Medical conditions can cause a great deal of emotional stress. The tradition medical model does not address the emotional and then exasperated elements of pain. Pain can be physiological or emotional and both are significant. Dysmenorrhea is a diagnosis usually made simply on a medical history of extreme menstrual pain that interferes with daily activities. It is nondescriptive in its nature and acts as a catch all for many female reproductive causes of pain. This article is to help legitimize the totality of pain in regards to women’s reproductive conditions both physically and emotional.
Pain can be physiological or emotional and both are important. Physicians help to alleviate and heal a great variety of conditions but don’t usually confront the patient as a whole and emotional being. However, our emotional health plays a physiological roll as well. The International Association for the Study of Pain (IASP), the publisher of the scientific journal Pain, is a professional organization promoting research, education and policies for pain management and improved pain relief worldwide. IASP’s definition of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (Merskey, 1979, p. 250)
We all experience pain and express what we are feeling in many different ways. This is especially true when comparing men and women (Unruh, 1996). There are cultural influences and expectations, and general socially accepted relational norms. Women generally are freer to share feelings and weaknesses since nearly the beginning of time women, as a whole, carried along with their expressive hearts the weaker role in most societies. For women, weakness was to be expected and was not noteworthy. Women are generally paid lower wages and have had to fight for much political and social equality. This feminine dismissal has extended into the health industry as well.
Dysmenorrhea is a medical condition of excessive pain during menstruation. The diagnosis of dysmenorrhea is usually made simply on a medical history of menstrual pain that interferes with daily activities. It does not address the cause of this pain. This somewhat nondescript label can be placed upon a patient that is actually experiencing other harder to diagnosis and more complicated conditions such as: endometriosis, adenomyosis, polycystic ovarian syndrome, ovarian cysts, uterian fibroids, or in rare cases a reproductive carcinoma. However, these require time consuming detailed clinical histories from the patient, ultra sounds, MRIs, and/or exploratory surgery just for a diagnosis.
Endometriosis is one of those medically complicated and many system encompassing gynecological disorders. It is characterized by the presence and growth of endometrial tissue outside the uterine cavity. These endometrial cells lodged in other parts of the body, generally the pelvic cavity, still respond to monthly fluctuations in hormones, and consequently bleed into surrounding tissue and organs (Evans, Moalem-Taylor & Tracey, 2007). It usually causes severe pain, irritation, and inflammation. It can be a source of infertility and although some theories egoist (Simsa et al. 2010) the etiology is undetermined and exploratory surgery is needed for proper diagnosis. Adenomyosis is similar in that it is a condition that responds to monthly fluctuations of hormones. But these bleeding glands are within the muscular wall of the uterus. Again, the blood is trapped, can cause tissue damage, and may cause severe pain. This time the lesions cannot be surgically removed alone because the position within the muscle wall. Quieting hormonal drugs may be prescribed for both but it may not rid the patient of pain. Both can lead to infertility or hysterectomy.
Polycystic ovary syndrome (PCOS) is an endocrine condition associated with hyperandrogenism, infertility because of lack of ovulation, and metabolic dysfunction. Weight management through diet and exercise are fundamental to its management (Jeanes, Barr, & Hart, 2009). Diagnosis of this condition can be complicated by other major physiological condition such as obesity or diabetes. The male characteristic symptoms of this condition may be difficult to talk about and less readily available to a rushed physician.
Ovarian cysts and uterian fibroids are unusual growths. Generally they are not linked to cancer. They may cause pain, abdominal swelling, additional blood loss or pain with menses and if they grow rapidly or become too large they are surgically removed. Many times an ultrasound can discover condition and keep it monitored until surgical options are employed. These can also be quieted with hormonal drugs, puts a woman in a state of infertility, and may not rid the patient entirely of pain.
Many of the pharmaceutical treatments for these conditions have life altering side effects. Birth control may be the only and most desirable effect. Pills may be given as a first step. They are administered daily and according to the labeling have risk of weight gain, nausea, vomiting, dizziness, risk of blood clot, stroke, and other allergic reactions. Shots and other treatment administered under the skin may last for 3 months at a time and a patient may experience similar side effects. The drug, Lupron, shuts down the pituitary gland, a valuable endocrine organ within the brain, and places the woman’s body in a menopausal state giving the body a break from menses. A major risk for this drug is that it can end up irreversible. Severe depression may occur without this organ functioning and a menopausal effect of disrupting hormonal swings, abrupt temperature changes, and vaginal dryness may occur.
We are complicated creatures, dynamic, and many different biological systems work together and affect each other. The diagnosis and then proper treatment can sometimes take years. Misdiagnosis and bunny trails in: immunological conditions, cardiovascular, neurological (Landro et al. 2013), gastrointestinal, endocrine or hormonal, psychiatric treatments, and even an over simplified label of dysmenorrhea can distract from the proper treatment of pain both physically and now emotionally.
