Gender Medicine Definition, History and Examples

Gender and health - women and men get differently ill
Sex and gender, in German biological and social gender, are critical variables that influence health and disease. The concept of gender is based on a complex relationship and integration of gender - as a biological and functional part of the human body - and cultural and psychological behavior, which in turn is characterized by ethnic, social and religious background.

contents

• Diseases vary in men and women
• Psyche and body play together
• The cells react differently
• The history of gender medicine
• Gender medicine at the university
• Why does medicine affect men and women differently??
• Differences between men and women in heart disease
• depression
• Depression and role image
• Psychosocial and biology
• Cultural discrimination of biological characteristics
• What is physical, what is mental?
• Reactions to substances
• Women are more likely to get Alzheimer's than men
• lung cancer
• Sexually transmitted diseases
• Autoimmkrankheiten
• Pain
• Is it the hormones?
• The brain
• Fat and estrogen
• heart disease
• alcohol
• Risks in men

Diseases vary in men and women

Men and women differ in their health problems. Traditionally, in medicine it has been taken for granted that the diagnoses and effective treatments for the male part of society were just as valid for women - if they were not complaints that can only be biologically given to women, such as pain during menstruation or inflammation of the ovaries.

Men get sick differently than women. The
Gender medicine addresses the gender differences in health care, disease development and treatment options. (Image: WavebreakMediaMicro

Gender medicine is a new way to look at the physiological and pathophysiological differences between men and women and it takes a great effort in research and education to revise many chapters in medicine. It's about how illnesses differ in men and women, so it makes sense to prevent them from recognizing clinical signs, adapting therapies, and making predictions that take into account the psychological and social background.

Psyche and body play together

Gender medicine is based on the fact that men and women experience health and illness in different ways. The causes, the risk factors, the symptoms, the diagnosis, the treatment, the course of treatment and the prognosis are factors that significantly diverge in men and women - and this in a large number of individual pathologies.

Each gender responds to similar infirmities in entirely different ways. These differences have their origins in the combination of biological, cultural and societal factors.

The cells react differently

Gender differences affect not only the sexual and reproductive systems, but also the heart, blood circulation, bone metabolism and the immune system. For example, autoimmune diseases affect women more than men, and coronary heart disease is more likely to affect postmenopausal women and secondly, they have different symptoms, depending on gender.

The sexes are also different in the cells: women's cells react differently to stress, for example, induced by drugs, than the cells of men. Men and women not only react differently to drugs, but also to natural substances that they absorb in their diet.

Sex has an influence on the immune system. (Image: ag visual / fotolia.com)

The history of gender medicine

Gender medicine is a new field with the aim to study the effects of gender on human physiology and health. As late as the 1980s, all health studies, as far as they did not involve pure female or male diseases such as uterine disease or testicular cancer, were targeted at men. The first report on women's health was published by the National Institute of Health (NIH) in the United States in 1985.

In the mid-1980s, many historians, philosophers and sociologists in the United States turned against the neutrality of science or natural scientists that was assumed at the time. At the same time, a new medical research approach was developed that linked the risks to health with gender. Previously, the paradigm "white, male, young" had been applied to standard diagnoses and treatments for various illnesses.

Gender also influences the social, cultural and economic roles. And the traditional therapies assumed that men and women are the same in the medical field, even though they are exposed to different social, cultural and economic pressures.

It was only in the late 1990s that the disadvantages for women were recognized and explained medically - structurally, socially and institutionally. Then the World Health Organization and the United Nations developed programs based on gender medicine. This perspective even became an integral part of the UN system and established itself globally: in governments as well as non-governmental organizations (NGOs).

In 1991, the New England Journal of Medicine first dealt with the "women's question" in medicine. Bernadine Healy, a cancer doctor and director of the National Institutes of Public Health, published a report on the Yentl syndrome. Two separate studies were conducted comparing men and women with coronary artery disease. It turned out that doctors discriminated against women with their attitudes and behavior. Compared to men, women had to undergo significantly more false diagnoses and ineffective surgery.

