Women have always been left aside in medical and psychological theory, medical and psychological experiments, and medical and psychological treatment. Women experience a dismissal of their concerns and are often left with questions unanswered. There is a diagnostic bias in medicine, leading women to be gaslighted and misdiagnosed. Women are less likely to receive treatments or procedures due to disparities in treatment. We also may be mistreated during pregnancy.  

Medicine is a male dominated field, filled with male doctors and specialists, male treatments and male focused diagnostic criteria. Medicine has forever been this way, with majority of research being based on men, and carried out with male only samples. Because of this, there is a superiority for the male body in medicine. On top of this, women’s pain is often seen as “hysteria” or “hormones” and brushed off. Women in pain are seen by society very differently than men in pain. Women’s illnesses are often falsely linked back to the uterus.  

Gaps in medical research leads to gaps in knowledge. 

Many researchers previously believed that men were the perfect test subjects for medicinal research because they don’t experience menstrual cycles and cannot get pregnant. Doctors would treat women based on this research, completely ignoring the fact that there are hundreds of biological differences between men and women. The differences between sexes can influence how diseases, drugs, and therapies affect people. The lack of research into genders other than men have led doctors to have a limited understanding of female, intersex, and trans people’s health.  

ADHD 

Women may be less likely to receive a diagnosis or evaluation for ADHD due to societal expectations and diagnostic thresholds. There are lower expectations for women about their behaviour or academic performance compared to men, leading to a lack of help or diagnosis. The threshold for referral and diagnosis is higher for women. This means that their symptoms need to be more severe or disruptive before they are addressed. Societal expectations of ADHD are that this is a “male” disorder, which leads to misinterpretation of ADHD symptoms in women.  

Diagnostic criteria for ADHD were developed from male samples. There is not much research into ADHD in women, which leads to misdiagnosis when it is seen. Hormonal fluctuations also affect how ADHD symptoms are shown in women.  

Women are often misdiagnosed, shut down, or delayed treatment when they show ADHD symptoms. ADHD symptoms in women are usually less disruptive, and therefore easier to overlook. Symptoms such as low self-esteem, anxiety, and depression are overlooked, as they are not often associated with ADHD.  

Autism  

Autism is more prevalent in men, causing doctors to often misdiagnose, underdiagnose, or not even diagnose when women present autism symptoms. Research shows that autistic women show greater social interaction and social communication skills than autistic men. Men show more social interaction difficulties, and a more severe presentation of symptoms. Autistic women are more likely to show worse intellectual performance, greater internalising and externalising, and more impaired functioning outcomes. Women show higher levels of social relationships and less social impairments, as well as lower levels of restricted and repetitive interests than men.  

The diagnostic criteria for autism were validated using mainly male samples, lacking any female representations of autism. Autistic women also tend to camouflage their symptoms or “mask” them, leading to family, teachers, and primary care physicians to miss the signs. Young women are more motivated than young men to fit in.   

Vaginismus 

Vaginismus is a condition often overlooked, and undereducated. It is a condition that causes involuntary pelvic floor muscle spasms during penetration. Its misdiagnosis is often because this condition may overlap others such as vulvodynia and dyspareunia. Vaginismus is often misdiagnosed as vulvodynia. It is a condition difficult to determine as dyspareunia or painful sex may mimic it.  

To avoid a misdiagnosis of vaginismus it is important to ensure a comprehensive evaluation by a healthcare professional that is experienced in vulvovaginal diseases and pelvic floor disorders.  

Endometriosis 

Endometriosis is a gynaecological disease that is characterized by symptoms of infertility, painful sex, heavy bleeding, and pelvic pain. It is caused when endometrial-like tissue grows outside of the womb. There is no cure for this disease, but there are treatments. Endo is hard to diagnose, as the symptoms correlate with many other conditions. Delayed diagnosis, failure to diagnose, or a misdiagnosis can have severe consequences with this condition, as patients will continue to experience these painful symptoms, and a lessened quality of life. Women are often misdiagnosed with IBS, leaky gut syndrome, haemorrhagic cysts, or cancer when they present endometriosis symptoms.  

Many doctors also overlook the possibility that their patient has endometriosis. They may opt to diagnose the patient with a UTI, or menstrual irregularities instead of looking further. Research shows that many women have experienced this, with it taking them years to finally receive a clear diagnosis. Many doctors undermine the issue, or their patient’s pain, and simply blame it on their menstrual cycle. Endometriosis is an incredibly painful disease that is too often overlooked. If you are experiencing difficulties in your medical care, ensure that you get second or third opinions from other doctors. A doctor’s failure to diagnose a patient can lead to years of extended pain.  

I spoke with Paige Pronger, who has been diagnosed and received surgery for her endometriosis. She experienced severe delays in receiving a clear diagnosis and felt undermined by her doctors consistently.  

When did you start experiencing symptoms of endometriosis? 

In year ten, my periods just started getting unbearable to the point where I just couldn’t move. The pain was everywhere, and I would just collapse.  

When did you officially get diagnosed with endometriosis? 

After surgery-5 years later.  

What were your experiences with medical neglect, did doctors ignore your symptoms or pain? 

At first I was just put on birth control and investigated with ultra sounds, and they told me I didn’t have endometriosis, so I suffered for years then went back to a specialist last year and was told that in New Zealand you can’t see endo on ultrasounds and it cannot be ruled out via that. They then put me in touch with a surgeon and got me on an urgent list due to how much it was affecting my everyday life. Not long after that I was hospitalised after getting an IUD put in and sent into labour pains. I was taken from my medical centre to the hospital in ambulance and given two green whistles and fentanyl on drip and kept for two days. While there the first specialist I saw said that the pain could be due to the endo and that they were going to push my surgery forward to this month and outsource me to private and send me home with very strong pain killers. The next day a female doctor told me that I didn’t have endo, and I shouldn’t be taking codeine for periods. She wouldn’t give me the strong painkillers to take home because ibuprofen and Panadol is always enough and shared a story of how she sprained her ankle and ibuprofen got rid of the pain and I’d be surprised how well it worked after I had already said that those painkillers don’t make any difference to my pains. A few weeks later I got a call that my surgery was in a couple days, and I got diagnosed with extensive stage 3 endo with adhesions. The neglect wasn’t just those experiences but also the many appointments I had over those years crying for help and being told to just change my birth control repeatedly and being refused to be put on a list for a specialist. 

Did you feel a gender bias against you during your doctor appointments? 

Possibly, just due to women being in pain always being assumed as just normal period pain and that we just must have low pain tolerance even by other female doctors who haven’t experienced endo. As well as that when I had appendicitis two years ago I was sent to hospital from urgent care to get urgent surgery and had to wait a whole day in hospital in the corridor because they wouldn’t perform surgery without an ultrasound to prove it wasn’t a cyst in the uterus even though I was in unimaginable pain and clearly presenting as appendicitis but I had to wait for ages till I was able to get a ultrasound then had urgent surgery, ended up getting an infection as it was left too long and was in hospital for a little over a week. if I was a male I would have got surgery instantly and been out of hospital in a day with it being acted on quick enough. 

Solutions 

To solve this gender bias in medicine, there must be more women and intersex inclusion in medicinal studies and research. We cannot accept a male sample anymore, everything must be tested on women as well. Workplaces need to hold accountability for staff showing bias or discriminatory behaviour. There also needs to be an increase in self-advocacy. If you are receiving medical care, you must stand up for yourself. Seek a second opinion from a different doctor, speak to a specialist, or bring a friend for support and to act as witness. Ask your doctor why they are not pursuing further tests or treatment for you and report any bias or discrimination that is obvious or severe.