Latest news with #medicalgaslighting
Medscape
15-07-2025
- Health
- Medscape
Am I Gaslighting My Patients?
Melissa Geraghty, PsyD, a clinical health psychologist at the US Department of Defense, developed unexplained episodes of lower body paralysis at the age of 34. 'I was told [by healthcare professionals] that it was 'just anxiety.' Throughout my life, I had been experiencing chronic pain and other odd symptoms but was told they were 'all in my head,'' she said in an interview with Medscape Medical News . Melissa Geraghty, PsyD Eventually, Geraghty was diagnosed with tethered cord syndrome, a rare neural tube defect requiring neurosurgery. Geraghty was a victim of medical gaslighting — the dismissal or minimization of a patient's symptoms. The term derives from a 1938 play (later adapted into a movie called Gaslight ), in which a husband intentionally manipulates his wife into questioning her perceptions of reality. The term 'gaslighting' became so popular that in 2022, it was identified by Merriam-Webster as its 'word of the year.' It has come to mean not only intentional manipulation of a person's perceptions but also dismissal of the person's legitimate concerns. In 2023, 'medical gaslighting' was trending on TikTok, garnering over 226 million views. A new review focuses on harm caused by medical gaslighting, which the authors refer to as 'symptom invalidation.' Researchers examined 151 qualitative studies, encompassing 11,307 individuals and 11 conditions, including long COVID, fibromyalgia, endometriosis, Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome, and systemic lupus erythematosus. The analysis identified broad classes of negative consequences: emotional states and beliefs (eg, self-doubt and shame), healthcare-specific responses (eg, loss of trust in clinicians), behavioral changes (eg, avoiding medical care), and diagnostic delays, leading to adverse outcomes. Allyson Bontempo, PhD 'Patients described questioning reality and asking themselves self-doubting questions such as, 'Am I making this up? Is it all in my head?' This can lead to long-term trauma and self-doubt and can adversely affect medical care going forward,' lead author Allyson Bontempo, PhD, a postdoctoral fellow at Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, told Medscape Medical News . Said Geraghty, 'This type of dismissal erodes trust and chips away at a person's sense of self.' It left Geraghty with 'medical trauma.' Respondents 'reported downplaying symptoms to their providers so as not to look overdramatic,' Bontempo recounted. 'Many such patients avoid healthcare providers, even for unrelated conditions, because they feel hopeless and think that nothing will come of their visit.' In these scenarios, diagnosis and treatment are delayed. Delays in diagnosis and treatment compromise the health of individual patients, and the negative sequelae of medical gaslighting go beyond its harmful psychological impact. It's a major public health issue, according to a report issued by the global healthcare safety nonprofit organization ECRI, topping the organization's 2025 list of the most significant threats to patient safety. Why Do Physicians Gaslight Patients? Devora Shapiro, PhD 'Physicians are under significant stress and strain, given continually increasing demands on their time and pressure from administrators to increase patient volume and decrease time spent in direct patient care,' Devora Shapiro, PhD, associate professor, Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, told Medscape Medical News . Physicians are also under tremendous pressure to justify their decisions (eg, ordering tests or performing treatments) to entities such as administrators and insurance companies. Alexandra Fuss, PhD, director of Behavioral Medicine in Inflammatory Bowel Disease at Massachusetts General Hospital, Boston, noted that 'with every medical decision, providers are authorizing the use of medical resources and must weigh the value of the service against the patients' needs, preferences, and circumstances.' Alexandra Fuss, PhD Physicians can find themselves needing to justify their medical decisions to patients 'who seem to think they know as much as their doctors or make specific requests for tests and treatments and have a customer-service mindset, where the provider is regarded as an employee who meets customer requests,' Fuss, an instructor at Harvard Medical School, Boston, told Medscape Medical News . Additionally, physicians are more vulnerable to engaging in dismissive behaviors when there are medically unexplained symptoms, maybe because complex stories or nonspecific symptoms 'don't fit neatly into the categories required by many health systems and insurance companies,' Bontempo explained. 