Rebecca Rose Varghese
As I write this, I am in pain — mentally and physically! In a week, I will have my next period, and for the past two days, the pre-menstrual abdominal cramps that come a week before have been warning me about the impending 5-day-long pain. I am now confused and nervous about choosing between two medical treatments (laparoscopy or hormonal contraceptives) offered by doctors after the latest diagnosis of my chronic pain — Endometriosis.
I remember the first time I went to consult a doctor for my abdominal pain. I was just a ten-year-old, in pain, but excited about undergoing my first scan. When the doctor saw my report, he said the pain had more to do with me missing my dad who had left home to go abroad for work, than being strictly physical. Back then, I loved that diagnosis because what could be a better symbol of love than pain?
For years now I have had pain — in the abdomen, legs — as also back cramps. Hot water bags, pain balms, oils, and pain killers have been my regular companions on those five days, along with someone massaging my legs (and of course, the mock comments emanating from some of my relatives and teachers).
I can proudly say that I was the reason for many of the men in my extended family becoming aware of period pain! While almost all the girls around were shy and ashamed to talk about it, I was encouraged by my family to be a sort of ambassador for menstrual pain. I talked about it, and my painful cries were good enough testimony for it.
I remember some of my teachers mocking me for availing the highest number of leaves in the school, and telling me that my pain was natural, something that I had to bear as a sign of being a woman. For them, every time I talked about it, I was somehow insulting the strength and endurance level of womankind! Though I have not for once given serious thought to their utterings, I now realize how much those opinions had affected me in how I viewed the pain that I endured.
By the tenth grade, new discomforts came ambling along — nausea, vomiting, and gastric issues to the extent that anything I ate came out as soon as it went in. More than the two days of having to consume only O.R.S., it was the sad look on my parents’ faces that pushed me into the gloom. Even now, on those days, I see my father or mother coming into my bedroom in the middle of the night, just to check if I had finally gone to sleep, after having writhed and squirmed around on my bed throughout the day and most part of the night.
When I went to see the doctor at that time, he told me that it was just a sign that my menstrual cycle was changing. I remember asking him if I needed to take a scan of the uterus, to which he replied that scans were not necessary in such cases. “This pain is natural”, he had said. And though I knew in my heart that nothing was natural about the pain I had been enduring, I chose to listen to him!
For years, I tried various treatments — allopathy, homeopathy, Ayurveda. My parents took me to some of the most famous doctors in the region, mostly men who despite giving me different medications, gave the same diagnosis — the pain is natural!
About a year ago, I had another new symptom, and the pain increased to the point that when I used an electric heat pad and burnt my skin, I did not even feel the burn due to the intensity of the pain I was enduring. When my sister was diagnosed with endometriosis the same year, she was the one who urged me to again see a doctor. I thought she was being paranoid. I mean, wasn’t it “natural”? I had had it for years.
Reluctantly, I approached an old doctor. But he was more disinclined than me to accept that my pain was even real. It was only when I showed him the burn-marks on my stomach that the chronic nature of my pain caught his attention! It was this doctor, who for the first time, told me the name of my condition — dysmenorrhea (something I had googled and already found out).
He, however, reassured me that it was not serious! In spite of describing my symptoms, including the pain that occurred a week before my menstrual flow, and also informing him about my sister’s diagnosis, all he prescribed were painkillers and an iron supplement. When I asked him whether I needed to undergo a scan, he advised me against it.
I was, however, grateful for the medicine that he had prescribed because that was the first time a painkiller had worked for me! I could eat and be functional even without ignoring my pain with all the determination I could muster for the first time in years. But since painkillers were only a temporary solution, I decided to take Ayurvedic medicines. However, even after taking those medicines for two months, the pain did not decrease. When I met him the next time, I asked him whether he recommended a scan examination. He responded positively to my suggestion, the first doctor to do so!
Just imagine the sense of betrayal I felt when the doctor who scanned my stomach told me that I had a 7-cm cyst in my ovary!
After enduring more than 15 years of chronic pain and misdiagnosis, it took a woman doctor to look at my report and explain the following: There are two different types of menstrual dysmenorrhea — spasmodic pain, which is sharp abdominal pain that occurs during the start of the menstrual flow, and congestive pain, which is a dull, deeper pain, that starts before the menstrual flow and is mostly an indicator of a pathological state. Hence, the pain I had for years was an indicator of my condition.
It was not the lack of explaining my symptoms that had prevented my doctors from taking my pain seriously. The only mistake I did was to trust my doctors who had misdiagnosed me over and over again. I fell into the narrative that the pain was natural, despite years of studying about bias towards female pain.
In the article, titled, Women and pain: Disparities in Experience and Treatment, Laura Kiesel writes how it takes longer for women’s chronic pain to be diagnosed, and how since medications for diseases are based on male diagnosis, the treatment for women and other genders are not as effective. To prove her case, she has quoted the examples in New England Journal of Medicine to explain how women are seven times more likely than men to be misdiagnosed and discharged even in the middle of a heart attack.
In the same article, the author further adds how when a man talks about chronic pain, the international medical community sits up and takes notice even as it ignores millions of women on a daily basis.
Similar to my situation, it was after years of enduring dismal pain, which doctors had been dismissing as “natural”, that Laura Kiesel was diagnosed with having endometriosis.
The fear about laparoscopy and recurrence of the condition even after undergoing laparoscopy, fear of infertility, mental pressure, anxiety, and depression caused by the condition make most women suppress their pain and carry on.
Unfortunately, here a woman is looked at as an individual who had not taken care of her health, and the medical community refuses to take responsibility for it. They wouldn’t admit it is medical negligence and bias against women that cause such situations! It is unfortunate that despite publishing hundreds of similar articles and testimonies, the medical community and society pass judgments on women’s experience of pain!
When a woman talks about pain, her capacity to endure pain is questioned! She is even accused of being dramatic and narcissistic! Whatever may be her condition or age, women are expected to toil in the kitchen, or give presentations in her office enduring menstrual cramps, as well as give birth! Isn’t her pain “natural”, and hence easy to endure”? And I see women going through this without complaining because they simply cannot afford to be otherwise, lest they be left out of the race!
My mother once told me that though childbirth is indeed a magical experience, while everyone celebrated the second time she became pregnant, the first thing that had come to her mind was the pain she had endured while giving birth the first time.
Women anticipate and prepare mentally to take on the impending gloomy phases. I prepare myself for my period a week ahead, keeping medicines, hot water bag, and kettle close to my bed, and despite being someone who has often questioned the presence of God, every time I negotiate with him/her/they to give me the pain only during evenings because I would not be able to work or sleep otherwise. I cannot remember the number of times I have prayed merely to be able to sleep without pain for at least an hour before I had to write my exam or organize an event. When I refused to stay home on those days, my worried father has always asked me how my pain magically disappears, desperately hoping that his comment would stop me from going ahead with whatever I had been planning to do.
Today I have the assurance I need as I know the reason behind my pain. And, though the diagnosis may have come too late in the day for comfort, I hope my experience adds to the testimonies of millions of women out there fighting against their pain being “normalised”, and in questioning the gender disparity existing in matters of medical diagnosis and treatment.