Men, Women and Medicine: Does the Sex of the Patient Make a Difference?

In spite of the push for political correctness, it turns out that men and women are unexpectedly and profoundly different not only in their normal function, but in the ways that they experience the same diseases. That doesn’t mean males and females can’t be equally successful in performing most (but not all) tasks, but it definitely means that the sexes achieve goals and solve problems using very different strategies and abilities.

Over the past 15 years and for the first time in medical research, scientists have turned a laser beam on women, studying them first–hand rather than assuming that to study men is a good enough way to explore the characteristics of both sexes. We are, in fact, deeply different in ways that we never expected and it means that doctors will have to revolutionize the way we take care of patients: we’ll have to master the new information about how men and women differ and how that modifies what doctors do to prevent, diagnose and treat disease.

Here are some of the things we’ve learned about gender–specific medicine:

• The Brain: Men’s brains are larger than those of women, but women have more intricate connections between brain cells in the part of the brain devoted to speech and understanding language. When huge numbers of people are tested, there is a difference in innate abilities: men navigate three dimensional space more easily than women and women decode the tone and facial expressions of people with greater accuracy. That doesn’t mean individual people aren’t exceptions to this, or that we can’t learn to solve problems with greater facility. But we may use quite different parts of our brains to do that! The famed ability of women to multitask is reflected in the fact that when doing most things, more areas of the brain are activated than is the case for men, and there are more connections between the left and right sides of the brain in females than in males.
• Drug Metabolism: When we take most medicines into the body, it’s necessary to break them down into smaller, modified particles that the kidney, sweat or lung can excrete. Much of this processing takes place in the liver, and men and women have very different systems that achieve it. It’s important to know what medications work effectively in men and women and which are actually dangerous for one of the two sexes, although they may be very effective for the other. Most drug trials were done in men, so it’s important to know the latest information about how to prescribe medicines to avoid problems.
• The GI Tract: The gastrointestinal tract is more than just a hole in the doughnut of our bodies: it’s a continuous tube that pushes and processes the food we eat until we excrete what we can’t use. Women’s stomachs are slower to pass food on into the next part of the digestive tract than men, they secrete bile of a very different composition, and they are more susceptible to contractile disorders of the gut like irritable bowel syndrome (IBS). These differences need to be taken into account when we prescribe medicines that are largely absorbed in the stomach (women may need lower doses than men). The difference in bile composition and the products of bile breakdown may account for the higher incidence of colon cancer in women compared with men and differences in the nerves that control gut motility can explain the greater frequency of irritable bowel syndrome in females.
• The Immune System: Women have a stronger response to infection than men and can fight off invaders more effectively than men. High concentrations of testosterone, moreover, promote the multiplication of parasites, so that during mating season, the most attractive males may actually be in the greatest danger of parasitic infestation!
• Sexual Function: We’re finding out more and more about differences in the sexual function of men and women. Men are strongly aroused by visual stimulation; functional studies of the brain during sexual arousal show that the part of the brain involved in image processing lights up when men engage in sexual activity. Women are more likely to become aroused only after foreplay begins; many of them go to bed more for intimacy and comfort than because of lust! However, stroking the neck and upper back of women promotes the secretion of oxytocin, which promotes desire in women and helps bond them to their partner. So investing