Gender Medicine

Medicalization of menopause is a relatively recent phenomenon, originating from and shaped in the Northern American and Western European cultural context. This article, which is based on data from ethnographic research done in Istanbul between June 2006 and March 2007, explores how menopause is perceived and constructed in Turkey. Since the 1920s, Western science and technology has been accepted as the ‘‘guide’’ for the Turkish modernization project. Starting with the 1980s, neoliberalism and globalization brought structural changes, new notions, and practices in the health care sector as well as furthering and changing the modernization ideals. In this article I illustrate the interactions between modernization, globalization, femininity, and health by juxtaposing narratives of menopause as told by women and physicians. I argue that the ideals of modernity, especially the concept of ‘‘consciousness’’ (bilinc¸), provide a discursive basis for the adoption of the global medical discourse around menopause in the Turkish context.

Background The importance of sex and gender as modulators of disease biology and treatment outcomes is well known in other disciplines of medicine, such as cardiology, but remains an undervalued issue in oncology. Considering the increasing evidence for their relevance, ESMO decided to address this topic and organized a multidisciplinary workshop in Lausanne, Switzerland, on November 30th and December 1st, 2018. Design 20 invited faculty members and 40 selected physicians/scientists participated. Relevant content was presented by faculty members on the basis of a literature review conducted by each speaker. Following a moderated consensus session, the final consensus statements are reported here. Results Clinically relevant sex differences include tumor biology, immune system activity, body composition and drug disposition and effects. The main differences between male and female cells are sex chromosomes and the level of sexual hormones they are exposed to. They influence both loca...

Introduction. Gender responsive approaches are relatively new in the substance use field, although many studies highlight barriers to women's access to substance use services. The aim of this exploratory study was to investigate to what extent a gender responsive approach is applied in the Italian substance use treatment services and to explore the professionals' opinions regarding the advantages and the challenges of applying such approach. Methods. Administration of a structured questionnaire sent by e-mail to public and private non profit substance use treatment services (n = 329). Results. The majority of professionals recognize the importance of including a gender responsive approach in their working agenda, and the need for specific training. Overall , the gender-responsive approaches are limited to pregnant women and mothers. A subset considered this approach counterproductive as compared to individualized treatment options. Discussion. Results seem to indicate a general lack of understanding and awareness among professionals about the potentials of applying gender responsive approaches and about the social, economic and cultural factors that determine health inequalities and influence women's access to services. A reductionistic interpretation of the gender responsive approach seems to prevail, which limits women's needs to those of pregnant women and mothers.

Background: Atrial fibrillation (AF) is the most common arrhythmia encountered in both male and female patients. Objective: This evidence-based update attempts to address the advances in the science of AF management in light of key gender issues. Methods: In October 2009, 2 investigators (H.I.M. and B.D.P.) independently searched MEDLINE (PubMed [1950(PubMed [ -2009 and Ovid [2000][2001][2002][2003][2004][2005][2006][2007][2008][2009]) for all publication types in the English language, using database-specific controlled vocabulary describing the concepts of AF and gender (atrial fibrillation, gender, women, and men for PubMed; atrial fibrillation and gender for Ovid). The reference sections from the identified publications were also used. The methodologic quality of publications, their content relevance, and the authors' expert opinions guided publication inclusion in this evidence-based narrative review. Articles relevant to gender differences in pathophysiology, outcomes, and treatment of AF are summarized and discussed.

Background-Preeclampsia is new onset hypertension during pregnancy with proteinuria. The initiating event in preeclampsia has been postulated to involve reduce placental perfusion which leads to widespread dysfunction of the maternal vascular endothelium.

The increased medicalization of different life stages, including menopause, is a subject studied mostly in the Western context. Examining medicalization in the non-Western world advances discussions of body, identity and health. In this paper, I analyze the discourses around postmenopausal osteoporosis in Turkey, focusing on the different constructions of risk in the medical and popular literature. The empirical basis of the paper draws on ethnographic research done in Istanbul, Turkey between June 2006 and March 2007. The research includes participant observation in gynecology clinics, interviews with clinicians and menopausal women and archival research on the representations of menopause in the Turkish media between 1999 and 2006. Referred to as kemik erimesi (melting of the bones) in colloquial Turkish, osteoporosis has been an essential component in the medicalization of menopause in Turkey. I argue that postmenopausal osteoporosis is defined as a combination of embodied risk, which is related to the definition of menopause as a risky period, and lifestyle risk, demonstrated in discussions around “traditional” vs. “modern” clothing and healthcare habits. The Turkish example emphasizes the importance of local conditions in defining medical risk and complicates the embodied vs. lifestyle risk categories.

