Gabrielle Jackson Piatkus, 2019, PB, 368pp, £14.99, 978-0349424552
It is a truth universally acknowledged, that man is the default human being, and any deviation from that is atypical, abnormal, and deficient. This is the conclusion I reached on reading Jackson’s Pain and Prejudice, and this, surely, must change. Following on from Invisible Women, if further proof of the gender data gap and the bias against women’s health is needed, it can be found in this polemic.
Fourteen years after receiving the diagnoses of endometriosis and adenomyosis, and after suffering pain for many years, the author is shocked to find that little has changed in the understanding or management of these conditions. One in 10 women of reproductive age has endometriosis, yet it is funded at 5% of the funding rate for diabetes, despite affecting the same number of women and costing the economy more. Other grossly underdiagnosed and mismanaged conditions such as irritable bowel syndrome, migraine, pelvic pain, and auto-immune conditions also come under the spotlight, as the author charts our historical understanding of the diseases and their social impact.
The author provides interesting commentary on social taboos. For example, in India, poor menstrual hygiene severely impacts girls’ education and causes 70% of all reproductive illnesses. In many cultures sex is used as a method of control, sometimes with extreme consequences, such as stoning, female genital mutilation, foot-binding, and honour killing. There is also a thought-provoking critique on discriminatory workplace culture (including that affecting women in medicine), and analysis of the #MeToo movement.
The chapters on female anatomy and physiology are aimed at a non-medical readership but there is much to learn for clinicians, especially for doctors dealing with medically unexplained symptoms (the highest risk factor for which is being a woman). As Jackson states, ‘I gave myself the title of hypochondriac before it became a complaint whispered behind my back.’ She is not alone. Women need to exert greater control over their health and this starts with being heard.
- © British Journal of General Practice 2020