Severe dysmenorrheal is emotionally painful and disruptive. It shapes ones views (Huntington & Gilmour, 2005) and quality of life is affected, careers, social and relational choices are altered, it is disturbing. Pain can be scary. The unknown and undiagnosed condition can leave a patient frozen. A patient may be afraid of their next period and what she may experience the following month. She may decline vacations and business trips because of the fear of the unknown. Pain may keep her from favorite events or special opportunities. It may influence her choice of career, looking for an employer who will allow enough sick days to an other wise healthy looking individual. The onset of menses can be sudden and the unpredictability of it may leave a patient exposed to a painful public display. These embarrassing considerations are often times undervalued and misunderstood. Women with these conditions may feel ashamed, unfeminine, like damaged goods. They may have only received feedback that questions the validity of their experience, if it is legitimate or exaggerated. Woman that are unable to function under the severity of pain for several days may be treated like hypochondriacs. Friends and loved ones may also misunderstand and interpret pain management as an excuse not to engage. Woman may feel disappointed and may feel the disappointment of others whose expectation cannot be met relationally. Dysmenorrhea is not necessarily heretical (Nouri, Ott1, Krupitz, Huber & Wenzl, 2007) so family may not be familiar, understanding, or walk compassionately beside the woman in her distress. Dysmenorrhea may alter the ability to naturally conceive, have expected sexually relations, and it may change the atmosphere of a home and family dynamics.
The emotional pain is legitimate and yet unsupported. In a review to medical community called, “Don’t Dismiss Dysmenorrhea!” by Berkley & McAllister (2011). The authors explore the taboo nature of menstruation and question cultural and religious expectation that would consider the pain unworthy of report. Religiously, as part of the fall of man, it would be normal for a woman to deal with severe pain monthly. This theory would allow the traditional medical community to descend into a sort of dismissal as well.
The (doctors) attending behaviors (Ivey, 2003) that would allow for women to feel understood or cared for within a physical exam most often are not present. Traditional medical doctors are in a hurry, they may not have time to sit down, may not value eye contact, vocal quality may be distant as they problem solve, and lacking immediacy a quick unempathetic prescription may be written before fully listening to a patients story. These sort of arrogant actions lack a sense of positive regard and take away the doctor’s ability to be an agent of hope. This could cause a patient to leave a doctors office in more pain than before the visit. To make matters worse, care has become so compartmentalized that an undiagnosed woman may need to visit a gastroenterologist, immunologist, oncologist (Kakehashi et al. 2011), neurologist (Landro et al. 2013), cardiologist, endocrinologist, and a gynecologist sometimes for years with this sort of disrespectful and judgmental treatment. All along feeling like her concerns are not heard or cared for, and her needs not met.
Conclusion: Women in severe pain need physical and emotional relief. Healthcare professionals are given the opportunity to attend to the whole individual even in a practicing specialty and even if it is only for a short appointment. Emotional health is as important as physical health and healing can take place within the story telling process (Ivey, 2003). Emotional pain needs the salve of a compassionate ear that legitimizes her experience. Congruent, emotionally sensitive, nonjudgmental care is needed. Healthcare professionals that stay in the moment with each patient, focusing their attention and attending to their patient’s story will have the power to heal. Patients that experience an altruistic appointment may be given relief from their pain and a deposit of hope in their chronic condition.
References
Berkley, K. J., & McAllister, S. L. (2011). Don’t dismiss dysmenorrhea!. Pain, 152, 1940-1941.
Evans, S., Moalem-Taylor, G., & Tracey, D. J. (2007). Pain and endometriosis. Pain, 132, S22-S25.
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Huntington, A., & Gilmour, J. A. (2005). A life shaped by pain: women and endometriosis. Journal of Clinical Nursing, 14, 1124-1132.
Ivey, A. E. (2003). Intentional interviewing and counseling: Facilitating client development in a multicultural society (8th ed.). Australia: Thomson.
Jeanes, Y. M., Barr, S., & Hart, K. H. (2009). Dietary management of women with polycystic ovary syndrome in the United Kingdom: the role of dietitians. Journal of human Nutrition & Dietetics, 22, 551-558.
Kakehashi, A., Tago, Y., Yoshida, M., Sokuza, Y., Wei, M., Fukushima, S., & Wanibuchi, H. (2011). Hormonally Active Doses of Isoflavone Aglycones Promote Mammary and Endometrial Carcinogenesis and Alter the Molecular Tumor Environment in Donryu Rats. Toxicology Sciences, 126, 29-51.
Landro, N. I., Fors, E. A., Vapenstad, L. L., Holthe, O., Stiles, T. C., & Borchgrevink, P. C. (2013). The extent of neurocognitive dysfunction in a multidisciplinary pain centre population. Is there a relation between reported and tested neuropsychological functioning?. International Association for the Study of Pain, 154, 972-977.
Merskey, H. (1979). Pain definition. Pain, 6, 250.
Nouri, K., Ott, J., Krupitz, B., Huber, J. C., & Wenz, R. (2010). Family incidence of endometriosis in first-, second-, and third-degree relatives: case-control study. Reproductive Biology and endocrinollogy, 8, 85.
Simsa, P., Mihalyi, A., Schoeters, G., Koppen, G., Kyama, C. M., Den Hond, E. M., Fulop, V., & D’hogghe, T. M. (2010). Increased exposure to dioxin-like compounds is associated with endometriosis in a case—control study in women. Reproductive Biomedicine, 20, 681-688.
Unruh, A. M. (1996). Gender variations in clinical pain experience. Pain, 65, 123-167.
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