'Lack of comprehensive objective testing or results that may not match expectations also contribute,' noted Anna Hayburn, PsyD, clinical health psychologist, Neuromuscular Center, and assistant professor of psychiatry, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland. 'Ambiguous symptoms are often attributed to psychiatric or psychosocial factors, even when those aren't the primary driver of the symptoms.' Anna Hayburn, PsyD Most of Hayburn's patients have complex neurologic conditions and 'have experienced some form of medical gaslighting and/or other forms of medical trauma throughout their healthcare journey. Providers often lack understanding of the symptoms or approach them with preconceived notions.' It can take years to receive a diagnosis and appropriate care. 'Patients are often burned out by the time that happens,' she told Medscape Medical News . The Role of Implicit Bias Fuss encourages medical providers to 'be mindful that we all have heuristics and biases that influence our behaviors and decision-making.' Zed Zha, MD, a family physician and dermatologist who practices at the Yakima Valley Farm Workers Clinic, Toppenish, Washington, told Medscape Medical News that her practice consists primarily of underserved populations — mostly immigrants. 'It's known that people of color, immigrants, members of the LGBTQ population, people with obesity or disabilities, and women more frequently have their symptoms dismissed, compared to White cisgender males, and I've seen this in my patients.' Zed Zha, MD For example, Zha treats patients with hidradenitis suppurativa (HS), a chronic inflammatory skin disorder characterized by painful lesions affecting intertriginous areas. HS disproportionately affects women and people of color and is typically associated with a 10-year delay between symptom onset and diagnosis. 'The diagnostic difficulty is compounded by the fact that this is a population more frequently dismissed and not taken seriously,' Zha said. Zha recalls a patient who had HS symptoms for more than 20 years without accurate diagnosis. 'The first thing she said was, 'I know I'm having these problems because I'm fat.' This is what she had been told by previous providers, and she accepted this flipped version of reality that was a totally untrue theory.' Another bias comes from the old adage, drummed into the heads of physicians from the first day of medical school: 'When you hear hoofbeats, think horses, not zebras.' This encourages physicians not to attribute a patient's symptoms to some rare disease but to look at more common conditions — an approach that can lead to dismissal or misattribution of symptoms in the quest to find a 'common' explanation, such as anxiety. 'A deeper question is what constitutes a 'rare' disease,' commented Zha . 'Are certain diseases actually rare, do they just more frequently affect women, people of color, transgender patients, or patients from other cultures?' Even common conditions are often missed in marginalized populations because of implicit bias. 'When we think about heart attack symptoms, we think about a hunched-over man with crushing chest pain, holding the left side of his chest or left arm. But that type of presentation isn't common in women. Women experience 'atypical' symptoms. By definition, if we're defining symptoms as 'atypical,' we're implying they're rare. But how can the presentation of a common medical emergency be defined as 'rare' if it affects women who comprise 50% of the population?' Misdiagnosis of myocardial infarction in women is more common than that in their male counterparts because 'atypical' symptoms are misattributed to anxiety and because of a stereotype that women are less affected by cardiovascular disease than men. Another myth is that Black people feel less pain, Zha noted. This misperception has contributed to undertreatment of pain in Black vs White patients. And women, more often seen as exaggerating pain, are less likely to receive pain medication than men presenting with the same complaints — a phenomenon Zha described as 'medical misogyny.' Zha asks herself throughout the day, 'How would I approach this patient's care if the patient were an able-bodied, thin-bodied cisgender straight White male without an accent?' She acknowledged that this self-investigation requires 'courage,' adding, 'every day, I'm still working on it.' Tips for Physicians The experts offered tips to help physicians avoid medical gaslighting. Don't be afraid to admit you don't know the answer. 'Most patients aren't expecting perfection,' Geraghty said. 