gender bias in medical diagnosis gender bias in medical diagnosis gender-biased diagnosing is the idea that medical and psychological diagnosis are influenced by the gender of the patient. several studies have found evidence of differential diagnosis for patients with similar ailments but of different sexes. female patients face discrimination through the denial of treatment or miss-classification of diagnosis as a result of not being taken seriously due to stereotypes and gender bias. according to traditional medical studies, most of these medical studies were done on men thus overlooking many issues that were related to women's health. this topic alone sparked controversy and brought about question to the medical standard of our time. popular media has illuminated the issue of gender bias in recent years. research that was done on diseases that affected women more were less funded than those diseases that affected men and women equally. a female doctor takes the pulse of a male patient history the earliest traces of gender-biased diagnosing could be found within the disproportionate diagnosis of women with hysteria as early as 4000 years ago. hysteria was earlier defined as excessive emotions; adapted from the greek term, "hystera", meaning "wandering uterus". these terms stemmed from mind-body associations regarding the uterus affecting women's overall health, especially emotionally and mentally. within a medical setting, this hysteria translated to the over exaggeration of symptoms and ailments. because traditional gender roles usually place women at a subordinate position compared to men, the medical industry has historically been dominated by men. this has caused for a misdiagnosis within females due to the large number male workers in the industry holding on to beliefs regarding gender stereotypes. these gender roles and gender biases may have also contributed to why pain associated with experiences unique to women, like childbirth and menstruation, were dismissed or mistreated. women's overall health has long been associated with their reproductive abilities; further compounded by traditional views of sex, female gender roles, and femininity. emotional and mental health were correlated with reproductive functions; menstruation, fertility, labour; as well as societal expectations such as desire for children, motherhood, subservience, and femininity. more specifically, if a woman did not meet the expectations of reproductive functions (such as inconsistent menstruation cycles, inability to conceive or carry to term, as well as display negative reactions such as nausea, pain), it was assumed that she held resentment or non-desire to bear and raise children, as well as being defiant of her feminine nature and role. conversely, if a woman were not to behave in alignment with femininity and gender role expectations, unable to maintain and care for family and housework, insubordinate, sick or in pain; then it were to mean they were mentally ill or disturbed, often diagnosed with hysteria. in 1948 some women volunteered to take part in an experiment designed to quantify pain in laboring women. during their labor, their hands were burned in order to try to measure their pain threshold with the option to quit at any time and to receive treatment. during childbirth and as it kept progressing, the females were unable to feel an increase in pain insomuch as many of them received second degree burns without realizing. in a 1979 observational study, 104 women and men gave responses to their health in 5 areas: "back pain, headaches, dizziness, chest pain, and fatigue". when receiving these complaints, it was seen that doctors gave extensive checkups to men more often than women with similar complaints, supporting that female patients tend to be taken less seriously than their male counterparts with regard to receiving medical illnesses. in 1990, the national institutes of health recognized the disparities in research of disease in men and women. at this time, the office of research on women's health was created, primarily to raise awareness of how sex affects disease and treatments. in 1991 and 1992, recognition that a "glass ceiling" existed showcased that it was preventing female clinicians from being promoted. in 1994, the fda created an office of women's health by congressional mandate. the women's health equity act, passed in 1993, gave women the chance to participate in medical studies and examine the gender differences. before the act was introduced, there had been no research done on infertility, breast cancer, and ovarian cancer, which are conditions prevalent to women's health. clinical trials and research the approach to women shifted from paternalistic protection to access in the early 1980s as aids activists like act up and women's groups challenged ways that drugs were developed. the nih responded with policy changes in 1986, but a government accountability office report in 1990 found that women were still being excluded from clinical research. that report, the appointment of bernadine healy as the first woman to lead the nih, and the realization that important clinical trials had excluded women led to the creation of the women's health initiative at the nih and to the federal legislation, the 1993 national institutes of health revitalization act, which mandated that women and minorities be included in nih-funded research. the initial large studies on the use of low-dose aspirin to prevent heart attacks that were published in the 1970s and 1980s are often cited as examples of clinical trials that included only men, but from which people drew general conclusions that did not hold true for women. in 1993 the fda reversed its 1977 guidance, and included in the new guidance a statement that the former restriction was "rigid and paternalistic, leaving virtually no room for the exercise of judgment by responsible research subjects, physician investigators, and investigational review boards (irbs)". the national academy of medicine published a report called "women and health research: ethical and legal issues of including women in clinical studies" in 1994 and another report in 2001 called "exploring the biological contributions to human health: does sex matter?" which each urged including women in clinical trials and running analyses on subpopulations by sex. although guidelines have been introduced, sex bias remains an issue. a 2001 meta-analysis found that of 120 trials published in the new england journal of medicine, on average just 24.6% of participants enrolled were women. in addition, the same 2001 meta-analysis found