MED 2 Renal: Gender and Health

• Renal: Gender and Health is the topic.
• The class is MED 2 School of Medicine Bahrain.
• The course is Renal with course code REGUB.
• The lecturer is Dr. Sally Doherty; email [email protected].
• The date is March 2025.

Learning Outcomes

• Distinguish between sex and gender.
• Summarize how gender is experienced.
• Identify ways to reduce the inequalities in health associated with gender.
• Summarize the factors, such as gender stereotypes and masculinity, that impact health and mortality.
• Identify the role of healthcare professionals in promoting gender-sensitive healthcare.

Topic Overview

• In the 1980s, cardiologist Marianne J. Legato discovered that many female heart attack patients did not display typical symptoms like chest and arm pain.
• Female symptoms were often sweating, nausea, and pain in the back, head, and neck.
• Doctors sometimes dismissed these life-threatening conditions, leading to fatal outcomes.
• It made Legato question why women with heart disease displayed different symptoms than men, and why doctors were unaware.
• Legato is considered a founder of gender medicine.

Definition of Sex

• Sex is the physical and biological aspects of an individual, like chromosomes, hormones, and reproductive anatomy, that make someone biologically male or female.
• Sex is typically assigned at birth as male, female, or intersex.
• Intersex individuals cannot be categorized as male or female across all traits.
• Intersex could include those with ambiguous genitalia, chromosomes that are not XX or XY, or misaligned external genitalia and internal reproductive organs.

Definition of Gender

• Gender is the socially constructed roles, expectations, and behaviors often ascribed to different sexes.
• Gender identity is a personal, internal perception of oneself based on socially constructed roles, behaviors, and customs.
• People identify and express their gender in a variety of ways.
• Gender identity is how you feel inside and your personal understanding of your gender.
• Gender expression is how a person chooses to present themselves to the outside world.

Sexuality

• Sexuality has three elements: who you're attracted to, your sexual behaviors, and your identity.
• Sexuality takes into consideration your sex or gender and the sex or gender of any partners.
• Sex doesn't predetermine sexuality.
• Societal norms and social stigmas influence sexual behaviors, who you're attracted to, relationships, and personal identity.

How Gender is Experienced

• Gender Identity is the degree to which an individual sees herself or himself as feminine or masculine based on society's definitions of appropriate gender roles.
• Gender Roles are socially constructed roles, behaviors, activities, and attributes that a given society considers appropriate for men and women.
• Gender Relations refers to how differing genders relate, communicate, and interact with one another.
• Institutionalized Gender includes how processes, systems and structures reinforce gender differences.

Gender in Healthcare

• Biology is crucial in shaping the health experiences of different genders.
• Interplay between genetics, hormones, and evolutionary biology influences disease susceptibility and lifespan.
• These biological factors are key to understanding why health outcomes often differ between males and females.

Gender Influences on Health

• Men have more social contacts which means a greater risk of exposure to contagious disease.
• Immunological differences make men more susceptible.
• Cultural barriers mean women have unequal access to healthcare.
• Stigma and fear disproportionately affect women and impair health-seeking behaviour.
• Gender roles and social norms, and the low priority of women's health, means men (breadwinners) and children are a priority.

Gender Impact on Healthcare

• A significant presence of gender bias exists in healthcare.
• Women often report their symptoms being dismissed or underestimated compared to men.
• This can lead to misdiagnosis or inadequate treatment.
• Historically, medical research has focused more on male bodies.
• There are gaps in understanding and treating conditions that predominantly affect women or manifest differently in different genders.
• Gender can influence the quality of healthcare received.
• Women may face challenges in accessing reproductive health services.

Bias in Gender Healthcare

• Some gender-related stereotypic views exist among health care providers.
• Some health care providers believe that men are underreporting their pain in comparison to women.
• Social learning history and other psychosocial factors contribute to gender and provider differences in pain management decisions.

Health differences

• Men have more life-threatening chronic illnesses like coronary heart disease, cancer, cerebrovascular issues, cirrhosis, and kidney disease.
• Women have higher rates of chronic illnesses such as anaemia, thyroid issues, migraines, arthritis, and autoimmune disorders.
• Heart disease is the leading cause of death in the USA.
• In 2017, heart disease accounted for 24.2% of all deaths for men and 21.8% for women.
• Women suffering from ischaemic heart disease are older, and this difference is historically believed to be due to the protection of endogenous oestrogens

Impact of COVID-19

• Men face increased risk for lower respiratory complications and cytokine storm.
• Men experience prolonged virus shedding.
• Pregnant individuals face hospital admission and ICU risks; stillbirth and abortion risks increase.
• There is viral shedding in milk and increased infection risk for breastfed babies.
• The menstrual cycle experiences less activity, heightened ferocity, irregular volume, and hormone secretion.
• Men experience increased ED, decreased libido, and semen excretion of the virus.

Reducing Health Inequalities

• Gender medicine must consider the needs of both sexes.
• Give greater attention to women where specific data on women are lacking.
• Give greater attention to men where specific data on men are lacking.
• More data on men are needed regarding osteoporosis and depression.
• More data on women are urgently needed in the cardiovascular area.