'They're looking for someone to walk alongside them. Saying, 'I may not know yet, but I'm committed to figuring it out with you' is far more supportive than minimizing symptoms or blaming the patient.' You don't have to do everything the patient wants. Patients, often armed with articles from the internet, may ask for a medication, procedure, or test that's not warranted for their condition or symptoms. If this happens, 'take a moment to explain why that's the case, which can reduce the patient's feeling of being dismissed,' Hayburn advised. Some patients have developed their own hypotheses about what's causing their symptoms, which may not be 'based in empirical evidence,' Fuss added. 'The willingness to listen to their perspective regarding causation is important for establishing trust.' But this doesn't mean physicians are 'required to defer to patients' perceptions about the etiology of their symptoms.' Be careful about 'diagnostic overshadowing.' 'Be mindful not to over-engage in diagnostic overshadowing,' Fuss warned — a process by which healthcare professionals wrongly attribute a person's physical symptoms to other causes, such as disability or mental illness. She encouraged physicians to engage in 'thoughtful communication' when discussing potential psychological interventions. For example, patients with irritable bowel syndrome 'often describe unhelpful messages they've heard in the past, such as 'it's all in your head' or 'it's just stress.' So it's important to communicate the role of the gut-brain axis and discuss how psychological support is a valid treatment option recommended as part of comprehensive healthcare, as psychological factors can influence physical symptoms. Providers should emphasize that they'll continue to work on addressing [physical] symptoms as well.' Empathetic demeanor and validation build trust. Demeanor is an important component of helping people feel valued and taken seriously. Fuss advises clinicians to build trust by 'bolstering perceptions of competence and warmth.' Competence includes intelligence, skill, and assertiveness, while warmth includes qualities such as empathy, kindness, and honesty. Demonstrating both qualities also builds trust. An empathetic demeanor also includes validating the patient's statements, which 'doesn't take a lot of time but just takes intention,' according to Geraghty, whose private practice includes a specialty in medical gaslighting. 'You can say something like, 'I believe you' or 'that sounds really difficult,' which only takes a few seconds. That kind of acknowledgment can completely change the tone of the appointment.' Allow patients to ask questions. 'Asking if the patient has any questions means patients are more likely to feel heard and listened to,' said Fuss. Despite the compressed nature of medical appointments, time can be reserved for questions at the end of the visit. If patients require additional time for the discussion, a follow-up appointment can be scheduled. Validation isn't the same as reassurance. Bontempo recommends that physicians 'do not reassure patients that their symptoms are 'normal,' especially if they've been living with them for a long time and have distress about them. Patients know when something is wrong with them, especially the longer they live with their symptoms.' Research suggests that reassurance isn't helpful to patients with high distress about their symptoms and may be perceived as dismissive. So instead of reassurance, Bontempo recommends validation. 'Many patients who struggle to receive a diagnosis actually have reported wanting to have their symptoms validated independent of whether a diagnosis can be identified. At the very least, this validation reassures patients that they are not crazy and offsets the self-doubt that ensues from being undiagnosed, which is only exacerbated when physicians normalize their symptoms.' A Call for Action Although the term 'medical gaslighting' has 'exploded,' it has garnered relatively little formal research, Zha pointed out. Furthermore, 'some are even arguing that we need to abandon the term because it's cynical and not good for our business.' But that itself is a form of gaslighting — acting as though a real problem doesn't exist. 'The popularity of the term is a message to us. Rather than putting our energies into eliminating this term, let's put our energies into providing patient care that is affirming and takes symptoms seriously.' Geraghty emphasized that her statements reflect her own views and not those of the US Department of Defense, and Zha emphasized that her statements reflect her own views and not those of the Yakima Valley Farm Workers Clinic. Hayburn, Fuss, Geraghty, Zha, and Shapiro reported having no relevant financial relationships.
