Excerpt from Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It by Alyson J. McGregor, MD.

We are in the midst of a second women’s revolution.

The first was the movement that gained women the right to operate in the world alongside men as legally equal human beings. We claimed the right to own and govern our bodies, our minds, and our property. We demanded the opportunity to pursue our educations, our passions, and our dreams. My mother’s generation tore down the walls that, a mere fifty years ago, would have made my career in medicine and medical leadership challenging, if not impossible, to pursue. The first revolution in women’s health began in the 1970s with the publication of the groundbreaking book Our Bodies, Ourselves. This was the first time women were invited to understand themselves as biologically different from men. Women demanded access to things like birth control and pain relief. They realized that their bodies were not somehow flawed or “less than” simply because they were female. They demanded autonomy, and when the establishment resisted, they claimed it anyway.

Now, though, we need to call in another wave of change—a change based on the irrefutable facts available to us around women’s health and women’s bodies in all areas, not just in sexual and reproductive health.

Although we women have spent the last several decades fighting for equality, we are also becoming aware, sometimes painfully, that there are significant differences between men and women— differences for which our egalitarian vision did not account. These differences are at the heart of this new women’s revolution, which is now coming to prominence.

Physiologically, neurologically, cognitively, socially, and experientially, women are unique. Every system in our bodies operate according to a biological imperative fine-tuned to our womanhood and the daily functions that womanhood necessitates. We are not simply men with breasts and ovaries—or, conversely, men who lack penises and testicles. We are not a genetic offshoot of men, as literal interpretations of scripture might imply. We are unique in every single cell of our bodies.

When I first started my research on sex and gender differences in emergency medicine, I classified my work as “women’s health.” That made perfect sense to me, since I was literally researching the ways in which women’s bodies operate and how their unique physiology influences diagnosis, disease progression, morbidity, pharmacological response, and other factors in health care. However, the outdated thinking around women’s bodies is unbelievably pervasive; I wasn’t prepared for how often others in my field would miscategorize and even misrepresent my work.

For most people—including the majority of medical professionals—“women’s health” is synonymous with “reproductive health.” OB/GYN and breast health immediately come to mind as areas of medical practice directly related to the health of women. (In fact, I spent much of my residency being called all over the ED to perform pelvic exams—not because no other doctor in the ED could do them, but because everyone thought that, as a women’s health specialist, that would be my first priority. It still makes me laugh when I think about it!)

The truth is, women’s health deals with exactly what the words, removed from their vernacular context, imply: the overall health and well-being of women. It is not simply about female reproductive organs, or pregnancy, or breast health, although those are all vital components. When I talk about women’s health, I’m referring to the health of the whole woman, body and mind, with all the complexities inherent to a physiologically female body.

Every cell in a human body contains sex chromosomes. These chromosomes in turn influence every biological, chemical, sensory, and psychological function performed by that body. Most cells both produce and respond to sex hormones such as estrogen, progestins, testosterone, and androgens, and the functionality of each cell is affected in both subtle and overt ways by its relationship to these hormones.

Although these genomic differences have not been widely researched in all organs and systems, in areas where they have been studied, the implications are clear: women’s bodies deal with everything from internal communication (neurotransmission) to external influences such as pharmaceuticals according to a different set of genetic and hormonal criteria. This means that what is considered medically “normal” for men may not be normal for—or even applicable to—women.

Here are a few common examples of how male-centric medicine impacts women’s health every day:

  • Coronary artery disease is the leading cause of death in both men and women, but women have statistically poorer outcomes and higher mortality in otherwise equivalent situations. A 2010 study found that “the under-recognition of heart disease and differences in clinical presentation in women lead to less aggressive treatment strategies and a lower representation of women in clinical trials.”
  • Women are more likely to receive a psychiatric diagnosis for a multitude of conditions—including stroke, cardiac events, irritable bowel syndrome, autoimmune disorders, and various neurological disorders—while men are more likely to be referred for tests.
  • Men and women have markedly different responses and reactions to pain. Women have both a lower threshold for pain and a lower pain tolerance—meaning, they are more likely to perceive and report a lower level of discomfort as “pain” than men despite an equal degree of stimulation—however, the more vocal women become about their pain, the more likely their providers are to “tune them out” and prescribe either inadequate or inappropriate pain relief medication.
  • Women often present with nontraditional symptoms of stroke, which causes delays in recognition by both them and their health professionals. When they get to the hospital, women experiencing stroke are less likely to receive rapid brain imaging (which is defined by the American Heart Association and the American Stroke Association as a CT scan within twenty-five minutes). They are also less likely to have echocardiography and carotid ultrasound performed during their stroke evaluation (important tools in both evaluating the cause of the stroke and preventing future episodes) or to receive treatment for acute stroke with the “clot-busting drug” called tPA (tissue plasminogen activator).
  • Women metabolize prescription drugs differently. For example, women experience greater adverse effects from using Ambien (zolpidem), a popular sleep aid, including morning sluggishness and impairment while driving. As it turns out, women only need half the originally recommended dose. Nearly twenty years after the drug’s release, and after thousands of reports from patients who experienced adverse effects, the Food and Drug Administration issued its first sex-specific prescribing guidelines.

We need to wake up, individually and collectively, to the reality of being female in our current medical system. Only when we understand what’s really going on can we make the fundamental changes necessary to improve women’s outcomes. This isn’t a single-layered issue of bias or faulty protocol. Every part of our current medical system—from research and analysis to medical education, from diagnostic testing to prescribing guidelines— needs to evolve at the same time, starting now.

This is a problem that can no longer be ignored. But while it may seem insurmountable, change is possible. By picking up this book, you have become part of the new women’s health revolution. From now on, every time you speak to your doctor, every time you ask the right questions, every time you advocate for the right tests, you will be contributing to a landslide effect of awareness, improvement, and eventual reversal of our current male-centric paradigm. No effort is too small, no case too insignificant. Every time you advocate for the sex- and gender-specialized care that you and the women you love deserve, you will move our whole medical model one small step in the right direction.

Excerpted from Sex Matters: How Male-Centric Medicine Endangers Women’s Health and What We Can Do About It by Alyson J. McGregor, MD. Copyright Alyson J. McGregor, MD 2020. All rights reserved.