Author: Martyna Bachar
This article is a part of the MAGIEL GO GLOBAL initiative, a program aimed at international cooperation between quality student publications.
If women have in fact been continuously neglected, it is thus easy to deduce that they might be receiving poorer medical assistance compared to men. But why would researchers and doctors want to overlook 50% of the population in their studies if it leads to such fatal consequences? Is it possible that gender bias actually exists in medical research?
Are women being poisoned on a monthly basis?
A significant portion of the world’s population will experience menstruation at some point. Those who menstruate need to manage menstrual bleeding for several days each month over many years. That’s why the study – Tampons as a source of exposure to metal(loid)s (Shearston et al., 2024) – became popular over such a short period of time; before the publication of this work, no study measured the amount of heavy metals in tampons. The researchers tested samples from 14 brands to determine the concentration of 16 metals. They confirmed the presence of several toxic chemicals such as lead, cadmium and arsenic in tampons. Lead is the one that the researchers were concerned about the most, because it has no safe exposure level; any amount that could leach from a tampon and enter the systemic circulation might lead to adverse health effects.
Why are those metals in the hygiene products anyway? One way they could’ve been introduced is through the raw material themselves (cotton on rayon) being already contaminated. Toxic chemicals were also found in the water used during the manufacturing process. Lastly, several metals found in tampons might be added by the manufacturers because of their antibacterial, odor-control or pigmentation properties. Concerningly, consumer protection regulations regarding potential contaminants in tampons are nearly nonexistent in the US, EU, and UK. Additionally, none of these governments mandate that manufacturers test their products for harmful chemicals, including metals.
Generally, those are the reasons why people on social media are so outraged with the results of this study. It is often forgotten though, that the concentration being measured was of the metals in hygiene products, not the vaginal uptake of these toxic chemicals. There does exist a possibility of this absorption being substantial, but there needs to be more research conducted to be able to make honest conclusions. It would be preferable, of course, for women not to be exposed to toxic metals at all, especially through such a sensitive and highly absorbent organ. Nevertheless, we cannot be sure if panic needs to be spread only based on the results from this study. This work does raise an important question though. If no one tested tampons for heavy metals before, is it possible that other important aspects of women’s health have also been under-researched?
The history of women’s health
Most of us understand the meaning of the word „hysteria,” and we likely recognize that it is almost always associated with women. The term actually originates from the Greek word for uterus, hustérā. Its current usage dates back to the 17th century during which a common belief was that a malfunctioning womb could drive women to madness. According to this myth, conditions ranging from menstruation to menopause were considered diseases of the body or mind. Eventually, in the 19th century gynecology, psychiatry and neurology have all been recognised as independent medical specialities. This change was not all that positive for women though. Instead of improving the understanding and appreciation of their health, the emergence of new medical specializations did little to change the narrative around their supposed chronic hysteria. It merely entrenched sexism in the fields of science and medicine.
In the medical research environment, there has been a long and prevalent misconception that female bodies do not differ that much from male ones. Although there is now an acknowledgment of the importance of including women adequately in clinical trials, previous decades saw men being prioritized in research design and execution. Science has always had a tendency to assume a ‘default male’ position; this attitude basically portrays female bodies as small versions of men’s bodies, only with distinct reproductive organs. Therefore, scientists used to include almost exclusively males in their health studies. One explanation for such actions is that the menstrual cycle makes the female body too variable to yield reliable results, thus complicating and increasing the cost of running trials and analyzing results. Secondly, this neglect is often justified by safety concerns, for female subjects might be – or could become – pregnant. Protecting an unborn child has long been prioritized over including women in research. The fact that there are not many studies that consider those that are expecting a child is an issue in its own right.
Some of the areas of neglect
Cardiovascular disease
Cardiovascular disease, which means any condition affecting the heart or blood vessels, is an area that is in desperate need of recognizing sex-related differences in symptoms by medical professionals. According to the study Gender differences in coronary heart disease (Maas & Appelman, 2010), the risk of heart problems in women is often underestimated because of the erroneous belief that they are 'protected’ against cardiovascular disease. This lack of recognition, combined with differences in how this disease manifests in women, leads to less aggressive treatment and fewer women being included in clinical trials. Past studies have indeed incorporated mostly men, thus focusing on their symptoms only, ignoring the fact that female bodies might react differently.