Forbes
13-06-2025
- Health
- Forbes
Medical Gaslighting Is Real. Women Leaders Are Raising Their Voices
Before walking into the doctor's office, I felt hopeless. Four other doctors had dismissed my complaints. I was expecting the typical responses the other practitioners shared, 'Eat less and exercise more.' They assumed my size was the problem. However, nothing could have prepared me for the ultimate medical gaslighting of my life. After hearing my story, the new doctor looked me up and down twice with her eyes and responded, 'Well, obviously, you don't have a tapeworm.' Gaslighting, once thought to be the domain of toxic bosses and manipulative domestic partners, has found an alarming new home in the medical profession. Countless Americans have faced medical dismissal, causing shattered trust in doctors and spiraling depression. A staggering 72% of millennial women report feeling gaslit by medical professionals, according to a Mira study. This is a silent epidemic undermining the very foundation of our healthcare system. A Health Central survey also found that more than 94% of respondents said their doctors had ignored or dismissed their symptoms. Nearly all of those women said it had happened more than once. 'Most of us go into medicine wanting to help people; I don't think this is done out of malice,' states Dr. Chailee Moss, a gynecologist at the Centers for Vulvovaginal Disorders, who coauthored a paper on gaslighting in patients with vulvovaginal disorders. 'This happens because physicians don't have the time or the expertise to help patients. Pain conditions are complex, and patients require a lot of time to share their full stories. When you combine a culture that gives less weight to patients' accounts of their illness with very little time and teaching on pain conditions, it's a perfect storm. Unfortunately, in that context, it can become easier to question the problem than to admit we don't know how to fix it.' It took almost two years to be diagnosed with lipedema. The condition is characterized by estrogen signaling fat cells to multiply and enlarge, predominantly affecting the arms and legs. This process leads to the distinctive disproportionate shape familiar to those living with the condition. Lipedema affects around 11% of women globally (approximately 400 million people). Still, it's often misdiagnosed or dismissed as simple weight gain when it's much more complicated, considering there's no cure for the condition. Before undergoing 19 intensive advanced treatment sessions in Turkey, my legs felt like tree trunks, limiting how far I could walk or how long I could stand. Yet even on days when chronic pain significantly disrupted my daily functioning, I persisted in meeting my leadership responsibilities. This situation led me to ask a deeper question: How do other women navigating ongoing medical conditions continue to show up consistently and effectively as leaders? Ellen Rudolph, CEO and cofounder of WellTheory, treats medical appointments like high-stakes leadership meetings. 'I prepare with a clear agenda, supporting data and follow-ups,' she says. She's also ditched the habit of minimizing her needs to avoid discomfort. 'I've learned not to downplay what I'm experiencing just to make other people comfortable.' Ellen Rudolph, CEO and cofounder of WellTheory courtesy of WellTheory After years of medical dismissal and debilitating symptoms that once left her bedridden, she now leads a pioneering virtual care platform for autoimmune patients with empathy led by firsthand experience. 'Running an early-stage company while living with an autoimmune disease means constantly managing my energy physically, mentally and emotionally,' she says. 'But I've learned the hard way that pushing through at all costs isn't sustainable.' Instead of masking her pain, Rudolph models transparency. She's built a culture where well-being is non-negotiable. 'We can't say one thing to our members and do another ourselves,' she says. 'That means making space every day for the basics like sleep, movement, a nourishing diet and connection.' The turning point came when Brooke Young, a lifestyle television host, stopped internalizing the gaslighting. 'There was no compassion in their eyes. I was constantly told to take more mental health medication as if that was the only explanation.' Brooke Young peaking onstage at TEDx Raleigh. Courtesy of Brooke Young Trying to be normal cost her tens of thousands of dollars and countless sleepless nights. As a leader, she felt caught between two competing forces: the need to appear competent and composed and the invisible pain she was managing every day. 'I was constantly focused on how others perceived my pain instead of checking in with how I actually felt.' Her message to other women navigating similar experiences is not to give up and to stay rooted in the belief that you are not weak or crazy. Today, Young leads differently. Her success is no longer defined by pushing through pain. She honors her body's needs, even when that means showing up imperfectly. The entrepreneur explains, 'I accept those down days instead of telling myself I'm not enough.' Nicoletta Sozansky spent nearly eight years searching for answers before finally receiving a diagnosis of Mast Cell Activation Syndrome. During that time, she worked full-time in New York's high-stakes financial sector while grappling with debilitating symptoms and repeated misdiagnoses. 'Even when I was close to 100 pounds and barely functioning, I never gave up on my career,' she says. 'I had worked too hard as an immigrant, as a professional to walk away.' She learned how to operate through the fog of pain, even squeezing in endoscopic procedures during lunch breaks. As the founder of Healthcare Redefined, Sozansky took her struggles with the healthcare system and built a platform that connects patients with vetted providers. Most importantly, she's built a community. Gigi Robinson, author of A Kid's Book About Chronic Illness, leads by designing her work around her health. 'Chronic illness hasn't stopped me from showing up. It's simply changed how I do it,' she shares. Through her company, It's Gigi LLC, she's created a model where flexibility is a core value. She doesn't hesitate to seek second opinions and share with her team when she feels unwell and needs to slow down. By sharing her reality in real time, she fosters deeper empathy within the communities she leads. Diagnosed with Hypermobile Ehlers-Danlos Syndrome and later endometriosis, Robinson has since become a powerful voice for chronic illness advocacy in media and business. 'Dismissal taught me to speak louder, not smaller,' she says. 'Self-trust is non-negotiable.' These women's stories challenge a culture that too often equates strength with silence. True leadership is about creating space for humanity. As more women speak up and advocate for their needs, they change the conversation around chronic illness and transform leadership. Dr. Moss emphasizes that solutions must start with systemic change, 'The antidotes are research, education and training in the kind of exam or interview techniques that affirm patient symptoms and help patients feel they have a partner in their care.' Diagnosis is just the beginning. As I continue to advocate for myself, I refuse to accept 'It's all in your head' as the final verdict from doctors who don't yet understand.
