By Manasi Jiwrajka

We look back at some of our case reports:

Gender remains an important determinant of health. For example, in HIV in India: the Jogini culture , we read that female gender ensured a lifestyle that exposed the patient to HIV.¹

“The patient never attended school. At menstruation, she awoke to a startling reality as she had her first sexual encounter in her parent’s home.”

Another case from India reports that more women and girls are illiterate compared to men (41.2% and 21.4% respectively).² Karande states that “maternal illiteracy directly affect[s] health-seeking behaviours,” and in this case, maternal illiteracy as well as maternal undernutrition results in infantile iatrogenic Cushing syndrome.

In this case from the USA, a patient without prenatal care has devastating consequences by attempting to deliver at home. ³

Sometimes, being a female is uncertain in and of itself as in intersex individuals or rare conditions such as female hypospadias, which may be recognised early in the patient’s life or much later.^4,5 Some females have had gender reassignment surgery, and were previously males. The surgical intervention to become a female may lead to complications.

“Vaginal reconstruction does come with a myriad of complications including rectovaginal fistula, urethral fistula, vaginal stenosis, with loss of either depth or width, urethral stenosis, hair growth in the vaginal canal if scrotal skin is used for construction”⁶

Women’s health is often equated to maternal health or gynaecological health but women’s global health includes cases such as the following:

1. Mental health in a Dominican, HIV+ woman who was scared of being considered “loca” and promiscuous. The authors write:

“Although the patient voiced suicidal intent, she was reluctant to see the psychologist for fear of being labelled as a ‘loca’ (crazy person). Locas are rejected in Dominican society for being perceived as being out-of-control, unpredictable and unable to fulfil expected gender roles…HIV-positive women are often negatively perceived as sexually promiscuous, which can be considered an insult to their partners’ ‘machismo’ (sense of manliness), and women who disclose their serostatus are at a greater risk of abandonment and abuse by their partners.” ⁷

2. Multiple Sclerosis in an anaesthesiologist from Trinidad and Tobago: MS incidence is higher among females, and the burden of the disease is high for any patient especially for someone working in “a medical specialty with a high level of stress and long hours of exposure and night shifts.” The patient, and the doctor, in this case writes:

“For those who read this article, just be part of those who are disclosing this global health problem for the well-being of many.”⁸

Women around the world are facing significant health issues both as patients and doctors. Some emerging priorities for women’s health globally are well outlined in this paper by Temmerman et al.⁹

1. Restricted physical activity among women due to social norms
2. Tobacco use, maternal smoking and COPD
3. Women’s cancers such as breast cancer, and cervical cancer
4. Conditions of older age without adequate treatment
5. Structural determinants of women’s health

Women in health are also celebrating today that we have come a long way to become anaesthesiologists, surgeons, gynaecologists and urologists.

References:

1. Borick J. HIV in India: the Jogini culture. BMJ Case Reports. 2014;2014.
2. Karande S. Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome. BMJ Case Reports. 2015;2015.
3. Kumar N, Gilbert L, Ellis T, Krishnan S. Consequences of delivery at home in a woman without prenatal care. BMJ Case Reports. 2017;2017.
4. Prakash G, Singh M, Goel A, Jhanwar A. Female hypospadias presenting with urinary retention and renal failure in an adolescent: uncommon and late presentation with significant hidden morbidity. BMJ Case Reports. 2016;2016.
5. D’Cunha AR, Kurian JJ, Jacob TJK. Idiopathic female pseudohermaphroditism with urethral duplication and female hypospadias. BMJ Case Reports. 2016;2016.
6. Rezwan N, Basit AA, Andrews H. Bilateral ureteric obstruction: an unusual complication of male-to-female gender reassignment surgery. BMJ Case Reports. 2014;2014.
7. Santoso LF, Erkkinen EE, Deb A, Adon C. HIV-associated dementia in the Dominican Republic: a consequence of stigma, domestic abuse and limited health literacy. BMJ Case Reports. 2016;2016.
8. Reyes AJ, Ramcharan K, Sharma S. Multiple sclerosis in a postgraduate student of anaesthesia: illness in doctors and fitness to practice. BMJ Case Reports. 2016;2016.
9. Temmerman M, Khosla R, Laski L, Mathews Z, Say L. Women’s health priorities and interventions. BMJ : British Medical Journal. 2015;351.