Women face struggles as patients with Covid-19 — and beyond

Women's health is about far more than reproductive health, author Maya Dusenbery argues.

(CNN)Women's health is about far more than reproductive health.

That was true long before the coronavirus pandemic struck, says Maya Dusenbery, author of "Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick."
Women already face many inequities in the health care system, documented in Dusenbery's 2017 book, including dismissal of symptoms and lack of gender-based research. During the pandemic, those same inequities may be exacerbating women's treatment.
A chronic lack of Covid-19 testing in the United States makes it harder for women to prove their symptoms are real, and long-standing biases about women and hysteria can leave women at a loss when trying to explain the disease's "long-haul" symptoms.
    Here, Dusenbery explains how the current global crisis exposes how gender weighs on the health care system. This interview has been edited for length and clarity.
    Maya Dusenbery documents medical gender bias in her book.
    CNN: Why is gender-specific medicine important?
    Maya Dusenbery: Men and women tend to have somewhat different experiences of health and disease, due to both gender and sex differences. There are differences between men and women prevalent in many conditions, as well as in symptoms and risk factors for the same disease. For example, rather than having the "textbook" symptoms of a heart attack, women tend to have more "atypical" symptoms, like fatigue and jaw pain. There are differences in the side effects and effectiveness of treatments and in the accuracy of diagnostic tests.
    In order for women — and men — to receive the best medical care, it's important for health care providers and researchers to be aware of these differences. Unfortunately, until the early 1990s, medical research was largely focused on men, so we are still playing catch-up in understanding women's health.
    CNN: How might systemic bias appear during a doctor's appointment?
    Dusenbery: Women face two big systemic problems in the medical system. First, there's a relative lack of knowledge about women's conditions, symptoms and bodies. Second, there's a tendency to dismiss women's unexplained symptoms — to normalize, minimize or attribute them to psychological causes. I call these "the knowledge gap" and "the trust gap," and they manifest in various gender disparities in treatment, research and diagnosis.
    For the average woman, the gender bias in medicine means that she may be prescribed a drug that causes unrecognized side effects because it was primarily studied in men. It means that she's more likely to have a poorly understood condition, one that disproportionately affects women and has been neglected by researchers. It means that she's likely to face a longer diagnostic delay compared to her male counterpart, especially for rare or difficult-to-diagnose diseases, because health care providers are quicker to conclude that her mysterious symptoms are "just stress" instead of doing a more thorough workup.
    CNN: For years, "hysteria" was once a catchall women's diagnosis for many medical conditions. Have we moved beyond that thinking?
    Dusenbery: Medicine has not moved past that thinking to a really alarming degree. In recent decades, unexplained symptoms that previous generations would have called "hysteria" have just gotten new labels: terms like psychogenic, functional or "medically unexplained symptoms."
    By and large, medicine has held onto the idea that any physical symptoms that cannot currently be explained physiologically can, by default, be attributed to the psyche. This idea is dangerous for all patients, and it continues to particularly harm women, who frequently encounter health care providers who say or imply that their symptoms are "all in their heads."
    CNN: Many Covid-19 patients have reported persistent symptoms months after infection. Are "long hauler" women likely to be treated worse than men?
    Dusenbery: I do (think so). While we're still in the early stages of collecting solid data, I would be very surprised if we don't see some gender disparities in long haulers' experiences within the medical system. This is not to say that male long haulers have been treated well. Early in the pandemic, the narrative was established that most Covid patients would recover in two weeks. Consequently, many long haulers, regardless of gender, have faced skepticism from health care providers convinced that their lingering symptoms couldn't be related to Covid. Hopefully, as long haulers have gotten media coverage over the last few months, that's starting to change.
    Medicine's long history of viewing women as especially prone to psy