Health care consistently fails for women. Blame bikini medicine

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Women who have a heart attack, for example, may not experience the overwhelming chest pain that men do. Their blood pressure readings can be dangerously high, putting women at a higher risk for heart disease, even though they still fall within what doctors often consider a normal range. Their arterial blockages may not show up on angiograms or other routine diagnostic tests. The symptoms they may experience during heart attacks, such as nausea, fatigue, and abdominal pain, can be more easily mistaken for different ailments. And, studies reveal that if they are faced with doctors who are not trained to recognize the symptoms of a heart attack as they occur in women, they are much more likely to be misdiagnosed and sent home, with potentially fatal consequences.

Our understanding of women’s health has changed dramatically over the past few decades. For much of the history of modern medicine, experts say, physicians have largely followed a philosophy of bikini medicine, which theorized that men and women were medically interchangeable, with the exception of parts of anatomy of a woman that could be covered by a bikini. This, coupled with the paradoxical belief that men were easier to study, meant that women were systematically excluded from medical research and, therefore, from understanding the different ways in which diseases present themselves in people.

This problem extends to mental health as well. Girls and women with Attention Deficit Hyperactivity Disorder also tend to have different symptoms than their male counterparts. Girls with ADHD are less likely to exhibit the impulsivity and hyperactivity that are common in boys with ADHD, and more likely to experience emotional issues such as depression and anxiety, according to a study. It also takes more clinic visits on average before girls are diagnosed with ADHD, and they tend to be older than boys when they are finally diagnosed.

It is easy to think that these disparities are the result of individual cases of sexism on the part of medical providers, and it can sometimes be the case, with numerous studies showing that women are more likely to be disbelieving, fired and under-treated when they show symptoms but the roots of the problems are more systemic. If we want to reduce the disparities in health outcomes between men and women, we need to rethink our understanding of these medical conditions and their diagnostic criteria and it starts in the classroom.

Carolyn M. Mazure, director of women’s health research at Yale, founded the center in 1998 to fill what she calls the knowledge gap in our understanding of women’s health. Back then, says Mazure, the term women’s health was more or less synonymous with obstetrics and gynecology, erasing the impact of sex and gender in all other aspects of medicine. When medical research included women, it typically combined them with a predominantly male group of participants, making it difficult to find gender-specific data on disease prevalence, symptoms, and treatment.

The tradition in science was really to pool data, to homogenize data, rather than segregating data on the basis of sex or gender, Mazure says. The lack of gender-specific analysis meant that information about women’s health was rarely factored into medical decision-making.

The scientific community has gradually started to reassess such practices, which Mazure points out is exactly what should be happening. Science is supposed to evolve, it’s supposed to change, she says. And the way it felt like we needed to make changes was to start with people learning to be doctors.

In addition to funding research focused on women’s health in all areas of medicine, the Mazures Center strives to update the Yale School of Medicines curriculum for future generations of physicians. A 2019 study analyzing Yales’ medical curriculum found that less than a quarter of lectures and workshops for first and second year students mentioned the impact of sex and gender, and only about 8% explored the problem in depth, a problem which, according to Mazure, afflicts. medical schools around the world. Today, she and her team strive to integrate sex and gender specific information into all aspects of medical education.

We don’t want to separate women’s health and discussions about how sex and gender can influence health outcomes, we want to mainstream it into everything, says Mazure. There is so much [data] now to support the fact that in many areas women are not receiving sufficient attention in terms of their medical needs because data has not been incorporated into education.

Part of this integration includes updating the terminology doctors use to describe women’s symptoms, especially when they don’t fit the traditional diagnostic mold. The term atypical, often used to describe symptoms of a disease as they appear in women, strongly implies that there is a typical way, and that is the male way, says Mazure. You can no longer set standards entirely based on male data, because for a lot of things those standards are different.

Up-to-date information on the role of sex and gender in medicine should also not be limited to medical schools. References for ADHD assessment, for example, often come from a child’s teacher. The sooner we can identify and treat medical problems, the less people will have to suffer in medical limbo, unable to receive adequate treatment.

Turning a blind eye to women’s health only creates more barriers for people of all genders struggling for medical care. We need to update our collective understanding of the many ways sex and gender impact our health in order to end medical disparities between men and women. Rewriting diagnostic criteria is not just about political correctness, it will save lives.

Maya Homan is a cooperative at The Globe and a journalism student at Northeastern University. Follow her on Twitter @MayaHoman. Send your comments to [email protected].

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