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.

people do their own minge swabs in std clinics don't they? so we could do our own smears too (although not keen on idea of rummaging all the way up to cervix would rather it was me than anyone else)

but apparently people are looking into biomarkers so maybe the days of the smear test are numbered, they do cause problems - forgotten why, something to do with sensitivity or specificity and too many colposcopies or something

Margery............

That is a screening test for detecting the HPV virus. There is a small but significant difference in the technique used for collection of the sample.

A smear test involves the collection of cells from different locations upon and around the cervix to check for dyskaryosis. It is incredibly precise. Inadequate results are given by the lab should there be any doubt as to the accurate placement and collection of the cells as well as for contaminated smears.

For what it's worth, I've NEVER had a smear by a man or a GP (always been a female nurse and only the very last one was done by a male gynea). So fail to see the misogynistic link there. I also remember participating in a trial for a less painful smear technique using a swab rather than a scraper thingy - for the comfort of the woman, believe it or not.

Money side - how many times have I heard that little gem. How we had to have x, y or z drug/procedure because it's so lucrative to the person administrating....apparently this is why caesarean sections are so popular and why my son was put in neonatal care cos he was premature - it was all about money for those greedy consultants, and all those drugs and vaccines that we get foisted onto us....Beggars belief! And to all those posters who complain about women-only invasive procedures - that's just biology. Get over it.

I also have a huge objection to the word misogynistic used anytime some poster actually wants to say - bias. This word is deeply unpleasant - the dictionary def is 'hatred of women', alhough I realise that in RL, usage of this word is broader to include cultural attitudes. To say/imply the medical profession, in the west and in our day, is misogynistic is just plain wrong and inflammatory. Good grief. I'm embarrassed to call myself a feminist after reading this thread.

Yes LeBFG - the world is flat, because that's how it looks

Margery - I was thinking the same as you.

You realise, Margery, that your strange comment applies just as well to your POV?

Strangely enough, on a personal level the only misogyny I've encountered wrt my health has been from other women who have dismissed severe period pain as nothing, who told me I was "pregnant not ill" and that morning sickness was "all in my head." I've found that any medical problems I've had have been taken very seriously by doctors.

Paradoxically a big failing of the medical profession, the fact that it tends to treat the body rather than the person, is a positive thing when it comes to feminism IMO. Women are seen the same way as anyone else - as a set of symptoms to be treated. That attitude tends to limit sexism but has huge negative implications for more complex conditions such as mental illness.

I followed the link about DIY smear tests and there isn't much info in it. I can't figure out though how most women would be able to do the test on themselves, unless they were extremely flexible. It's not like a general swab that you swish around in the vagina then stick in a test tube. You have to collect cells from precisely the area of the cervix where two kinds of cells meet - the "zone of transformation," so you really have to be able to see the cervix clearly to do that. Sometimes even experienced health care practitioners don't manage to get enough of the right cells for the lab to see if there are changes.

That is what the cervical smear actually checks for. It's the area where two different kinds of cells meet where the changes are likely to occur. These changed cells sometimes just die off and cause no problems (which is why they don't always do anything immediately about "mild changes" as they can and do often die off and cause no problems.) The problem is when the changed cells continue to grow and replicate and become cancerous. That is what cancer is - normal cells that have changed, have mutated into cells that grow quickly and take over from healthy, normal cells.

It has been found that in the presence of HPV virus, the cells at the transformation zone are more likely to change. So while it doesn't cause cervical cancer, it seems to contribute to an environment where cells that can become cancerous are more likely to form.

As others have said, if you wait until "cancer markers" turn up in the blood, the cancer will already be quite advanced so treatment then will require surgery at the very least, and possibly it will be too late.

So, back to the original point - I can't work out how a DIY test which would have to extract cells from a very specific small area on a body part that the individual can't easily see or perhaps even reach would be effective. I'd need to know more about how it works to be convinced.

As undignified and uncomfortable as cervical smears or colposcopy may be for some women, it is still a relatively non-invasive test to diagnose changes before cancer is actually present, meaning the chances of successful treatment if detected are far better than for most cancers. This is pretty rare. Most diagnostic techniques involve punctures or cutting somewhere, often under local or even general anaesthetic with the associated risks of that. So, in that way we are fortunate that the smear procedure exists.

