Do you know what a heart attack looks like? What the signs to look for if you suspect someone near you is having a cardiac episode are? You’ll probably picture a person clutching their chest right?

But in Australia, this stereotype only reflects the reality of 49.3 per cent of the population. Because the other half often have a very different experience.

Heart attack symptoms are often far more subtle for females, manifesting in jaw or back pain. It’s even common for the symptoms to present like those of the flu. Although people with female anatomy make up more than half of the population, these symptoms are labelled as “atypical”. This perception and other implicit biases mean that females are often under-treated for cardiac incidents. As a result they’re are twice as likely to die following a heart attack when compared with males.

This is just one instance of medical misogyny, the systemic gender bias that contributes poorer health outcomes and higher mortality for women.

As a young woman, I had a complicated relationship with doctors. I have some very uncomfortable stories about the medical system failing me. But I spent years thinking my experience was an outlier. I only first became cognisant of the concept of medical misogyny as a complex, systemic issue about 10 years ago. I started noticing how quickly the pain of the women around me seemed to be dismissed by many medical professionals, something I had also experienced. A colleague I was working with at the time recommended the book Pain and Prejudice to me. It was at this point, I realised just how deep the roots of this issue run.

Even seemingly unrelated factors like women’s higher burden of domestic labour tie deeply into holding up medical misogyny.

As with most systemic issues, there is not one single cause. But this one is unique in that it can only be truly solved by undoing our entire system of patriarchy, because even seemingly unrelated factors like women’s higher burden of domestic labour tie deeply into holding up medical misogyny. Before we dive in, it is also important to recognise that this experience is amplified for women of colour, who face even poorer outcomes than their white counterparts. This year’s International Women’s Day theme is Balance The Scales; a push to break down the discriminatory laws, policies, and practices that harm women in our society. But before we can dismantle medical misogyny, we have to understand it.

Female health conditions are under researched – sometimes not researched at all

Did you know that there has been more research funding on male baldness than on endometriosis, a condition that affects 1 in 10 people with female anatomy? We have multiple solutions to male baldness but we’re yet to have a cure or even a reliable diagnostic test for endometriosis beyond surgery.

The reality is that historically, there has been very little research and very little funding to support research into female health. Less than 2.5 per cent of global medical research funding goes towards female reproductive health. This is a trend that dates all the way back to the era of “hysteria”. Women in the 19th and 20th century who were experiencing depression or anxiety had their symptoms reduced to an invented condition called hysteria. It was a catch-all that was often weaponised against women; and the list of treatments for this condition included regular marital sex, pregnancy and childbirth. While we have come a long way from attempting to treat serious conditions like depression with childbirth, we still aren’t acknowledging the uniqueness of female health conditions, researching them or even naming them correctly.

Just one example is Polycystic Ovarian Syndrome (PCOS). Despite affecting one in eight females, it is one of the most under-researched health conditions. Modern experts argue it’s also incorrectly named. This condition is a metabolic one that can trigger insulin resistance leading to diabetes – but it’s named purely for the ovarian cysts it can cause. Despite roughly 50 per cent of those diagnosed not actually presenting with cysts. And oddly, the cysts aren’t even cysts at all, they’re follicles. As a result, there is now a push to rename PCOS acknowledging the name is not congruent with the impacts and experiences of those living with the condition.

Conditions that affect both males and females are only seen through the lens of male symptoms, and conditions that affect solely females are not a priority to fund or research.

This is a pattern fed by the male as norm bias. Conditions that affect both males and females are only seen through the lens of male symptoms, and conditions that affect solely females are not a priority to fund or research. Because when doctors and researchers have been predominantly men for most of history (thanks to the historic exclusion of women from education and workplaces), of course conditions that affect men have been the priority.

Female bodies are treated as atypical versions of male ones – not their own category

Female bodies were not researched at all for a long time. Instead female bodies were simply considered scaled down versions of male ones, plus a uterus. What this means is that the vast majority of medical research and research on the principles of human anatomy over human history were done only male bodies only.

Of course, we now know that it is not the case that female bodies are just smaller male ones. Our bones are lighter, our blood carries less oxygen through our veins, our hormone patterns are unique, our feet are entirely different shapes... Female bodies are fundamentally different, they are not simply shorter and more compact male ones.

It was the case that researchers actively chose to exclude female participants from their research with the belief that the female hormone cycle added an extra layer of variability and could cloud the results. There are now laws in multiple countries around certain levels of female participation, but still many of the most common drugs and treatments emerged from an area with little to no female testing.

