Defining Women’s Health

Defining Women’s Health bigleyj

Women’s health is really designed for all people who need it.

But what does that big, broad statement actually mean? There’s a lot of history behind the effort to provide safe and affirming care to women of all backgrounds. And much of what we discuss when we address women’s health concerns is rooted in reproductive health, mental health, self-care and equal access to medical services. But is there even more that’s a part of women’s health? And what can you do to be sure you get the best care? Let’s talk about it.

Urogynecologist Cecile Ferrando, MD, MPH, explains more about what women’s health means, who it applies to and ways you can continue to put your needs first — no matter how you identify.

What is women’s health?

Women’s health is a relatively new area of study. When you consider the great span of medical science, most medical research has been historically centered around biological male bodies. For some, that may be a little shocking to learn. But it’s only within the last several decades that women have been truly included in clinical research — the methods used to study and advance medical treatments.

Women’s inclusion in clinical research

In 1993, the National Institutes of Health (NIH) passed the Revitalization Act that required the inclusion of women and racial/ethnic minorities in NIH-funded clinical research. The reason is that prior to that passing, women and ethnic minorities were largely excluded from clinical trials even in their earliest stages.

And it wasn’t until 2016 that the NIH passed a policy stating sex was a biological variable that needed to be factored into studies of both animals and humans. This meant that biological sex differences needed to be considered from the earliest stages of developing research questions and designing studies, all the way through analyzing the results and reporting on published work.

Translation: The NIH determined the sex you’re assigned at birth has a direct impact on your overall health and, therefore, should be taken into consideration when we make decisions about how we develop and advance medical treatments.

And yet, research continues to show that women and people assigned female at birth (AFAB) are still underrepresented in the earliest phases of clinical trials, where men make up 64.1% of the subjects studied.

“Women are just the tip of the iceberg,” says Dr. Ferrando. “Ethnic minorities, individuals of color, are really underrepresented in research. A lot of studies also exclude individuals who are trying to conceive or have the potential to become pregnant.”

How sex impacts your health outcomes

“We know physiologically, biologic females and biologic males are different in some respects,” says Dr. Ferrando.

For example, women and people AFAB have an increased risk of breast cancer and Alzheimer’s disease when compared to men and people assigned male at birth (AMAB). Other conditions that affect women and people AFAB differently include:

• Stroke.
• Heart disease and heart attacks.
• Urinary tract infections (UTIs).
• Chronic pain.
• Depression and anxiety.

One 2019 study of 6.9 million Danish people found that women were diagnosed much later than men for more than 700 conditions. On average, researchers found that women were diagnosed with cancer two-and-a-half years later in life than men with the same diagnosis. And for metabolic diseases like diabetes, women received a diagnosis four-and-a-half years later than men.

The researchers couldn’t determine the direct cause for any delay in diagnosis, and the study looked only at people who were hospitalized who had access to a single-payer healthcare system. But we know that women, especially women of color, have a long history of dealing with healthcare disparities, leading to an increase in undiagnosed or misdiagnosed conditions.

That’s why it remains so important for women to continue to advocate for themselves in the healthcare space. By being direct about how you’re feeling, the symptoms you’re experiencing and the concerns you have when speaking with a healthcare provider, you can help minimize the potential for misdiagnosis.

And that’s also why it’s important to start asking ourselves who else has been left out of the same conversations?

Who does women’s health apply to — and what services are included?

Historically, women’s health has been designed to fill a gap in healthcare needed by people who were overlooked or excluded simply for having biologically female anatomy. Areas covered by women’s health have traditionally included:

• Taking care of individuals with female pelvic organs from childhood through adolescence, reproductive ages and postmenopausal ages.
• Treating pelvic floor disorders.
• Treating cancers of the female pelvic organs (like cervical cancer) and breast cancer.
• Providing care for adolescent teenagers as they go through puberty.
• Reproductive health, pregnancy and postpartum care.

Over time, we’ve come to learn that there are even more differences at play between the sex you’re assigned at birth, your gender identity and your sexual orientation. The intersection of all these things has a direct impact on your everyday health and they all inform the type of care that you need to live a full and healthy life. And because of our current understanding of these concepts, what was once known as simply “women’s health” has now expanded beyond the male/female gender binary by opening the door for anyone who needs this type of healthcare.

“As we become progressive, accepting and inclusive, what sometimes happens is some patients end up falling through the cracks,” acknowledges Dr. Ferrando. “To categorize ‘women’s health’ as just one thing I think really excludes so much of the population that would and should be seeking the type of care that has gone under that umbrella previously.”