that 14% of the trials included sex specific data analysis a 2005 review by the international council for harmonisation of technical requirements for pharmaceuticals for human use found that regulation in the us, europe, and japan required that clinical trials should reflect the population to whom an intervention will be given, and found that clinical trials that had been submitted to agencies were generally complying with those regulations. a review of nih-funded studies (not necessarily submitted to regulatory agencies) published between 1995 and 2010 found that they had an "average enrollment of 37% (±6% standard deviation ) women, at an increasing rate over the years. only 28% of the publications either made some reference to sex/gender-specific results in the text or provided detailed results including sex/gender-specific estimates of effect or tests of interaction." the fda published a study of the 30 sets of clinical trial data submitted after 2011, and found that for all of them, information by sex was available in public documents, and that almost all of them included sub-analyses by sex. as of 2015, recruiting women to participate in clinical trials remained a challenge. in 2018 the us fda released draft guidelines for inclusion of pregnant women in clinical trials. in a 2019 meta-analysis it was reported that 36.4% of participants in 40 trials for anti-psychotic drugs were women. medical diagnosis the possibility of gender differences in experiences of pain has led to a discrepancy in treating female patients' pain over that of male patients. the phenomenon may affect physical diagnosis. women are more likely to be given a diagnosis of psychosomatic nature for a physical ailment than men, despite presenting with similar symptoms. women sometimes have trouble being taken seriously by physicians when they have a medically unexplained illness, and report difficulty receiving appropriate medical care for their illnesses because doctors repeatedly diagnose their physical complaints as related to psychiatric problems or simply related to female's menstrual cycle. clinical offices that rely on healthcare routines become less distinct due to biased medical knowledge of gender. there is a distinct differentiation between gender and sex in the medical sense. because gender is the societal construction of what femininity and masculinity is, whereas, sex is the biological aspect that defines the dichotomy of female and male. the way of lifestyle and the place in society are often considered when diagnosing patients. an example of a significant condition from which an extreme gender bias and differential medical attention and treatment can be noted is that of cardiovascular disease. of this condition, coronary heart disease is the most prevalent; with women more often than men reported as fatalities. due to sex based medical prerogatives, women tend to be more concerned with their primary and secondary sex health characteristics; i.e., gynecological health and breast health especially in terms of cancer; as opposed to heart health. furthermore, mortality rates of women have increased since 1979; whereas men's conversely have displayed a decline. this can be attributed to differential treatment, specifically; preventative measures, refined diagnostic techniques and advanced medical and surgical capabilities that are directly catered to men's health. one proposed explanation of gender bias pertaining to cardiac concerns and treatment is that men are more likely report or assume symptoms to be cardiac related than women, i.e., stress, (in stressful situations, personal situations or as a controlled variable); however these hypothesis were found to be inconsistent. when addressing women's health in relation to cardiovascular health, sexed based differences are imperative in acknowledging in order appropriately diagnose and treat symptoms. specific diagnostic criteria for assessing women's cardiovascular health include: evaluating for high levels of triglycerides/low levels of hdl cholesterol (after menopause), diabetes, smoking, metabolic syndrome, gestational diabetes, and pre-eclampsia. men and women are biologically different. they differ in the mechanical workings of their hearts and in their lung capacities, resulting in women being 20-70% more likely to develop lung cancer. the differences between men and women are also seen at the cellular level. for example, the ways immune cells convey pain signals are different in men and women. as a result of these biological differences, men and women react to certain drugs and medical treatments differently. one example is opioids. when using opioids for pain relief, women and men have different reactions. surveys of the literature also conclude that there is a need for more clinical trials that study the gender specific response to opioids. although there is evidence pointing to the biological difference between men and women, historically women have been excluded from clinical trials and men have been used as the standard. this male standard has its roots in ancient greece, where the female body was viewed as a mutilated version of the male body. however, the male bias was furthered in the united states in the 1950s and 60s after the fda issued guidelines excluding women of childbearing potential from trials to avoid any risk to a potential fetus. additionally, the thalidomide tragedy led the fda to issue regulations in 1977 recommending that women should be excluded from participating in phase i and phase ii studies in the us. studies also excluded women for other reasons including that women were more expensive to use as test subjects because of fluctuating hormone levels. the assumption that women would have the same reaction to the treatments as men was also used to justify excluding women from clinical trials. however, more recent studies have shown that women respond differently to a variety of common drugs than men, including sleeping pills, antihistamines, aspirin and anesthesia. as a result, many drugs may actually pose health risks to women. for example, a 2001 study conducted by the government accountability office about drugs removed from the market between 1997 and 2000 showed that "eight of the 10 prescription drugs posed greater health risks for women than for men." pain bias in recent decades, the disparity between female pain treatment and male pain treatment has been receiving more attention. chronic pain is more prevalent in women than in men, and women report more severe, frequent, and prolonged cases of pain; however, they are less likely to receive adequate