How did the male domination of medicine neglect and endaner the health of millions of women?

 When talking about gender bias, the first thing that comes to mind may be the discrimination women face in education, employment opportunities, or political participation. But the reality is that women suffer discrimination in other areas that are not highlighted, such as the medical field for example.

Throughout its history, Western medicine has supported social prejudices against women, which has contributed to the strengthening of men's dominance and dominance, depriving women of their rights to education, political participation, and control over their bodies, as well as ignoring the diseases they are exposed to.

The dominance of men, which was accompanied by his physical superiority, was an integral part of the precursors of Western medicine established by the Greeks, who was one of their most famous philosophers, Aristotle, who believed that the woman’s body is a “distorted” copy of the man’s body because it does not contain the penis.

The fact that a woman's body contains an organ of great biological and social value, the womb, determines its function in bearing and nurturing children.

How did these prejudices begin and develop throughout history, and have they stopped or are they still continuing?

roving uterus

It seems that the doctors of ancient Greece, beginning with Hippocrates, considered the father of modern medicine, were obsessed with the woman's womb, and for them its presence was very important in explaining the physiological and mental differences between women and men.

The "roving uterus" theory was used by Hippocrates and his disciples to explain these differences.

The Greek physician Aratius wrote in the second century AD that the uterus can leave its place, and roam freely within the body "here and there on both sides of the body, upward in a straight line under the chest, or right and left towards the liver or spleen, or it falls downwards."

If the uterus moves upward, for example, it causes lethargy, weakness, dizziness, and headaches. If it descends, it causes a feeling of suffocation, loss of speech and consciousness, and even sudden death.

In the middle of the third century BC, the great Athenian philosopher Plato described the womb as a living being, "angered and sad" if his desire to become pregnant was not fulfilled.

It was believed that the menstrual cycle is related to many diseases that affect women. The treatment prescribed by doctors at that time was more social than medical: for a girl to marry at a young age, to have regular sex with her husband, and to have a large number of children.

During the Middle Ages, Christian moral codes in Europe forbade doctors from examining women's bodies. The female body was shrouded in mystery, secrecy and shame, and the doctors were content with their observations and did not listen to the patients.

“The women themselves did not dare reveal the sensitive details of It happens in their bodies...Although the writers of the Hippocratic Collection were advising doctors to ask women about the cause of their diseases, they also believed that their shame, as well as their ignorance of medical matters, meant that their account should not be trusted.”

Beginning in the fifteenth century, a new medical culture emerged that concerned the way women's organs and their internal systems worked. Doctors have tried to shed light on what is happening inside the woman's body, away from myths and superstitions.

But despite this, they agreed that the sick uterus affects women’s health in a big and frightening way, and they began to talk about strange symptoms that they observed in women who were suffering from what was called “uterine asphyxia”: shortness of breath, paralysis, convulsions, fits of laughter, singing and crying. The victims were usually young women or older women, most of them widows, who were deprived of sex and menstruation, which were believed to cleanse blood.

hysteria

In the seventeenth century, a number of ideas and theories prevailed that talked about the relationship between the "sick" uterus - which does not bear children or who has stopped menstruating - and a number of diseases and symptoms. Whether these diseases and symptoms were physical or mental, they were described as "hysterical", a word of Greek origin taken from the word "ὑστέρα" or "hostera" which means "womb". Hysterical agitation became the only explanation for all the ills that afflict women.

The famous doctor Thomas Sydenham, who was called the "English Hippocrates" believed that hysteria affects the vast majority of women, due to their fragile nature and weak bodies.

Sydenham believed that women suffering from hysteria exaggerate and imagine that they will face all the tragedies that can befall the human race.

Hysteria became the hanger on women's ills, becoming, according to Eleanor Cleghorn, "whatever male physicians want it to be. The common diagnostic factor was that the patient was a woman."

Although the theory of the uterus and its relationship to hysteria began to subside at the beginning of the eighteenth century, the theories that followed during the eighteenth and nineteenth centuries continued to explain the diseases that afflict women according to the same assumption that they are weaker than men, both physically and mentally.

Medicine began to view women as hostages of their weak nerves, and it was advised that females not continue their education after puberty, because this would constitute a health burden on their weak nerves, or it might become a path that leads them towards perversion and moral corruption.

Women: a carrier of sexually transmitted diseases

During the nineteenth century, Europe witnessed the spread of a number of venereal diseases, and the finger was pointed at sex workers.

In 1864, the British Parliament passed the Infectious Diseases Act to stop the spread of these diseases among naval officers and soldiers who frequented brothels.

The law gave police officers in certain locations the power to subject women who were suspected of being sex workers to painful examinations.

According to Eleanor Cleghorn, medical historian Dr. Anne Hanley who wrote an article on the matter in the London Guardian, doctors at the time were helping husbands who passed on diseases such as syphilis or gonorrhea to their wives to conceal the cause of their infection, often at the request of the husbands. These women knew they were sick, but not necessarily with a sexually transmitted disease.

