Written by Maryam Ibrahim
Have you ever read about the history of the term “hysteria”? This outdated medical term, literally meaning “wandering womb” in Greek, was once used to explain a wide range of women’s ailments, from anxiety to fainting. Shockingly, it wasn’t until the early 20th century, specifically the 1980s, that the medical community began to understand these symptoms weren’t caused by a wandering organ, but by a complex interplay of biological and psychological factors.
The “treatments” were equally brutal ranging from bloodletting, forced marriages, and sex, all based on the assumption that women’s bodies were inherently flawed. Yes, medicine has come a long way, but has it come far enough for women?
Even today, women face a disproportionate risk of misdiagnosis due to a lack of research on female-specific health issues. This article, “Misdiagnosed, Mistreated, Misunderstood”, delves into this critical issue. We’ll explore how historical biases and a lack of female-specific data lead to a gender gap in healthcare and contribute to the misdiagnosis and mistreatment of women. We’ll look at real-life examples of the consequences of this gap and propose solutions for a more equitable healthcare system.
WHY DO THESE GAPS EXIST?
First things first, the good old “women will never be equal to men”. This is quite interesting because biologically, women and men have never been equal. But what the gaps in traditional medicine do is really portray how systemic the dehumanization of womanhood is. What do I mean?
Historically, research has been biased towards men, with women being left out of clinical trials entirely, leading to a situation where men were seen as the “standard” for human health. We only recently discovered women might need more sleep than the standard 8 hours, based solely on male data!
This isn’t new, though. According to Criado Perez in her book “Invisible Women”, these biases have roots stretching back to ancient Greece, where some viewed the female body as a “mutilated” version of the male.
Also, women’s health has historically been all about reproduction – periods, getting pregnant, childbirth, the whole shebang. But that’s just one piece of the puzzle, right? Think about it – for a long time, society saw women, basically, as baby machines. Traditional views of sex and femininity placed a ton of emphasis on this role, pushing aside other health concerns, and this further pushed the need to understand other aspects of women’s health just as much.
THE DIAGNOSIS GAP
We’ve been talking about how women’s health gets overshadowed by a limited focus. But this narrow view extends beyond just reproduction. It spills over into how women’s pain is perceived and treated by the medical system. Here’s the shocking part: studies show women are more likely to experience chronic pain than men. They often describe it as more severe, lasting longer, and happening more frequently. Despite this, they’re far less likely to receive the treatment they need. This disconnect between the reality of women’s pain and the care they receive is a glaring example of the DIAGNOSIS GAP. Over 90% of women with chronic pain feel they’re treated differently because of their gender. This perception reflects a troubling reality: women’s pain is often downplayed, dismissed, or misdiagnosed.
The underestimation of women’s pain isn’t just an isolated occurrence; it reflects a concerning trend within the medical system. Studies suggest a deeply ingrained bias that leads some healthcare professionals to downplay the severity of women’s pain compared to men’s. This dismissal can manifest in several ways. Women’s complaints of pain might be dismissed as emotional outbursts or psychosomatic, lacking a physical basis. This not only invalidates their experience but also leads to inappropriate treatment plans.
The consequences of this bias are far-reaching. Women who are experiencing genuine pain might be referred to mental health professionals or prescribed medications for anxiety or depression when the root cause is entirely physical. This is a prime example of treating the symptom, not the source. For instance, a study examining post-surgical care found that women undergoing coronary artery bypass surgery received more sedatives for anxiety instead of actual pain medication compared to their male counterparts.
The most interesting part is, this bias against women’s pain might even begin before they can speak for themselves. A study by Yale researchers found something shocking: adults who participated in the study were asked to rate the perceived pain of a child receiving a finger prick for a blood test. Participants in the study rated the perceived pain of the child they believed to be male as higher than the child they believed to be female.
Here’s why:
Society often expects boys to be stoic and hide their pain. So, even if a boy is quietly enduring a finger prick, adults might perceive him as being in more pain because they expect him to downplay it. On the other hand, girls are often seen as more emotional and their expressions of pain might be dismissed as “exaggerated.” It’s a lose-lose situation, and what this societal bias does is that it makes girls feel their pain isn’t taken seriously, which can lead them to believing their pain isn’t as valid as a boy’s, setting the stage for a lifetime of battling to be heard when they experience pain later in life.
The gender gap in medical diagnosis and treatment also extends to critical conditions like cardiovascular disease, particularly coronary heart disease, which tragically claims more women’s lives than men’s. However, women are seven times more likely to be misdiagnosed and sent home during a heart attack.This disparity stems from two key factors: different symptoms and a healthcare focus skewed towards men. Women often experience atypical heart attack symptoms like flu-like aches, while the medical system prioritizes male-presenting symptoms like chest pain. Furthermore, the focus on women’s reproductive health may overshadow concerns about heart health which results in women receiving unequal access to preventative measures, advanced diagnostics, and specialized treatments compared to men.
CONSEQUENCES OF THE GENDER GAP IN HEALTHCARE
Many women, as evidenced by a recent survey I conducted, experience the devastating consequences of the diagnosis gap in healthcare. One such woman, whom we’ll call Sarah (to protect her privacy), experienced severe pelvic pain and irregular periods for years. Her initial doctor visits resulted in dismissive explanations, with doctors attributing the pain to stress or ovarian cysts. They prescribed birth control and pain medication to manage the symptoms. However, these treatments offered little relief, and Sarah’s concerns continued until years later, after a number of hospitals and doctors, she was finally diagnosed with endometriosis.