CNN
26-05-2025
- Health
- CNN
Women face medical gaslighting for chronic pain, experts say
EDITOR'S NOTE: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation. For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people — most of whom identify as women — sexual intercourse and routine pelvic exams are unbearable. Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women. Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain. READ MORE: Ovarian cysts can be painful when they burst. When do you need to see a doctor? We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions. We've consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training. A 2024 study of patients who went to a clinic for vulvovaginal pain — pain experienced in the external female genitals and vagina –- found that 45% of these patients had been told that they 'just needed to relax more' and 39% were made to feel that they were 'crazy.' A staggering 55% had considered giving up on seeking care. These results echo what one of us — Elizabeth Hintz — found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this 'it's all in your head' response from doctors. Another study followed patients in two different major US cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information. These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care? 'Let me describe the pain that would drive me to try so many different doctors, tests and treatments,' a patient with vulvovaginal pain said to her doctor. For her, sex 'is like taking your most sensitive area and trying to rip it apart.' 'I can now wear any pants or underwear that I want with no pain,' said another patient after successful treatment. 'I never realized how much of a toll the pain took on my body every day until it was gone.' Many patients worldwide experience medical gaslighting — a social phenomenon where a patient's health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright. Medical gaslighting is rooted in centuries of gender bias in medicine. Women's reproductive health issues have long been dismissed as psychological or 'hysterical.' Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy. These historical views help shed light on why these symptoms are still not taken seriously today. In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity. This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed. Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist. Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men. This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women's health has actually declined over the past decade. Despite these known disparities, in April the Trump administration threatened to end funding for the Women's Health Initiative, a long-running women's health research program, further worsening the problem. READ MORE: The Women's Health Initiative has shaped women's health for over 30 years, but its future is uncertain Without sustained federal funding for women's health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded. As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race. One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients' pain and offered them less accurate treatment recommendations. Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men. Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine. These lingering erroneous beliefs about gender and race are key reasons patients' pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death. Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients' lived experiences and admit when an answer isn't known. In the meantime, people navigating the health care system can take practical steps when encountering dismissive care. They can educate themselves about chronic gynecological pain conditions by reading books like 'When Sex Hurts: Understanding and Healing Pelvic Pain' or educational information from trusted sources like the International Society for the Study of Women's Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease. Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting. READ MORE: Endometriosis pain leads to missed school and work in two-thirds of women with the condition, new study finds If someone you know has experienced medical gaslighting and would like support, there are resources available. Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information — like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.
