IN 1807, a 77-year-old woman from Liverpool, UK, known as J. S, died after years of pain in her uterus. She had consulted several physicians, but none could explain the cause. A postmortem revealed extensive damage in her pelvic and abdominal organs.

But the last physician she saw, John Rutter, wasn’t convinced that any of the findings in the report were severe enough to account for the degree of pain she had complained of. He concluded that her agony was exacerbated by her “nervousness”. J. S was given a posthumous diagnosis of , a term for uterine pain chosen for its associations with hysteria, that infamous historical label for inexplicable illness in women – particularly those who dared to speak up about their pain.

J. S’s pain wasn’t taken seriously throughout her life because she was a woman. Today, many women and people assigned female at birth still have their reports of pain invalidated, discredited and minimised, especially when compared with those of men. This form of bias is called the gender pain gap, and it is rooted in stereotypes about pain that have been ingrained into medical discourse about female bodies and illnesses over centuries. Research into the gap and the biases that support it is far more recent.

An increasing number of studies have shown how bias against women’s expressions of pain negatively affect diagnosis and treatment of their health conditions. revealed that terms like sensitive, malingering, complaining and, indeed, hysterical are applied more frequently to pain reports from women.

When women’s physical pain is dismissed as exaggerated and imaginary, or misdiagnosed as psychological, their health and lives are measurably affected. Women in US emergency departments reportedly wait, on average, , and they are 7 per cent less likely to receive that treatment in the first place. UK . A , which takes an average of seven to nine years to be diagnosed, found that associations of gynaecological pain with mental ill-health contributed to delayed and missed diagnoses in 50 per cent of cases.

Women who are Black, Asian or from ethnic minority backgrounds, who experience greater health inequalities than white women, risk having their accounts of pain underestimated and discounted because of false beliefs about racial difference and pain sensitivity. As the UK’s , the effects of implicit racial bias on perceptions of Black women’s pain contributes to missed and delayed diagnoses in maternal and reproductive health especially.

Globally, women experience more chronic pain than men. With the burden of pain-causing diseases rising in women across the world, it is crucial that the causes and consequences of disparities in clinical responses are properly understood, addressed and mitigated against. Bias awareness training, gender-sensitive diagnostic processes and increased research into the biological and psychosocial bases of pain differences could all help.

But to fully achieve gender equality in healthcare, medicine must also examine its past as it looks to the future. Historical cases show how gendered myths about pain resonate powerfully across centuries of scientific and biomedical advances.

Although hysteria as a diagnosis is thankfully obsolete, health professionals still evoke it when they judge a woman’s expressions of pain to be neither credible nor valuable. We must learn from the case of J. S. and aim to put an end to the gender pain gap.

There are well-known biases that limit the number of women in science and technology. Now evidence has shown that fewer women are named on biomedical patents, which appears to have led to a reduced number of patented technologies designed to address problems specifically or disproportionately affecting women.

at Harvard Business School and his colleagues used machine learning to analyse more than 444,000 biomedical patents filed in the US between 1976 and 2010.

Algorithms analysed the text of drug and medical patents, attributing each with a male or female tag depending on what the text contained. For instance, texts mentioning “female organs” or “female genetics” were tagged as female. The researchers also cross-checked the gender of named inventors whenever possible.

The proportion of patents awarded to inventor teams containing at least as many women as men has increased over the years, but not by much. Some 6.3 per cent of all patents awarded in 1976 fell within this category; in 2010, the equivalent figure was 16.2 per cent. In total, women were listed as co-inventors in just a quarter of all patents filed during the period analysed.

“We know there’s just a lot of sexism in society,” says Koning. “And we know that women face barriers just becoming scientists, and they face barriers when commercialising their ideas.”

Koning and his colleagues also analysed what the patents in the study were intended to achieve. Patents filed by all-female teams were a third more likely to focus on issues concerned with women’s health than those filed by all-male groups.

Teams in which most of the co-inventors were women were 18 per cent more likely to have filed patents for technologies that would help women.

Had there been equality in the number of men and women applying for patents, Koning and his colleagues estimate that there would have been roughly 6500 more female-focused inventions successfully patented between 1976 and 2010.

“Not only are women’s needs and problems invisible, when fewer women get patents and commercialise their ideas, this reinforces the stereotype that women do not create things of value and are neither inventors nor entrepreneurs,” says at Victoria University of Wellington in New Zealand.