Women's Health is more than our Reproductive Organs
Updated: Mar 26, 2021
When you hear the words “women’s health”, what the first thing that comes to mind? It’s probably something related to pregnancy, or hormones, or breast cancer. Media and societal expectations around female bodies have lead us to believe the only important health concerns for women are those involving their reproductive or sex organs.
This often unquestioned mindset is incredibly problematic for women, it stems from the longstanding assumption that women’s and men’s bodies are identical except for reproductive organs- this is FALSE. It has lead to the frequent misdiagnosis and misrepresentation of women’s diseases and health conditions. Women’s bodies have complex and unique differences in every common organ shared by both sexes.
Women’s Bodies in Education
Studies dating back to 1992 analyzing anatomy textbooks used in medical schools anatomy classes have demonstrated an underrepresentation of women.
A 1992 study found that women were underrepresented in anatomy textbooks in both examples and in syntax.
In eight anatomy textbooks published in 1971, the clitoris was either not represented or was depicted but not labeled.
Modern textbooks reduce descriptions of female anatomy to only that in relation to men.
The female body is also frequently misrepresented in anatomy textbooks.
The 39th edition of Grey’s Anatomy (a commonly used textbook) only featured illustrations of the female genitalia that were old-fashioned and lacked details and only described in relation to the male anatomy.
Grey’s Anatomy for Students featured mainly males as patients and medical practitioners in their clinical case examples.
This lack of education about the female body in medical school anatomy classes is very problematic for many reasons- especially in regards to surgery on female reproductive organs. Poor understanding of anatomy and the reproductive cycle has led to common complications following hysterectomies. In surgeries like a urethrectomy or vaginectomy, sexual function and its preservation are often overlooked for lack of knowledge on the tissues responsible for female sexual function.
Beyond surgical complications, the lack of inclusion of women in anatomy textbooks, aside from sex organs, only furthers the false belief that male and female bodies function the same. The male body is used as the standard or "norm" against which to compare female bodies. Against the standard of the male body, the female body is then judged as weak or faulty. In reality, female bodies simply function differently and thus must be aptly studied.
Lack of inclusion in clinical studies
Women, and even female animals, have long been excluded from clinical studies for a number of reasons. Until 1993, women were banned from participating in clinical studies in an effort to protect female fertility. Female animals are often left out of studies for fear that female hormones will taint results. This has been proven false multiple times- in 2014 a meta-analysis of over 300 mouse studies found that physiological, behavioral, and other biological measures in male and female mice did not vary, regardless of the menstrual cycle. In 2016, a similar meta-analysis was performed on rat studies and found similar results. Yet, males are still more commonly used in clinical studies to this day.
Ambien is the most famous example of a drug that was only tested on males and thus had harmful effects on women. Soon after its release, reports of dangerous side-effects for women, including “sleep-driving”, began appearing. But it took over 20 years for researchers to finally realize that the drug was metabolized differently in men and women. Women metabolize the drug slower than men, causing them to require a lower dose.
Women are also underrepresented in clinical studies that very relevantly pertain to them:
Less than a third of subjects in heart disease studies are women- but women are more likely to die from a heart attack.
Twice as many women suffer from depression, but female animals make up less than half of clinical studies.
Women make up only 38% of cancer trials.
Misdiagnosis from Doctors
Due to the underrepresentation and misrepresentation in anatomy textbooks and exclusion from clinical studies, women are frequently misdiagnosed or turned away by doctors. A study that analyzed hospital admissions from 6,909,676 patients found that women are diagnosed an average of 4 years later than men for over 700 diseases. For cancer specifically, women are diagnosed an average of 2.5 years later than men.
The 5 most common conditions to be misdiagnosed are as follows:
Heart Disease- Women have a 50% higher chance of being misdiagnosed after a heart attack when compared to men. This is because women have different heart attack symptoms than men. Yet, the standard testing protocol physicians use to detect heart disease was created for and tested on men. Because women have smaller blood vessels around the heart, it is not effective in discerning heart disease.
Autoimmune diseases- On average, it takes 5 doctors and nearly 4 years to get an accurate autoimmune diagnosis. Women make up 75% of autoimmune sufferers. Female patients are accused of “exaggerating” their symptoms or are told they’re experiencing normal hormonal causes.
Endometriosis and Polycystic Ovary Syndrome- Women are frequently misdiagnosed with IBS or depression when they are actually suffering from endometriosis of PCOS. Testing for endometriosis requires surgery, which makes doctors unwilling to do so.
Sleep Apnea- Before the 1990s, it was assumed that men were 10 times more likely to have sleep apnea- the actual ratio is closer to 1:2 or 1:3. Due to this misconception, most symptoms used to diagnose sleep apnea occur in men. But men and women actually have different symptoms- women tend to have more vague symptoms- like fatigue or weight gain. This causes doctors to misdiagnose them for conditions like low thyroid or mood disorders.
Breast and Ovarian Cancer- The number of breast cancer misdiagnoses are shockingly high- as high as 31% of cases. Distinguishing between benign lesions and early-stage breast cancer can be difficult for physicians who lack thorough education on women’s anatomy. The same is true for ovarian cancer- doctors frequently misdiagnose it as a GI issue because of the subtle symptoms. Only about 20% of ovarian cancers are diagnosed at an early stage.
Why are male and female bodies different?
The main cause of differences between male and female bodies is the role of hormones. While yes, men and women have the same hormones (i.e., estrogens, progesterone, and testosterone), there are key differences in production sites, blood concentrations, and their interactions with different organs, systems, and apparatus. Sex hormones work in nearly every part of the body: the distribution of body fat mass and fluids, the maintenance of muscle and bone mass, the hepatic synthesis of many enzymes, and the metabolism. The differences in hormones between the sexes mean all these systems are functioning slightly differently.
One of the most important, and often ignored, issues in women's health is the role of estrogen in the brain. Estrogen plays a key protective role in the female brain- studies have demonstrated estrogen works to defend the healthy brain and works against Alzheimer's Disease. When a woman goes through menopause, her estrogen levels drop and the brain is no longer protected. This is likely why women are over 75% more likely than men to develop Alzheimer's Disease.
Steps to take to avoid misdiagnosis:
Don’t be a passive patient- Do your own research and present your findings to your doctor. Don’t leave the office until you feel all of your questions have been answered.
Get a second opinion- If you don’t feel satisfied or feel understood by the first doctor you go to, don’t be afraid to look for a second opinion. Every doctor is different, and approaching a functional doctor might be a better option for you.
Bring up everything that bothers you- Don’t ignore or undervalue the symptoms you are feeling, make sure to relay everything to your doctor.
Think about finding a female physician- Research has suggested women are more likely to provide thorough medical care. Female doctors are more likely to follow recommendations for prevention counseling and to order preventative tests.