As a result, women are living in a world where the signs and symptoms of many conditions are seen as only the ones that present in males. And the drugs created to treat them have been designed to work on male bodies. The implications of this system are extremely serious.

The drugs created to treat them have been designed to work on male bodies.

Females often have an increased likelihood of dying of conditions like the aforementioned heart attacks, but even diseases like lung cancer when compared to men. Because decades of female exclusion from research mean we simply don’t understand their symptoms as well as we do the male ones.

But perhaps the more insidious aspect of this is that dosages and ingredients of drugs are all based around what has historically worked on males. There is growing evidence that some drugs are dosed incorrectly for female anatomy. In some instances, drugs are even less efficacious on the female body compared to the male body.

“According to the FDA, the second most common adverse drug reaction in women is that the drug simply doesn’t work, even though it clearly works in men,” explains Caroline Criado Perez in her book Invisible Women.

Medical gaslighting is real

Have you heard of a WW? It stands for “whiny woman”.

Dr Mary Claire Haver recently spoke about the term in an interview with Katie Couric. She also wrote about her experience on her Substack. She talks about being an intern seeing one of her very first patients, a woman who presented with fatigue, mood swings, anxiety, poor sleep, brain fog, joint pain, low libido, bloating, and weight gain. When the labs returned back normal, the doctor mentoring her simply said she had a “whiny woman” and that “there’s not much we can do. Pat her on the knee and tell her to drink some water and get more rest.”

It is not new or shocking information to any woman that our current medical system often gaslights women into believing their symptoms are exaggerated or imagined without proper investigation. Women’s pain, discomfort and symptoms are routinely dismissed thanks to a heady combination of lack of education around women’s health and straight-up sexism.

As women begin to speak up, we’re hearing more and more horror about IUD insertions, pap smears and the removal of cervical lesions – most of which are done without the support of adequate pain medication. But despite the requests for anaesthesia, many women are told it’s simply not necessary and that all they’ll feel is “pressure”. It’s due to the belief that the cervix has low sensitivity, a myth that that can be traced to a poorly understood passage in the Kinsey Report. Yes, women are being under-treated and under-medicated for painful procedures thanks to a human sexuality report from the 1950s.

93 per cent of women 25-34 said they’d felt dismissed when seeking medical help.

It is also commonplace for women to have their physical symptoms pathologised as simply manifestations of stress or anxiety – the “it’s all in your head” trope. In other instances, their experiences are written off as “just part of being a woman”. A recent survey published by Psychology Today showed that 93 per cent of women 25-34 said they’d felt dismissed when seeking medical help.

The result of these biases has catastrophic impacts for women seeking medical attention. According to Northwell Health: “women who went to the emergency room (ER) with severe stomach pain had to wait for almost 33 per cent longer than men with the same symptoms.” As for trying to get a diagnosis for something like endometriosis, the average time diagnosis is between eight and ten years. In the meantime, women are left to live with the debilitating symptoms untreated.

Inequality in other areas drives lower participation in medical research

It is here that we truly begin to understand just how patriarchy and misogyny feeds itself, growing bigger – unless we as a society step in.

With the knowledge and understanding that we need specific research on female anatomy, many drug companies are actively calling out for female participants in their studies. Unfortunately, female participants are a difficult group to attract due to time poverty. Participation in medical studies requires time and carer support; two things which women participants are less likely to have compared to their man counterparts. Women have a higher burden of domestic work compared to men, even when they hold the same full-time job hours as their male partners. It leaves them with less available free time for extracurriculars. And since women are often the main carers in their households, actively engaging in a medical trial, where they themselves might need care can be an impossible situation.

Participation in medical studies requires time and carer support; two things which women participants are less likely to have compared to their man counterparts.

Additionally, some research studies can require overnight stays, and there is evidence that culture can impact participation in some of these instances. Since some cultures and religious beliefs can prevent women from being able to engage in overnight stays with or without supervision.

So, where do we go from here? The health gap between men and women exists, but every day we get closer to closing it. The only way forward is to understand the issue, bring attention to it – and as women, talk to each other and advocate for ourselves.

You are not making it up, you were never making it up.

Editor’s note: in the context of this article, we use 'female' to denote people with anatomically female sex characteristics. We use 'women' to denote gender and to refer to people who identify as women. There may be exceptions when language is taken from a direct quote.