Banner by Kira Klein

Medicine’s Misogyny Problem

by Maya Albanowski

Women make up half the population, yet their typical presentation of symptoms is considered abnormal. You probably know a woman with a horror story of ways that she has been failed by the health care system. One need not look far to find accounts of women whose concerns were dismissed, symptoms misdiagnosed and side effects unaccounted for in ways that would not have occurred if they had been male. This phenomenon has a long history that has persistently allowed prejudice to risk patients’ lives. 

For decades, the inclusion of female patients in medical studies was considered unnecessary, and if anything, an inconvenience. The common belief among researchers was that incorporating female participants in research on medical conditions and pharmaceuticals would corrupt the data due to women’s fluctuating hormonal cycle. It was not considered that perhaps those fluctuating hormones should be considered when creating treatments that will interact with those hormones. In pharmaceutical clinical trials that did include female participants, women of childbearing potential were excluded from these studies, as pregnant women were considered a “vulnerable population,” and in many cases, were legally prohibited from participating in these trials. While protecting mothers and babies from unexpected side effects may seem noble, in application, this led to any pre-menopausal women being ineligible to participate in these studies. The reality of this policy is that women were being prescribed medications that had never been tested on bodies like theirs on the assumption that their bodies were similar to men’s but with extra, annoying hormones. The 1980s saw federal agencies such as the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH) mandating the inclusion of female participants, but the exclusion from medical trials is not the only way that the United States health care system has historically failed women.  

For much of history, women’s concerns were diagnosed by health care providers as “female hysteria” – a condition that assumed a woman’s symptoms were the result of her being weak or overdramatic. The supposed cause of this condition was often a “wandering uterus and/or sexual frustration” and the treatments included herbs, prescriptions for a vibrator or commitment to an asylum. While it is easy to laugh these ludicrous practices off as relics of an unscientific time, thousands of women have had negative experiences with the healthcare system where they felt dismissed and disrespected.

They claim that when they addressed their concerns with their doctors, they were simply told to “take a Tylenol” or that its “all in your head.” One article from the Journal of Law, Medicine, & Ethics cited a study in which a significant number of female participants left an appointment with their general practitioner (GP) about their pelvic pain feeling like their doctor did not understand what they said and that aspects of their pain were left undiscussed. They also stated that they felt as though their GP implied “nothing was wrong.” A prominent example of this is Serena Williams, who found that her concerns about a pulmonary embolism following the birth of her daughter by cesarean section were disregarded by hospital staff. It was ultimately her insistence that she knew her body that allowed the blood clot to be recognized and to get the necessary treatment to survive. Women of color are even more likely to be dismissed by health care professionals in this way. In recent years, this phenomenon has been coined “health care gaslighting” by activists and advocates. 

For many patients, this has negative consequences on their health. Women are less likely to be prescribed aspirin or cholesterol-lowering medications following a hospitalization due to heart disease. Physicians also prescribe less pain medication to women than to men with the same condition. Multiple studies have shown this in a variety of conditions and procedures, such as appendectomies, abdominal surgery, coronary artery bypass procedures, cancer and Acquired immunodeficiency syndrome (AIDs). 

These doctors’ dangerous assumptions are linked to gender roles which say that men are rational, reasonable and have a high pain tolerance as opposed to women who are dramatic, hysterical and weak. 

To make matters worse, women’s symptoms often go unrecognized because they present differently than men’s symptoms for the same condition. Most people believe that heart attacks look like a person clutching their chest with excruciating pain down the left side of their body. However, women’s heart attacks can look much different. Female patients, for instance, are more frequently experience nausea, fatigue and back pain during a heart attack. This lack of awareness has deadly effects. The median time that men wait after the presentation of heart attack symptoms before seeking medical attention is sixteen hours, whereas the median time for women is 54 hours. Within five years of experiencing their first heart attack, 47 percent of women develop heart failure, suffer a stroke or die, versus 36 percent of men. Heart disease is the leading cause of death in the United States in both women and men – something that many women are not aware of. The definition of men’s symptoms as “typical” and women’s symptoms as “atypical” are not only textbook conventions, they have real and dangerous consequences. This is all linked to the societal idea that men’s bodies are the default and women’s bodies are other—an unscientific idea that has persisted in a highly scientific field.  

According to Dr. Bridget Keown, an expert on women’s studies and the history of medicine at the University of Pittsburgh, “No science is free from the culture that creates it.” This problem is not only linked to gender, but also race, class, sexuality and other factors that may make people uncomfortable but must be discussed openly if anything is to change. The American health care system has always been tainted with bias and, according to Keown, removing that bias will require nothing short of a “cultural shift”. Doctors best serve their patients when they make every effort to be aware of and to rectify their own bias. On top of that, the world needs diverse doctors. We need more women doctors, more doctors of color, more LGBTQ+ doctors and many other factors that will allow the medical field to represent the population that it serves. Everyone needs medicine, so it should be welcoming to everyone.