In Her Own Right The Institute of Medicine's Guide to Women's Health Issues (1997) / Chapter Skim
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2 Gender Differences in Health
2 Gender Differences in Health
Pages 15-32
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From page 15... ...
Of the 46 chromosomes that compose the human genome, 45 distinguish not at all between males and females. The crucial forty-sixth alone determines genetic gender at the moment that sperm meets egg.
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From page 16... ...
The müllerian duct stands poised to become uterus and fallopian tubes, the Wolffian, the male reproductive organs. In addition, the embryo's equipment includes as-yet undifferentiated gonadal cells, forerunner of its future ovaries or testes.
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From page 17... ...
Some differences arise from reasons so obvious as to be trivial; men cannot suffer preeclampsia of pregnancy nor women contract prostate cancer (although men can and do develop breast cancer)
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From page 18... ...
Henderson, M.D., D.P.H., professor of epidemiology and medicine at the University of Washington and a leading expert in the epidemiology of disease.2 Nor do the factors favoring females seem to cluster in any particular stretch of the human life span. "Women's survival advantage exists in infancy and childhood, that is, before puberty and circulating levels of reproductive hormones," says Henderson.3 "At all ages, from conception on," adds Leon E
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From page 19... ...
How people perceive symptoms, what they think they should do about them, and where they stand in the social structure all influence whether they consider themselves sick. Denying illness, Rosenberg notes, is "culturally approved" behavior that discourages men from seeing a doctor in the first place or complying with instructions when they do.8 Cultural factors aside, does the first mystery, women's longer survival, even more paradoxically suggest an answer to the second, their higher disease rate?
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From page 20... ...
Existing figures, obviously, cannot give the answer. "Throughout their reproductive and later lives," Henderson continues, underlining Rosenberg's point, "women go to the doctor's office more often than men," a habit that can grow in the early years from needing the most effective forms of birth control, available only by prescription, and in the later ones from seeking annual Pap smears.
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From page 21... ...
Osteoporosis, which thins the bones and causes painful and disabling fractures, strikes vastly more often in women, afflicting 73% of those between 65 and 69 and 89% of those over 75.15 An American woman faces a risk of life-shortening hip fracture three times greater than a man's and as great -- 15% during her lifetime -- as her combined total risk of breast, uterine, and ovarian cancer or a man's lifetime risk of prostate cancer. Half of hip fracture victims never walk again, many falling prey to such complications of immobility as pressure sores, urinary infections, heart arrhythmias, and pneumonia.
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From page 22... ...
, and seven times his risk of somatization disorder, which involves various bodily symptoms. He, meanwhile, has almost twice the chance she does of abusing drugs, and about five times her chance of abusing alcohol or developing antisocial personality disorder.22 Whether gender differences in rates of substance abuse are truly as large as the statistics suggest or whether the discrepancies represent women's hesitancy about coming forward for treatment remains unclear, however.
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From page 23... ...
For him, it can indicate toughness, a macho, devilmay-care attitude -- up to a point, at least. For her, it often still carries an implication of sexual promiscuity, of "easiness," of generally not being a "good" woman.23 Overall, males tend to shove their mental distress outside of themselves -- to "externalize" it, in technical terminology -- through "acting out" disorders that use violence, crime, chemicals, or some other generally risky behavior to transform feeling into behavior.
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From page 24... ...
A substantial body of research, for example, links androgens to aggression in a variety of animals, although Donald Pfaff, M.D., professor of neurobiology and behavior at Rockefeller University, notes that "the occasions for the aggression and the target for the aggression might be different between species." Couldn't reproductive hormones influence behaviors as well? Pfaff counsels caution in drawing analogies between humans and other animals; "the linkage of hormonesensitive forebrain circuits" varies among species "in form and magnitude" 24
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From page 25... ...
"I would argue," Frank concludes, "that this is setting up a kind of fragility in the circadian rhythm" that may partially explain why many more girls than boys of this age become depressed.30 But as important a role as physical changes may play during this tumultuous period, girls must deal with powerful social changes as well. "Pubertal and endocrine changes can't be considered in isolation from the social context in which they occur," Frank insists.31 And one of the starkest social differences dividing the genders is also among the most disturbing.
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From page 26... ...
"Societies, subcultures and individual families vary widely in this respect."34 American society appears rather hard on girls moving into adolescence; the stage constitutes the main exception to the pattern we have observed of greater feminine resilience across the life span. From birth through age 10, boys appear more "vulnerable to both physical and psychosocial stressors" than girls, according to an IOM study of mental disorders.35 The second decade of life reverses those odds, with girls now showing heightened vulnerability to a host of bodily and psychological ills.
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From page 27... ...
Male substance abusers much more often suffer antisocial personality disorder than disorders of mood.36 A girl who responds to the stresses or biochemical changes of adolescence with depression thus runs an increased risk of becoming a substance abuser and even an addict. Smoking, long a mainly masculine addiction, now poses a particular threat to emotionally vulnerable young women.
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From page 28... ...
Alcohol presents a similarly dismal outlook among young women. More adolescent males than females drink, but the percentage of girls among the very youngest persons drinking to getting drunk -- children between 10 and 15 -- is rising fast.43 As with cigarettes, this increase portends grim possibilities because alcohol can both devastate a developing fetus and disproportionately injure a female drinker.
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From page 29... ...
Female fat acts decisively in both the economy of reproduction and the physiology of bone. Too little means amenorrhea and premature bone loss.
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From page 30... ...
The tendency in men toward riskier driving and more dangerous jobs and recreational activities may partially explain this paradox. Both genders lose bone tissue as they age, but for some reason menopause speeds up the process.
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From page 31... ...
9. Assessing Future Research Needs: Mental and Addictive Disorders in Women (Transcript)
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From page 32... ...
24. Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research, 85.
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