Gender medicine at the university

Although the gender problem has now entered the discussion, it took almost 10 years before it had any practical consequences for medical education. The first course on gender medicine even took place at Columbia University in 2002, under the title "A new approach to health care with insights on biological differences between women and men"..

To achieve the goals of gender equality and to balance men and women in all areas of life, the Council of Europe sought new strategies and methods to define and develop labor standards based on gender considerations. Gender equality has been developed with general principles and standards to ensure the full participation of men and women in society. Gender mainstreaming, a new perspective on gender equality, has been developing at all levels since 1998.

Why does medicine affect men and women differently??

1. Physical size and anatomy

Women are often smaller than men but receive the same dose of medication. Thus they have a higher concentration of the funds in their body, which could explain different reactions to specific substances. Anatomical differences between the sexes can also lead to a higher sensitivity in women to certain medications.

Women are usually smaller and lighter than men but receive the same medicines. Accordingly, they are often overdosed, which can lead to dangerous side effects. (Image: Alfonsodetomas / fotolia.com)

2. Differences in the body processes

The kidneys play an important role in neutralizing toxins and transporting excess medication out of the body. In older women, the performance of the kidneys decreases, according to studies to a greater extent than in men.
Therefore, some women are exposed to higher concentrations of the active substances of a medication. In addition, specific enzymes in the stomach and liver of the P450 system behave differently in males and females. But these help to remove excess medicine from the body.

3. Differences in the level of gastric acid

The digestive system of men and women works differently, and therefore, medicine taken by men and women orally is different in the sexes. In women, the level of stomach acid is lower than in men, and therefore the stomach empties slower. As a result, women's stomach absorbs the active substances longer and their total dose increases.

4. Physical differences

Traditionally, the effect of medication was considered to be the same in both women and men, with men usually testing the subjects. New studies indicate that women do not respond to certain substances as men do. This is most likely due to physical differences directly related to the intake and processing of these substances.

Thus, women have a higher proportion of body fat than men, a menstrual cycle and hormonal fluctuations. The menopause and hormone treatments in later life also affect the reactions to drugs.

Differences between men and women are therefore explicitly not limited to the reproductive organs, but both sexes respond differently to certain medications, are different susceptible to certain diseases, which also have different effects.

The following examples show some forms of how illnesses and medications affect men and women differently.

Differences between men and women in heart disease

Most assessments of women's heart disease have come from studies on men in the past. The symptoms are different in women, and they are at greater risk of dying in one year after a heart attack. Women also respond worse to procedures to resolve heart-related medical problems and respond more poorly to blood thinners.

The symptoms in women are more subtle and therefore less recognizable. These include malaise in the stomach, neck, jaw or back and shortness of breath - all of which are nonspecific symptoms that may indicate various illnesses. Therefore, women often do not suspect that their perceptions could be a heart attack. They push the warning signals aside because they assume another cause of the symptoms.

In addition, women's medicine is often a misdiagnosis of symptoms, and in the end, sufferers recognize their heart disease when it's too late. Men, on the other hand, benefit from more thorough diagnoses and more aggressive treatment.

This is not a sideline: in the United States, 500,000 women die each year from heart disease, which is 50,000 more than men. Compared to men, they have a higher risk of suffering a second year after the infarction.

The risk factors also differ. Men are generally at risk from the age of 55. In women, there is an increased risk during menopause when their hormone balance changes.

In a heart attack, women usually have different symptoms than men. In addition to typical chest pain, these are e.g. Backache and shortness of breath. (Image: Adiano / fotolia.com)

depression

Depression affects women two to three times more often than men. This is partly because the female brain produces less of the neurotransmitter serotonin, which regulates the emotions.

The gender differences in the causes and course of depression require different therapies. As a result, twice as many girls are diagnosed as teenagers, but adolescents are more vulnerable to depression, while girls are more episodic.

While twice as many teenage girls suffer from depression, the risk of developing substance or drug addiction is far greater, as is the risk of suicide.

Studies show that a depressive illness has different effects on the brain of boys and girls, both sexes experience the disease differently and consequently require a different therapy.

