Q&A: How Sex and Gender Affect Health, Disease and Medicine

March 10, 2015

Alyson McGregor, MDMale and female bodies have so many similarities that the practice of medicine, until recently, didn’t make many accommodations for their uniqueness. While the reproductive organs obviously require separate specialties, researchers are discovering other ways that sex and gender affect health, disease and medicine. Alyson J. McGregor, MD, is an attending physician at Rhode Island Hospital and the director for the division of sex and gender in emergency medicine at the Warren Alpert Medical School of Brown University. Her research interests include evaluating sex and gender differences in emergency medicine and women's health, and she was a recent presenter on the topic for TEDx.

Q. What do we know about women’s emergency medicine today that we didn’t know a decade ago?  

A decade ago, women walked into an emergency department and could expect the medical care they received would be based upon research performed on men. We can now walk around and clearly see how women are different than men in the ways in which they have heart attacks, strokes, lung diseases, psychiatric disorders, autoimmune conditions, traumatic injuries and responses to medications and treatment regimens. Emergency medicine today has an opportunity to embrace these differences to improve the emergency care of women.

Q. When you discuss “women’s” medicine, you aren’t confining yourself to female reproductive organs, correct?  

Traditionally, medical issues relating to childbearing, breast health and menopause defined “women’s health.” It was thought men and women were similar in all conditions except the reproductive system. This created a foundation for medical research to be performed on men and then apply the results to women. We now know that women are different than men in more ways than just their reproductive system and sex hormones. Women’s health now depends upon complex interaction among biology, behavior and the environment.

Torso diagramQ. What are some of the common illnesses or diseases where sex and gender differences matter?  

A person’s “sex” refers to the biological differences between men and women. This biological effect is defined by men’s and women’s sex chromosomes, XX for female and XY for male. These sex chromosomes are within all of the cells in the body and influence health and disease. For instance, if women and men smoked the same number of cigarettes, women are more susceptible to airflow obstruction (COPD/emphysema) because they have smaller airways on average then men. “Gender” refers to the different roles and values that men and women may have in society. This can also have dramatic effects on health. For instance, in Liberia, 75 percent of those infected with Ebola are women. This is largely due to the fact that women are more often caretakers for the sick in this region, which places them at higher risk of contracting the infectious agent.

Additional examples include:

  • Women are two times more likely to contract HIV from intercourse than men.
  • Women metabolize alcohol at a slower rate then men leading to more cognitive impairment, motor vehicle accidents and liver disease.
  • Women are more susceptible to migraine headaches than men, which predisposes them to neurovascular disease.
  • Women are more likely to have atypical symptoms of heart attacks and strokes than men.
  • Women are more likely to attempt suicide, but men are more likely to be successful at it.
  • Men are more likely to suffer a cardiac arrest outside of the hospital than women.
  • Women are more susceptible to fatal abnormal heart rhythms when taking medication.
  • Men are more susceptible to fatal abnormal heart rhythms when exercising.
  • Women are more likely to have a diagnostic procedure that includes radiation than men when undergoing evaluation in the emergency department. Women are also more susceptible to the dangers of radiation (ex: breast cancer) than men.
  • Autoimmune disorders are 78 percent more common in women than men.

Q. How has this affected emergency medicine today?  

The specialty of emergency medicine is in a unique position to have a major impact on improving patient care in the area of sex and gender medicine. There are over 136 million emergency department visits per year that include a spectrum of acute illness and chronic conditions in every facet of human health, trauma and disease. The Department of Emergency Medicine at Rhode Island Hospital has the first of its kind Division of Sex and Gender in Emergency Medicine (SGEM) dedicated to conducting the research needed to discover differences in men and women in emergent conditions as well as designing educational programs that teach this new knowledge to the health care providers as well as the patients. Programs like SGEM have the ability to transform the way in which emergency medicine is delivered – safe, effective, high quality and patient-centered medical care that can benefit women and men.

Q. What do you think women can expect in the coming years regarding their health care?  

Women should expect a vastly different medical landscape in the near future. There are now increasing recommendations that research be conducted to include the ability to determine if important differences exist between men and women. We need to move toward not only understanding differences in susceptibility of diseases for women and men, but also to tailoring blood tests, imaging studies and medication regimens based upon patient sex. This will help create personalized, individualized medical care that will take these important differences of sex and gender into account.

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