Why is it that women have a field of medicine to themselves and not men?

Considering that almost all medical practice and teaching, including “Standard” practice, diagnosis and treatment is based on males, women needed an additional specialty.

Men have a relatively simple sex characteristic; gynecological structure and obstetric practice is very complicated.

Because women have a uterus and ovaries and experience gestation.

The Urology office I go to has three specialties with their own specialists. 1) Urology, bladder incontinence, 2) Prostate issues, 3) Erectile dysfunction.
I never see a woman patient going into rooms 2 and 3.

There’s a vas deferens between men and women. :D

Other than the reproductive organs, there is no internal difference that would warrant gender specialties in medicine.

@Blueroses Ah…...

Because the default for medical research and practice is to study men and treat all humans as if they were men.

Nearly all clinical research is done on men, especially those using animal models. However, medical outcomes often vary widely between men and women.

@Blueroses, sex differences exist at every level of biology, from individual cells on up to the systems level (review).

@Blueroses, GA. That was awesome. I needed a good laugh.

@nikipedia , glad to know you’re alive.

Not to mention the field of andrology. An andrologist specializes in issues of male fertility. I didn’t quite understand why @Blueroses mentioned the vas deferens, but I can personally attest to the difficulties that the lack of one causes a person. Fortunately, modern medicine really is quite miraculous. Had I been born ten years earlier, I doubt I would have had children. As it was, my wife nearly ran out of fertility before we got our babies.

i would never want to be hangin around testicles all day.

@jazmina88 that would totally mean you’re a dick

@wundayatta vas deferens . . . . . . . vast difference? I’m surprised at you.

Because mens whole system doesn’t rely so heavily on their reproductive organs. Plus giving birth or not giving birth has a funny way of sometimes screwing up an otherwise healthy system and certainly disturbing our hormones.

@Sunny2 I know, I know. [hangs head in shame]

Rumors of my sense of punnery are vas-ly overrated.

Because men are the the default humans. Hahahahaha. I’m sorry, I know I can’t match @Blueroses for sheer fabulosity of punnery, but I couldn’t resist.

@nikipedia You are wrong. There is no default to men in human medical research. Good Clinical Practices, The various Ethical Oversight Commissions and the FDA require that clinical trials involve broad demograqpics representative of the target population. This means that, if a the pharmaceutical or procedure being tested is intended for use in the general population, the allowable tolerances would be a subject population of 49% to 51% of one or the other sex. Nobody in the medical world would otherwise take the results of a demographically skewed trial seriously, especially the FDA. And companies involved in medicine would find such a study useless, especially in today’s legal environment. Any such protocol would never pass protocol review.

Until the 20th century, one of the main reasons that research was skewed toward men was the difficulty in obtaining female cadevers due to societal taboos worldwide. It was hard enough to get male cadavers. Most work on female cadavers was done in secret and at great risk to one’s reputation if the physician were to be caught. The research results had to be published privately and anonymously also at great risk and therefore not widely diseminated. The taboo against women being exposed to the nude male body kept women out of anatomy classes in both the arts and sciences and without their input both these disciplines suffered.

I would like to see the sources from which you made your statement before I rate you Pants On Fire.

Uhhhh…. Of all people I don’t think I would challenge @nikipedia on this one.

@Espiritus_Corvus There were some very high profile heart studies in the1970s and 1980s that were men only. The recommendations coming out of these trials were applied to all, even though women were not included.

The bias was so strong that Congress mandated that medical studies be …designed and carried out in a manner sufficient to provide for a valid analysis of whether the variables being studied in the trial affect women … differently than other subjects in the trial’.

But that mandate does not require female participation, just an evaluation if the findings are valid for women.

@Espiritus_Corvus, I’m glad you asked!

Since you mentioned the FDA, let’s start there. In the 1970s, the FDA actually recommended that women who may become pregnant (so, any woman of childbearing years) should be excluded from research studies completely (pdf). This guideline was not revised until 1993 (pdf). As a guideline, however, it was not a law. No actual laws were created until 1998, at which time the FDA required drug studies to report the number of men and women in their study—not to balance the numbers, or even to analyze the two groups separately!

Since the 1993 report, the number of women included in research studies has steadily increased. However, there is little oversight and compliance is poor. From a 2001 report to Congress: “There is no management system in place to record and track the inclusion of women in clinical drug trials or to monitor compliance with relevant regulations, so FDA is unaware that many new drug application submissions failed to meet standards.” The same report found that even when sex differences were actually found and different dosage recommendations should be made, the investigators in every case failed to make this distinction.

And even with these recommendations, drugs that survive clinical trials and are put on the market tend to be more dangerous for women. Of the ten prescription drugs withdrawn from the market between 1997 and 2001, eight of them were more dangerous for women.

So that is the FDA. Consider also that this is the last stop for drug development, which does not encompass all medical research. I don’t have a source for this, but as a research scientist I would estimate that more than 99% of medical research does not make it to the FDA. (Because it fails. Science is mostly a long string of failures.) So I do not think that regulating research at the level of the FDA is sufficient.

Since most medical research in the US is funded by the National Institute for Health, you might think this would be a good place to regulate the study of sex differences in medical research. In 1990 they established the Office for Women’s Health Research to encourage this. But equal investigation of men and women (or male and female animals) is still not a requirement of NIH-funded research.

Also, from a report by the Institute of Medicine: ”...a recent review of high-impact publications of clinical studies, including clinical trials and prospective cohort studies, of non–sex-specific cancers… found that women constituted less than 40% of participants (Jagsi et al., 2009). Other research indicates that studies of cardiovascular disease are particularly male-biased. A review of 19 randomized controlled cardiovascular trials found that only 27% of the participants were female and that only 13 of the studies presented sex-based analyses of the data.”

Let me conclude by telling you an anecdote about my own research. In 2006 I started taking birth control pills. I noticed some subtle changes to my memory, verbal fluency, and other cognitive functions, so as a recent college graduate with some knowledge of the brain and of research, I thought I would look up whether or not birth control actually affects any cognitive functions, or if I was just imagining things.

What I found was that as of 2006 fewer than ten studies had ever been done on the effects of birth control on cognition. This is a drug that 100 million women in the world use, and effects on memory, attention, perception, learning, and every other important behavioral trait were almost entirely unexplored. So in 2011 I co-authored a paper showing significant differences in memory in women using hormonal contraception.

As you can see, I think this is a very important issue. We have made a lot of progress recently, but there is a lot left to do.

Finally, let me refer you to a 2010 report on this issue from the National Academy of Sciences. Please let me know if you would like to see more sources.

@Espiritus_Corvus , told ya. I knew @nikipedia would clean your clock on this subject.

@nikipedia Thank you for your excellent answer. Evidently I have been working in organizations for the past ten years that operate within the spirit of the regulations, rather than just the letter of the law. In my capacity as clinical coordinator, it seems that I have been insulated from bad science by layers of ethics boards, lawyers, clinical monitors, great bosses who know how to screen out badly designed studies—and the fear of the FDA and their police powers. We hear and read about result-oriented labs in our journals, but they are far and few between and don’t last long. Or so I thought until now,. Thank you for the education, nikipedia, it was shocking and welcome. Is your paper online, can I read it somewhere?

@Judi, thanks :)

@Espiritus_Corvus, sure, I’ll send you a message with a link to the abstract.