How Sex and Gender Affect Health (And Why Knowing Matters)
By Dr. Janine A. Clayton
Medical schools are falling short. Despite the fact that women make up 50% of the population, schools’ curricula too often do not address how diseases and treatments affect women differently than men.1,2
In fact, 44% of medical schools in a recent study reported having women’s health curricula, and even fewer (7%) offer interdisciplinary courses that include a solid grounding in women’s health.
As a result, most medical school students graduate without a complete understanding of how to treat half the population. To provide the best care for men and women alike, medical school and postgraduate curricula,3 as well as continuing education, must include instruction on the ways in which sex and gender affect health.4
The NIH Office of Research on Women’s Health (ORWH) and others took notice of this knowledge gap. As part of our mission to promote the understanding of sex effects and to integrate the study of sex into the research process, ORWH has developed an online course on sex and gender influences on health and disease, working in partnership with the Food and Drug Administration (FDA), Office of Women’s Health, and non-Federal subject matter experts. We’re very excited about the course’s potential—especially because online learning has proved effective in educating researchers and medical professionals about sex- and gender-based health inequalities and inequities.5
The course is called “Bench to Bedside: Integrating Sex and Gender to Improve Human Health,” which is just the latest addition to ORWH’s online Career Development and Interprofessional Education. The first three of its six modules—on immunology, cardiovascular disease, and pulmonary disease—are available right now on the ORWH website. The second three—on neurology, endocrinology, and mental health—will be released later this year. Each module addresses the influences of sex and gender on health and disease in its respective area of medicine, with the goal of preparing learners to apply this knowledge when conducting research and interpreting evidence for clinical practice.
The modules also offer course-takers a challenge: We don’t yet fully understand the mechanisms or extent of the effects of sex and gender in all areas of health and disease. We hope the modules inspire learners to look for answers in their own research and practice areas.
In addition to “Bench to Bedside,” ORWH and the National Institute of General Medical Sciences are currently developing a complementary course, “Sex as a Biological Variable: A Primer.” Its four modules will cover the consideration of sex as a biological variable, or SABV, in biomedical research, particularly at the preclinical stage.
Who would benefit from taking “Bench to Bedside” and the SABV primer? The answer is a wide range of people. Although their content is perhaps most relevant to researchers (including clinician-researchers), the effects of sex are so prevalent, so measurably different, and so biologically and clinically meaningful that no one who works in the health care field can ignore them. For example:
- For professors who teach biomedicine and public health in medical schools and graduate schools and for their students, “Bench to Bedside” would be a valuable addition to standard curricula.
- Physicians, nurses, pharmacists, dentists, physician assistants, nurse practitioners, allied health providers, and physical therapists need to better understand how diseases, conditions, and treatments affect their patients who are women differently than they affect their patients who are men.
- For all others in health care—including those in associations, community organizations, and government—the knowledge gained will enhance their work in women’s health.
The modules of “Bench to Bedside” have been well received. We’re confident that individuals who complete the course will be not only very satisfied but also inspired to share their new knowledge with colleagues. All of us in the health care field benefit from greater understanding of the effects of sex and gender on health and disease, so we all have a role to play in promoting it.
I encourage educators to incorporate the study of sex and gender in medical education and basic and clinical research training. I urge researchers and clinicians to incorporate the course’s content in your research and clinical practice as appropriate and explore unanswered questions. By all means, share course materials with colleagues.
I wish to acknowledge the many individuals who contributed to the development of “Bench to Bedside.” Their work is expanding the knowledge base for sex and gender influences and has the potential to improve the health of women and men. Such knowledge is essential to good science, at all levels of biomedical research and in clinical practice, where bench and bedside meet. Only when those effects are studied and understood can women and men receive the clinical care all of us deserve.6
1 Song MM et al. Biol Sex Differ. 2016. PMID: 27785343; Jenkins MR et al., Biol Sex Differ 2016. PMCID: PMC5073801.
2 Ashurst JV et al., Acad Emerg Med. 2014. PMCID: PMC6452861.
3 Keitt SK et al. MedGen. 2003. PMID: 14603139.
4 Henrich JB and Viscoli CM. Acad Med 2006. DOI: 10.1097/01.ACM.0000222268.60211.fc.
5 Schreitmuller J et al. GMS J Med Educ. 2018. PMCID: PMC6120162
6 Regensteiner JG, Libby A, Begg L, Ghim M, Clayton JA. J Womens Health (Larchmt). 2020. DOI: 10.1089/jwh.2019.8114. [Epub ahead of print]