The Importance of Gender in Medical Practice

          Narratives about treatment and rates of disease often involve conversation around the role sex plays in these statistics, including mortality and morbidity rates. Governments and private organizations spend considerable amounts of money towards identifying and focusing research on diseases that predominately affect one sex over another. For example, prostate and breast cancer, found primarily in men and women respectively, receive significant funding and generate considerable public interest.

Sociologically, sex refers to the biologically determined aspect of an individual’s identity, while gender is considered to be culturally or socially constructed. While the role that sex plays in the dimorphism of these diseases is evident, gender’s role is far less clear and researched. In a medical world where treatment paths are largely determined by the patient, individuals must choose an option that they are most comfortable with.^2,4 In the case of prostate cancer, men are often faced with impotence or other sexual deficiencies resulting from treatment. Similarly, the focus on breast cancer treatment often stresses saving the breasts rather than the woman herself. Decisions about how to proceed in the treatment process in such cases can be heavily influenced by conceptions of gender. For example, a man’s idea of masculinity may affect his choice to lose sexual function.¹ Treatment time with procedures such as chemotherapy and radiation may be extended, despite the fact that radical prostatectomy or other procedures that damage nerves may be more effective in preventing mortality. However, these procedures damage sexual function, making them less desirable for some men. 

Additionally, gender plays a critical role in how individuals experience coping strategies both during and following treatment. Sharing of one’s personal feelings is considered by society to be a feminine quality; therefore fewer men feel comfortable participating in group sessions due to this stigma.⁴ Research suggests that gender, not sex perceptions play a role in these results. This is important because counseling or the ability to speak openly about personal psychosocial issues surrounding treatment has been associated with morbidity rates.² Specifically, several studies have focused on psychiatric morbidity rates of patients experiencing treatment and how counseling affects these rates. One such study looking at mastectomy patients showed that morbidity rates were significantly less in counseling patients than those in a control group (12% to 39%).³

           If the ultimate goal of medicine is to reduce morbidity and mortality rates, then consideration of gender before, during, and after treatment must be taken into account. Health professionals must be aware of gendered belief systems and speak with patients openly about ramifications of conforming to these societal notions. Individuals also must be made aware of their own gender perceptions in order to allow them to best select treatments. For example, a male undergoing prostate procedures may be driven by gendered expectations of masculinity towards certain treatment options. The idea of losing sexual ability often conflicts with a man’s idea of how masculinity is maintained. If he is not able to engage with his partner sexually, the ability to perform masculinity may be compromised. By making him aware of gendered notions of masculinity and clearly presenting why certain treatment options are stigmatized, procedures that decrease mortality and morbidity, rather than those that preserve notions of gender, may become more desirable. Ignoring gender in medical practice is a detriment the moral codes of the medical community as well. As I mentioned earlier, the institution of medicine is more concerned with saving what is considered important for masculinity or femininity, rather than what is necessary for the individual, both phsyically and emotionally. This is not simply an issue of intellectual discourse, but notably affects medicine at an economic and moral level. If we are to believe that medicine is concerned with reducing illness and death, then taking gender into account, rather than simply sex, is important to combating vital psychosocial effects related to the experience of disease.

                                                            References

1. Kiss A and Meryn S. Effect of sex and gender of psychosocial aspects of prostate and breast cancer. BMJ. 2001: 323(7320): 1055-1058.
2. Krizek C, Roberts C, Ragan R, Ferrara JJ, Lord B. Gender and cancer support group participation. Cancer Pract. 1999:7:86–92.
3. Maguire P, Tait A, Brooke M, Thomas C, Sellwood R. Effect of counselling on the psychiatric morbidity associated with mastectomy. BMJ. 1980; 281:1454–1456.

4. Volkers N. In coping with cancer, gender matters. J Natl Cancer Inst. 1999:91:1712-1714.

Social or biological factors: What decides the differences in self-disclosure between the two sexes?