Background: Studies have suggested that sex/gender, ethnicity, and anxiety toward pain affect pain sensitivity response. However, most studies have been conducted in a developed (Western) country, where the "ethnic" comparison group was in the minority.

Background: There is evidence that amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is more common in men than in women and that gender influences the clinical features of the disease. The causes of this are unknown.Objective: This review examines the gender differences that are found in ALS and postulates reasons for these differences.Methods: A literature review of PubMed (with no date limits) was performed to find information about gender differences in the incidence, prevalence, and clinical features of ALS, using the search terms ALS or MND and gender or sex, ALS prevalence, and SOD1 mice and gender. Articles were reviewed for information about gender differences, together with other articles that were already known to the authors.Results: The incidence and prevalence of ALS are greater in men than in women. This gender difference is seen in large studies that included all ALS patients (sporadic and familial), but is not seen when familial ALS is studied independently. Men predominate in the younger age groups of patients with ALS. Sporadic ALS has different clinical features in men and women, with men having a greater likelihood of onset in the spinal regions, and women tending to have onset in the bulbar region. Gender appears to have no clear effect on survival. In animals with superoxide dismutase 1 (sod1) mutations, sex does affect the clinical course of disease, with earlier onset in males. Possible reasons for the differences in ALS between men and women include different exposures to environmental toxins, different biological responses to exogenous toxins, and possibly underlying differences between the male and female nervous systems and different abilities to repair damage.Conclusions: There is a complex interaction between gender and clinical phenotypes in ALS. Understanding the causes of the gender differences could give clues to processes that modify the disease.

OBJECTIVE:The main objective of this research was to determine the effects of exercise on primary dysmenorrhea in the high school girls. STUDY DESIGN: This study was a randomized clinical trial of 150 students suffering from severe dysmenorrhea. After getting permission from ...

9th Congress of the International Society of Gender Medicine
First Published October 22, 2019, Abstract
https://doi.org/10.1177/2470289719881516

Original:
https://journals.sagepub.com/doi/full/10.1177/2470289719881516
https://journals.sagepub.com/doi/pdf/10.1177/2470289719881516

Background: Studies have suggested that sex/gender, ethnicity, and anxiety toward pain affect pain sensitivity response. However, most studies have been conducted in a developed (Western) country, where the "ethnic" comparison group was in the minority. Objectives: This study measured the responses of Libyan men and women to cold pressor pain, and also examined the effect of anxiety about pain and of body characteristics such as height, weight, and body mass index (BMI) on pain responses. Methods: Students attending Garyounis University, Benghazi, Libya, took part in an experiment in 2007 that consisted of 2 cold pressor pain tests. During each test, participants plunged their nondominant hand into a slurry of ice. Time to pain threshold, time to pain tolerance (removal of the hand from the ice), and pain intensity and unpleasantness were measured using a 100-mm visual analog scale. Participants also completed a 20-item Pain Anxiety Symptoms Scale (PASS-20) questionnaire, with each item scored on a 6-point Likert scale anchored by descriptive phrases (0 = never, 5 = always). Results: Fifty-eight self-declared students (29 men, 29 women; age range, 19-38 years) participated in the study. Pain threshold was significantly higher for men (mean difference, 8.2 sec; 95% CI,-1.7 to 18.0; P = 0.04), but there were no significant differences in pain tolerance, intensity, or unpleasantness. Women had significantly higher scores on the PASS-20 total score

Estrogens and progestagens (ovarian steroids) not only play an important a role in sexual behavior and reproduction, but they are involved in the development, regulation, and function of all body systems, including aging, sleep, pain, pharmacodynamics, immune response, and cognition. They are essential to the maintenance of cardiovascular, renal, mental, and bone health. Often, their effects are positive and their absence, negative. However, in certain contexts they can promote the development of cancers and neurologic conditions. Finally, ovarian steroids can even affect the response to pharmacologic treatments for many diseases. Given their central role in human biology, it is essential to be able to accurately determine the circulating levels of these hormones. To facilitate such endeavors, this review provides a comprehensive overview of the role of ovarian steroids in normal and abnormal physiology, primarily in women. It discusses the sensitivity, specificity, and precision of the most commonly used assays for estrogens and progestagens: bioassay, immunoassay, and mass spectrophotometry. Examples of how each of these assays has been used with samples taken from serum, urine, and saliva are provided. Strengths and limitations of each method are discussed. (Gend Med. 2011;8:283-299)

Background: Men and women differ substantially in regard to degrees of insulin resistance, body composition, and energy balance. Adipose tissue distribution, in particular the presence of elevated visceral and hepatic adiposity, plays a central role in the development of insulin resistance and obesity-related complications.Objective: This review summarizes published data on gender differences in insulin resistance, body composition, and energy balance,

Background: Several types of renal disease progress at a faster rate in men compared with women, but the reasons for this sex difference are not well understood. Chronic renal disease is associated with elevated levels of toxic reactive oxygen species (ROS). Superoxide, the major ROS in the kidney, is generated by nicotinamide adenine dinucleotide phosphate (NADPH) oxidase.

