What does clinical gender bias mean?
Meghan Cleary found that out firsthand when her uterine fibroid tried to—brace yourself!—birth itself, and she went into a labor of sorts.
"It was the last day of my period, and I was having really, really sharp jabbing pain in my lower back," Cleary tells The Blossom, "and I had mentioned to my friend in the morning, 'I feel like I slept on my back wrong.'" A few hours later, "I was doubled-over in the bathroom." But her horror story had only just begun because a visit to the ER didn't unearth any immediate answers. "The doctor said, 'I see no reason for your pain." Doctors suspected appendicitis, as they watched her writhe in agony. "They did a CT Scan, and they said, 'Well you have a couple fibroids, but mostly you're probably just constipated,' which was so hilarious."
If that bizarre narrative sounds all too familiar, it should: millions of women with endometriosis and other reproductive-related disorders have long fought against doctors who downplay their pain, and in the process, delay a time-sensitive diagnosis. It's clinical gender bias in motion, the origins of which are seemingly rooted in medical research excluding the female experience.
“Clinical gender bias in medicine is very insidious, and it hides itself in a lot of ways that end up playing out on women’s bodies, and in ways they and their caregivers may not even be aware," explains Cleary. "Most medical studies have been conducted on white men. It was not until 1991 that the National Institute of Health (NIH) decided to study women. The reason clinical gender bias in medicine is so scary is that when you enter into these gynecological diseases, it's like falling off a cliff," adds Cleary, "you basically start to operate in the land of myths." Cleary says that the lack of evidence-based standards, in turn, makes the dismissal of women’s health issues all the more possible. “Women's pain is not adequately treated both in the ER environment and primary care environment. It's really just a shorthand version of 'women are hysterical.'"
Her experience with fibroid labor wasn't the first time that she felt discriminated against by her doctors because of her gender. Her own endometriosis diagnosis took a 31-year delay. She recently underwent an endometriosis excision surgery and soon after, successfully fought and won full coverage of her surgical costs from her insurance company. Since then, Cleary says she began a new career as a patient advocate to help other women successfully stand up for themselves in and out of the doctor's office. She also launched her website, Bad-Periods.com, which she says includes tools to "translate your symptoms into clinical language," a list of endometriosis excision surgeons, and a seminar on how to appeal to insurance companies to cover the high cost of endometriosis excision surgery.
Today, despite her health nightmares, Cleary says she feels lucky to be on the other side of it all. “I'm a white woman, very privileged, I have health insurance, and I couldn't help but think, 'It was hard enough for me to find out what was going on, what about people who don't have access to all the things that I do?' And so that's kind of been my driving force.”