To some extent, Hanley adds, "pragmatic patriarchy was behind these decisions: Doctors thought they were the most knowledgeable and outweighed the best interest as they saw it: if a woman discovered that her husband had caused her a venereal disease, she would make a commotion and make her husband's life difficult, and as The husband was usually the one who paid the doctor's fees, so his interests took priority.

Uterine hysteria is transmitted to the ovaries

The second half of the nineteenth century witnessed a debate among physicians about whether hysteria was caused by a defect in the nervous system or in a woman's reproductive organs.

For some physicians at the time, the ovaries replaced the uterus as the main cause of every ailment that affects women.

Followers of this school believed that a woman could "irritate" the ovaries by reading, looking at pictures and listening to music, which could lead to hysteria.

Some of the most famous doctors at the time believed that excessive education of girls led to many diseases. This may reflect their fears that educating girls will lead them away from what they see as a woman's true role in life as a wife and mother.

Doctors in America and Europe began performing ovaries to rid women and girls of a large number of organic and psychological diseases. In some cases, this was done without consulting the patient.

"excretions"

In the first decades of the twentieth century, the attention of gynecology shifted from focusing on the reproductive organs to the "internal secretions" of those organs and of a number of glands, chiefly the thyroid gland - those secretions that were later termed "hormones".

It was believed at the time that these secretions are what makes a woman a woman. According to William Blair-Bell, who was considered one of the greatest gynecologists of the twentieth century, a "normal" woman is one who has a moderately balanced amount of secretion, and therefore a moderately balanced femininity whose ambition is to marry and have children.

But if the rate of secretions in women is disturbed, it either leads to their unwillingness to marry and have children, or to have their sexual desires out of control.

Blair-Bell says in his book "The Sex Complex" that women cannot reach the "highest echelons of genius" because the female mind does not rise to that. But if she happens to be a woman of genius, she is "no longer a woman in the biological sense of the word".

And since a woman's "excretions" are constantly changing during the menstrual cycle, during pregnancy and menopause, this makes her metabolism unstable, in Blair-Bell's opinion, unlike a man whose metabolism has evolved to become stable and uniform so that he can control his nerves and clear his mind during hunting.

Whereas in the past the female nature was described as “hysterical” or “nervous”, “secretions,” or hormones, and the changes and fluctuations that occur to them are the main explanation for many chronic diseases that some women suffer from.

Prejudice forms now

Many researchers in the field of women in Western medicine believe that prejudice against women continues to this day, and is still based on historical stereotypes and prejudices.

This bias takes many forms. For example, although women generally suffer from chronic pain more than men, a 2018 review by the National Institute of Health in the United States that included 77 medical articles showed that in many cases, the chronic pain experienced by women patients is ignored They are described as being overly sensitive, hysterical, or time-consuming.

And recently, a study in Canada found that women are 32 percent more likely to die when they are operated on by male surgeons, compared to female surgeons. Among the possible reasons espoused by the study is that there is a significant difference in pain perception or pain appreciation between male and female surgeons. Male doctors have "a lack of appreciation or perhaps a kind of underestimation of the severity of symptoms in patients".

And a lot of research indicates that diseases that appear in women with symptoms different from the symptoms experienced by men usually go undiagnosed. Also, the diseases that primarily affect women are still shrouded in mystery, as there is a lack of studies that address them and the treatments that target them.

Historically, females, both humans and animals, have been excluded from participating in clinical trials and studies. Among the excuses presented, the hormonal changes that the female body undergoes complicate the results. But a 2010 study by Irving Zucker and Annalis Berry on gender bias in medical research concluded that this justification has absolutely no scientific basis.

Some scientists also excluded women of fertile age from drug experiments to avoid the risks that drugs may pose to fetuses in the event of pregnancy. But the reality is that women of all ages are excluded.

Studies conducted on men only were justified by the belief that what works in treating men will succeed in treating women, which led to disastrous results, as the latest studies show that diseases and medicines used to treat them affect men and women differently.

For example, between 1997 and 2000, eight out of ten drugs were withdrawn from the US market because of side effects experienced mainly or exclusively by women.

Women are more likely to develop a number of diseases that remain a major challenge to medicine, notably autoimmune diseases, rheumatoid arthritis, Alzheimer's, chronic fatigue and Lyme disease, however, says Maya Dusenberry in her book Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed and Sick), these conditions are not adequately researched and usually go undiagnosed or treated.

Bias against women in Western medicine, whether intentional or unintentional, is a serious and documented problem, and according to many research and reviews conducted in this regard, it puts women's health and lives at risk.

Although some countries have begun to take measures to confront the problem, such as the United States, for example, which made it mandatory to include women in clinical studies, and required pharmaceutical companies to provide evidence of drug safety and how they are affected by gender, race and age, there is still a long way to go to bridge the gap. The vast majority of women and men in this field.

“Gender bias in medicine is not only a scientific or biomedical bias, it is a cultural, social and political bias as well,” says Eleanor Cleghorn. “Whether medicine admits it or not, the centuries-old outdated notions that women’s pain is emotional rather than physiological are still Today, it is manifested in the way doctors deal with the symptoms that women suffer from.”