What is the gender health gap, and how does it manifest in diagnosis and treatment?
The gender health gap refers to disparities in healthcare outcomes and experiences between different genders, predominantly impacting women. This gap manifests in several ways, including significant delays in diagnosis for women across a wide range of conditions. For instance, women are diagnosed, on average, four years later than men across 770 diseases, and 2.5 years later with cancer. They are also twice as likely to need to report symptoms five or more times before a cancer diagnosis. Furthermore, women spend 25% more of their lives in debilitating health compared to men. In terms of treatment, women are twice as likely to suffer adverse side effects from medication, partly due to historical exclusion from pharma research. They are also more likely to be given sedatives instead of painkillers when experiencing pain.
How does the lack of female-specific research and historical exclusion impact women’s health?
The underinvestment and historical exclusion of women from research have profound impacts. Only 1% of global healthcare research and innovation is invested in female-specific conditions beyond cancer. Women were not even required in U.S. clinical research until 1993. This lack of research means that conditions more prevalent in women, such as autoimmune conditions (some are 16x more common in women, with women 2x more likely to develop multiple sclerosis and 9x more likely to get lupus), are often misunderstood or misdiagnosed. This deficit in understanding also contributes to women experiencing twice as many adverse side effects from medication. Even in areas like fertility, where male factor infertility accounts for 50% of cases, research still primarily focuses on female infertility. Moreover, there is five times more research on erectile dysfunction (affecting 19% of men) than on PMS (affecting 90% of women).
What specific challenges do women face regarding heart health?
Women face unique and severe challenges in heart health. Heart disease is the leading cause of death for women, yet only one-third of clinical trial participants are women. This disparity in research translates to worse outcomes, as women are more than twice as likely to die after a heart attack than men. Alarmingly, women presenting with heart attack symptoms are often misdiagnosed with stress or panic disorder instead of receiving a full cardiovascular diagnostic workup. Additionally, women who visit emergency departments with chest pain wait 29% longer than men to be evaluated for a possible heart attack.
What are some examples of misdiagnosis and medical gaslighting experienced by women?
Misdiagnosis and medical gaslighting are prevalent issues. Women are 33% more likely than men to be misdiagnosed after a stroke. Patients with hypothyroidism are more likely to be misdiagnosed with depression and anxiety or have their symptoms attributed to menopause. In the context of autoimmune conditions, 45% of patients (the large majority being women) are labelled as “chronic complainers” during their diagnosis journey. For endometriosis, which affects 1 in 10 women, diagnosis can take up to 10 years (even longer for Black women), and 75% of patients report being misdiagnosed with a physical or mental health problem before receiving a proper diagnosis. Furthermore, 72% of female patients report experiencing medical gaslighting. Patients with vaginitis are more likely to be misdiagnosed than correctly diagnosed, and up to 61% of bacterial vaginosis cases are misdiagnosed. Nearly half of women diagnosed with an uncomplicated UTI were given the wrong antibiotics.
How does the gender health gap affect reproductive health beyond specific conditions?
The gender health gap significantly impacts reproductive health in broader ways. Infertility is often primarily attributed to women in research, despite male factor infertility accounting for 50% of cases, and over 70% of internal medicine residency programs did not include infertility in their curriculum in 2016. There’s also a striking lack of fundamental anatomical understanding; a full anatomical understanding of the clitoris wasn’t achieved until 2005, and the NIH didn’t have a research branch dedicated to female sexual organs beyond their reproductive role until 2012. Historically, women have faced reproductive control abuses, such as the sterilization of one-third of women in Puerto Rico between 1930 and 1970 to address “surplus population” concerns. In contemporary terms, over 19 million women in the U.S. live in a “contraceptive desert” requiring publicly funded birth control, and 29% live in states with severely restricted or unavailable abortion access. The feeling of being unheard is also prevalent, with women, trans men, and non-binary people being five times more likely to feel unheard when seeking medical help for their reproductive health.
What are the challenges in diagnosing and treating specific female health conditions like PCOS and PMDD?
Specific female health conditions like Polycystic Ovary Syndrome (PCOS) and Premenstrual Dysphoric Disorder (PMDD) face significant diagnostic and treatment hurdles. PCOS is a common hormonal condition in women of reproductive age, yet up to 70% of cases are undiagnosed. PCOS patients, on average, have to consult three different health professionals over two years before receiving a proper diagnosis, and nearly 40% of internal medicine residency programs in 2016 didn’t include PCOS in their curriculum. For PMDD, patients, on average, have to see six different providers and wait 12 years to receive an accurate diagnosis. Endometriosis also suffers from long diagnostic delays, sometimes up to a decade, with less than half of patients having a documented diagnosis.
What issues are highlighted regarding maternal mental health and its support?
Maternal mental health faces critical challenges, with severe consequences. The number of people dying in the U.S. from pregnancy-related causes has more than doubled in the last 20 years, with the worst outcomes seen among Black, Native American, and Alaska Native people. Despite these dire statistics, only 1% of pharmaceutical R&D spending goes to maternal health. Approximately 14% of people experience postpartum depression, with higher rates among Asian and Black women compared to white women. A concerning 75% of women experiencing maternal mental health conditions are left untreated and undiagnosed. While paid maternity leave is linked to lower rates of postpartum depression, only 13 U.S. states currently offer it.
What broader societal and systemic issues contribute to the gender health gap?
The gender health gap is exacerbated by several broader societal and systemic issues. A pervasive lack of education about the female body is evident, with 76% of students believing they are taught more about the biology of frogs than the female body. This contributes to a general lack of understanding and potentially a reluctance to seek care, as only 54% of women seek medical input for menopause symptoms because they worry it isn’t a valid reason to seek help. The design of medical instruments also reflects a lack of innovation focused on women, as the speculum has not had a widespread design update since the 1800s. The disproportionate misdiagnosis and dismissal of women’s symptoms, often labelling them as “chronic complainers,” further highlights a systemic bias that contributes to delayed or incorrect diagnoses and a feeling of being unheard in the healthcare system.