This Won’t Hurt by Marieke Bigg: A quietly furious call to arms over neglect of women’s health

Consider the following. One in ten women has endometriosis, roughly the same proportion who have diabetes. Both conditions have similarly deleterious impacts on quality of life. And yet research into diabetes attracts 20 times the funding of endometriosis, which remains a shadowy, enigmatic illness, to the extent that it takes an average of eight years to get a diagnosis.

Consider this too: heart disease is still considered largely a male problem, and symptoms in women are woefully misunderstood.

And this: women who go to the emergency department of US hospitals with acute pain are less likely to be given opioid painkillers than men.

And this, in the words of US artist Sophie Wallace: “Neil Armstrong walked on the moon in 1969, but it took another 29 years for the complete anatomy of the clitoris to be proven.”

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And this: 20 per cent of people worldwide suffer chronic pain, the majority of them women – yet the standard research subject in preclinical pain experiments is the male rodent.

And this: Gwyneth Paltrow’s Goop teaches women that their vulva is dirty, in need of cleansing.

All of these data points and observations underline something deeply troubling – a science and medicine (and even the pseudoscience perpetuated by people such as Paltrow and her vaginal-steaming devices) that is doing women a huge disservice.

In This Won’t Hurt: How Medicine Fails Women (Hodder & Stoughton), a hugely informative and quietly furious call to arms, Cambridge sociologist Dr Marieke Bigg corrals a grim catalogue of evidence from the history of scientific research, medicine, culture and society to make the compelling, enraging case that medicine is not gender neutral. “Female bodies have not only been ignored but also misunderstood in part as a result of the assumption that the male body was the default.”

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With the skill and methodological precision of a surgeon, she unpacks what one researcher, Bart Fauser, professor of reproductive medicine and gynaecology at the University of Utah, calls “the bikini version of biology”, which is “the idea that everything beyond the reproductive organs is the same across the genders ... In a world that has been historically dominated by men, we should always be suspicious of claims of gender neutrality, all too often, all too easily, used to disguise the ways in which a male standard is upheld as normal, often better, and definitely more important.”

Because male anatomy has been the default, she argues, “a whole complex system ... has been relegated to the shadows”. As a result, women’s pain and symptoms have been disregarded, misunderstood, dismissed or ignored.

Take heart disease awareness, for example, one of the areas in which this is most visible. Heart disease remains the leading cause of death in women, yet there is poor recognition of this among the general public. What might be regarded as typical symptoms for women have historically been considered “atypical.” We now know that most women do not experience what Bigg dubs the “Television Heart Attack” – “that classic chest pain we see in TV dramas” (which invariably feature male patients thrashing about on gurneys or hospital floors.) “Instead fatigue, nausea, jaw back or arm pain. or shortness of breath are more common manifestations.” Partly as a result of these kinds of misconceptions, research by the American Heart Associations found that only 13 per cent of women saw heart disease as their greatest personal health risk. Other studies have shown they are more likely to worry about breast cancer – even though heart diseases kills six times as many women annually.

“Culture shapes perception, and popular culture sends a clear but wrong message: only men have heart attacks,” she writes.

Bigg suggests that at the core of Goop’s health agenda is a general fear of femininity, a need to suppress and control it

Bigg argues convincingly that it is impossible to dissociate medicine and science from culture. Femininity in our society has always been “fraught with conflicting demands”, demanding that women be “both virginal and sexy – an impossible, contradictory ideal that has been mobilised throughout history to silence and stifle and torment women.”

A fascinating section dives into the controversial – at least, if you’re a male sexologist – subject of female ejaculation. “Female ejaculation is real,” Bigg writes. “It has been reported, recorded. It has even been filmed.” Our awareness of it goes back to the time of Aristotle. Ancient eastern and western texts differentiated between vaginal lubrication during sex and the “rarer external ejaculation of sexual fluids.” And yet researchers continually dismissed women’s accounts of it as insignificant, or misinterpreted by other researchers, because there was no scientific explanation for the phenomenon. It is a choice, the author notes, to value a certain kind of observed, but directed, “scientific” evidence over the anecdotal, “unscientific” evidence provided by women about their own bodies.

In this way, the book raises intriguing questions about what objectivity actually means, when science that is “guided by assumptions about whose perspective matters: that of the scientist over the patient and of the man over the woman”. A good, if depressing, illustration of this is an intriguing phenomenon that arises when women are subjected to tests measuring both physiological and subjective signals of sexual arousal in a lab setting. The results, Bigg writes, “showed that while women were physically aroused by the whole range of videos, they would often say they weren’t.” The researchers concluded the women were confused. Bigg cites the argument of Katherine Angel who suggests the problem isn’t with women participants’ understanding of what turned them on, but with the limitations of the scientific tools used to gauge arousal.

