Making gains in pelvic pain

Underdiagnosed and potentially debilitating - pelvic pain effects women across their life course, impacting their ability to participate in education, employment, exercise and recreational activities. Most commonly associated with menstrual periods, though it can be exacerbated by a range of medical conditions such as endometriosis, persistent and chronic pelvic pain can severely impact health and wellbeing, affecting a persons relationships with their partners, families and friends. With almost half of Australian women having experienced pelvic pain in the last five years, addressing pelvic pain is a pressing issue for gender equality.

A recent Jean Hailes report has found that women who speak a language other than English at home were significantly more likely to report experiencing pelvic pain than those who speak only English (56% compared to 44%). Interestingly, the research also found that women who speak a language other than English at home were just as likely to discuss pain with their doctors as women who spoke only English. Just over half of all women surveyed reported that they had discussed pelvic pain with their doctor, with both groups reporting comparable results relating to the impact of pain on daily life and emotional and mental wellbeing. They also reported similar reasons for not discussing their pelvic pain with a doctor: 69% of women overall thought the “symptoms were not bad enough” to raise with their doctor.

So what would it take to make gains on pelvic pain for migrant and refugee women?

Firstly, we need to acknowledge the deeply racialised and gendered history of medicine, particularly around gynaecological and pelvic-pain related conditions such as endometriosis. Historically, doctors assumed that endometriosis was an exclusively white, middle-class disease, establishing a flawed association between endometriosis and whiteness which persists in treatment today. For women in general, medical misogyny has meant pain is often dismissed and normalised by doctors. For women of colour, gendered factors promoting underdiagnosis are compounded by stereotypes based on race and class.

Secondly, we need to acknowledge that migrant and refugee women are the experts on their own bodies and acknowledge their efforts to seek appropriate healthcare in a system that often fails to meet their needs. The Jean Hailes report does not mention whether women were satisfied with their doctor’s response when they discussed pelvic pain, but the report does note that many forms of pelvic pain are treatable. If women who speak a language other than English are seeking help from doctors at the same rate as women who speak English, yet are reporting higher rates of pelvic pain, could this be an indication that the medical system in Australia continues to dismiss and normalise the pain of women of colour? We would argue yes.

We need more research on the pelvic pain experiences of migrant and refugee women that includes their encounters with healthcare practitioners and systems. Likewise, we need healthcare professionals to shift from a focus on prevalence studies to centring patient disease experiences and symptom descriptions. Crucially, healthcare professionals must be aware of how their personal biases can intersect with historical, disciplinary biases that deny appropriate levels of care to women of colour. Migrant and refugee women also need accurate, accessible information about pelvic pain symptoms and treatment options in their own languages. Such patient-centric approaches to pelvic pain care and treatment promote better health outcomes for all women seeking care for their pain.

First published in edition #125 of The WRAP on 28 September 2023.