In the era of booming feminism whereby women demand rightful recognition in a wide array of aspects, the field of medicine has to face the facts. Until roughly two decades ago, aside from differences in reproductive systems, the male body has been the universal model for anatomy – as there was little knowledge that gender mattered in Western medicine.

Also, clinical trials recruited mainly males back then; and results were held as “the evidence base” for the diagnosis and treatment of both genders equally. Interestingly, medication dosages were classically altered for patient size and women were deemed as “small men”.

We have come a long way since then. Just nine years ago, the World Health Organisation (WHO) issued guidelines on “teaching gender competence”. Through this, healthcare professionals are aided in recognising where gender-based differences are significant, and how to guarantee more equitable results.

It is important to note that gendered medicine is not just about women. Simply, it is about picking up disparities in clinical care and ensuring the best healthcare is delivered to everyone. Additionally, it zooms into ensuring equity of healthcare access and about gender equity in professional roles and composition.

Some disease incidences and symptoms undeniably vary between genders

Taking medical conditions for example, research has proven that they vary between genders in terms of presentation and incidence. Discussing heart diseases, it has been found that women are less likely to seek help for a heart attack as their less typical symptoms render it difficult to identify. On top of that, research shows that they don’t attain potentially beneficial treatments for heart disease as men do – thus, they have lower chances of survival.

Shifting the focus to the heavily highlight mental health, depression is known to be more common in women; suicide rates are higher in men. Even the nature of conditions like heart diseases, osteoporosis and lung cancer vary between women and men too – as well as their outcomes.

Unfortunately, when assessing all the blind individuals in the world, two-thirds of them are women – even after adjusting for the reason that women live longer compared to men.

Investigators have also recognised sociological differences like women who present with an eye socket fracture, eye socket fracture, a ruptured eyeball or bruised eye are at risk of dying. This risk is not from the injury; but, woefully, from a perpetrator’s additional assault.

Differences are also notable in terms of the immune system. The evolutionary basis of it is that survival of the species could mean men are greater affected by viruses such as tuberculosis and Epstein-Barr. However, a woman’s reactive immune system renders her more susceptible to autoimmune diseases and allergies such as lupus and asthma.

Medical trials: “All-men” research groups – a thing of the past

As mentioned earlier, clinical trials centred on males back in the day for reasons such as availability to participate and concerns about the impact on women’s reproductive health, or the impact of menstrual cycles on the trials. On top of that, cost was saved as sample sizes were reduced – ignoring the inaccuracies for numerous vital subgroups.

The results of these trials clearly impacted women, as they were subjected to the evidence based medicine guides that followed this. Not just this, when women and men were included in the trials, results were published as one common conclusion – bearing inaccuracies in results once again.

Even in pre-clinical research using animals, female animals have been rejected to simplify management and cost, as well as decrease measurement variation.

Ultimately, we have to give credit where credit is due. A change in trial design has been evident and is prominent these days. For instance, Australia’s largest medical research grant body, the National Health & Medical Research Council, has introduced guidelines that necessitate applicants to address gender equity among research partakers.

Mandated quotas to include women in trials are noteworthy and ongoing, as researchers uncover the disparities when deciphering statistics of diseases globally.

Departments targeting women and sex differences in medicine call for better education

An obvious, but far from easy way of curbing this issue is a better education, says Marcia Stefanick, PhD, professor of medicine and co-director of the Stanford Women & Sex Differences in Medicine (WSDM) Centre.

“A good example is the ‘red dress campaign’, which educates women to be aware of their risk and symptoms for heart attack and to report their symptoms in a way that will get more immediate attention by medical professionals,” she says.

Stefanick adds that physicians can also be educated through this campaign to identify the different symptoms women may report (fatigue, nausea, pain in the right arm) before reporting the chest pain that men typically report.

The WSDM Centre is keen on understanding the biology that does – or does not – differentiate between men and women, as well as the gendered issues which bias medical practice to a man’s or a woman’s advantage – or disadvantage.

Besides that, an Italian review article which was published a few years ago clearly illustrated the need for gender-specific medicine in many diseases and conditions.

“In terms of cancer, the questions about the differences between the sexes just don’t end. Why do women’s colon cancers tend to concentrate on the right side compared to men? We just don’t know,” says Dr. Marianne Legato, a professor of clinical medicine at New York’s Columbia University and director of the Foundation for Gender-Specific Medicine.

She even argued that specific training in gender-based differences should be brought up in medical school, but physicians might object due to the increased workload. MIMS

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