Sex differences in medicine

Sex differences in medicine include sex-specific diseases or conditions which occur only in people of one sex (for example, prostate cancer in males or uterine cancer in females); sex-related diseases, which are diseases that are more common to one sex (for example, systemic lupus erythematosus occurs predominantly in females);[1] and diseases which occur at similar rates in males and females but manifest differently according to sex (for example, peripheral artery disease).[2] Sex differences in medicine should not be confused with gender differences. The US National Academy of Medicine recognizes sex differences as biological at the chromosomal level, whereas gender differences are based on self-representation and other factors including biology, environment and experience.[3] Sex differences in medicine should also not be confused with sexually transmitted diseases, which are diseases that have a significant probability of transmission through sexual contact.

Historically, medical research has primarily been conducted using the male body as the basis for clinical studies. The findings of these studies have often been applied across the sexes and healthcare providers have traditionally assumed a uniform approach in treating both male and female patients. More recently, medical research has started to understand the importance of taking sex into account as evidence increases that the symptoms and responses to medical treatment may be very different between sexes.

Sex-related illnesses have various causes:

• Sex-linked genetic conditions
• Diseases of the reproductive system that are specific to one sex
• Social causes that relate to the gender role expected of that sex in a particular society
• Different levels of prevention, reporting, diagnosis or treatment in each gender.

Women

Examples of sex-related illnesses and disorders in female humans:

• 99% of breast cancer occurs in women.[4]
• Ovarian cancer, endometriosis and other diseases of the female reproductive system occur only in women.
• Approximately four times more women suffer from osteoporosis than men.[5]
• Autoimmune diseases, such as Sjögren's syndrome and scleroderma, are more prevalent in women. Roughly 70 percent of those living with autoimmune diseases are female.[6][7] See Sex differences in autoimmunity.
• In Western cultures, almost ten times more women than men suffer from eating disorders such as anorexia nervosa and bulimia nervosa.[8][9]
• Alzheimer's disease has a higher rate in women than in men.[10][11]
• About two times more women than men suffer from unipolar clinical depression (although bipolar disorder appears to affect both sexes equally).[12][13]
• About three times more women than men are diagnosed with borderline or histrionic personality disorder.[14]
• Conditions such as chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME), postural orthostatic tachycardia syndrome (POTS), fibromyalgia, irritable bowel syndrome (IBS) and idiopathic hypersomnia, which have unclear causes, are more common in women, with sex ratios ranging from 2:1 in IBS,[15] fibromyalgia[16] and idiopathic hypersomnia[17] to 4:1 in CFS[18] and 5:1 in POTS.[19]
• Most people with psychogenic non-epileptic seizures (PNES) (75%) are women.[20]

Men

Examples of sex-related illnesses and disorders in male humans:

• Prostate cancer and other diseases of the male reproductive system occur only in men.
• Diseases of X-linked recessive inheritance, such as colour blindness, occur more frequently in men, and haemophilia A and B occur almost exclusively in men.[21]
• Abdominal aortic aneurysms are six times more common in men, and thus some countries have introduced screening for males at risk of suffering the condition.[22]
• Autism is approximately 4 times more prevalent in males than females.[23]
• Schizophrenia is about 1.4 times more common in males and on average starts 2 years earlier and has more severe symptoms.[24]
• More than two times more men than women are affected by antisocial personality disorder and substance use disorder.[25][26]
• Several cancers, including stomach cancer (2:1),[27] oesophageal cancer (3:1),[28] liver cancer (2:1 to 4:1)[29] and oral cancer (2:1 to 3:1),[30] which have mostly lifestyle-based risk factors, are more common in men.

See also

• Andrology
• Health equity
• Men's health
• Obstetrics and gynecology
• Reproductive medicine
• Sex differences in humans
• Women's health

