Female reproductive care is both familiar and extremely foreign to many women. Talking about menstruation and other biologically female processes that concern the female reproductive system is often considered taboo. While this stigma may seem harmless, it can greatly restrict patient comfort and autonomy by allowing increased medicalization of the female body when women seek treatment for reproductive issues. In many instances, medicalization causes dismissal of female pain and exclusion of the woman from her own treatment plan. Under-medicalization refuses recognition of her pain and thus denies medical remedies, placing the blame on the woman. However, over-medicalization can also reject a woman’s autonomy over her own body, giving doctors jurisdiction because of the taboo subject area (Zola, 2012). Medical control over a woman’s reproductive organs normalizes the dismissal of female-reported pain and a lack of patient-doctor communication due to the taboo nature of the subject.
A Personal Story
(Note: I changed the name of the woman here because the story is personal and I wanted to preserve her privacy.)
Last year, Stacy experienced the impacts of medicalization when she sought care here in South Bend. At midnight, Stacy went to the ER experiencing extreme pain in her lower abdomen. The ER was empty, and she was the only person in the waiting room. Her pain was so extreme that she could not walk. However, Stacy waited over an hour before a healthcare professional was able to see her. Once she was able to be seen by the doctor on call, she was shamed for her potential promiscuity.
“Doctors asked me over and over again if I was pregnant. When I said no, they would ask, ‘Are you sure?'”Stacy on her experiences seeking treatment for lower abdominal pain at Beacon Memorial Hospital in South Bend
She rated her pain an 8 on a scale of 1 to 10 and yet doctors continually dismissed her pain. As a college-age woman of color, her self-reported pain was not deemed significant enough to warrant urgency. She was left alone in her hospital room for six hours, and doctors ran no tests besides bloodwork, despite her intense physical pain. When they ran urine tests, Stacy asked for water and was denied with no explanation. She eventually was given two ultrasounds and sent back to the room to wait.
At roughly 6:30 AM, several doctors and healthcare professionals came rushing into the hospital room to give her an IV with morphine. They told Stacy that her pain was coming from ovarian torsion and that she might lose an ovary. They said that she may need surgery, and that the doctor would be in at around 4 PM to perform it. When the doctor finally arrived, she told Stacy that surgery was not needed, and doctors discharged her. The medical situation was never explained to Stacy, who went back to campus; she was simply sent home with 8 oxycodone pills and a bill for $6400 in hospital fees, although she never received care.
Reading Stacy’s story in conjunction with texts from this module of the course reveals three major themes for women as they experience healthcare: the dismissal of female pain, moral judgements surrounding healthcare, and the refusal of female agency. These themes represent an over-stepping of the medical field and provide concrete examples of medicalization in the real world.
Dismissal of Female Pain
When Stacy first arrived at the hospital, her pain was dismissed by doctors, possibly due to her age, race, or gender. This is not an uncommon experience for women, especially women of color like Stacy.
One in five women say they have felt that a health care provider has ignored or dismissed their symptoms.Emily Paulsen, Duke University Healthcare
The refusal to accept and treat female pain can be viewed as an under-medicalization. One of the four ways that Zola reports medicalization occurring is “through the retention of absolute control over certain technical spheres” (Zola, 2012). Through this logic, isn’t the refusal to take control by treating pain an example of under-medicalization? When doctors deny that a woman’s pain exists, they are not only denying her treatment—they also characterize her as an unreliable narrator, stripping her of the psychological agency to report her own pain.
Because doctors and medical professionals deny women the psychological credibility to be perceived as rational actors over their own bodies, women are often refused agency in their treatment plans. As seen in Stacy’s story, the doctors who treated her assumed that the pain she reported reflected some sort of mistake on her part. Had she practiced unprotected sex? Was she having sex? This moral judgement relates to the discussion in Zola where our society’s perception of illness inherently places blame on the patient (Zola, 2012).
Denial of Agency
Ranging from period taboo to difficulties with fertility, many women are shamed for talking about reproductive health. This relegates female reproductive health to the medical sphere, placing it solely within the doctors’ jurisdiction. When female bodies become the property of the physician rather than the woman herself, an inevitable loss of autonomy occurs. In Stacy’s story, her own pain was not explained to her. Doctors abandoned her to suffer in confusion rather than walk her through treatment options. Even when her diagnosis was finally made, it was not explained. There was never any option for an active involvement in her own treatment. As a young woman of color, Stacy was not given the option to communicate with the doctor as she devised Stacy’s treatment plan. Depersonalization transformed Stacy from an agent to a body in the eyes of the medical field. Dehumanization does not just work in the medical field—systematic racism impacts everything from housing to food access through policies like segregation and redlined (Bailey et al 2021). Women of color lose agency in the medical field because of power hierarchies that have been in place for hundreds of years and still function today.
Cost of Care
In Stacy’s story, she was charged $6400 and ended up paying approximately $1800 out of pocket, although she ultimately received no treatment but pain medicine (which was not regulated). In fact, she was denied water when she asked for it. How can doctors justify that charge? Profit-driven hospitals use medicalization to decrease quality of care and increase margins of profit (Rosenthal 2013). Stacy experienced how medicalization can create high charges and worse care firsthand.
Bailey, Z. D., Feldman, J. M., & Bassett, M. T. (2021). How structural racism works — racist policies as a root cause of U.S. racial health inequities. New England Journal of Medicine, 384(8), 768–773. https://doi.org/10.1056/nejmms2025396
Paulsen, E., & Paulsen, E. (n.d.). Recognizing, addressing unintended gender bias in patient care. Duke Health Referring Physicians. Retrieved February 24, 2023, from https://physicians.dukehealth.org/articles/recognizing-addressing-unintended-gender-bias-patient-care
Rosenthal, E. (2014, April 18). Paying till it hurts. The New York Times. Retrieved February 24, 2023, from https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html
Zola, I. K. (1972). Medicine as an institution of Social Control. The Sociological Review, 20(4), 487–504. https://doi.org/10.1111/j.1467-954x.1972.tb00220.x