Why Doctors Are Often Not Able To Diagnose Women’s Complaints Correctly…

We are often taught that one should not question medical research, that it is inherently objective, rational, and free of bias, but we forget the biases of researchers who are also human.

Did you know that gender bias in medical research is one of the major reasons why women get misdiagnosed or remain untreated for serious illnesses for years?

In India, women are also at a disadvantage when it comes to taking control of their healthcare due to socioeconomic constraints. These constraints arise due to many factors such as

  • lack of education,
  • lack of financial independence due to limited involvement in the labour force,
  • living within a patriarchal system that gives the men in their lives majority of decision-making control,
  • caste and religious discrimination, etc.

These factors combined with the inherent gender bias in medical research jeopardises women’s health severely.

Women were excluded from medical research

Women’s ailments have been frequently misdiagnosed or undiagnosed due to centuries of female exclusion from medical research. In the past, scientific investigations were frequently conducted on samples that were primarily or entirely made up of men.

This research was then used to develop diagnostic criteria and other diagnostic instruments such as questionnaires and checklists. Women were simply never included in the research and so there was often not enough data to diagnose their symptoms correctly. And as many recent insights show, women have a different physiology, and may show symptoms different from men.

In 2014, researchers at the Brigham and Women’s Hospital in Boston chronicled this exclusion of women from health research and its impact on women’s health: “The science that informs medicine – including the prevention, diagnosis, and treatment of disease – routinely fails to consider the crucial impact of sex and gender. This happens in the earliest stages of research when females are excluded from animal and human studies or the sex of the animals isn’t stated in the published results.

Once clinical trials begin, researchers frequently do not enrol adequate numbers of women or, when they do, fail to analyse or report data separately by sex. This hampers our ability to identify important differences that could benefit the health of all.”

We’re taught that medicine is the sacred science of healing the body’s illnesses. We expect medicine as a science, to adhere to the norms of objectivity and proof. We expect medical research to be inclusive of all genders and races, free of prejudice and biases.

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But this is not so, increasing research suggests that data from medical research is often deeply skewed because there has been a systematic failure to include sex differences in the research for centuries.

‘Hysteria’, and a history of ignoring women’s symptoms

For centuries, the theory of hysterical neurosis or hysteria linked women’s physical and mental illnesses to a “wandering womb.” The womb was considered to be a floating organ that moved up and down in a woman’s body, pushing on different organs, causing her physical and mental suffering. This theory was supported by several Greek medical practitioners including Hippocrates, the father of modern medicine.

Hysteria led to the misdiagnosis of women’s medical complaints for centuries in the west. The theory was finally disregarded as a diagnosis in the 1980s. But the belief that women are over-emotional and exaggerate their physical symptoms has persisted in most cultures. Women’s pain continues to be accepted as normal and seen as the price paid for owning a uterus and having childbearing abilities.

Indian women continue to be mentally conditioned to tolerate pain with patience and silence, period cramps, pain related to childbirth, or menopause discomfort are all normalised.

We also live in a society that makes it taboo for women to communicate their concerns, especially those involving their health and reproductive organs. This also contributes to a pervasive dearth of medical understanding concerning women’s health. Women are also expected to have a higher threshold for pain and thus their physical complaints often go dismissed by healthcare providers.

Misdiagnosed and ignored

The list of illnesses misdiagnosed or diagnosed late in women remains long – for example, endometriosis continues to be diagnosed late in many women (about seven years) since its primary symptoms such as pelvic pain and heavy periods are still considered “normal”.

Heart disease, autoimmune diseases, rheumatoid arthritis, multiple sclerosis, and Alzheimer’s disease are just a few of the illnesses that lie untreated for years. Chronic pain diseases affecting women, such as fibromyalgia, chronic fatigue syndrome, and chronic Lyme disease, are understudied and frequently go undetected and untreated.

According to The Girl who Cried Pain, a landmark study on the treatment of a woman’s pain symptoms, it was concluded that it is harder for women to receive aggressive treatment for their pain, they are often labelled as being “over emotional” and their pain was dismissed as “not real.”

The problem lies in the fact that men and women often experience different symptoms for the same illness, and there is still a dearth of consistent data on the symptoms exhibited by women.

For example, the primary complaint of men experiencing a heart attack is chest pain. But oftentimes women report subtler signs such as indigestion, fatigue, shortness of breath, pain in their neck, jaw, arms which is often diagnosed as the flu or symptoms of stress by doctors.

More male subjects in research on neuro divergent conditions

Even research in the field of mental, neurological, and developmental disorders relies heavily on data collected from male subjects. Research on disorders such as Attention-deficit/ Hyperactivity Disorder (ADHD), autism, including Asperger’s syndrome, and other neurodivergent conditions are conducted with predominantly male subjects. This leads to a narrow and gendered diagnostic criteria.

Women especially with autism are often incorrectly diagnosed with anxiety or menstrual-related mood disorders that only exacerbate their problems. Thus many neurodivergent girls suffer years of poor mental health by the time they reach adulthood, never having received a correct diagnosis, they wonder what is wrong with them.

Overmedication of women

According to new research from the University of California, Berkeley, and the University of Chicago, women are also more likely than males to experience negative side effects from medicines. This is because prescription dosages have traditionally been based on clinical trials conducted on men.

The findings of the research suggest that there remains a “persistence of pharmacological dose gender gap” stemming from a historical disregard for the fundamental biological differences between male and female bodies.

The study found that overall women had nearly twice as many adverse medication reactions as men. Side effects such as nausea, headaches, depression, cognitive impairments, seizures, hallucinations, agitation, and heart irregularities were more common in women.

Scientific development needs to be more inclusive of women!

We are often taught that one should not question medical research, that it is inherently objective, rational, and free of bias, but we forget that the humans involved in medical research are people like us, subject to the same social and gender biases as the rest of society.

Women have been excluded from clinical medication studies for decades, in part due to fears that women’s hormone changes make them difficult to examine. This exclusion in clinical studies is putting women’s lives at risk.

The framework within scientific development needs to be more inclusive of women. It is not too late to recognise gender biases in our sciences and course correct for the benefit of women all over the world.

Developing a more accurate diagnostic test is an issue of safety, it will lead to early detection and accurate diagnosis of diseases that will improve the quality of life of women and lengthen their lives.

The medical world needs the will and the right funding to create equal foundations for research. We need a world where medical systems and access to healthcare are more equal and safe for all genders.

Image source: a still from the film Kaasav

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