Feminism and Medicine

[macaroonmunch]

Hi

I'm a frequent lurker on these pages and have learnt a lot from what I've read so I thought this would be a good place to ask what people's thoughts were on how women and women's health issues are seen in medicine. Apologies if I seem poorly informed, I've only recently begun really thinking about feminist issues.

I'm a current medical student and a lot of things in my education so far have just really annoyed me and don't seem right. The norm for all medical examples and anatomy is almost always male and the whole characterisation of some problems as 'women only' just seems odd to me when there is comparatively so little emphasis on 'men's health', as though men's health is the default and women's health problems are a whole other category. Even diagrams and models of the female reproductive system seem odd compared to the male versions- why is the vagina always depicted as gaping open whereas diagrams of penesis are always flaccid?

I don't know if I'm being over-sensitive but I know that the medical profession has not always been known as a bastion of feminism so I just wanted to gauge other people's opinions. What are the main ways in which medicine/medical education are sexist? And why? Sorry for the length of the post, I hope it's not too rambly.

Platform 51 briefing on women and antidepressants

Callin

You also say, "it's not the fault of the doctors" when it is precisely the doctors who could research alternatives.

Saying women should just consider a smear as nothing more embarrassing than a throat swab is to misunderstand what thousands of years of patriarchy dominating women's lives means.

So, yes, dismissing the women's fears / apprehensions / dislike of smears is to blame the women for their own hang ups.

Regarding developing new ways of detecting cancer of the cervix rather than smear tests, a lot of that is economics, surely. It's 'quick, non-invasive and cheap' - so who's going to pay to develop a new form of testing? And, if it costs more than smear tests, would the NHS/medical insurance companies pay for it once it's developed?

That's partly true I think Bonsoir, but it's also true that a smear is going to be a lot more painful if you're tense, which a lot of women are due to feeling embarrassed and nervous. The fact of the matter is, smears wouldn't be given if they were pointless. They're not done for the good of medicine or doctors, they're done for the good of the women being tested. You are not required to attend so if you find them objectionable, don't go. There isn't currently a better option and there is unlikely to be one in the near future.

I am not dismissing women's fears Greythorne. What I meant was from a purely physical point of view a smear should be the same as a throat swab. But clearly it's not the same, and that is due to our society. The fears women have are part of that societal influence, so basically I'm saying the same thing as you are. But dismissing smear tests because of those fears doesn't seem sensible to me, seeing as they do save lives.

"What I meant was from a purely physical point of view a smear should be the same as a throat swab."

That statement is very wrong. The sensitivity of my genitals is really quite different to the sensitivity of my throat and, from what I have gathered, I am far from alone

I certainly agree that the medical establishment has been and remains one that reflects patriarchal values. For that matter, imho it is also institutionally racist, homophobic, disablist, ageist and classist.

I also agree that the adult, white, non-disabled, straight male is seen as the "industry standard," and that there is ample evidence clinical trials that have used such a narrow range of subjects have led to skewed results. That has meant that treatments for women, for people from not white ethnic backgrounds and even people of different ages have not always been the most appropriate for their physical circumstances.

I also agree that sexism within the disciplines of psychiatry and psychology have resulted in inappropriate, ineffectual and often counterproductive treatment and care for women (and for people of colour, working class people, disabled people, etc.)

However, there are certainly investigations and treatments that have benefited the health of women and I think there is a risk of throwing the baby out with the bathwater here. Just because the health care establishment is sexist doesn't mean that it is in women's interest to reject all things connected with health care.

Screening for most conditions (including cancer) is to varying degrees inconvenient, uncomfortable and potentially upsetting, regardless of the sex of the client. Definitely there are things health care practitioners can do to reduce the impact of all of these, but it may not be possible to eliminate them all together. I certainly don't think it's wise to reject screening or treatment just on the basis that it's provided by a medical establishment that's sexist and/or that they should be doing more to make it less painful or traumatic (and not using it until that happens.)

With any health care system, cost is going to be an issue, whether the state pays for it through taxes or the individual patients or their insurers pick up the tab. Low cost but effective screening and treatment regimes are likely to be more accessible to more people than expensive and exclusive ones. Again, that's the case regardless of who the clients are.

I'm certainly grateful that I now live in a country where screening for specific women's health and general health condition is available free at the point of delivery. I know not everyone has had such a positive experience as I have of accessing such care, but it's quite likely I would be very ill or even dead now had I not had such access.

I'm more fortunate than my friend in the US who was recently made redundant and with that, lost health insurance for her (in the middle of investigations for possible gynae related cancer) and her daughter (who has a chronic bowel condition,) and has no idea how she will pay for any further tests or treatment until she gets another job (and even then may be denied insurance due to "pre-existing conditions.")

Even more sobering is the millions of women around the world denied even the most basic health care, including reproductive health care. Something in me feels "not quite right" about not engaging with screening and treatment programmes freely available in the UK while other women in the world are literally suffering and dying for want of these.

