Gender Medicine

Here’s what each gender needs to know to get the right care.

Painful reality

Women have a higher pain threshold than men because they have the babies, right? Well, not really. Men and women experience pain differently.

Men’s blood pressure (BP) rises when they’re in pain; women’s heart rate increases but their BP remains stable or may even fall.

The genders also have different reactions to pain with women feeling some kinds of pain more strongly. Men often get less relief from certain pain-relieving opiates.

“Pain is poorly managed in hospitals on the whole. The fact that women and men have different responses to pain isn’t well included in practice,” says Dr Jo Wainer, director of the Gender and Medicine Research Unit at Australia’s Monash University. “Young men are under-treated for pain because nurses call them wimps. Actually, they are more sensitive to specific types of pain than women.”

Ticking Hearts

New research is bringing to light the differences between the genders when it comes to heart attacks. One of the problems has been that women have made up less than seven percent of participants in cardiac research.

The major symptoms of heart attack in men include crushing chest pain, pain radiating to the left arm and a feeling of acute indigestion. Women’s symptoms are quite different and can include shortness of breath, weakness, unusual fatigue, a cold sweat and dizziness.

Balancing Blood Sugar

A 2007 study released this year by the US Centres for Disease Control found that although the death rate from diabetes had dropped significantly for men in the US, women weren’t seeing that improvement. Some experts suggest that’s partly because cardiovascular risk factors and coronary heart-disease were not treated as well in women as in men. There’s also concern at the numbers of pregnant women developing gestational diabetes. It can cause lifelong problems for both mother and baby.

How Moods Swing

There is a strong body of evidence emerging that male and female brains are wired differently. Women, for example, are more likely to suffer hypersomnia (excessive sleepiness), overeat or have other anxiety disorders, and attempt suicide. They are also more likely to get seasonal affective disorder (SAD, or winter blues) and be prescribed anti-depressants. But since these drugs stored in body fat, women can suffer side effects sooner.

A Different Prescription

Women can suffer greater side effects from drugs than men. This is due to hormone fluctuations, body weight, body composition, how their liver and kidneys metabolise drugs and how their bodies excrete drugs all come into play. Again, some doctors don’t take this into consideration when prescribing certain medications.

Gender Specific Drugs

Medical researchers are just starting to identify gender specific drugs. The three most common drugs have been found to effect the sexes differently.

• Acetylsalicylic Acid (ASA): The National Institutes of Health study found that middle-aged women taking ASA drugs (such as Aspirin) didn’t significantly reduce their risk of having a first heart attack, although it did reduce the chances of women (but not men) having a stroke. It took until age 65 for ASA to protect women from heart attack.
• Statins: Research published in the Journal of the American Medical Association in 2004 found statins had no effect on the mortality rates of women without cardiovascular disease.
• Zoloft: This antidepressant, used to treat various conditions was shown to have little effect on men suffering from post-traumatic stress disorder PTSD.

Into Our Future

Sex differences have implications for the care of older people. Women are more likely to be looking after others as they age. By the time they need care themselves, many will be widowed and living alone, says Professor Julie Byles, director of the Research Centre for Gender Health and Ageing at Newcastle University.

Men, on the other hand, tend to become more isolated. They’re more likely to continue driving but may struggle if they have to cook and look after the house themselves.

“It is important that services are designed with an understanding of the differences for men and women,” says Professor Byles.