The genesis of ‘Yentl syndrome’ can be found in the 1983 film Yentl which told the story of a Jewish woman in Poland who, to receive an education, pretended to be a man. It was coined to describe the phenomena whereby women are misdiagnosed and under-treated unless their symptoms conform to that of the male disease patterns because research had only been carried out on male bodies.
As a consequence of this lack of research, since 1989 cardiovascular disease has been the top killer of women in the US and following a heart attack women are more likely than men to die. Not only this, but heart disease kills a greater number of women of all ages than breast cancer does, with 1 out of 2 women being impacted by cardiovascular disease in their lifetime. Moreover, for every male death associated with this disease, 2-3 women die.
The main reason for this disparity is because male-patterned heart disease symptoms have been studied for 50 years, whereas female patterns have only been studied for the past 15 years. This means that the typical symptoms of a heart attack mainly characterise the symptoms of male bodies leading to female symptoms being seen as atypical. The ‘typical’ heart attack, known as the ‘Hollywood heart attack’ in medical circles, mainly embodies
male symptoms, which is probably why research has shown that women are 50% more likely to be misdiagnosed following a heart attack (rising to 60% for some types of
heart attacks).
There is good news, though. Scientists have discovered evidence that suggests reasons for why women show disease patterns distinct from men. Fatty plaque in women is different and deposited differently than that in men. Therefore, many women are sent home following a heart attack, or signs of one, as their symptoms are dismissed. This ties into the premise of Caroline Criado-Perez’s book Invisible Women: Exposing Data Bias in a world Designed for Men which attempts to explicate how the male body is the default, and women are seen as atypical.
The lack of research on female heart attacks has not only caused hindrances in recognising symptoms but also in treatment. Aspirin, a common preventative method used to mitigate the first heart attack in men, was shown in 2005 to have a ‘nonsignificant’ effect in older women. Furthermore, a similar study in 2015 found that aspirin can be ‘ineffective or even harmful’ in the ‘majority’ of women in primary prevention of cancer or heart disease. Nevertheless, new evidence is coming to light that can help diminish the undertreatment of women; one study found that men and women have different biological pathways for chronic pain which rationalises why some pain medicine that works for men may not work for women.
‘Yentl syndrome’ can now be used to elucidate ‘the phenomena whereby women are misdiagnosed and under-treated unless their symptoms conform to that of the male disease pattern’ (Criado-Perez, 2019) in several different medical-related scenarios. To name a few, just 8% of girls with Asperger’s are diagnosed before the age of 6 compared with 25% of boys, rising to 21% and 22% after the age of 11; up to ¾ of girls with ADHD are undiagnosed, and women are around 30% more likely to have symptoms of strokes misdiagnosed.
As I have said above; there is hope for the future. Doctors, scholars and institutions are starting to recognise the impact of seeing the male body as the ‘typical’ or ‘default’ is having on women across the globe. In 2017 England’s National Institute for Health and Care Excellence released its first-ever guide for doctors to deal with endometriosis with the main recommendation being ‘listen to women’. I think this perfectly sums up issues women experience within the medical world and society in general. We need to start listening to women, talk about gender data gaps and, as Criado-Perez said, ‘stop dismissing women, and start saving them’.
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