Throughout my career in medicine, when studying the care of
children, I have often heard the phrase “ Children are not just small
versions of adults” . They have their own unique characteristics
that make them special, and which require a different approach
when providing medical care. I have found the same is true when
it comes to women’ s health care, i.e. women are not just different
versions of men. Certainly, men and women have their similarities.
At the root of our existence, bodies of both men and women have
the fundamental missions of surviving and reproducing, albeit
the way men and women go about both of these is very different.
Fundamentally women are biologically, chemically, hormonally,
genetically, mentally, and spiritually, and sexually different
than men. As a result, there are a whole host of conditions and
diseases that disproportionately affect women, such as depression,
anxiety, obesity, thyroid problems, and many autoimmune diseases
including lupus, rheumatoid arthritis and multiple sclerosis.
Now let’ s begin to take a look as some of the differences which
contribute to these discrepancies.
The most profound difference between women and men is the fact
that women have babies and men don’ t. This basic fact propels us
into a whole host of other characteristics that distinguish women
from men. In addition to the obvious anatomical differences
there are many other unique characteristics of women. Women
go through puberty earlier, mature quicker, but have fewer fertile
years than men. In order to produce healthy offspring, women
must have a higher percent of body fat, and a higher waist to hip
ratio. They have different mating, sexual, and orgasmic tendencies
than males. Men are taller, with more body hair and have thicker
skin. Women tend to tolerate pain better and live longer. Sugar
metabolism in the brain is different in women and men. This may
help to explain why women are more likely to suffer depression
and act impulsively, while men are more likely to be aggressive
and hyperactive.
Women generally have smaller organs, including liver and
bladder. I can personally vouch for the bladder issue after taking
many long road trips with my daughters and having to stop every
thirty minutes for the potty. The smaller liver is associated with
an increase in sensitivity to toxins. This fact may help to explain
why women are much more likely to suffer from multiple chemical
sensitivity than men. Also associated with the liver is the fact
that alcohol is metabolized more quickly by women, therefore
the effects of alcohol come on quicker and are more pronounced.
Compounding this fact is the tendency of women to be more likely
to be binge drinkers. Women also have a higher fat to water ratio
which makes it more difficult for them to dilute toxins.
Breast cancer is much more common in women than in men and
it has reached epidemic proportions. This contributes to breast
cancer being the most feared disease of women. However, it
is vitally important to understand that heart disease kills about
six times more women than breast cancer. Hearts are smaller in
women. They beat faster and are less prone to atherosclerotic
disease while being more prone to spasm of the heart arteries.
Differences in men and women are seen even at the genetic level.
In many situations, men and women may have many of the same
genes, but the expression of the genes often has a significant
gender based component.
Hormonally men and women are quite different. Women have the
cyclic production of estrogen and progesterone associated with
ovulation, while men have about 10 times as much testosterone as
women. This has a profound effect on women at every level.
The implications of these differences are profound for women. In
my many years as an ER doctor, we applied a male model of heart
disease to women for many years. In order for a women to be
considered for a cardiac diagnosis we thought that she had to have
the same symptoms that men had, i.e. chest pain, nausea, left arm
pain, and shortness of breath. Recently we have begun to realize
that almost half of women with a heart attack have no chest pain.
As a result women often don’ t get the help they need until it is too
late. Women are less likely than men to survive their initial heart
attack, less likely to get out of the hospital alive, and more likely to
die within a year of their heart attack.
As evidenced by the above differences, women and men are
each unique unto their own. Yet most of the medical literature
is based on studies of men. Historically we have just assumed
that what is good for men is also good for women. The American
medical community was so negligent in this arena that the federal
government finally had to step in and in 1993 pass a law that
required that women be included in medical studies. Medicine still
has some catching up to do as far as appreciating the uniqueness of
women. We need to develop a more gender specific approach to
diagnosis, treatment and prevention in order to improve women’ s
outcomes. Indeed, women are not just different versions of men.
There are fundamental differences at every level, which have a
profound effect on wellness.
James E. McMinn, M.D.