Sexism in medicine: Medical misogyny, gaslighting and trauma in women’s healthcare Part 2
“Dismissal, gaslighting and biological sex discrimination between male and female patients is a path to medical trauma.”
- Ericka Thomas
Transcript
Ep 192 Sexism in medicine:
Medical misogyny, gaslighting and trauma in women’s healthcare Part 2
Welcome back this is part 2 of our 2 hysterical history. Today we shift into examples of medical misogyny in modern medicine.
Our work IN today is a mix of healthcare history and a rebellious call to action for women everywhere to stand up, challenge the establishment and raise the standards of care for themselves and our daughters.
But is this Medical misogyny?
I hate to believe that any of these things are done with purposeful ill intent. But when these kinds of biases are brought to light and intentionally dismissed or ignored that’s when I have a real problem.
Hormones
Let’s talk about the disparities in diagnosis and treatment for hormone replacement and sexual dysfunction. In a research poll from the UK women need an average 10 GP visits for a menopause diagnosis. 2 out of 5 being offered antidepressants or cognitive behavior therapy before HRT.
In the US most insurances don’t cover HRT for menopause symptoms. So interesting.because when insulin is low we replace it. When thyroid hormone is low we replace it. When you think about it, birth control pills are HT and insurance typically covers that. Why, with a list of over a hundred physical symptoms related to hormonal chaos that is peri and menopause and the associated increased risk of cardiovascular disease (remember that jump at age 60 that I mentioned earlier?), insulin resistance and osteoporosis for women can we not access bioidentical hormones through insurance?
Viagra and testosterone replacement for men on the other hand isn’t over the counter yet but may as well be.
What is going on here?
Jump into the way back machine 1942 the FDA approved HRT for the treatment of hot flashes. Insomnia, mood swings and other menopause symptoms. Now jump to 1966 when gynecologist Robert A.Wilson wrote the best seller Feminine forever. Here’s a quote from that book that I found in an NBC article by Robert Bazell since the book itself is no longer in print and I didn’t want to spend 50$ on it. Although after reading some of these quotes it sounds hilarious.
“Every woman alive today has the option of remaining feminine forever,” he wrote. “No longer need she fret about the cruel irony of women aging faster than men. It is simply no longer true that the sexuality of a woman past forty necessarily declines more rapidly than that of her husband.”
If a woman refused HRT, the consequences would be unthinkable. “All post-menopausal women are castrates," Wilson wrote. But, with HRT, a woman’s “breasts and genital organs will not shrivel. She will be much more pleasant to live with and will not become dull and unattractive.”
Honestly the driving force behind this medical miracle sounds like it’s all about a man’s comfort. And it was.
The author defined a natural human condition as a disease and the cure as the “off-label” or unapproved use of a drug that healthy people would take every day for the rest of their lives.
Pharmaceutical sales of HRT quadrupled after the release of this book.
My grandmother was one of the women who took unopposed estrogen during this time in history. She died of uterine and ovarian cancer. In her 80’s
But menopause has real symptoms and women deserve to know the science, the benefits and risks involved with HRT without the scare tactic rumors in order to be able to give informed consent and make a choice that’s right for them.
1996 - WHI debacle & true risk
Let’s talk about the Women’s Health Initiative study and while we’re at it how about the Million Woman Study out of the UK. I’m linking a great chronological breakdown of the results of these 2 studies. These studies were a bit flawed in that they included a broad range of ages of women and jumped the gun on the interpretation of the results in that they didn’t do any before releasing them to the press. The headline..HRT causes breast cancer, heart attack and stroke! (Talk about hysterical!) …Scary right. Causing a lot of fear and dismay. Fear in the medical professionals and dismay in women. Only to have to come back a few years later and try to explain that maybe just maybe it’s not as bad as all that because they didn’t really take into account that the age and baseline health of these women might also be factors. Like obesity and smoking. The study included women from 50 - 79. And excluded anyone who was currently experiencing menopause symptoms. I know counter intuitive, right . but that would throw off the placebo potentially. But that initial hysteria did its damage for over 20 years.
These studies used conjugated equine estrogens NOT bioidenticals like we have now. They were using relative risk not absolute risk and the data were skewed in many many ways.
We deserve clean well designed studies that clarify the evidence of benefits and risks not muck it up. And doctors who are required to stay up to date on the latest science in menopause. Alo that there actually be science in menopause. Honestly if your doctor tells you estrogen causes breast cancer in all women, isn’t that a head scratcher. As a woman you have higher levels of estrogen when we’re younger. Why don’t we all have breast cancer in our 20’s? Just putting it out there. Every system in our body depends on estrogen in some way and it interacts with all other hormones, including cortisol and testosterone and insulin and more. We learn more every day or we would be if we got more funding for research on women's bodies.. Maybe we need to bring things into balance. Or better yet if we are so complex, ask that our doctors be brought up to speed on the latest information on female physiology.
Look, we don't have to know all of this. But we deserve to be treated by medical professionals who care enough to at least try to understand it.
Because what we have now is a lot of confusion and some really high doctor and pharmacy bills because insurance companies are slow to the party and play by their own rules when it comes to what they will and won’t cover.