Depression and role image

Social roles also have an effect on the course of mental illness, which in turn also has organic causes. An example is depression: men in traditional roles often do not dare to talk about their illness, since it does not correspond to the image of a "strong man"; Women in traditional women's roles develop feelings of guilt because they are no longer able to fulfill their "maternal duties" and their other awarded reproductive work.

Psychosocial and biology

Depression, anxiety, negative stress, sexual violence, domestic violence and escalating rates of substance abuse affect women more than men - in different countries and different social milieus.

This reveals the complex task of gender medicine: Biological differences between men and women are linked to the social roles that societies attribute to men and women.

Pressure from multiple roles, gender discrimination and related factors such as poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse also have a negative impact on women's health. The more of these social factors occur, the more frequent and severe are the impairments of mental health in women, from mental disorders to psychosomatic illnesses.

Cultural discrimination of biological characteristics

An example of these specific pressures on women is religious and cultural discrimination against women during their menses. Many women suffer from discomforts such as abdominal pain, iron deficiency due to heavy bleeding, or discomfort due to the fluctuation in hormone levels before and during their menses.

In countries like India or Nepal, the menstrual period is considered impure and women have to isolate themselves during this time. In rural areas this often means that they have to move into unheated stables or other unhygienic buildings. This aggravates the complaints.

What is physical, what is mental?

A typical intertwining of psyche and body is also shown by the often discussed "hysteria" in women in the age of Freud. These mental symptoms characterized an irrational behavior in which those affected no longer had self-control over their actions. Although hormone levels in the body may have changed, the thesis that women are naturally prone to emotional outburst was wrong.

The then patients were mainly women from the bourgeoisie - locked up in a corset of constraints, as a "real woman" had to behave. The victims had to submit to the man in a patriarchal society. Allegedly irrational behavior could not be controlled and thus offered an unconscious possibility, temporarily break out of this prison.

The challenge for gender medicine is to include the interplay of biological and social factors in diagnosis and therapy and to avoid short-term purely biological or purely psychosocial inferences.

Reactions to substances

Women and men differ in their reactions to medication. These differences may be critical in treatment, so they need to be adjusted to ensure effective therapies.

The majority of Alzheimer's patients are female. (Image: Photographee.eu/fotolia.com)

Women are more likely to get Alzheimer's than men

Two-thirds of people with Alzheimer's disease are women. In addition, women are usually those who privately care for Alzheimer's patients. So they carry both the risk of falling ill and the burden of caring for the sick.

Without supporting this by studies, until recently, the "wisdom" was that women therefore more often suffer from Alzheimer's because they live longer. New studies suggest, however, that menopausal hormone changes and other gender differences offer potential explanations.

lung cancer

More women die each year from lung cancer than from breast, ovarian or uterine cancer, which is a sheer female disease. The main cause of lung cancer is undisputed smoking. But three times more women die of lung cancer, which never smoked than men.

So far, research has rarely looked at the role of gender-specific factors such as hormones in the onset of lung cancer. This makes it difficult to identify differences in the emergence, risk and survival of women and men, and to verify these studies.

Sexually transmitted diseases

The anatomy of women exposes them to sexually transmitted diseases to a greater extent than men. Unlike the relatively thick skin of the penis, a woman's vagina is covered by a thin membrane that makes it easier for viruses and bacteria to invade. The vagina is also warm and moist, providing the environment in which bacteria thrive.

In addition, in some of the most common sexually transmitted diseases, the symptoms are much more direct in men than in women, for example in fungal infections or chlamydia.

Autoimmkrankheiten

Autoimmune diseases are a collective term for diseases in which the immune system responds to its own defense in case of damage or dysfunction of tissue. They can be systemic or affect only individual organs. Three out of four people with such diseases are women. For example, you may be suffering from multiple sclerosis or rheumatoid arthritis.

The causes why such diseases especially affect women are unknown, but it is known that they are related to previous infections. Such diseases are in the top ten causes of death of women over 65 in the US.

Firstly, because these illnesses often start when young women are "at the height of their powers" and also show up in nonspecific symptoms, at first they often go unrecognized: multiple sclerosis, for example, can last for decades. As women are severely affected, research on gender medicine is urgently needed.

