Michelle’s parents rushed her to the emergency room. A doctor there asked her (in front of her parents) if she could be pregnant. No, she couldn’t be, Michelle explained, because she hadn’t had sex, and in any case, the pain was in her intestines. ‘They wheeled me into an exam room and without any explanation, placed my feet into stirrups. The next thing I knew, a large, cold metal speculum was crammed in my vagina. It hurt so badly I sat up and screamed and the nurse had to push me back down and hold me there while the doctor confirmed that indeed, I was not pregnant.’ She was discharged with ‘nothing more than some overpriced aspirin and the advice to rest for a day’.
Over the next decade Michelle sought help from two more doctors and two (male) gastroenterologists, both of whom told her that her problems were in her head and that she needed to be less anxious and stressed. At the age of twenty-six Michelle was referred to a female GP who scheduled her for a colonoscopy: it revealed that the entire left side of her colon was diseased. She was diagnosed with both irritable bowel syndrome and ulcerative colitis. ‘Funnily enough’, Michelle says, ‘my colon is not in my head.’ As a result of the extended delay in receiving a diagnosis and treatment she has been left with an increased risk of colon cancer.
It’s hard to read an account like this and not feel angry with the doctors who let Michelle down so badly. But the truth is that these are not isolated rogue doctors, bad apples who should be struck off. They are the products of a medical system which, from root to tip, is systematically discriminating against women, leaving them chronically misunderstood, mistreated and misdiagnosed.
It begins with how doctors are trained. Historically it’s been assumed that there wasn’t anything fundamentally different between male and female bodies other than size and reproductive function, and so for years medical education has been focused on a male ‘norm’, with everything that falls outside that designated ‘atypical’ or even ‘abnormal’.1 References to the ‘typical 70 kg man’2 abound, as if he covers both sexes (as one doctor pointed out to me, he doesn’t even represent men very well). When women are mentioned, they are presented as if they are a variation on standard humanity. Students learn about physiology, and female physiology. Anatomy, and female anatomy. ‘The male body’, concluded social psychologist Carol Tavris in her 1992 book The Mismeasure of Woman, ‘is anatomy itself.’3
This male-default bias goes back at least to the ancient Greeks, who kicked off the trend of seeing the female body as a ‘mutilated male’ body (thanks, Aristotle). The female was the male ‘turned outside in’. Ovaries were female testicles (they were not given their own name until the seventeenth century) and the uterus was the female scrotum. The reason they were inside the body rather than dropped out (as in typical humans) is because of a female deficiency in ‘vital heat’. The male body was an ideal women failed to live up to.
Modern doctors of course no longer refer to women as mutilated males, but the representation of the male body as the human body persists. A 2008 analysis of a range of textbooks recommended by twenty of the ‘most prestigious universities in Europe, the United States and Canada’ revealed that across 16,329 images, male bodies were used three times as often as female bodies to illustrate ‘neutral body parts’.4 A 2008 study of textbooks recommended by Dutch medical schools found that sex-specific information was absent even in sections on topics where sex differences have long been established (such as depression and the effects of alcohol on the body), and results from clinical trials were presented as valid for men and women even when women were excluded from the study.5 The few sex differences that did get a mention were ‘hardly accessible via index or layout’, and in any case tended to be vague one-liners such as ‘women, who more often have atypical chest discomfort’. (As we’ll see, only one in eight women who have a heart attack report the classic male symptom of chest pain, so in fact this description is arguably not only vague, but inaccurate.6)
In 2017 I decided to see if much had changed, and set off to a large bookshop in central London with a particularly impressive medical section. Things had not changed. The covers of books entitled ‘Human Anatomy’ were still adorned with be-muscled men. Drawings of features common to both sexes continued to routinely include pointless penises. I found posters entitled ‘Ear, Nose & Throat’, ‘The Nervous System’, ‘The Muscular System’, and ‘The Vascular System and Viscera’, all of which featured a large-scale drawing of a man. The vascular-system poster did, however, include a small ‘female pelvis’ off to one side, and me and my female pelvis were grateful for small mercies.
The gender data gaps found in medical textbooks are also present in your typical medical-school curriculum. A 2005 Dutch study found that sex- and gender-related issues were ‘not systematically addressed in curriculum development’.7 A 2006 review of ‘Curr-MIT’, the US online database for med-school courses, found that only nine out of the ninety-five schools that entered data into the system offered a course that could be described as a ‘women’s health course’.8 Only two of these courses (obstetrics and gynaecology classes taught in the second or third academic years) were mandatory. Even conditions that are known to cause the greatest morbidity and mortality in women failed to incorporate sex-specific information. Ten years later, another review found that the integration of sex- and gender-based medicine in US med schools remained ‘minimal’ and ‘haphazard’, with gaps particularly identified in the approach to the treatment of disease and use of drugs.9
These gaps matter because contrary to what we’ve assumed for millennia, sex differences can be substantial. Researchers have found sex differences in every tissue