Misdiagnosis and Delayed Treatment: For years, Sarah’s condition remained undiagnosed. This delay in diagnosis is a common consequence of the gender gap in healthcare. Doctors are more likely to attribute women’s pain to stress or other non-physical causes, leading to misdiagnosis of endometriosis and other conditions. This can have serious consequences, as the underlying condition progresses without proper treatment. In Sarah’s case, the delay in diagnosis likely allowed the endometriosis to spread, potentially requiring more invasive surgery in the future.
Mistreatment and Ineffective Care: The initial treatments Sarah received, birth control and pain medication, were aimed at managing symptoms rather than addressing the root cause. This is another consequence of the diagnosis gap. When women are misdiagnosed, they may receive treatments that are ineffective or even inappropriate for their actual condition. In Sarah’s case, the pain medication offered temporary relief but did nothing to address the underlying endometriosis.
Aversion to Healthcare and Loss of Trust: The experience of being dismissed and misdiagnosed can be emotionally draining and lead women to lose trust in the medical system. Sarah’s story reflects this consequence. After years of seeking answers and receiving dismissive explanations, she was hesitant to seek medical attention in the future, fearing another misdiagnosis or dismissive treatment. This can create a cycle of suffering, where women avoid healthcare due to negative past experiences.
HOW THE GENDER GAP IN MEDICINE SHAPES HEALTHCARE FOR AFRICAN WOMEN
The historical legacy of racism in medicine undeniably shapes the experiences of African women today, just like it does for Black women in other parts of the world. This legacy casts a long shadow, with its roots reaching back to the very beginnings of gynecology. Early pioneers of the field, like J. Marion Sims, conducted unethical experiments on enslaved Black women without anesthesia. This history of exploitation has fostered a distrust of the medical system in some African communities, which can create a barrier to seeking essential healthcare.
However, the challenges faced by African women go beyond this single factor. While the legacy of racism is undeniable, other factors like limited access to healthcare facilities, cultural taboos surrounding women’s health, and a shortage of female healthcare providers all contribute to the gender gap in healthcare for African women.
Reproductive stigma is another specific consequence fueled by the historical disregard for African women’s bodies and experiences. The racist myth of African women being hypersexual or promiscuous can be linked to the shame associated with seeking help for reproductive health issues. This stigma discourages young women and girls from discussing menstruation, contraception, or potential problems freely. The silence surrounding reproductive health perpetuates misinformation and prevents them from accessing preventive care and early diagnosis.
WHAT CAN BE DONE?
Moving Beyond Binary Thinking in Research and Practice:
Traditionally, medical education and research have focused on a male body as the default. We need to acknowledge the spectrum of female sex characteristics and experiences. This refers to the inclusion of diverse populations of women in clinical trials and research studies. Additionally, collecting and analyzing health data specific to women is crucial. Sex-disaggregated data allows researchers to identify and address health concerns specific to women’s bodies.
Combating Bias Throughout the Healthcare Journey:
Standardized diagnostic tools and guidelines can be powerful allies in the fight against bias. Implementing checklists and guidelines during diagnosis helps healthcare providers avoid subconscious biases. These tools ensure a more objective evaluation of women’s symptoms and a wider range of conditions are considered. Additionally, medical professionals can benefit from implicit bias training. This training helps doctors and nurses recognize and challenge unconscious biases that might influence their decisions, such as stereotypes about pain tolerance, risk factors, and treatment options. Finally, fostering patient-centered communication is essential. Doctors should create a safe space for women to discuss their concerns without judgment and ensure they understand their treatment options through open communication and active listening.
Transforming Research and Treatment for Women:
Historically, women have been underrepresented in medical research. Increased funding specifically for research on women’s health issues is crucial. This research is essential to develop more accurate diagnostic tools, treatment options, and preventive measures tailored to women’s bodies. Furthermore, clinical trials should actively recruit women to participate. Diversity in these trials ensures the effectiveness and safety of new medications, and treatments are assessed for women’s bodies. Expanding access to healthcare through telehealth and mobile health technologies can be particularly beneficial in underserved communities. These tools can bridge geographical gaps and empower women to take a more proactive role in managing their health.
Building Trust and Empowering Women:
Investing in community outreach programs can help address cultural taboos and misinformation surrounding women’s health. Educational programs can empower women to recognize symptoms, advocate for themselves, and seek preventive care. Encouraging more women to enter healthcare professions can create a more relatable environment for female patients. Having female doctors and nurses can address cultural sensitivities and promote open communication, further strengthening the doctor-patient relationship.
By fostering a culture of inclusivity for women in healthcare, challenging unconscious bias, and investing in research specific to women’s health, we can create a healthcare system that truly serves all women. These solutions, implemented together, can bridge the gender gap and ensure women receive the effective and equitable healthcare they deserve.
REFERENCES
- Anke Samulowitz, Ida Gremyr, Erik Eriksson, Gunnel Hensing, ““Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain”, Pain Research and Management, vol. 2018, Article ID 6358624, 14 pages, 2018. https://doi.org/10.1155/2018/6358624
- Brian D Earp, Joshua T Monrad, Marianne LaFrance, John A Bargh, Lindsey L Cohen, Jennifer A Richeson, Featured Article: Gender Bias in Pediatric Pain Assessment, Journal of Pediatric Psychology, Volume 44, Issue 4, May 2019, Pages 403–414, https://doi.org/10.1093/jpepsy/jsy104
- Rosseland, L. A., & Stubhaug, A. (2004, December 1). Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery. Pain. https://doi.org/10.1016/j.pain.2004.08.028
- Gender bias in medical diagnosis. (2024, May 9). Wikipedia. https://en.m.wikipedia.org/wiki/Gender_bias_in_medical_diagnosis#:~:text=A%20significant%20disparity%20exists%20in,patients.%20Female%20patients%20have%20also
