What’s the Difference? Sex & Gender Influences on Health & Disease A to Z – Office of Research on Women’s Health (ORWH)
Resources
Sex-Specific Reporting of Scientific Research: A Workshop Summary.
What’s the Difference?
Sex & Gender Influences on Health & Disease A to Z
Research on sex and gender differences — research that spans basic studies on cells to large, clinical trials involving thousands of patients — aims to understand health differences between males and females at all levels. The knowledge will improve health for both women and men. Get the facts here about how sex and gender influences health and disease.
A to Z Vocabulary Index
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A
Alcohol Use • Arrhythmias
Alcohol Use
Drinking alcohol is a common activity in most cultures around the world, for both women and men. However, while drinking in moderation may be considered generally safe, alcohol abuse poses many risks to a woman’s health. For example, although men are more likely to drink alcohol than are women, and men often drink more and more frequently, women are more vulnerable to some of alcohol’s harmful effects. These effects are based on both gender– and sex–based factors, and they include differences in metabolism. In addition, alcohol use by women is also linked to many other physical and psychosocial health issues, such as unprotected sex, illicit drug use, and intimate partner violence. Here are some of the facts about women and alcohol use.
Moderate, or low-risk, drinking for women is defined as no more than three drinks on any single day and no more than seven drinks per week.
Low to moderate alcohol consumption in women, defined as fewer than three drinks per day, increases the risk of certain cancers, including breast cancer.
After drinking similar amounts, women have higher blood levels of ethanol than do men, and women are more susceptible to alcoholic liver disease such as hepatitis.
A woman’s moderate alcohol intake may reduce her coronary heart disease risk, although details remain unclear.
Research showed that female college-student drinkers exceeded NIH-defined guidelines for weekly drinking more frequently than did their male counterparts, which may have long-term consequences on drinking behavior in these women.
The drug naltrexone is used to treat alcohol dependence, but it does not work for everyone. A small study showed that naltrexone worked better in women to reduce alcohol’s positive subjective effects, suggesting it may be useful in therapy for alcohol dependence in women.
Research with the model organism Drosophila (fruit flies) showed that female fruit flies are more prone to the sedative effects of alcohol than are male flies.
No amount of drinking during pregnancy is safe. However, 20 to 30 percent of women drink at some time during pregnancy, which includes the period of time before a woman knows she is pregnant.
Read More
Moderate alcohol intake and cancer incidence in women (Journal of the National Cancer Institute)
High blood alcohol levels in women. The role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism (New England Journal of Medicine)
Prospective study of alcohol drinking patterns and coronary heart disease in women and men (British Medical Journal)
Sex differences in college student adherence to NIAAA drinking guidelines (Alcoholism, Clinical and Experimental Research)
The effect of naltrexone on alcohol’s stimulant properties and self-administration behavior in social drinkers: influence of gender and genotype (Alcoholism, Clinical and Experimental Research)
Acute ethanol responses in Drosophila are sexually dimorphic(Proceedings of the National Academies of Sciences)
Fact Sheets: Excessive Alcohol Use and Risks to Women’s Health(Centers for Disease Control and Prevention)
Women and Alcohol (National Institute on Alcohol Abuse and Alcoholism)
Rethinking Drinking (NIAAA)
Fetal Alcohol Syndrome Disorders (MedlinePlus)
Fetal Alcohol Exposure (NIAAA)
Arrhythmias
As an electrically controlled organ, the heart beats when a wave of electricity courses through heart muscle in a defined regular path. Any disruption of this path of conduction, called an arrhythmia, causes the heart to beat irregularly. An arrhythmia can be very mild, even undetectable, or serious and fatal. Sex and gender differences are known to affect heart rhythms. Here are some examples.
Certain medications, including the allergy drug Seldane and the gastrointestinal drug Propulsid (both of which have been taken off the market in the United States) trigger a potentially fatal heart arrhythmia more often in women than in men.
A 2009 study showed that women are more likely than men to have complications from implantable cardiac defibrillators, devices that monitor heart rhythms and deliver shocks when needed to restore a normal heartbeat.
Although men are more likely than women to experience a usually mild condition known as atrial flutter (heart palpitations), surgical treatment (ablation) of this arrhythmia affects women and men differently, according to a 2013 study. Although less women than men are treated with ablation, women are more likely to experience surgical complications and also more likely to have atrial flutter after the surgery.
Read More
MedlinePlus: Pacemakers and Implantable Defibrillators
Gender differences in procedure-related adverse events in patients receiving implantable cardioverter-defibrillator therapy
Sex-related differences in peri- and post-ablation clinical data for patients with atrial flutter
Female gender as a risk factor for drug-induced cardiac arrhythmias: evaluation of clinical and experimental evidence
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C
Cardiovascular Risk
For the most part, an individual has direct control over whether he or she will develop heart disease, by managing behaviors that raise or reduce the chances that heart disease will take root in their body. NIH-funded medical research that goes back decades has defined a core set of cardiovascular risk factors that individuals can manage with the help of a doctor. The risk factors include smoking, high cholesterol and triglycerides, high blood pressure, diabetes, and being overweight or obese.