Unfortunately, there isn't such a reliable, simple or non-invasive method for detecting ovarian or breast cancer - not specifically because of a misogynistic health care establishment, but because of the nature of these cancers specifically.

Sorry if this is a diversion, but I just wanted to pick out something that Sunnywithachance said about fertility investigations and treatment. For a very, very long time, I have felt uneasy with the language and culture that dominates this field and the sort of expectation that the woman is somehow to blame for "failing to conceive," and should be willing to undergo painful and even potentially dangerous procedures in order to conceive - even when there is nothing wrong with her own reproductive health.

I think it was Renate Klein who wrote quite a bit about this, probably 20 or 25 years ago when "assisted conception" was still relatively new and not yet considered as the "obvious" option for couples having difficulties getting pregnant.

In at least half of cases of infertility, the woman is physically healthy with no problems. However, with the exception of artificial insemination by donor (AID), most fertility "treatments" involve drug and surgical interventions on her body, some of which carry the risk of reducing her fertility. I've always thought this is a bit ethically dodgy, but perhaps that's more of an issue for a separate discussion.

On the infertility issue - 40% of problems are with women, 40% with men and 20% there is a joint issue. This was the case certainly until five years ago when I left the medical field.

I think this 'blame the woman' idea is indeed the residue of patriarchy and misogyny plus ignorance i.e. the idea that there is a lot more to go wrong with women because it's all inside them and very complex whereas with men it is all very simple. We now know that is not the case and male reproductive problems can be complex too. We also now know that men have a biological clock with declining fertility after 40, though not so sharply or as early as women. There is much more emphasis now on tests and help for males and now, normally, they are the first to have their sperm tested for numbers, motility and morphology.

Hi there,

I am new here, and I am afraid I don't have much time to post.

However, I'm really pleased to find this board, and I wanted to just add my tuppence to this topic (though I realise it has moved on to a discussion of smears and fertility treatments, really).

But just quickly, I was struck in a book I read recently (Barbara Duden, Disembodying women) how recent the whole medicalisation of pregnancy is. Historically, it was a woman who recognised the changes in her body and who was able to tell the presence of a baby (quickening), whereas now, pregnancy is a medical event, and the foetus is no longer hidden. Obviously this crosses over into debates about abortion, but it is worth reflecting on the pressure which women are under to have ultrasounds and prenatal screening and the invasive nature of this to pregnancy. One goes through a process without really considering that there are other ways to approach the advent of a child. I don't think it matters the gender of the medical professionals treating you, but it is worth considering historically how this very medical, intrusive approach has developed. It is very, very gendered.

Secondly, contraception. I'm really glad that someone else at the top of the thread questioned whether the pill/implants is really that good a thing for women. It is so much taken as read that when you start having a sexual relationship as a woman, you use a hormonal contraceptive. I find that astounding, given the impact of hormones on women's bodies.

Thirdly, to the fact that the test subject is male - again, there are historical reasons for this, to do with the fact that male physicians only tended to get interested in women as reproductive beings. Someone mentioned Vesaluis, but there are other examples of anatomists looking at women (Hunter's Gravid Uterus, for example). Point is that historically, male anatomists have only been interested in women as different from men in their reproductive capacity, which has affected the way in which the body is understood and research medicine has developed.

I think this is compounded by gendered structures in society. Let me give one example: Doll and Hill's groundbreaking epidemiological work on smoking in the late 1940s was a prospective study of doctors because they were easy to follow. But they were also mostly all male, hence it was not until 1980 that they had sufficient data on the effects of smoking on women to publish.

Finally, the point about men not accessing medical attention as much as women is really interesting. This must be to do with women's caring role in society and assumptions along those lines. Again, to look historically, women were less likely to access professional medical attention before the advent of the NHS because insurance was organised along the breadwinner model. It would actually be really interesting to know how, when and why that changed.

