The experience of dysmenorrhea

Today's post is by Carlota Serrahima on her recent paper, "The experience of dysmenorrhea" (Synthese,  2023). She is a postdoctoral fellow within the ERC funded project "Rethinking Conscious Agency", based at the Universitat de Barcelona.

Carlota Serrahima

My main research topic is the philosophy of bodily awareness, and Manolo Martínez has worked on the philosophy of pain. We were both surprised that, in the literature our work overlaps on, menstrual pain — technically, “dysmenorrhea” — is rarely mentioned. For one of us, dysmenorrhea is the pain most often experienced, and we suspected that this was so for many people. Indeed, according to conservative estimates almost half of menstruators experience dysmenorrhea. That’s probably close to a billion people.

Our paper highlights an important tension: various assumptions operative in the philosophical literature about pain are actually doubtful, or maybe even false, of dysmenorrhea. In the paper we criticize  the model of pain conjured up by those assumptions, which we call the injury-centered model of pain [ICMP], and investigate the phenomenological and functional profile of dysmenorrhea beyond this model.

The first assumption of the ICMP is that pain is primarily a tool for the management of bodily damage. Pain is then adaptive when and because it is a response to such damage. But uterine contractions that expel endometrial tissue during menstruation are part of the correct functioning of the reproductive system, and hence, typically, not damaging. Yet, they are painful in dysmenorrhea. 

This is problematic for mainstream intentionalist views on pain, which would disappointingly deem dysmenorrhea an illusory or misguided pain. Fixing this requires significant elaboration of the intentionalist picture, and in particular of the kind of damage pain is supposed to respond to.

The second assumption is that pains subside as the triggering injury disappears. In other words, injury-centered pains are acute. In fact, dysmenorrhea cannot be readily categorised as either acute nor chronic: it is a cyclical pain, sharing features of both. On the one hand, it occurs in relatively short-lived episodes; on the other, because it recurs, it can result in central sensitisation, as chronic pains do.

We speculate that this temporal profile puts dysmenorrhea in a special position regarding pain catastrophising. First, because its recurrence allows for dysmenorrheic women to get used to the typical unfolding of their pain. Second, because of the widespread, but false, belief that dysmenorrhea is normal. We hypothesize that this broader network of pain-related beliefs will affect the way in which women feel threatened by and catastrophise about dysmenorrhea.

Finally, the ICMP sees pain as an affective kind independent from others, in particular moods. Dysmenorrhea, however, belongs to a class of affective conditions that includes both pain and negative mood intertwined in phenomenologically inextricable ways. Because of this phenomenological profile, and because it is likely that mechanisms underlying pain and mood in dysmenorrhea overlap substantially, the experience of dysmenorrhea is in important respects close to those conditions that fall under the so-called “pain-depression dyad,” such as fibromyalgia.

Anyway, we’ve tried to pay attention to the peculiarities of the lived experience of women, hoping that it will result in a richer understanding of the intricacies of pain, beyond injury management.