Background: Male-female differences in the expression of hypertension and in end-organ damage are evident in both experimental models and human subjects, with males exhibiting a more rapid onset of cardiovascular disease and mortality than do females. The basis for these male-female differences is probably the balance of the complex effects of sex steroids (androgens, estrogen, progesterone) and their metabolites on the multiple regulatory systems that influence blood pressure (BP). A key target of estrogen and other steroids is likely to be the different components of the renin-angiotensin-aldosterone system (RAAS).

1. Dipartimento di Giurisprudenza, Universita degli Studi di Ferrara. Received by invitation on 24 June 2015. Abstract. Gender medicine is a very interesting fi eld of research, on account of its critical, deconstructive and innovative function with regard to medical knowledge. Its attention to gender is also likely to favour dialogue with other theoretical and research perspectives, fi rst and foremost with sociology and philosophy of law. In these disciplines, in particular, over the past few decades we have witnessed a special attention to “gender”-based discrimination, considered as a mechanism by which the various societies have historically attributed individuals roles and statuses, imposing what we know as “gender identity”. Over time, this consideration has led to the gradual emersion of women’s political and legal standing, thereby favouring the recognition of their full entitlement to rights. The latter undoubtedly also include the right to health, which gender medicine fa...

Topoi, Springer, September 2017 Topoi. An International Review on Philosophy Special Issue: Philosophy of sex and gender in gender medicine Index M. Cristina Amoretti and Nicla Vassallo
 Introduction: Philosophy of sex and gender in gender medicine 1. Mari Mikkola Sex in medicine: What stands in the way of credibility? 2. Emmalon Davis What is it to share contraceptive responsibility? 3. James A. Marcum Clinical decision-making, gender bias, virtue epistemology, and quality healthcare 4. Eileen Willis, Debra King, Jo Wainer, and Kei Owada Women and gynaecological cancer: Gender and the doctor-patient relationship 5. Anke Bueter Androcentrism, feminism, and pluralism in medicine 6. Leah McClimans Place of birth: Ethics and evidence 7. Stephanie Julia Kapusta Intersex diagnostics and prognostics: Imposing sex-predicate determinacy 8. Sylvie Gambaudo The regulation of gender in menopause theory

Background: Because patients with coronary artery disease (CAD) could benefit from interventions to decrease psychological distress, it is important to identify these individuals. Both salivary cortisol level and the Hospital Anxiety and Depression Scale (HADS) are recognized measures of stress/anxiety and depression.

Background: Women are especially vulnerable to HIV infection because of biological, social, cultural, and economic factors. In Brazil, AIDS was initially seen predominantly in homosexual men, but the epidemic gradually reached a gender balance as increasing numbers of women became infected with HIV.

Well-established gender differences in the clinical picture of fibromyalgia syndrome (FMS) have been suggested. However, studies on gender differences in demographic and clinical features of FMS have contradictory results. Their significance is limited by the small number of patients included and selection bias of single settings. The purpose of this study was to compare demographic characteristics (age, family status) and clinical variables (duration of chronic pain and FMS diagnosis, tender point count, number of pain sites, and somatic and depressive symptoms) of male and female patients in different settings (general population, FMS self-help organization, and different clinical settings). FMS was diagnosed according to survey criteria in the general population and in the self-help organization setting and by 1990 criteria of the American College of Rheumatology in the clinical settings. Tender point examination was performed according to the manual tender point survey protocol in clinical settings. Somatic and depressive symptoms were assessed by validated questionnaires. A total of 1023 patients (885 female, 138 male) were included in the analysis. Compared with male participants, female participants reported a longer duration of chronic widespread pain (P = 0.009) and time since FMS diagnosis (P = 0.05), and they had a higher tender point count (P = 0.04). There were no gender differences in age, family status, number of pain sites, or somatic and depressive symptoms. We found no relevant gender differences in the clinical picture of FMS. The assumption of well-established gender differences in the clinical picture of FMS could not be supported.