One of the sex-related differences is that exposure to endogenous estrogens during a woman’s fertile years delays the onset of atherosclerotic disease (the accumulation of fats, cholesterol, and other substances in and on the artery walls). Before menopause, the incidence of coronary heart disease (a narrowing or blockage of the blood vessels that carry blood and oxygen to the heart) in women is low and primarily linked to smoking. Therefore, women with early menopause tend to have a slightly lower life expectancy than those with its normal occurrence. The transition to menopause is thus linked to a higher risk of heart disease.
Because research on heart attacks has also primarily focused on men, women often tend to ignore its symptoms because they simply don’t recognize them. It is widely believed that the main manifestation of a heart attack is chest pain, which actually occurs more often in men. What is different though, is that women might also experience dizziness, nausea, or vomiting more frequently than men. Other signs that they should watch for, in addition to chest pain or discomfort, include shortness of breath and back or jaw pain.
In general, to enhance therapeutic strategies and outcomes for women, it is essential for healthcare professionals to develop a better understanding of gender differences, including the gender-based interpretation of diagnostic tests. Cardiology guidelines should incorporate considerations of sex-related differences where applicable. Additionally, what will hopefully follow the incorporation of women in clinical trials, is the increased awareness of their individual risk factors and the signs of cardiovascular disease.
Autoimmune disease
In autoimmune diseases, women are at a significantly greater risk of falling ill; the vast majority of people affected are women. Rhonda Voskuhl (2011) confirmed it in her work Sex differences in autoimmune diseases. To comprehend why women are more susceptible, it is necessary to conduct more research on sex-related differences. In fact, if acquiring knowledge about women’s health in order to be able to give them better quality help is not enough, it is good to know that studying differences between sexes is actually crucial for both of them. This research aims not only to understand why women are more at risk, but also to discover why most men are less susceptible. Identifying a protective factor in males could provide insights into why some of them do develop autoimmune diseases.
Chronic pain
The issue of pain is a particularly difficult one; women are often dismissed when discussing their problem because it is often automatically assumed that it has something to do with their menstrual cycle, menopause or pregnancy. Even though in most epidemiological research, women are more likely than males to report various types of temporary and persistent pain, as well as moderate to severe pain associated with menstruation and childbirth, those cases are obviously not the only reasons for them to experience chronic pain.
Anita M. Unruh draws attention to several issues in her work Gender variations in clinical pain experience (1996). The first is that the factor of one’s gender may be independent or interactive with other aspects of the pain experience, such as severity, frequency, duration, and location. This consideration should be incorporated into both epidemiological and clinical research. Sex should be considered not merely as a demographic variable, but as a factor that may significantly impact all aspects of the experience. women tend to report more pain problems of bigger severity than men. Even under extreme conditions like homelessness, where one might expect both genders to experience pain at similar rates, women consistently report more headaches, musculoskeletal pain, and abdominal pain than men. This research suggests that women may bear a greater burden of pain, and this knowledge should continuously be explored in order to help more people more efficiently.
Do women deserve more attention than men?
The answer is: no. This is not an attempt to position women above men in any way, especially not when it comes to medical issues. What needs to be highlighted is that women have in fact been neglected in scientific research for many years. Since the beginning of the 21st century, things have slowly started to change, but as we can see on the basis of the aforementioned study on tampons, many aspects of women’s health are still under-researched.
The most important thing is to acknowledge and embrace that bodies of both sexes in fact differ from each other, and that gender should be incorporated in research as a variable in its own right. The importance of this incorporation cannot be emphasized enough, as it can help both men and women in getting the right diagnoses and thus proper support from healthcare professionals. The insufficient research on female bodies leads to a lack of knowledge, fueling bias and stigma in everyday conversations, which then results in even less studies conducted due to the absence of general discussion and interest in the subject. This endless cycle must be broken.
