Rooting out gender bias in sexual health treatment

Despite significant strides in women’s equality research shows that within healthcare, gender bias against women impairs their ability to receive appropriate diagnosis and treatment. This is especially true around sexual and reproductive health, according to Jane van Dis, MD, OB/GYN and medical director for MavenClinic, based in Altadena, Calif.

“Gender based biases physicians exhibit include dismissing or lessening women’s accounts of pain; assuming women’s complaints of pain-especially around sex and the menstrual cycle-have psychological rather than physiological origins; ignoring the often deep psychological pain that accompanies miscarriage or pregnancy loss and asking closed rather than open-ended questions in the patient interview,” van Dis says.

Such gender bias can be dangerous to women’s health. She cites a study showing that female heart attack patients treated by male physicians are less likely to survive. “The same study demonstrated that women treated by women physicians were three times more likely to survive their heart attack.”

Gender bias is most likely the reason why the average woman with endometriosis goes nine years before she is diagnosed, van Dis says. And if it’s hard for women in general to get appropriate diagnosis and treatment, it’s even worse for black women and other women of color, who also experience racial bias.

She is so concerned about gender and racial bias that she has been working with the American College of OBGYNs to create a Task Force to address gender bias and the history of misogyny and racism that inform care.

One problem might start as early as medical school. In her experience, physicians do not get the appropriate training they need in medical school to be comfortable taking sexual and reproductive history or giving pelvic exams.

“As OB/GYNs we often find that some non-OB/GYN physicians emerge [from medical school] uncomfortable taking a sexual and reproductive history. Some physicians express these uncomfortable biases when they consult us…as if there’s an ick factor around the patient’s reproductive system,” she says.

Additionally, menstrual issues are often all lumped together or dismissed as just normal discomforts women have to put up with. “I can’t tell you how many medical records I’ve reviewed where a heavy period is dismissed when cancer was present.”

Similarly, she says it is common for women with vaginal discharge to be told they have a yeast infection when they should be tested for sexually transmitted infections such as syphilis, bacterial vaginosis, chlamydia and gonorrhea.

This bias, she says, is a problem, because “a woman’s menstrual history can be an important vital sign.” She gives the example of a woman who isn’t menstruating. “This could be an indication that she is hyperthyroid or has poly cystic ovarian syndrome (PCOS), both of which can have devastating systemic consequences for her risk of cardiovascular disease and life expectancy.”

Additionally, lack of menstruation could be a sign of premature ovarian failure, she says.

She recommends that physicians consider taking courses or seminars in overcoming gender bias, or read books such as Maya Dunsberry’s Doing Harm and Jennifer Gunter’s The Vagina Bible.

In addition to male physicians educating themselves so they do not fall into the trap of gender bias, she would like to see more female physicians in positions of medical leadership where policies and practices are established.  “While it’s taken 100 years for women to reach parity in medical school enrollment, women are only 13 percent of healthcare CEOs, 18 percent of department chairs and 16 percent of medical school deans.”

“It’s important physicians consider how they have thought-unconsciously-about women’s pain and especially black women’s pain,” she says. “As a woman myself, I check my bias when I’m listening to women talk about their pain. I make a point not to interrupt or over-talk them, not to dismiss them, and not to explain their pain away as psychosomatic.”