From a purely personal point of view, bonsoir, I find throat swabs far worse than smears. But either way, they are both unpleasant but relatively straightforward procedures in a sensitive part of the body, that's why I made the comparison.

For women 30 and over, a test for the virus, HPV, is better than a Pap smear for predicting cervical cancer risk

As one of the 25% of women who have suffered a sexual assault I find smear tests difficult, painful and induces panic attacks. After years of drugging psyching myself up to take them I've finally taken the plunge and asked to be taken off the register. Even that required an interrogation from a (male) doctor and a lecture on how silly I was being

Cailin- I know if you are tense smears are worse. But ime what matters more is the expertise and sensitivity of the person doing it. I went for a smear not nervous and it was horrendous - so painful.

I refused to go for another for years. When I did I was shaking in the waiting room and very very tense. I hardly felt a thing and actually said to the lovely Dr - is that it - because I couldn't believe she had done it. IME my horrendous smear was dismissed as - I must have been tense and embarassed and of course it will be uncomfortable then.

I agree Eats, that some health care professionals are rubbish. But that's not restricted to smears.

Agreed. But was worse is how when I was ever asked why I wouldn't have a smear test I was treated as slightly hysterical

And my point was that some women have good reasons for avoiding them - its not all about embarassment

True. I definitely think health care professionals need more training in the personal element of care, particularly when it comes to sensitive topics. But again that doesn't relate directly relate to smears, it's a side issue.

is cervical smear screening actually wonderfully effective then? I thought there were question marks over it

Well said KRITIQ.

Alameda

"Cervical cancer is not uncommon. In recent years the number of cases has fallen due to cervical screening tests. However, there are still over 2,000 new cases of cervical cancer diagnosed each year in the UK. Most of these occur in women who have never had a screening test, or who have not had one for many years. Cervical cancer can be prevented if you have regular screening tests. It is estimated that up to 3,900 women are prevented from developing cervical cancer every year in the UK due to cervical screening."

Source: www.patient.co.uk

Sorry for not replying earlier, I fell asleep last night and don't have much access to the internet in labs. Thank you very much for replying, you've all given me an awful lot to think about.

I don't mean that I've found individuals running the course to be very sexist or that individual doctors I've encountered have been sexist, the doctors I've met so far all seem very dedicated to both their male and female patients. What I mean is that the whole practice and teaching of medicine seems to be based on the assumption that the patient is male and that doesn't make a lot of sense to me. Obviously some things, like pregnancy or cervical cancer, are women's health issues. But things like respiratory medicine etc. are not men's or women's health problems yet every example I come across or explanation of these conditions I read seems to be based on the assumption that the patient is male.

The issue of drugs also struck me as institutionally sexist. Nobody's suggesting that pregnant women should be routinely involved in drug trials but to routinely exclude women seems really quite foolish.

With regards to smear tests, I have wondered why they are offered so enthusiastically to everyone when they aren't needed (or wanted) by everyone. I'm not far along enough in my education to have been involved in much clinical medicine so my knowledge is obviously lacking in many areas but it just seems lazy to treat all women as the same. Although there will be financial restrictions I don't see why that means women refusing smear tests should be treated as stupid. I also don't understand why there isn't an equivalent screening program for prostate cancer. Why aren't all men over 50 automatically asked to come in for a prostate exam in a similar way that smears are offered to women? The blood test for prostate cancer is inaccurate so why isn't a quick exam offered there? It just feels like men are allowed to make their own health decisions and not be subject to potentially embarrassing examinations whereas women must just put up with it. I hope that there is a clinical explanation for this which I'm just unaware of, I'd really like to know it if anyone could tell me.

There is now some good evidence that a one-off PSA (prostate blood test) of

I agree with Greythorne's points on the cervical smear test. The point being not whether the actual procedure is medically effective and low cost and therefore very successful, but that large numbers of women do find this procedure undignified and uncomfortable and yet there seems to be very little interest in developing less invasive techniques. It does seem that in terms of gynaecological and obstetric procedures women are expected to just 'suck it up' so to speak. If men were being routinely tested in a similar way would things be different?

I honestly doubt it Emphatic. The NHS tends to go with screening tests that are cheap and effective no matter what the sex of the patient. Yes, cervical smears are uncomfortable and unpleasant but that doesn't negate the fact that they do save lives. I'm not a doctor but I can't think of another test that would be as effective.

True Cailin - I can't think of any either but medically humans are incredibly inventive and massive leaps forward seem to be taken all the time in other areas of diagnostics. Seems more likely a lack of will to change the status quo. Possibly due to the fact, as women we are conditioned to put up with pain and embarrassment for the greater good, (giving birth to healthy babies), and are less likely to cause a fuss over these types of procedures - I don't know, just thinking.

The thing is though, Emphatic, a smear test really is a simple, safe, relatively painless (for most) procedure. As medical tests go it's about as good as it gets - no needles, a nurse can do it, no bleeding and low risk of infection. Spending money on finding an alternative when money is tight doesn't seem sensible.