Okay, I've gone on enough, apologies. I find this really interesting.

hallo Sleeptime: Interested in what you said about Doll and Hill because I worked with Richard Doll and was involved in getting out the health message about smoking, including that arising from the 40 year follow up of the doctors' study. There was also another reason why the data on women were not so mature: apart from there being fewer female doctors in the early days, the smoking epidemic in women has a different time trend because women started smoking in large numbers a couple of decades later than men. The time lag from first cigarette to death is normally decades so after the health message on smoking really started to get through (in the 1970s) men's deaths then started to plateau and fall while women's were still rising (because of this later start).

Hi Grimbletart.

Thanks for your reply!

I think that is true. I guess I find it interesting though that the media coverage until the 1970s was so much aimed at men, and then the first campaigns aimed at women were at women as mothers ('Do you want a cigarette more than your baby' or something along those lines). In Britain at least.

I met Richard Doll in the late 1990s, he was absolutely lovely. His view was that he knew the effects would be similar in women, just didn't have the data to back that up. I think you can argue that this was due to the trajectory of smoking prevalence, but equally, if you don't include that many women in the first place, it is kind of a self-fulfillng prophecy.

Not to single out Doll though. Cuyler Hammond in the States also only looked at men. I just looked this up - he wanted to recruit 100 000 volunteers, but it was too expensive to use a polling organisation such as Gallup, so his wife suggested that he should use female vounteers (housewives) to recruit participants and conduct the interviews. Can't decide whether that is liberating or exploitative, or neither...

Nice to talk to someone who knew Sir Richard. Why on earth he did not get a Nobel Prize I don't know, seeing that his epidemiological work on smoking (and other health related issues) has probably saved more lives that loads of other clever lab. research put together.

Incidentally, with you talking about the 1970s, Sir Richard was absolutely adamant and quite open in remarking that the biggest advance in the dangers of smoking getting across were the media. Until the 1970s in the interests of 'balance' every article warning of the dangers of smoking always included the 'other' side from the tobacco industry. Once the media - and particularly the tabloid media - accepted that smoking caused cancer and stopped 'balancing' every article by going to the tobacco industry the health message really took off.

I know what you mean about using the mother and baby message to warn about smoking. There was probably the remnants of patriarchy in it but TBH those warning about smoking have to decide what is the most effective way of getting the message across. In the case of women, the thought that they might harm their babies was a powerful disincentive to smoke, so women were collateral beneficiaries IYSWIM. In the same way it can be more effective getting a message over to teenagers if you ask them if want to kiss someone who smells like an ashtray, rather than warning them they might die in middle age because, as we all know, teenagers think they are immortal.

Sorry - don't want to derail the thread. Just don't think that patriarchy is always the motive behind some things. Sometimes, as with cervical smears, what works, works. It's that simple.

CailinDana, ever read 'The Yellow Wallpaper'? It's a Victorian short story about that kind of topic and it's chilling, and a good read.
www.library.csi.cuny.edu/dept/history/lavender/wallpaper.html

Thanks for the link cinnamonnut, I'll take a look :)

Great thread.

Yellow Wallpaper...chilling.

Ok, only read up to page 2 so far, but this is proper crazy - obtaining cells to be able to test them for changes instead of waiting for some non-existing technology to do something which goes for a related marker which doesn't target the actual cell that changes is misogynist?

Developing contraceptive methods which not only protect from unwanted pregnancy but help fighting a whole host of unpleasant side effects of periods or hormonal changes in general is misogynist?

And then again the whole bunkum that only a birth were women aren't allowed any pain relief than warm water but move around is good and non misogynist. (What do I know though, I insisted on being sliced open)

Nah, if fighting patriarchy means protesting against evidence-based ways of relieving period pain, avoiding unwanted pregnancy, fighting birth pain and detecting cancer early, then that's not for me

I read a couple of years ago about how they were beginning to test pain medication on women - reported as if this was ground breaking.

It is. And I note your other comment about women taking painkillers. Children take painkillers too.

For a clinical trial you want as few variables as possible so you look at healthy male adults.

One it has been established as safe for 100+ men it is trialed by 1 woman. Then later other women. This is because female hormones are at different levels at differnet times of the month, unless you are using a hormone based contraception in which case you are squewing the figures again.

So there are sound scientific reasons for using men.

Can see the logic of a stable hormonal background... but do the testosterone levels in young men fluctuate more or less than hormonal fluctuations in post menopausal women (not on HRT of course)?