A partner once pointed out to Bigg that she seemed to spend a lot of time thinking about her body compared with the rather perfunctory consideration he gave to his. This is true of many women, she – rightly, I think – suggests. “Women do spend a lot of time thinking about their bodies, not through any fault of their own, but instead simply by existing in a culture that perpetually confronts us to the limitations of our bodies, but at the same time telling us that our bodies define us, give us value as sexualised objects and baby makers.”

This cultural ambiguity about the female body leaves women vulnerable to the snake-oil, vaginal-egg-peddling of Paltrow’s Goop. Bigg notes how gynaecologist and pain medicine physician Dr Jen Gunter and others have consistently called out Goop and its fellow wellbeing merchants, in an industry now worth $4.2 trillion, for selling a warped vision of female gynaecological empowerment, a “version of female biology that is dependent on purchasable products to manage a reproductive system ... otherwise inherently seen as dirty.”

[ Endometriosis: A condition surrounded by taboo, myths, delayed diagnosis and unreliable treatments ]

The first (of many) Goop products with which Dr Gunter took issue were jade eggs, which could, the site claimed, “balance hormones”. Dr Gunter pointed out that this was biologically impossible, criticisms which were echoed in a 2018 lawsuit brought by California’s consumer protection office. “Goop paid the fine, but continues to sell the eggs, alongside a slightly modified, much more modest description” of their potential, writes Bigg. She suggests that at the core of Goop’s health agenda is a general fear of femininity, a need to suppress and control it.

I would argue that the amount of time women spend thinking about our bodies, and the conflicted ideas society has about them, has made us increasingly adept at mobilising information and resources for ourselves. When science and medicine let us down, we turn to other women, in real life or online. As Bigg observes, social media platform TikTok has become a forum for open discussions about women’s health, just as in Ireland, the somewhat unlikely platform of RTÉ’s Liveline became a powerful forum for women to share stories of menopause, perimenopause and later endometriosis – more than that, it gave women permission to being sharing their experiences with one another. As someone navigating the hormonal rollercoaster that is perimenopause, I think it would be difficult to overstate the importance of its contribution to more dialogue and better sources of information.

If there is a criticism it is that, for all the importance Bigg attaches to subjective experience, This Won’t Hurt is light on it. Other than an account of her horror at the casual way a gynaecologist would suggest inserting a camera into her pelvic cavity to investigate a general feeling on unwellness she had, the book rarely strays from research, expert views and academic texts to make its point. That said, the point is powerfully and convincingly made.

[ Medical gaslighting: ‘No man would be asked if they suffer from panic attacks while having a heart attack’ ]

The fascinating third section explores developments in medicine and science that sound like they belong to the realm of science fiction. From “femtech” (a term, she notes, that allows male investors to bypass words such as “menstruation” or “urinary incontinence”) to artificial wombs to support premature babies, she shows how advances in research – whether it’s fertility awareness apps, reinvented vibrators or smart tampons that may one day help doctors to detect endometriosis ahead of time – will slowly help to unravel assumptions about “gender as the thing that answers our questions”. It will instead become the starting point.

Technology, she argues, has the “power to disrupt the stories about gender roles that we can come to accept – about the role of reproduction in a woman’s life and her role in society”. Science will come to serve not just women, but every gender, better, not merely by including them in clinical trials, but by “drawing us into new imaginative landscapes, a future of scientific potential that does away with the limitations of the gender roles we are assigned”. That’s something we can all look forward to.

Invisible Women: Exposing Data Bias in a World Designed for Men by Caroline Criado Perez (Chatto)

If you’ve ever wondered why smartphones are uncomfortably big for the average-sized woman’s hands, why office temperatures have you reaching for another layer or why women take longer (precisely 2.3 times longer) to use the bathroom, this book has the answer. “This is a man’s world” isn’t just a song, it’s an incontrovertible fact borne out by data.

Further reading

Women Don’t Owe You Pretty by Florence Given (Cassell)

Medicine owes women more, but women don’t owe the patriarchy anything – especially not an aesthetically pleasing package. Billed as the ultimate book for anyone who wants to challenge the outdated narratives created by the patriarchy, Women Don’t Owe You Pretty explores aspects of the contemporary female experience – from refusing to find comfort in other women’s flaws to unpacking the male gaze and how it shapes our identity.

Men Explain Things to Me by Rebecca Solnit (Granta)

Rebecca Solnit – who is often erroneously credited with creating the term ‘mansplaining’ – takes a tour through the full spectrum of “slippery slope of silencings” women experience, including domestic violence, motherhood, sexual exploitation.