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 different than adults, 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 disease 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.
Men and women both have breast tissue, but 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. The symptoms of a woman’s heart attack may be very subtle. 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 must be 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 they passed 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. If men had to deal with many of the issues that women experience, there would have been solutions long ago, but instead the medical community often turns a blind eye to women’s concerns. Indeed, women are not just different versions of men. There are fundamental differences at every level, which have a profound effect on wellness.