CNN
26-05-2025
- Health
- CNN
Women face medical gaslighting for chronic pain, experts say
EDITOR'S NOTE: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation. For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people — most of whom identify as women — sexual intercourse and routine pelvic exams are unbearable. Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women. Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain. READ MORE: Ovarian cysts can be painful when they burst. When do you need to see a doctor? We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions. We've consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training. A 2024 study of patients who went to a clinic for vulvovaginal pain — pain experienced in the external female genitals and vagina –- found that 45% of these patients had been told that they 'just needed to relax more' and 39% were made to feel that they were 'crazy.' A staggering 55% had considered giving up on seeking care. These results echo what one of us — Elizabeth Hintz — found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this 'it's all in your head' response from doctors. Another study followed patients in two different major US cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information. These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care? 'Let me describe the pain that would drive me to try so many different doctors, tests and treatments,' a patient with vulvovaginal pain said to her doctor. For her, sex 'is like taking your most sensitive area and trying to rip it apart.' 'I can now wear any pants or underwear that I want with no pain,' said another patient after successful treatment. 'I never realized how much of a toll the pain took on my body every day until it was gone.' Many patients worldwide experience medical gaslighting — a social phenomenon where a patient's health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright. Medical gaslighting is rooted in centuries of gender bias in medicine. Women's reproductive health issues have long been dismissed as psychological or 'hysterical.' Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy. These historical views help shed light on why these symptoms are still not taken seriously today. In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity. This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed. Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist. Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men. This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women's health has actually declined over the past decade. Despite these known disparities, in April the Trump administration threatened to end funding for the Women's Health Initiative, a long-running women's health research program, further worsening the problem. READ MORE: The Women's Health Initiative has shaped women's health for over 30 years, but its future is uncertain Without sustained federal funding for women's health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded. As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race. One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients' pain and offered them less accurate treatment recommendations. Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men. Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine. These lingering erroneous beliefs about gender and race are key reasons patients' pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death. Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients' lived experiences and admit when an answer isn't known. In the meantime, people navigating the health care system can take practical steps when encountering dismissive care. They can educate themselves about chronic gynecological pain conditions by reading books like 'When Sex Hurts: Understanding and Healing Pelvic Pain' or educational information from trusted sources like the International Society for the Study of Women's Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease. Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting. READ MORE: Endometriosis pain leads to missed school and work in two-thirds of women with the condition, new study finds If someone you know has experienced medical gaslighting and would like support, there are resources available. Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information — like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.
CNN
26-05-2025
- Health
- CNN
Women face medical gaslighting for chronic pain, experts say
Fighting disinformation Women's health Chronic diseasesFacebookTweetLink Follow EDITOR'S NOTE: The views expressed in this commentary are solely those of the writers. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation. For people with chronic gynecological pain conditions, pain can be constant, making everyday activities like sitting, riding a bicycle and even wearing underwear extremely uncomfortable. For many of these people — most of whom identify as women — sexual intercourse and routine pelvic exams are unbearable. Endometriosis and vulvodynia, or chronic genital pain, are common gynecological conditions that can cause severe pain. They each affect about 1 in 10 American women. Yet many women face skepticism and gaslighting in health care settings when they seek care for this type of pain. READ MORE: Ovarian cysts can be painful when they burst. When do you need to see a doctor? We know this well through our research on social cognition and on how people with misunderstood health conditions manage difficult conversations with their doctors and family, as well as through volunteer work alongside people living with these conditions. We've consistently found that medical gaslighting around chronic gynecological pain is a complex societal problem, fueled by holes in medical research and training. A 2024 study of patients who went to a clinic for vulvovaginal pain — pain experienced in the external female genitals and vagina –- found that 45% of these patients had been told that they 'just needed to relax more' and 39% were made to feel that they were 'crazy.' A staggering 55% had considered giving up on seeking care. These results echo what one of us — Elizabeth Hintz — found in her 2023 meta-synthesis: Female patients with chronic pain conditions frequently hear this 'it's all in your head' response from doctors. Another study followed patients in two different major US cities who were seeking care for vulvovaginal pain. The researchers found that most patients saw multiple clinicians but never received a diagnosis. Given the challenges of seeking medical care, many patients turn to social media sources like Reddit for support and information. These studies, among others, illustrate how people with these conditions often spend years going to clinician after clinician seeking care and being told their pain is psychological or perhaps not even real. Given these experiences, why do patients keep seeking care? 