References

1. Ngo, ST; Steyn, FJ; McCombe, PA (August 2014). "Gender differences in autoimmune disease". Frontiers in Neuroendocrinology. 35 (3): 347–69. doi:10.1016/j.yfrne.2014.04.004. PMID 24793874.
2. Barochiner, J; Aparicio, LS; Waisman, GD (2014). "Challenges associated with peripheral arterial disease in women". Vascular Health and Risk Management. 10: 115–28. doi:10.2147/vhrm.s45181. PMC 3956880. PMID 24648743.
3. editors, Committee on Understanding the Biology of Sex and Gender Differences; Theresa M. Wizemann and Mary-Lou Pardue (2001). Exploring the biological contributions to human health : does sex matter? ([Online-Ausg.] ed.). Washington, D.C: National Academy Press. ISBN 978-0309072816.CS1 maint: extra text: authors list (link)
4. "Male Breast Cancer Treatment". National Cancer Institute. 2014. Archived from the original on 4 July 2014. Retrieved 29 June 2014.
5. Khaled A. Alswat (1 Apr 2017). "Gender Disparities in Osteoporosis". Journal of Clinical Medicine Research. 9 (5): 382–387. doi:10.14740/jocmr2970w. PMC 5380170. PMID 28392857.
6. Rose, NR; Bona, C (September 1993). "Defining criteria for autoimmune diseases (Witebsky's postulates revisited)". Immunology Today. 14 (9): 426–30. doi:10.1016/0167-5699(93)90244-F. PMID 8216719.
7. Hayter, SM; Cook, MC (August 2012). "Updated assessment of the prevalence, spectrum and case definition of autoimmune disease". Autoimmunity Reviews. 11 (10): 754–65. doi:10.1016/j.autrev.2012.02.001. PMID 22387972.
8. Diagnostic and statistical manual of mental disorders : DSM-5 (5 ed.). Washington: American Psychiatric Publishing. 2013. pp. 338–345. ISBN 978-0-89042-555-8.
9. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 345–349. ISBN 978-0-89042-555-8.
10. Di Carlo A, Baldereschi M, Amaducci L, Lepore V, Bracco L, Maggi S, Bonaiuto S, Perissinotto E, Scarlato G, Farchi G, Inzitari D (January 2002). "Incidence of dementia, Alzheimer's disease, and vascular dementia in Italy. The ILSA Study". Journal of the American Geriatrics Society. 50 (1): 41–48. doi:10.1046/j.1532-5415.2002.50006.x. PMID 12028245. S2CID 22576935.
11. Andersen K, Launer LJ, Dewey ME, Letenneur L, Ott A, Copeland JR, et al. (December 1999). "Gender differences in the incidence of AD and vascular dementia: The EURODEM Studies. EURODEM Incidence Research Group". Neurology. 53 (9): 1992–97. doi:10.1212/wnl.53.9.1992. PMID 10599770. S2CID 22725252.
12. American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 160–68, ISBN 978-0-89042-555-8, retrieved 22 July 2016
13. Schmitt A, Malchow B, Hasan A, Falkai P (February 2014). "The impact of environmental factors in severe psychiatric disorders". Front Neurosci. 8 (19): 19. doi:10.3389/fnins.2014.00019. PMC 3920481. PMID 24574956.
14. Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Washington [etc.]: American Psychiatric Publishing. 2013. pp. 645, 663–6. ISBN 978-0-89042-555-8.
15. "Definition & Facts for Irritable Bowel Syndrome | NIDDK". National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved 2019-07-04.
16. Clauw, Daniel J. (16 April 2014). "Fibromyalgia". JAMA. 311 (15): 1547–55. doi:10.1001/jama.2014.3266. PMID 24737367.
17. Mallampalli, Monica P.; Carter, Christine L. (2014). "Exploring Sex and Gender Differences in Sleep Health: A Society for Women's Health Research Report". Journal of Women's Health. 23 (7): 553–562. doi:10.1089/jwh.2014.4816. ISSN 1540-9996. PMC 4089020. PMID 24956068.
18. "Chronic fatigue syndrome". womenshealth.gov. 21 February 2017. Retrieved 13 May 2019.
19. Benarroch EE (December 2012). "Postural tachycardia syndrome: a heterogeneous and multifactorial disorder". Mayo Clinic Proceedings. 87 (12): 1214–25. doi:10.1016/j.mayocp.2012.08.013. PMC 3547546. PMID 23122672.
20. Mellers, JD (August 2005). "The approach to patients with "non-epileptic seizures"". Postgraduate Medical Journal. 81 (958): 498–504. doi:10.1136/pgmj.2004.029785. PMC 1743326. PMID 16085740.
21. "U.S. National Library of Medicine". Archived from the original on 12 October 2007. Retrieved 2 December 2007.
22. "Men to get aneurysm screening". BBC. 5 January 2008. Retrieved 6 June 2016.
23. Newschaffer CJ, Croen LA, Daniels J et al. The epidemiology of autism spectrum disorders [PDF]. Annu Rev Public Health. 2007 [archived 2013-09-03];28:235–58. doi:10.1146/annurev.publhealth.28.021406.144007. PMID 17367287.
24. Picchioni MM, Murray RM (July 2007). "Schizophrenia". BMJ. 335 (7610): 91–5. doi:10.1136/bmj.39227.616447.BE. PMC 1914490. PMID 17626963.
25. Alegria, Analucia A.; Blanco, Carlos; Petry, Nancy M.; Skodol, Andrew E.; Liu, Shang-Min; Grant, Bridget; Hasin, Deborah (July 2013). "Sex differences in antisocial personality disorder: results from the National Epidemiological Survey on Alcohol and Related Conditions". Personality Disorders. 4 (3): 214–222. doi:10.1037/a0031681. ISSN 1949-2723. PMC 3767421. PMID 23544428.
26. Galanter, Marc; Kleber, Herbert D.; Brady, Kathleen T. (17 December 2014). The American Psychiatric Publishing Textbook of Substance Abuse Treatment. doi:10.1176/appi.books.9781615370030. ISBN 978-1-58562-472-0.
27. World Cancer Report 2014. World Health Organization. 2014. pp. Chapter 5.4. ISBN 978-9283204299.
28. Montgomery, EA; et al. (2014). "Oesophageal Cancer". In Stewart, BW; Wild, CP (eds.). World Cancer Report 2014. World Health Organization. pp. 528–543. ISBN 978-9283204299.
29. Hefaiedh R; et al. (Aug–Sep 2013). "Gender difference in patients with hepatocellular carcinoma". La Tunisie Médicale. 91 (8–9): 8–9. PMID 24227507.CS1 maint: multiple names: authors list (link)
30. Chaturvedi AK, Anderson WF, Lortet-Tieulent J, Curado MP, Ferlay J, Franceschi S, Rosenberg PS, Bray F, Gillison ML (December 2013). "Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers". Journal of Clinical Oncology. 31 (36): 4550–9. doi:10.1200/jco.2013.50.3870. PMC 3865341. PMID 24248688.