Background: Anxiety disorders are more prevalent among women than among men. Objective: The aim of this paper was to investigate to what degree current psychological theories and treatment of anxiety disorders incorporate sex and gender considerations. were identified using the PsycINFO and PubMed databases as well as manual searches. The following search terms were used: anxiety disorders and sex differences, anxiety disorders and gender, anxiety disorders and women, anxiety disorders and men; combinations of these terms were used with prevalence, phenotypes, treatment, and therapy. In addition to all the aforementioned combinations, we replaced anxiety disorders with agoraphobia, panic disorder, social phobia, specific phobia, obsessivecompulsive disorder, posttraumatic stress disorder, acute stress disorder, and generalized anxiety disorder.

1.04 [1.01, 1.07], P = 0.002) were univariate predictors of CV events. When combined into one model, the estimate for BDI was reduced by 22% (P = 0.02) while that for CRP by 14% (P = 0.002). Both variables remained independent predictors of CV events after adjusting for CAD severity and traditional CAD risk factors, including obesity. However, when adding smoking to the model, BDI was no longer significant (P = 0.16) while CRP was (P = 0.02). Conclusion:

Structural MRI studies provide evidence for sex differences in the human brain. Differences in surface area and the proportion of gray to white matter volume are observed, particularly in the parietal lobe. To our knowledge, there are no studies examining sex differences of parietal lobe structure in younger populations or in the context of development. The current study evaluated sex difference in the structure of the parietal lobe in children (7-17 years of age). Also, by adding the cohort of previously studied adults (18-50 years of age), sex differences of parietal lobe morphology were examined across the age span of 7-50 years. In the youth sample, we found that, similar to adults, the ratio of parietal lobe cortex to white matter was greater in females. Unlike the adult sample, there were no sex differences in surface area. When examining effects of age, surface area had a significant sex-by-age interaction. Males had essentially no decrease in surfaces area over time, but females had a significant decrease in surface area over time. These findings support the notion of structural sex differences in the parietal lobe, not only in the context of cross sectional assessment, but also in terms of differences of developmental trajectories.

In the absence of microbicides or vaccines effective against human immunodeficiency virus type 1 (HIV-1), the development of new anti-HIV-1 drugs remains a priority. Our efforts in this area suggest that molecules belonging to the family of cell penetrating peptides (CPPs) may also be potent HIV-1 entry inhibitors. CPPs are short peptides that can efficiently cross the plasma membrane, which is otherwise a formidable barrier to many extracellular molecules. Because of this ability, CPPs are currently being studied as delivery vehicles for therapeutic agents and larger molecules that cannot enter the cell. A 10-amino acid peptide derived from HIV-1 Tat protein has been well studied as an attractive drug delivery agent. We have demonstrated concentration-dependent inhibition of HIV-1 IIIB (X4) infection by Tat peptide, yet minimal antiviral activity against BaL (R5). In contrast, a 9-arginine oligomeric CPP (R-9), which differs from Tat peptide by a small number of amino acid residues, was shown to have considerable activity against HIV-1 IIIB and, surprisingly, concentration-dependent activity against BaL. With consideration of previous studies, we hypothesize that (1) both Tat peptide and R-9 are CXCR4 antagonists and (2) the limited amino acid sequence differences in R-9 relative to the Tat peptide confer CCR5-specific antiviral activity. Using Tat peptide and oligoarginine as the starting points, further studies will identify sequence determinants for CPP biological activity, demonstrate mechanisms of antiviral activity, and explore the potential of these peptides as the basis for the development of novel HIV-1 inhibitors.

Background-Both high body fat and low muscle mass have been associated with physical disability in older adults. However, men and women differ markedly in body composition, where men generally have more absolute and relative lean muscle mass and less fat mass than women. It is not known how these anthropometric differences differentially impact physical ability in men and women. Objectives-This study examines differences in anthropometric predictors of physical performance in older women and men. Methods-Participants were 470 older women and men aged 72.9±7.9y. Body composition was measured using DXA. Maximum leg strength and power were measured using a leg press. Muscle quality (MQ) was calculated as relative strength (leg press strength per kg of leg muscle mass). Gait speed and chair rise were used to assess mobility performance and functional strength. Results-BMI, age and muscle quality emerged as predictors (p<0.05) of functional strength and mobility in men and women somewhat differently. After accounting for age and sample, leg muscle quality was related to chair rise time and gait speed in men but not women. BMI was related to gait speed in both men and women, but BMI was related to chair rise time in only women and not men. Discussion-Results implicate the prioritized importance of healthy weight and muscle maintenance in older women and men, respectively for maintained physical functioning with aging.