“Women are more likely to be treated less aggressively in their initial encounters with the health-care system until they ‘prove that they are as sick as male patients‘”
The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain (2003)
When we think of the inequalities facing modern women, we tend to think of the gender wage gap, the ever-looming threat of gender-based violence, or limited access to safe and legal abortions worldwide. But we rarely consider the gender disparities in healthcare.
From the gender bias in medical trials to the disbelief towards female pain and the subsequent disparities in womenâs treatment, the dismissal of women and people AFAB in the medical field is a downplayed but glaringly critical issue.
How could it be that a demographic that makes up half of the population is being so considerably let down? And why arenât we talking about it?
80% of all drugs withdrawn from the market are pulled due to the discovery of side effects on women.Â
How are we discovering major, sometimes even life-threatening, side effects that impact only women after a drug has been released to the public? The answer is rooted in the rarely discussed gender bias in clinical trials – clinical trials which are performed almost exclusively on men. In fact, it wasnât until 1993 that women were required to be included in most healthcare research studies. Previous to this, women of child-bearing age were excluded from almost all clinical trials, a decision inspired by a post-war fear of harming fertility. This was a decision often encouraged by researchers, who realised it was easier and cheaper to conduct studies on men who lacked fluctuating female hormones that could complicate research variables. Even relatively recently it has become a common phenomenon for researchers to use female participants exclusively in the early follicular stages of their menstrual cycles, when their hormones are lower and therefore mirror male levels.
The staggering result of this clinical trial bias is that women are being regularly treated with medications that have not been designed, trialed, or tested to be used in conjunction with their physiology. Perhaps one of the most bizarre instances of this was the approval of the first ever female sexual dysfunction aid, Addyi. In the process of its approval, the drug company was required to run clinical trials assessing the interaction of Addyi with alcohol – their trial enrolled 23 men, and only 2 women.
The prioritisation of the physiology of men meant that womenâs health up until the 90s became synonymous with reproduction – womenâs bodies were first and foremost reproductive bodies. This philosophy has become known as âbikini medicineâ: the belief that men and women are medically interchangeable outside of their reproductive organs. Womenâs uteruses are their only point of differentiation.Â
This is a philosophy with deep historical roots – ancient Greek medicine believed that the uterus was the root of hysteria (and thus only women could suffer from hysteria). In fact, the Greek word for hysteria is hystera. And what does modern medicine call the surgical procedure to remove the uterus? A hysterectomy.
The reality is that up until recently, we knew very little about the biology of the female body respective of its reproductive organs. So itâs unsurprising that women often receive significant delays in diagnosis, or even go undiagnosed.
And the implications of this can be life-threatening. While heart disease is the number one killer of both men and women, women are twice as likely to die within the first year of having a heart attack compared to men. Why? Because the tests used to determine heart attack risk were designed for men and tested on men. These tests do not take into consideration the physiological differences between sexes that impact heart attack symptoms, and so theyâre not as good at determining heart attack risks in women. Whereas men experience extreme chest pain, women have smaller blood vessels surrounding the heart and are therefore more likely to complain of uncomfortable pressure and shortness of breath. Despite the higher mortality rate in women, they still only make up 35% of participants studied in cardiovascular research.
The medical ignorance towards female physiology, as well as the implicit bias that downplays the experiences of women has a severe impact on the gender disparity for diagnostic wait-times. Consider one 2019 Danish study which looked at men and women of similar ages and found that it takes women 4 years longer, on average, to be diagnosed with the same chronic medical illness as men. For a cancer diagnosis, this delay is 2 years longer for women. Similar delays were found for diabetes, strokes and heart attacks – all of which were under-diagnosed and under-treated in women.
a long history of dismissal
In the healthcare system, thereâs a long history of dismissing womenâs pain. Itâs not at all uncommon for womenâs pain to be diagnosed as psychosomatic and go untreated for years without a genuine medical diagnosis. Women who complain of pain are much more likely to be prescribed anti-anxiety medication than men. In many cases, women who present to emergency departments complaining of abdominal pain are often assumed to have a gynaecological problem, which doctors frequently believe is less likely to require opioid treatments.
Essentially, women are not believed when they are in pain. Men are tough, and women are emotional, so when a woman underplays her pain she is dismissed, and when she outwardly expresses her pain she is exaggerating. Some medical professionals have coined the phrase the âits all in your headâ diagnosis to describe this phenomena, and its connections to female âhysteriaâ are not insignificant. After coronary artery bypass surgery, men who complain of pain are statistically more likely to receive pain medication, but when women complain of pain they are more likely to be given sedatives.
The implicit biases in the healthcare system that contribute to the disparities in treatment desperately need to be addressed. We have a right to have our experiences heard and our bodies recognised. Ultimately, women are not getting the treatment or the healthcare that they need, and our lives are being put at risk because we are being ignored.
This piece is part of a themed content week at UOB centred around Women’s Health