Gender medicine is a research field that integrates a sex- and gender-perspective in medicine where biological as well as social sex differences matter.
Analyses of what disease and health means from a gender perspective is a very important area for optimizing prescription and treatment with drugs to men and women.
In this context, sex differences refer to biological differences, and gender differences refer to differences related to attitudes in society as well as economic, ethnic and socio-psychological differences. In the current quest for individualized treatment (“personalized medicine”), it is important to also understand what the X and Y chromosome means for genotype and phenotype; that is, at the cellular level, organ level, for disease mechanisms and expression of disease, for the pathophysiology, and the socio-psychological.
It is now well-known that the incidence of some diseases differs between men and women even if one disregards the diseases related to our reproductive systems.
Some diseases occur to same extent in both sexes but there are still always aspects of how pregnancy, menopause and oral contraceptives or estrogen affect drug efficacy and drug use.
We also know that heredity, risk factors, disease mechanisms, treatment response and prognosis often differ between men and women. Some examples of diseases that are more common in women are osteoporosis, many lung diseases, inflammatory diseases (SLE, rheumatoid arthritis, multiple sclerosis, thyroid disease), gallstones, certain brain tumors, irritable bowel syndrome, eating disorders, depression, migraine, fibromyalgia, Raynaud’s disease, whip-lash, leakage and prolapse of the mitral valve, Takotsubos disease, paroxysmal atrial tachycardia, spasm and dissection of the coronary arteries and myocardial infarction without coronary artery stenosis.
Examples of diseases that are more common in men are myocardial infarction with coronary artery stenosis, infections, diabetes, esophageal cancer, colon cancer, peptic ulcer disease, schizophrenia, autism, ADHD, alcoholism, obesity and psoriasis.
The same disease may also differ mechanistically and cause different symptoms (myocardial infarction, heart failure), and manifestations of disease (Lyme disease) in men and women.
In 2001, The Institute of Medicine in the United States published a consensus report from eminent scientists and clinicians who summarizes what sex/gender means for disease and health in the medical specialties, Exploring the Biological Contribution to Human Health – Does Sex Matter? The summary was: “Sex does matter. It matters in ways that we did not expect” (1). Recently, an international textbook on gender medicine covering the most common diseases was published (2).
Now, more and more evidence are showing up, where it is found that gender differences are important in medicine, both from a biological and sociological perspective.
Karin Schenck-Gustafsson, 2013-09-03
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