That means that now, “women’s health” applies to everyone who needs it — regardless of gender identity.

If you were assigned female at birth and identify as female, women’s health is for you.

If you were assigned female at birth and identify as another gender, women’s health is also for you.

But women’s health is also for people who were assigned male at birth and identify as female, nonbinary or some other gender (regardless of whether or not they’ve had gender-affirming care).

“There are certainly individuals who identify as women who are biologically male and need care,” notes Dr. Ferrando. “And there are certainly individuals who exist on the trans-masculine or trans-feminine side of the spectrum of gender identity who need the same level of care.”

As our definition of what makes a family unit has evolved, women’s health is also for anyone interested in pregnancy, fertility, family planning and adoption. And as our definition of women’s health becomes ever more expansive, we’ve also moved on from the concept that all women can — or want — to get pregnant or be parents. And because of that, Dr. Ferrando says women’s health is also for anyone interested in birth control or anyone who has concerns related to sexual health and sexually transmitted infections (STIs) regardless of their gender.

For people AFAB, regardless of gender identity, you may be interested in women’s health services if you:

• Need preventive screening for breast cancer and cervical cancer.
• Need assistance with hormone management, medication and other concerns related to your gender identity.
• Experience abnormal uterine or vaginal bleeding, or menstrual disorders.
• Experience pelvic pain, sexual dysfunction, pelvic floor dysfunction and pelvic floor disorders like pelvic organ prolapse, or urinary and/or fecal incontinence.
• Desire birth control to prevent pregnancy.
• Desire family planning and/or counseling about conception.
• Are pregnant and need obstetric care.
• Have absent or malformed female pelvic organs and need any of the above care.

For people AMAB, regardless of gender identity, you may be interested in women’s health if you:

• Need preventive screening for breast cancer because you’re taking gender-affirming hormones.
• Need preventive screening for prostate cancer if you’ve had gender-affirming genital surgery.
• Have had gender-affirming genital surgery and are experiencing vaginal symptoms.

It sounds like there are a lot of nuances to considering who belongs under the women’s health umbrella, and there are. But an easier way to look at it is to consider what kind of anatomy you have and what kind of conditions lend themselves to that anatomy. A women’s health specialist is someone you can see on an annual basis for regular checkups. They can serve as your primary healthcare provider and address any concerns you have about your healthcare. And if they need to refer you to other specialists who can handle more specific concerns, they can do that, too.

It’s also important to find healthcare providers who can take care of any of your concerns regardless of how you identify, how you present yourself or what anatomical parts you have. But it’s also important to keep up on annual exams and cancer screenings, particularly if you’re transgender.

“The trans-masculine population has very poor screenings for breast cancer and cervical cancer because broaching the issue of performing a pelvic exam and pap smear can be very challenging and traumatic for some people,” states Dr. Ferrando.

“The same thing happens for trans-feminine individuals, especially those who have undergone gender affirmation surgery and genital reconstruction. They don’t often get the prostate cancer screenings that they should get.”

Putting you first and the importance of mental health

Societal and cultural norms have too often dictated that women are caretakers first and individuals second. Often, women feel obligated to put others, children especially, before their own needs. It’s why we so often point out that women should put themselves first and not feel selfish about self-care.

In truth, everyone, regardless of gender, could use a little bit of self-care more regularly, even in small but powerful ways. By taking care of your mental health, and by advocating for your mental health needs in a healthcare provider’s office, you can improve your relationship with yourself, your healthcare provider and anyone most important in your life. And women’s health providers, especially, are positioned to be empathetic and validating to your experiences.

If you have mental health concerns related to stress, depression, anxiety or just need a little bit of direction, a women’s health provider can refer you to a welcoming and affirming behavioral health specialist who can help with whatever you need. And that’s especially true for anyone in need of gender-affirming surgical services who need to follow the current guidelines from the World Professional Association for Transgender Health (WPATH).

“On top of all the minority stress that happens to certain women and female-identifying groups, cis or trans, mental health is an added layer of minority stress that is felt,” says Dr. Ferrando. “To also admit that kind of vulnerability and weakness is something that people really try to avoid.”

No matter how you show up in a healthcare provider’s office, you are valid. Your thoughts and your feelings matter. How you see yourself in relation to the world around you is important. And whether you align yourself with womanhood or define yourself by other means, who you are at your core and what kind of care you need in order to live a healthy, sustainable life is key to your human experience. And that experience in healthcare often begins with sharing your story.

“A lot of people just want to live life as themselves,” says Dr. Ferrando. “And in the right, supportive environment, your medical narrative, like your story, is relevant to the care you’re going to need.”