Self-disclosure is the process through which one person shares private information about him- or herself with others, usually for the development of an intimate relationship. This information, which covers virtually everything about the person, can include and is not limited to thoughts, feelings, dreams, goals, fears, and likes or dislikes. Although populations from different regions or cultures tend to view self-disclosure differently, people strikingly can spend up to either 60% or 80%, depending on where the conversation takes place, of their conversations talking about themselves.

Among the factors that contribute to the differences in self-disclosure, several have been well studied as pure social factors. These include image of the self, social norms of self-disclosure, topics of the conversation, and expectation of the future between the speaker and the listener. The role of one interesting factor, however, remains controversial—sex. It has been reported in multiple studies that males and females self-disclose differently. In general, females are more willing to self-disclose more personal information at higherfrequencies than males do. While most researchers agree that males are more reluctant to speak about themselves (Chelune, 1976; Rosenfeld, 1979) due to social expectations of male gender rolesand a greater need to control their privacy, it is indicated in a study by Chelune (1976) that females do not disclose more information than males do. Instead, females simply share a smaller amount of information each time at much higher rates. Regardless of this minor disagreement, it appears convincing to say that males and females differ in self-closure due to social factors. Therefore, sex induces differences in self-disclosure via different social expectations of the two sexes.

But wait! Can we safely conclude that sex functions solely as a social factor, as it is more than clear that the definition of sexes derives from biological differences between males and females? Let’s first find out whether self-disclosure can be biologically explained. Self-disclosure was found to be able to activate multiple regions in the dopamine pathway. Results of a recent study (Tamir, & Mitchell, 2012) suggest that subjects, when self-disclosing instead of describing characteristics of another person, had significantly more activation (see attached figure) in the nucleus accumbens (NAcc) and ventral tegmental area (VTA). These two regions are directly involved in the dopamine pathway, controlling the secretion and transduction of dopamine. Therefore, the activation of the NAcc and VTA will naturally lead to a dopamine-induced euphoric feeling, which makes self-disclosure a rewarding behavior.

This finding led to my suspicion that there could be sex-differentiated activation in those two regions, so that males may find self-disclosure less rewarding, compared to females. A significant amount of research has indicated that heterosexual and homosexual males and females differ in brain activations and behavioral responses when performing various tasks (smelling sex hormones, doing mental rotations, etc.). Similar to these findings, homosexuals and heterosexual females are found to be more engaged in self-disclosure than heterosexual males (Bliss, 2000), suggesting that NAcc and VTA activation may differ between sexes, and even within the same sex. Unfortunately, the exact differences in brain activation patterns were not examined. As a result, it remains unknown whether biological differences between the two sexes in NAcc and VTA activation can explain differences in self-disclosure. If such biological differences are confirmed in the future, we will have a much deeper understanding of self-disclosure, a major component of human conversations, and of peoples’ preference for self-disclosure. It is then possible to say that males, or even individuals with less sensitive NAcc and VTA, are not socially forced to self-disclose less, but are just born to find self-disclosure less rewarding. In other words, stereotypes may be reduced to simple differences.

Reference

Bliss, G. K. (2000). Self-disclosure and friendship patterns: Gender and sexual orientation differences in same-sex and opposite-sex friendships. (Order No. AAI9973608, Dissertation Abstracts International Section A: Humanities and Social Sciences, , 1749. Retrieved from http://search.proquest.com/docview/619562839?accountid=7379. (619562839; 2000-95021-096).

Chelune, G. J. (1976). A multidimensional look at sex and target differences in disclosure. Psychological Reports, 39(1), 259-263. Retrieved from http://search.proquest.com/docview/616097333?accountid=7379

Rosenfeld, L. B. (1979). Self‐disclosure avoidance: Why I am afraid to tell you who I am. Communication Monographs, 46, 63-74

Tamir, D. I., & Mitchell, J. P. (2012). Disclosing information about the self is intrinsically rewarding. PNAS Proceedings of the National Academy of Sciences of the United States of America, 109(21), 8038-8043. doi:http://dx.doi.org/10.1073/pnas.1202129109