The BMJ Today: Gender and health—are men and women so different?

navjoyt_ladherThere are differences in the way men and women experience healthcare. Sometimes this is because the sex of a person confers a particular risk for a disease. Sometimes societal norms and cultural values lead to inequalities between men and women, which in turn affect health. Several articles published on in the past couple of days illustrate these differences.

In India, 13 women have died after having laparascopic sterilisation as part of a government run mass sterilisation programme in the Indian state of Chhattisgarh. A further 14 women are described as “seriously ill.” As part of India’s attempts to control population growth, people are offered financial incentives to undergo sterilisation. These payments are offered for both vasectomy and female sterilisation; however, of the four million sterilisations that were carried out last year in India, 97% were in women. Given that vasectomy is considered a safer and less complex operation than tubal ligation, one wonders what is behind this particular difference?

I was taught at medical school that women were at lower risk of cardiovascular disease than men until menopause, when the protective effect of oestrogen was lost—but what happens in middle age? A newly published research paper explores the differences in cardiovascular disease risk between men and women aged over 55. The study looked at 8000 people living in Rotterdam and found that at age 55, men and women have similar lifetime risks of cardiovascular disease. However, the way cardiovascular disease manifests for the first time varies: men are more likely to develop coronary heart disease as a first event, while women are more likely to have cerebrovascular disease or heart failure as their first event.

At medical school, I was also taught how to carry out examinations of male and female genitalia. I remember learning how to use a speculum and how to examine for testicular lumps. But there was less of a focus on how to talk to patients about their anatomy.

Michael Berry argues that by using euphemisms when examining women, healthcare professionals are contributing to an unnecessary taboo. This not only implies a sense of shame around terms like vagina and vulva, but it can also be confusing for patients: “Delivery by forceps entails half a dozen healthcare professionals peering intently at a women’s vulva and repeated examinations down below are loudly announced by obstetricians of varying seniority. On more than one occasion has the rightly concerned birthing partner turned to me and whispered: ‘Where are they going to examine?’”

Using the correct words might empower patients to communicate more freely about medical issues, something that would be great for men and women alike: “As healthcare professionals we owe it to our patients to promote the view that every part of the body has a name and no part of it is shameful or embarrassing.”

Navjoyt Ladher is clinical editor, The BMJ. Follow Navjoyt on Twitter, @dire_tribe