Written by Aarini Guha

Introduction:

Picture yourself in this situation:

“Good afternoon, Doctor.”

“Good afternoon, what seems to be the problem?”

“I’ve been feeling really down lately— I feel as if my body doesn’t work the way it should. I feel weird pains in my abdomen. I’ve looked up my symptoms, and I think I may have something serious, like endometriosis.”

“I see— it’s probably nothing. You’re not pregnant, so you must be making it up.”

This is not an uncommon outcome of going to the doctor’s office if you’re a woman. If you identify with this treatment, you’re not the only one. In her article “Inside Medicine’s Gender Problem: When Women’s Pain Isn’t Taken Seriously,” Marie Claire describes this exact situation happening to her at the young age of fifteen, saying “Instead of concern, I was met with mockery”.

Now picture yourself in this one:

“Good evening, Doctor.”

“Good evening. What brings you here?”

“I’ve been really struggling to come to terms with my sexuality. It’s really affecting my mental health.”
“There’s no reason for that to happen. It’s all in your head.”

This situation is no more unique than the former if you belong to the LGBTQ+ community. In fact, according to a 2024 KFF survey, about 65% of LGBTQ+ adults report experiencing some form of discrimination in their daily lives compared to about 40% of non-LGBTQ+ adults. The statistics are just as concerning pertaining specifically to the healthcare field; 61% report a negative experience with a provider who made assumptions about them, blamed them for their own health concerns, and ignored their questions and requests for prescriptions compared to 31% of non-LGBTQ+ patients.

So why the disparity? A mixture of long-held practices of discrimination and implicit bias against marginalized groups have contributed to medical malpractice and lack of scientific data regarding said groups. This is an issue that must change in order to make the medical field a more accepting place for all.

Gender and Sex:

There is a concerning gap in quality of care that stems from the issues of gender and sex. A literature review conducted by Roberta Gualtierotti reveals that while women, on average, live longer than men, they are more likely to suffer from chronic pain and disease. In addition, their health issues are more likely than men’s to be underestimated in favor of more closely tracking a woman’s reproductive health. This coincides with experiences women have in the clinic— their symptoms are dismissed because implicit bias causes their healthcare providers to believe that women exaggerate their pain relative to men. Such beliefs lead to persistent discrimination within the healthcare field that discourages women from seeking professional help when they need it because of the fear that their care providers will either dismiss their concerns or not believe them at all.

This difference in care extends beyond the clinic; gender and sex-based differences have found their way into both clinical and wet-lab research. In clinical research related to disease symptoms and progression, women are often entirely excluded from studies, despite important biological differences between the sexes that would make it crucial to include them. Such studies result in researchers making broad generalizations about effects of certain diseases and treatments on all populations that can prove dangerously incorrect for women. In addition, bias towards men could mean that less research overall is conducted for maladies that mostly affect women.

In the laboratory, an increasing number of studies have reported a preference for experimenting on male mice over female mice due to concerns that female hormonal cycles might complicate analysis of results, a premise that has since been found unsound. Studies that account for both sexes as models allow for a more nuanced understanding of the differences in disease progression and symptoms between biological males and females, along with those that examine the influences of added hormones to simulate disease in transgender individuals. Increased equality when it comes to picking animal models can have lasting effects; one such study showed that experimental multiple sclerosis had a more serious presentation in female mice. Mice are genetically similar to humans, so such a discovery would disprove the stereotype that women are more likely to exaggerate their pain and therefore improve their experiences in the clinic.

In 2008, the World Health Organization coined the term “gender medicine,” defined as “the study of the influence of biological sex and gender, reckoned as a set of socioeconomic and cultural factors, on health and disease of each person”. In 2016, the Gender Policy Committee first published the Sex And Gender Equity in Research, or SAGER guidelines in an attempt to close the gap in treatment between marginalized and nonmarginalized groups of people on an international level. The teaching of both should be standardized in the medical field— with language tools that both define and suggest ways to eliminate discrimination in healthcare, we can ensure that compassionate treatment is accessible to everyone equally.

Sexuality:

In addition to biases regarding gender and sex, those belonging to the LGBTQ+ community are also more likely to experience some form of discrimination when seeking medical care. This stems not only from implicit biases regarding members of the LGBTQ+ community, but also from lack of awareness regarding their experiences with their sexuality and/or gender.

In a literature review published in 2020, Verrastro and colleagues have found that, while sexuality is considered to be an important part of holistic medical care and treatment, it is often overlooked for a variety of reasons. They cite a survey done in the UK that found that “although 60% of HCP [healthcare providers] agreed that sexual issues should be addressed, only 6% started frequent discussions with patients themselves due to personal blockages, like lack of training (79%), lack of time (67%), and embarrassment (50%).” They then go on to conclude that these “personal blockages” are best combated by programs designed to educate care providers on how to address sexuality and issues surrounding it with their patients. There are a number of trials that did just that, and while they vary in length, method, and rigor, providers found them to be “useful” overall.

This is not the only necessary way to increase visibility for LGBTQ+ issues. Education via reading material is also paramount to nipping implicit biases and stereotypes in the bud. For example, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, more commonly known as the DSM, has officially recognized asexuality as a normal sexual orientation in its latest version, the DSM-5. Asexuality is an umbrella term for a spectrum of sexualities defined by a general lack of sexual attraction to other individuals, with some variances in expression.

The legitimization of non-cishet sexual, romantic, and gender orientations (and asexuality especially, which is discriminated against even within the LGBTQ+ community) is essential in order to combat prejudice against marginalized groups of people and introduce more compassionate care in the clinic. While there are still a host of problems with the way asexuality is represented in the DSM-5 that are exacerbated by the lack of visibility for asexual issues, its inclusion in this vastly important text is a step in the right direction. Education for healthcare providers should reflect this increase in awareness for issues surrounding the LGBTQ+ community, in order to improve said community’s experience receiving treatment.

Conclusion:

Interactions between different peoples within the medical sphere represent a microcosm of interactions between those peoples in broader society. Thus, prejudice against certain sexes, gender identities, and sexualities have been present not only in society, but in healthcare, for a concerningly long time. This must change in order to make treatment more equitable for all parties. Instead of immediately dismissing marginalized groups’ concerns, providers need to learn to approach diagnoses with an open mind as a way to provide all their patients with the best possible care. Lack of judgment and bias in society begin with a desire to understand those who are different from oneself. Elimination of medical malpractice is no different.

Edited by Finn Chao