Pain

Women are more in pain than men. More than 70% of people suffering from chronic pain are women. The musculoskeletal system of women reacts differently than that of men. While there are no general differences in the incidence of muscle pain in men and women, women respond differently to rehabilitation programs.

Hormone fluctuations can trigger a migraine in women. (Image: blackday / fotolia.com)

Is it the hormones?

Hormones explain some of these gender differences. For example, the monthly ups and downs of female hormones, such as estrogen, can trigger migraine, a condition that is three times as common in women as it is in men and women, especially during the period when estrogen levels are low.

Studies suggest that variations in estrogen may even be related to the body's ability to control pain. During the period, women produce only a small amount of endorphins, and these are the body's natural painkillers.

The brain

The brain plays an essential role in the medical differences between the sexes, but not in the sense that women are more stupid than men or vice versa. Rather, men and women each use different areas of the brain to respond to pain.

Women activate their limbic system, the emotional center of the brain, while men activate the part in which the analytical abilities form. Researchers speculate that this reflects old gender roles, which in turn emerged in biological evolution.

Women had to protect their children in painful situations, an extremely emotional task. Injured men, on the other hand, were more concerned with eliminating the cause of the pain, such as a predator. But emotions would have been harmful.

In the case of illness, this causes women more often than men to develop anxiety disorders or depression while they are in pain. Fear and depression increase the feelings of pain.

Fat and estrogen

Much is unexplored, but only the focus on gender brings the questions to the table. Thus, the risk of women developing diabetes increases with their obesity, and the sequelae affect them more than lean women. Traditionally, this was simply explained by the fact that fat people generally develop diabetes more quickly. Prof. Dr. However, Suzanna Hofmann points out that estrogen could also play a role.

heart disease

In heart failure, various medications have different effects on men and women: digitalis, antiarrhythmics, anticoagulants, beta-blockers.

This is crucial in digitalis, because it is fatal in overdose: proportionally more women die whose heart failure is treated with digitalis than men. The causes are still unknown, but as "suspects" are a higher blood levels in women in question, as well as the low renal function of older women. In addition, female estrogen and male testosterone affect the ion channels on the heart.

Being female is therefore explicitly a risk factor when taking antiarrhythmics, antidepressants and antiallergic drugs.

The female body contains less water than the male, so women are more sensitive to alcohol. (Image: karelnoppe / fotolia.com)

alcohol

Men and women of equal weight and size experience the effect of alcohol in the body differently. Women are more vulnerable to the consequences of alcohol abuse and abuse.

The alcohol concentrates more strongly in her blood; they become drunk faster and suffer from alcohol poisoning at lower doses, which is also fatal in less alcohol than in men.

One reason for this is that women have less body fluid than men of equal weight and therefore achieve higher levels of alcohol in the blood with a lower amount of alcohol than men. The proportional ratio of alcohol to body fluid shifts.

In the long term, women's bodies are at greater risk of suffering damage from continuous alcohol consumption. Many women drinking are at high risk for the following conditions: high blood pressure, liver disease and damage to the pancreas. Proportionally, more women die of cirrhosis than men.

Risks in men

Gender medicine not only helps women, but also men who respond to certain treatments worse than women. This is how Prof. Dr. med Margarethe Hochleitner from the Medical University of Innsbruck: "If a woman and a man get the same cancer - same age, same health status - then the man has the much higher risk of dying from it. And when both die, the man dies faster. So a man is disadvantaged in any case. Chemotherapies work better in women. And there is the big exciting question: Why is that so? "(Somayeh Ranjbar, translated and supplemented by Dr. Utz Anhalt)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)

references
http://www.istud.it/up_media/pwscienziati13/gender_medicine.pdf
http://www.ba-bamail.com/content.aspx?emailid=21890
http://www.brighamandwomens.org/Departments_and_Services/womenshealth/ConnorsCenter/Policy/ConnorsReportFINAL.pdf
https://www.aarda.org/autoimmune-information/autoimmune-disease-in-women/
https://consumer.healthday.com/encyclopedia/pain-management-30/pain-health-news-520/pain-another-gender-gap-646166.html
https://pubs.niaaa.nih.gov/publications/aa46.htm