We trust doctors to understand how our bodies work. That’s why a recent statistic revealed by Evvy, a company specializing in vaginal health care, seems so heart-stopping.
In its new, eye-opening and activist coffee table book, 100 Effing Facts About the Gender Health Gap, Evvy reports that “less than half of medical schools have women’s health curricula.” I was incredibly shocked when I read this statistic, and I wanted to know the facts behind it. I wondered: How can we trust a doctor to diagnose and care for us if they have not received the proper training? What exactly are medical schools not covering? And why does this matter?
I found several studies demonstrating that medical schools are severely lacking in education on sex- and gender-specific topics. This idea has gained broad attention only recently, however, Back in the mid-1990s, one survey found that only 14% of schools had a women’s health curriculum. Only 10% had an office or program dedicated to integrating sex- and gender-specific information, and only 28% had a women’s-health clinical rotation separate from the traditional obstetrics/gynecology rotation. By 2004, the numbers had not improved much: Only 30% of the schools surveyed had information in their curriculum on sex- and gender-specific topics.
Researchers in the Yale School of Medicine published an article about their own program in 2015, documenting that “less than 25 percent of 548 first- and second-year lectures and workshops at [their school] contained relevant sex and gender content.” Those that did include such content usually “dealt with basic biology and prevalence of diseases and conditions, not the underlying data or how sex and gender affect diagnoses, treatments, prognoses, and the effects of medication.”
Other components of medical education demonstrate this same lack of attention to sex and gender differences. In its recommended reading list for first- and second-year students, Drexel University provides no textbooks this year that explicitly relate to sex and gender differences. A Mayo Clinic School of Medicine study in 2021—which repeated one done in 2012—found that nine years later, even fewer students reported that they had covered sex and gender topics in their studies of gynecology, cardiology, and pediatrics . Their feedback included the following statements:
- “I did not realize there were so many differences between the sexes until taking this survey.”
- “I definitely think we should be taught this throughout our medical education.”
- “I pretty much had no idea what the answer was to any of these.”
- “I didn’t know what most of these conditions were or if a professor would have stressed sex differences in the manifestation or management of those conditions.”
All this research led me to ask: Why don’t medical schools include a comprehensive look at women’s health? The Association of American Medical Colleges notes that these programs still focus on male biology as the “default,” with cultural stereotypes identifying men’s bodies as the “norm” and women’s bodies, therefore, as atypical. However, as Dr. Miller and co-researchers from the Journal of Women’s Health note, “It is erroneous to assume that specific pathways or mechanisms identified from experiments using material from one sex automatically apply to the other without corroborating evidence for or against such assumptions.”
Medical researchers also often avoid conducting studies on female mice due to concerns that their fluctuating hormones could confound results. This choice actually magnifies the problem: Instead of seeing the impact of female hormones as a worthy research question itself, researchers see this factor as an extra variable to avoid and to control for at all costs. Scientists and health-care providers often struggle with the best way to bring information on sex and gender differences into educational and training programs, and they often settle for presenting them in courses on pharmacology or physiology, rather than incorporating them into clinical rotations. In part, their reluctance may also stem from the fact that people simply don’t understand the difference between sex and gender.
Despite all this hesitation and confusion, a subset of researchers have identified a simple solution. In the words of Dr. Martha Gulati at Cedars-Sinai Medical Center, “Women shouldn’t be [put] in a ‘special populations’ category,” and “[students] need to be educated on sex differences, not just about heart disease, [but for] every organ system. There should be a component about what is the same, what differs, and what is unknown.” Medical school educators do not need to worry about finding the right resources to corroborate these discussions, because many existing textbooks do focus on sex and gender topics. Additionally, the NIH has a “Bench to Bedside: Integrating Sex and Gender to Improve Human Health” course, and the Institute of Gender and Health and Cedars-Sinai both have resources that medical schools can easily integrate into their curricula. The Sex and Gender Women’s Health Collaborative also provides a universally accessible, digital collection of women’s-health and sex-and-gender curricular materials for diverse training programs and clinical practices.
According to researchers from the journal Biology of Sex Differences, “Educators must first be educated about the importance of SGSH [sex and gender-specific health topics] and informed about the status of integration of these concepts into current curriculum before progress can be made.” Faculty, donors, deans, alumni, and students can get involved in pushing for change in the educational system. Dr. Miller and her colleagues even outline a systematic process for change. First, the involved parties must assess whether their institution evinces a willingness to change, and if so, what kind of change it seems prepared for. Second, they must emphasize the business case for change, stressing that expansion of the curriculum will lead to improved standards of care, and they must show how change aligns with the school’s mission. Finally, they must engage students and provide leaders with easy-to-use, well-designed teaching material that professors can easily incorporate into existing curricula.
The most important thing for anyone looking to update and modernize their curricula is to remember why this matters. A 2022 survey of 1,500 individuals found that 75% of women report that doctors gaslight them: they do not listen to their women patients, tend to blame them, minimize their symptoms, and dismiss their concerns. Inadequate knowledge of sex-specific symptoms contributes to this medical gaslighting, and the resulting inaccurate diagnoses can threaten lives. For instance, women who experience a heart attack are 50% more likely to be misdiagnosed than men, and men with breast cancer more frequently die from the disease than women do.
In the end, the goal of improving medical education encompasses so much more than just making sure that medical schools focus on women’s bodies. Doctors also must learn to recognize differences in the presentation of symptoms and in the effects of wide-ranging diseases and conditions on both women’s and men’s bodies. These differences have major implications for the efficacy of diagnoses and cannot be omitted from medical school curricula. We must equip doctors, in whose hands we place our trust and our lives, with all of the knowledge they need to make the most informed decisions.
Author notes:
- For the sake of this article, I focus on biological women, not on transgender women, gender-affirming care, abortion care, or any other gender-related topic.
- Emerging research increasingly shows that sex differences are both real and impactful. For more information, check out this webinar.
- The University of Pittsburgh medical school has an excellent website breaking down this issue.
Aynsley Szczesniak is the Student STEM Programs Chair of AWIS North Carolina. She is also a sophomore at UNC Chapel Hill studying Biology, Mathematics, and Entrepreneurship on the premedical track, and is the Founder and CEO of Speak Out Sisterhood, a global nonprofit for young professional women in STEM.
This article was originally published in AWIS Magazine. Join AWIS to access the full issue of AWIS Magazine and more member benefits.