormonal. She was referred to OBGYNs and asked about birth control. When tests came back normal, the questions shifted: How was her mental health? Was something going on at home? Was she seeing a therapist? The constant redirecting began to erode her own certainty. "Is this how I feel?" she recalls asking herself. "I'm not really sure anymore.”

This kind of gaslighting is a direct consequence of the Pain Gap. A 2023 meta-synthesis found that AFAB patients with chronic pain conditions are frequently told “it’s all in your head”--  despite research suggesting that women are actually more attuned to distinguishing physical pain from pathological pain than men, precisely because they experience pain as a regular part of biological life. Still, women are often doubted, ignored, or made to feel crazy, until many simply give up seeking care.

At best, this harms the psyche of a woman. At worst, it causes serious physical consequences as it extends into diagnosis timelines across the board. Women presenting to the ER with abdominal pain wait almost 33% longer than men with the same symptoms; with chest pain, they wait 29% longer to be evaluated for a possible heart attack. A 2015 study revealed that diagnosis for female patients took longer than their male counterparts in six out of eleven types of cancer. With treatment, having time on your side is everything– it’s the difference between remission and regression. But women, systematically, are afforded less of it.

The disparity runs even deeper in research. Although 70% of chronic pain patients are women, 80% of pain medication has been tested exclusively on men. Until 1993, female participants were excluded from clinical trials on the grounds that fluctuating hormones from menstruation might corrupt results— until a study found that hormones had no meaningful effect on variability in female rodents. The real reason for exclusion, it turned out, was cost. Currently, only 5% of medication research funding in the U.S. goes to women-specific conditions. This bottom line reveals that women’s bodies remain understudied not because of negligence, but because of deliberate policy and institutional decisions.

The downstream effects of that gap are still being uncovered. Women-specific conditions like PCOS, endometriosis, uterine fibroids, adenomyosis, and PMDD are heavily under-researched, affecting diagnosis and treatment. The average time to diagnose endometriosis ranges from four to twelve years after symptom onset, despite the condition affecting an estimated 190 million women worldwide. Neurological conditions like ADHD and autism are underdiagnosed in women, too, simply because women’s symptoms or behaviors present differently than in men. 

The Burden of Proof

The consequences of the Gender Pain Gap do not stay contained to the examination room, either. At its core, it is a question of whether women are believed, and that question echoes across our culture in ways that are difficult to dismiss as coincidence. 

The Me Too movement laid bare the same fundamental dynamic: women reporting real, documented harm and being met with skepticism, and the implicit demand that they prove their own suffering. The response to those allegations – "why didn't she say something sooner," "why does she only have her word," or, just plainly “we don’t believe you,” – mirrors almost exactly what women are told in medical settings every day. In both cases, the burden of proof falls entirely on the woman, and the cost of not being believed is borne entirely by her body.

The overturn of Roe v. Wade sharpens this further. Reproductive autonomy is, at its most basic level, a question of who has authority over a woman's body and her account of her own experience – her pain, her circumstances, her judgment about what she can bear. The Pain Gap and the erosion of reproductive rights are not separate issues that happen to affect the same people. They are expressions of the same underlying premise: that women's bodies are subject to external arbitration, and that women's own testimony about their bodies is insufficient on its own.

Perhaps most concerning, this bias is now being written into the technologies shaping the future of medicine. Recent studies show that AI diagnostic tools are absorbing the biases of the humans training them, systematically downplaying women's pain in data review. As healthcare professionals increasingly rely on these tools, the risk is that the bias becomes not just human and institutional, but algorithmic – faster, wider, and harder to challenge. If the gap is not actively addressed at the level of AI development, the next generation of medicine may quite literally have discrimination encoded into it.

The Cost of Being Believed Too Late

It’s been nearly 10 years since I lost my ovary. Since that time, I’ve been prescribed numerous different hormonal birth controls to try and regulate cysts– medical professionals still don’t know exactly what causes them to keep growing, or how to best treat them. At 22, I went through the process of freezing my eggs, in case my other ovary were to be damaged. I spent months injecting myself with hormones, being poked and prodded and inserted into. After the egg retrievals, in which they inserted a needle through the vaginal wall and into each follicle that contained an egg, they woke me up from anesthesia, gave me a pad for the bleeding, fed me 800mg of ibuprofen, and sent me home. 

Still, and again, mine is a success story. 

For others, the cost of disbelief is far greater than prolonged pain: isolation, trauma, and sometimes even death. The path forward requires action on multiple fronts. Some reforms are underway — but they have been hard fought.

Medical schools are beginning to incorporate gender-based medicine into their curricula, recognizing that understanding how disease and pain present differently in women is not supplementary knowledge but foundational. Organizations like the Sex and Gender Women's Health Collaborative have developed educational resources specifically designed to address unconscious bias in clinical training. At the policy level, the FDA's Drug Trials Snapshots program now requires pharmaceutical companies to report how drugs perform across sex, race, and age–  a direct response to decades of male-dominated research. On the AI front, researchers and ethicists are calling for bias audits of diagnostic tools that are deployed in clinical settings. 

Individual advocacy can be a stopgap: women can name the bias in the room, request second opinions, and seek physicians who take them seriously. But self-advocacy is not reform. It should not require research, stamina, and strategic confrontation simply to receive competent care. The Gender Pain Gap is structural, and it demands structural change — in medical training, research funding, regulatory policy, and algorithmic design.

At a time when reproductive medical care is becoming increasingly restricted — when abortion legislation narrows access even in cases involving ectopic pregnancies and life-saving care, when birth control access is limited, and when miscarriages are subject to investigation or criminalization — the consequences of disbelief deepen. If women’s accounts of their own bodies are treated as suspect in the exam room, they are even more vulnerable in the courtroom. The burden cannot rest on women to prove their pain. It rests on institutions to believe it.