If you really want to see misogyny in medicine let’s talk about sex.
Sexual dysfunction + Insurance insolence
Let’s take the treatments offered for sexual dysfunction for men and women.
There are over 26 different drugs on the market now to treat men’s sexual dysfunction ED. You know at least one of them. The little blue pill. It’s cheap and easy to get.
There are now 2 drugs for women. Specifically for hypoactive sexual desire disorder. Lack of desire for sex. And when they first came on the market insurance wouldn’t cover it until the woman had failed marriage counseling. Think about that. You can’t have this medicine for a medical condition until you fail marriage counseling. I wonder how they would prove that anyway.
Would we deny a patient insulin until they failed a weight loss program? No.
Testosterone therapy is an off label treatment for low libido in women. Off label because it isn’t approved by the FDA for women. For some reason even though we have more T in our body’s than estrogen the big men at the FDA don’t think we need it for anything so when it drops as it does when our ovaries retire or with adrenal fatigue or with age (like what happens in men) it isn’t important. When converted into the same measure. Our normal levels are 150-700 picograms/mL. Normal estrogen is 30 to 400 picograms per milliliter (pg/mL) pre menopause.
We talk a lot about estrogen levels but testosterone has some major benefits, including sex drive but also muscle and bone health and it can ease joint pain. But because it has to be compounded insurance isn’t going to cover it. You can get it, it's just out of pocket and pricey.
What’s up with the FDA? Is a woman’s sexual desire not as important as a man’s? It’s obviously not important enough. Inquiring minds want to know.
What that says to me is that there is an insidious bias throughout every layer of our medical treatment that believes that symptoms like low libido in a woman is psychological rather than biological (Untrue by the way, it’s totally biological) and is pleasure all that important for her anyway? Is it really that big of a deal for her? Just pat her on the head and give her an ssri instead.
When right down the hall all a man has to do is turn his head and cough to get a script for viagra and Testosterone replacement. Easy as that.
I’m not saying that that’s a good thing, anything to do with hormones male or female should be approached with lot’s of respect. And that’s the problem. Where is the respect for the differences and complexities between male and female bodies? There should be no double standard.
There is an excellent podcast episode with Dr. Gabrielle Lyon and Cindy Eckert on the double standard in sexual health. Definitely check that out
Medical Trauma
Why should we care about this? Because this implicit bias is being baked into our healthcare providers through their education and doesn’t seem to discriminate between male and female doctors and nurses. Maybe because so much of that education is coming from and sponsored by pharmaceutical companies.
In the second part of the US/Israeli study (mentioned earlier), the authors performed a controlled experiment with 109 nurses using clinical vignettes, which are case studies that are used as part of clinical training. This again revealed that pain was deemed less intense when the nurses were told that the patient in the scenario was female.
“Our research reveals a troubling bias in how women's pain is perceived and treated in emergency care settings,” said corresponding author Professor Shoham Choshen-Hillel, in a statement emailed to IFLScience. “This under-treatment of female patients' pain could have serious implications for women's health outcomes, potentially leading to longer recovery times, complications, or chronic pain conditions.”
Dismissal, gaslighting and biological sex discrimination between male and female patients is a path to medical trauma. It prevents women from reporting symptoms and interferes with and delays treatment and can lead to more negative health outcomes across the board. Not to mention triggering long term chronic pain, as well as mismanaged metabolic diseases as we age.
Maya Angelou said “Once you know better, do better.”
It doesn’t really matter why or how we got to this moment in our healthcare history. What matters is how we are going to proceed. We live in an extraordinary time where we have all of the information in the world at our fingertips and the ability to question it. (despite what some would have you believe it’s that piece, the questioning of science that makes good science.)
It seems unfair that women have to work harder to get the same medical care as a man. And it is unfair. It makes me angry on behalf of my fellow women. Perhaps we need to form our own lobby in order to push for more research funding, more time with our doctor, insist that insurance companies do their flippin job, insist that if the FDA is going to put their nose in everything anyway make it meaningful for the other 50% of the population and maybe while they’re at it go back and review their past decisions from time to time and maybe clean out their conflicts of interest too.
Unintentional misogyny and gaslighting is still misogyny and gaslighting and it all contributes to trauma.
If you're looking for ways to handle the effects of stress, physically, mentally and emotionally through the body head over to savagegracecoaching.com/theworkin you’ll find all the show notes for this and other episodes plus lots of free resources. And if you’re in a place where you are ready for more and you live in the Dayton Ohio area I’m taking private clients for trauma informed yoga and trauma release exercise in person and online. So you can book a discovery call and we can have a real life conversation. And of course I’d be ever so grateful if you would take a moment to like and subscribe to this podcast wherever you’re listening.
Thanks again everyone and as always stop working out and start working IN.
This podcast may contain affiliate links. I never recommend anything that I don’t have personal experience with.
Hey there!
I’m your host Ericka Thomas. I'm a health coach and trauma informed yoga professional bringing real world resilience and healing to main street USA.
I offer trauma release + yoga + wellness education for groups and individuals…regular people like you.
Book a call to learn how I can help.