PAIN IS NEVER NORMAL
MENSTRUAL CRAMPS ARE NEVER NORMAL -
(THEY MAY BE COMMON BUT THEY ARE NOT NORMAL)
PELVIC PAIN IS NEVER NORMAL
PAINFUL INTERCOURSE IS NEVER NORMAL
PELVIC PAIN IS NEVER “IN YOUR HEAD”
HOWEVER, EMOTIONAL STRESS WILL WORSEN PAIN
It is a sad commentary that over the years, a large number of women have come to my office believing that to suffer is normal. They have been told and they believe that painful periods are normal. They have been told and they believe that painful intercourse is normal. They have been told and they believe that to lose several days from work or school each month is normal. They have been told and they believe (maybe) that the pain they are experiencing is “all in their head”.
When these women have sought medical help for their complaints, they have been told that their pain is normal or that there is nothing wrong with them because nothing can be felt on pelvic exam. Many women stop complaining because they cannot get anyone to take their symptoms seriously. One common phrase heard in my office are words that “I have always had cramps with my period but they are just normal cramps”. One woman said that she thought intercourse was always supposed to be painful. For her, it had never been anything but! How tragic.
There is a bias that runs throughout the medical profession. This bias holds that women are neurotic – men are not. A study published in the New England Journal of Medicine many years ago showed that if men and women went to a physician with identical complaints, the woman was more likely to be given a prescription for Valium whereas the man would be taken more seriously and “worked up” for some illness. Several other studies have shown similar results. There is a great deal of organic disease masquerading as psychosomatic problems.
There is a common belief that pelvic pain in women is mainly “all in their head”. Experience has shown me that little if any pelvic pain is purely psychosomatic. This is not to suggest that emotional factors do not play a role in a person’s perception of pain – they do. Any emotional problem or significant stress will significantly worsen pain, regardless of cause. However, it is rare to see a woman with purely psychosomatic pelvic pain.
Perhaps the most extreme example involves a young woman, the wife of a sophomore medical student, who came to me number of years ago, supposedly for a routine problem. As part of my usual history, she was asked whether her periods were painful. She was asked whether or not intercourse was painful. To each of these questions, she responded no. I was, therefore, very surprised to discover that on pelvic examination, she was extremely tender.
This was discussed with her. It would be several years before she was in a position to begin a family. Despite her negative history, her pelvic examination was the classic tenderness seen with Endometriosis. A laparoscopy was therefore recommended which did indeed confirm the diagnosis of Endometriosis.
When she came back to the office after her surgery to discuss the findings and recommendations for therapy, she amazed us with the following comment. “Dr. Birnbaum,” she said, “I lied to you when I first came to the office. My periods are so painful I sometimes can’t stand it. Intercourse is sometimes so painful that we have to stop in the middle.” I asked her why she had not shared this information with me when I first questioned her and her reply was quite astounding. She said, “I’ve been to 2 other physicians with the same complaints. They both told me it was all in my head. I was afraid that you too were going to call me a nut.” Here was a woman who had lied and concealed the severity of her symptoms rather than risk being told again that it was imaginary or that there was nothing wrong with her.