Earlier in our Gender Pain Gap Series, we discussed the history of the gender pain gap and how racism factors into doctors dismissing women’s pain. This time, we look at gender expression and the pain gap to examine the experiences of LGBTQ people when it comes to chronic pain and untreated pain.
By ‘gender expression,’ we mean the characteristics of someone’s personality, behaviour, and appearance that are traditionally considered masculine or feminine by a culture.
How Chronic Pain is Treated Differently Across Different Sexual Orientations
Biological differences in the experience of pain are well documented, but how sexual orientation influences pain sensitivity is relatively unstudied.
Some evidence shows that youth of sexual minorities are more likely than heterosexuals to report chronic pain (Katz-Wise et al., 2015), though this is likely related to other factors. People who are lesbian, gay, bisexual, or transgender have a higher risk of depression than heterosexuals (King et al., 2008), and there is an association between depressive symptoms and chronic abdominal pain (Youssef et al., 2008).
Gender expression and body image may play a powerful role in the experience of pain. A research team at the University of Toronto is investigating why cisgender women tend to develop post-mastectomy pain while transgender men report little or no pain after a mastectomy done as part of gender-reaffirming surgery. More research like this can enhance the treatment of pain and help close the gender pain gap for sexually diverse populations.
Factors Impacting the Gender Pain Gap for the LGBTQ Community
Whether you identify as gay, lesbian, transgender, or another member of the LGBTQ community, there are a few factors that impact the pain gap.
Lack of Research on Gender Expression and the Pain Gap
Although research investigating pain tolerance in males vs. females has increased in recent years, little attention has been paid to how self-identity (including gender expression and sexual orientation) influences the experience and management of pain.
A study examining pain sensitivity in healthy young women found that lesbian and bisexual women were more likely to report lower pain intensity compared to heterosexual women (Vigil et al., 2014). Interestingly, self-assessed masculine disposition was correlated with higher pain tolerance. This indicates that biological sex is not the only factor that should be considered when trying to understand the experiences of women in pain compared to men in pain.
Prejudice and Discrimination Against the LGBTQ Community
White, heterosexual cisgender women experience a pain gap, but at least get to the point of seeking services for untreated pain. Women of sexual minorities are more likely to avoid preventative care and underutilize health services due to fear of discrimination (Cochran, 2001; Shires and Jaffee, 2015). This can lead to untreated pain, whether it’s related to an extremely painful period or not.
Racism Compounds LGBTQ Health Disparities
Although a health gap exists between lesbian, gay, bisexual and transgender communities and the heterosexual population, there’s an even larger gap for members of the LGBTQ community who are from diverse racial and ethnic groups. Lesbian, gay, and bisexual African American adults are more likely to delay or not get needed prescription medicine, and lesbian, gay, and bisexual Latino adults are least likely to have health insurance (Krehely, 2009).
Barriers to Treatment for Different Sexual Orientations
People with diverse sexual orientations and gender-based identities face additional challenges compared to cisgender women. A history of discrimination against gay, lesbian, and transgender people has impacted socioeconomic status, creating a barrier to accessing healthcare services.
One review that examined experiences of underrepresented Canadian military service members and Veterans (LGBTQ, women, people of colour) highlights vulnerabilities related to health outcomes and access to health care and services. Lesbian, gay, bisexual, and transgender Veterans tend to experience worse physical and mental health and more sexual trauma compared to other Veterans (Eichler et al., 2021).
More research into how gender identity influences the experience and management of pain is needed to ensure that all genders can access timely, effective care for chronic pain and other types of intense pain.
AIMA Stands With All Genders and Gender Expressions
When doctors downplay women’s health concerns, nobody wins. AIMA is deeply committed to considering gender expression and the pain gap through an intersectional lens to ensure everyone has access to pain relief, free from sexism and racism. We want all menstruators to be heard, empowered, and celebrated.
Through our values of transparency, scientific evidence, accountability, and focus on menstruators, we are developing innovative and effective ways for menstruators to manage their period discomfort.
We’re breaking the silence around period pain! If you have a story about gender expression and the pain gap, we’d love for you to share it with us by email so we can continue raising awareness (#myperiodstory).