Addressing Gender Health Inequalities

• A World Economic Forum and McKinsey Health Institute report revealed that women spend 25% more of their lives in poor health compared to men.
• This is largely because there is a systematic lack of sex and gender-specific disease understanding.

Gender Health Gap

• Four primary areas need addressing: science, data, care delivery, and investment.
• The study of human biology defaults to the male body, which hinders understanding of sex-based biological differences and results in fewer available and less effective treatments for women.
• Health burdens for women are systematically underestimated, with datasets that exclude or undervalue important conditions.
• Women are more likely to face barriers to care, and experience diagnostic delays and/or suboptimal treatment.
• There has been lower investment in women's health conditions relative to their prevalence.
• This drives a reinforcing cycle of weaker scientific understanding about women's bodies and limited data to de-risk new investment.

Gender Stereotypes and Health

• "Yentl syndrome" describes that women have to show the same symptoms as men to receive the appropriate diagnosis and treatments, because the knowledge of cardiovascular disease was based on studies conducted on men.
• Women with myocardial infarction receive less guideline-based diagnosis and less invasive treatment than men.
• Women with heart failure receive fewer guideline-based diagnostic procedures and treatments, and fewer implantations and heart transplantations.
• Women with atrial fibrillation receive less anticoagulation treatment with warfarin although they have a greater risk from stroke than men.
• Women obtain dialysis later than men, and undergo fewer kidney transplants, both from living and deceased donors.
• There is a significant delay in the referral of female patients with rheumatoid arthritis to an early arthritis clinic in comparison with male patients.
• Osteoporosis and depression are considered female diseases, which means they may be under-diagnosed in men.

Factors Influencing Health

• Masculinity and health face an impact of traditional masculinity norms on men's health.
• Access to healthcare faces barriers to healthcare access for different genders and gender inequality.
• Mental health faces gender differences in mental health issues and treatment.

Clinical Trials

• Traditionally males, particularly Caucasian males, are the norm in clinical trials.
• Women were excluded because there was believed no difference in health conditions (with the exception of hormonal fluctuations), it introduces additional variables like hormone cycles and increases cost.
• Lack of women is due to sex rather than gender.
• Vulnerable population (possible foetus), attempt to protect them.

Importance of Women

• Now, guidelines recommend sex-specific research in all phases of the clinical study.
• There’s an increase in side effects reported for women because of greater prescription, untested drugs and unrecognised effects from physiological differences.
• Weight, fat and Conditions can affect drug metabolism.

Mental Health Factors

• Gender differences in mental health are influenced by a combination of biological, psychological, and social factors.
• Women tend to experience higher rates of internalizing disorders, such as depression and anxiety.
• Men are more likely to suffer from externalizing disorders, including substance abuse and antisocial behaviours.
• Societal expectations and gender roles can impact mental health.
• For example, women may face more stress due to balancing work and family responsibilities.
• Men might experience pressure to conform to traditional notions of masculinity.
• Men are generally less likely to seek help for mental health issues, which can lead to underdiagnosis and undertreatment.
• Hormonal differences play a role in mental health where fluctuations in estrogen and progesterone can affect mood and contribute to conditions like premenstrual dysphoric disorder (PMDD) in women
• Women may be more affected by life events such as childbirth, menopause, and caregiving responsibilities.
• Men might be more impacted by job-related stress and societal expectations to be the primary breadwinner

Access to Healthcare

• Gender norms also influence health-seeking practices.
• Men may dismiss their own health care needs and avoid seeking healthcare because they feel pressure to appear strong.
• Women are more likely to seek help for physical and mental health problems.
• They are also expected to be self-sacrificing and put the needs of other family members before their own health.

Gender Sensitive Healthcare

• First, healthcare professionals must be educated about gender differences in health and the impact of gender norms on health behaviours and outcomes.
• Second, gender-sensitive care should be implemented where patients feel safe and respected, regardless of their gender.
• Third, healthcare professionals can advocate for policies that promote gender equality in healthcare settings.
• Fourth, research that explores gender differences in health can help identify gaps in care and inform the development of targeted interventions.
• Fifth, providing gender-sensitive support and counselling can help address the unique mental health needs of different genders.

Gender inequality in healthcare

• Gender inequality and discrimination faced by women and girls puts their health and well-being at risk.
• Women and girls often face greater barriers than men and boys to accessing health information and services, like restrictions on mobility, lack of decision-making power, lower literacy rates, and discriminatory attitudes of communities and healthcare providers.
• A lack of training and awareness amongst healthcare providers and health systems of the specific health needs and challenges of women and girls exacerbates this issue.

Men consulting GPs

• Men consult less than women between 16 and 60 years.
• The use of underlying medication shows there is a modest difference between healthcare between men and women.

Men vs Women in research

• A clear sex-gap exists in pharmaceutical research.
• From studies to markets women experience more problems in reaction to drug products.
• Post-menopausal women respond differently, in a worse way, to antidepressants compared with pre-menopausal women

Future Practice

• Gender perspective to tackle bias.
• Monitoring is essential.
• Facilitators and barriers.