'Let me describe the pain that would drive me to try so many different doctors, tests and treatments,' a patient with vulvovaginal pain said to her doctor. For her, sex 'is like taking your most sensitive area and trying to rip it apart.' 'I can now wear any pants or underwear that I want with no pain,' said another patient after successful treatment. 'I never realized how much of a toll the pain took on my body every day until it was gone.' Many patients worldwide experience medical gaslighting — a social phenomenon where a patient's health concerns are not given appropriate medical evaluation and are instead downplayed, misattributed or dismissed outright. Medical gaslighting is rooted in centuries of gender bias in medicine. Women's reproductive health issues have long been dismissed as psychological or 'hysterical.' Genital and pelvic pain especially has been misattributed to psychological rather than biological causes: A century ago, Freudian psychoanalysts incorrectly believed that female sexual pain came from psychological complexes like penis envy. These historical views help shed light on why these symptoms are still not taken seriously today. In addition to the physical toll of untreated pain, medical gaslighting can take a psychological toll. Women may become isolated when other people do not believe their pain. Some internalize this disbelief and can begin to doubt their own perceptions of pain and even their sanity. This cycle of gaslighting compounds the burden of the pain and might lead to long-term psychological effects like anxiety, depression and post-traumatic stress symptoms. For some, the repeated experience of being dismissed by clinicians erodes their sense of trust in the health care system. They might hesitate to seek medical attention in the future, fearing they will once again be dismissed. Although some chronic gynecological pain conditions like endometriosis are gaining public attention and becoming better understood, these dynamics persist. Part of the reason for the misunderstanding surrounding chronic gynecological pain conditions is the lack of research on them. A January report from the National Academies found that research on diseases disproportionately affecting women were underfunded compared with diseases disproportionately affecting men. This problem has gotten worse over time. The proportion of funding from the National Institutes of Health spent on women's health has actually declined over the past decade. Despite these known disparities, in April the Trump administration threatened to end funding for the Women's Health Initiative, a long-running women's health research program, further worsening the problem. READ MORE: The Women's Health Initiative has shaped women's health for over 30 years, but its future is uncertain Without sustained federal funding for women's health research, conditions like endometriosis and vulvodynia will remain poorly understood, leaving clinicians in the dark and patients stranded. As hard as it is for any female patient to have their pain believed and treated, gaining recognition for chronic pain is even harder for those who face discrimination based on class or race. One 2016 study found that half of the white medical students surveyed endorsed at least one false belief about biological differences between Black and white patients, such as that Black people have physically thicker skin or less sensitive nerve endings than white people. The medical students and residents who endorsed these false beliefs also underestimated Black patients' pain and offered them less accurate treatment recommendations. Studies show that women are more likely to develop chronic pain conditions and report more frequent and severe pain than men. But women are perceived as more emotional and thus less reliable in describing their pain than men. Consequently, female patients who describe the same symptoms as male patients are judged to be in less pain and are less likely to be offered pain relief, even in emergency settings and with female clinicians. Compared to male patients, female patients are more likely to be prescribed psychological care instead of pain medicine. These lingering erroneous beliefs about gender and race are key reasons patients' pain is dismissed, misunderstood and ignored. The very real-life consequences for patients include delayed diagnosis, treatment and even death. Correcting these problems will require a shift in clinical training, so as to challenge biased views about pain in women and racial minorities and to educate clinicians about common pain conditions like vulvodynia. Research suggests that medical training needs to teach students to better listen to patients' lived experiences and admit when an answer isn't known. In the meantime, people navigating the health care system can take practical steps when encountering dismissive care. They can educate themselves about chronic gynecological pain conditions by reading books like 'When Sex Hurts: Understanding and Healing Pelvic Pain' or educational information from trusted sources like the International Society for the Study of Women's Sexual Health, the International Pelvic Pain Society and the International Society for the Study of Vulvovaginal Disease. Although these steps do not address the roots of medical gaslighting, they can empower patients to better understand the medical conditions that could cause their symptoms, helping to counteract the effects of gaslighting. READ MORE: Endometriosis pain leads to missed school and work in two-thirds of women with the condition, new study finds If someone you know has experienced medical gaslighting and would like support, there are resources available. Organizations like The Endometriosis Association and the National Vulvodynia Association offer support networks and information — like how to find knowledgeable providers. Additionally, connecting with patient advocacy groups like Tight Lipped can provide opportunities for patients to engage in changing the health care system.