Yet, even though everyone should pay attention to these risk factors that affect heart health, the risks differ between women and men in various ways that appear subtle, but can be very significant.
In women, aspirin reduces risk of ischemic stroke, whereas in men, low-dose aspirin therapy reduces risk of heart attack.
Cholesterol plaque in women may not build up into major artery blockages, but instead spreads evenly throughout the artery wall. This means that artery blockages can be more difficult to diagnose in women, who may not have outright symptoms but are still at high risk for heart attack.
Cholesterol levels vary over the course of a woman’s menstrual cycle.
Read More
A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women
Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men: A Sex-Specific Meta-analysis of Randomized Controlled Trials
A longitudinal study of serum lipoproteins in relation to endogenous reproductive hormones during the menstrual cycle: findings from the BioCycle study
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D
Depression
Gender plays an important role in mental health disorders like depression, which is common but underdiagnosed. Epidemiological research shows that females are more likely than males to develop not only depression, but also eating disorders, panic disorder, and post-traumatic stress disorder. Here are some sobering facts about depression in women:
Depression is the leading cause of disability in the United States for individuals 15-44 years of age.
Depression is the 5th most common source of disability worldwide for women, and it is predicted to be the second leading cause of global disability by 2020.
Some diseases, including epilepsy, Alzheimer’s disease, cancer, and cardiovascular disease, can bring on depression in one sex but not the other.
Depressed middle-aged women have almost double the risk of having a stroke.
Read More
Gender and women»s mental health: World Health Organization.
Institute for Health Metrics and Evaluation: Global Burden of Disease Study 2010.
Not all depression is created equal: sex interacts with disease to precipitate depression.
Depression and risk of stroke in midaged women: a prospective longitudinal study.
Depression: Medline Plus
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H
Health Care • Heart Attacks
Health Care
Women and men have different health care habit and needs, both of which affect health in significant ways. Women are more likely to be the primary family caregiver, meaning their decisions affect the health of children and men in the household as well. Over the course of a woman’s lifetime, due in part to reproductive health issues, she relies on the health care system more than her male peers. Recent studies have shown other specific examples of health care gender differences.
2012 study showed that women are more likely than men to defer seeing their doctor(s) or dentist, or fill a prescription, because they could not afford the cost.
Women who have a heart attack are much more likely (57%) than men having a heart attack (28%) to call 9-1-1 for help. However, this 2013 study also revealed no difference in calling behavior among men and women with response to chest pain alone.
Read More
Gender differences in financial barriers to primary health care in New Zealand
Gender differences in calls to 9-1-1 during an acute coronary syndrome
Heart Attacks
Heart attacks are a leading killer of people all over the world. Heart attacks occur when heart muscle is deprived of oxygen-rich blood. Although heart disease affects both women and men, many women remain unaware that they are at risk. Moreover, many aspects of heart disease differ between women and men. Here are some of the ways.
Women often have early symptoms within the weeks prior to their heart attack — unusual fatigue, sleep disturbance, but not always chest pain or discomfort.
At the time of their heart attack, women have shortness of breath, weakness, and fatigue — but not always chest pressure, pain, or tightness.
In 2012, 56 percent of all women said they know heart disease as their number-one killer.
But… only 36 percent of black women and 34 percent of Hispanic women said they know heart disease as their number-one killer.
And… young women (25 to 34) remain least aware: only 44 percent said they know heart disease as their number-one killer.
Read More
National Heart, Lung, and Blood Institute’s “What Are the Signs and Symptoms of Heart Disease?”
Gallup poll on women’s emotional health after heart attack
Fifteen-Year Trends in Awareness of Heart Disease in Women: Results of a 2012 American Heart Association National Survey
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J
Joints
Sex-specific research analyses are especially important in orthopedics because of the substantial sex-based anatomical differences between females and males. Researchers are beginning to appreciate that structural differences of the knee joint and thigh muscles, differences in the ways male and female athletes move, and other sex differences explain why women are often more susceptible to injuries than men. Here are some examples of sex-based differences that affect the health of joints:
Females are two to three times more likely than males to develop patellofemoral pain syndrome, one of the most common causes of knee pain in teen and young-adult athletes, a 2010 study reports.
Anterior cruciate ligament (ACL) tears are more common in females than in males — this is thought to be due in part to hormones, but other sex-based differences also appear to play a role.
Temporomandibular joint and muscle disorder (TJMD)-type pain is 2.25 times more prevalent in women than in men.
As reported in a 2013 study, among people undergoing total hip replacement, women were 29 percent more likely than men to require repeat surgery within the first three years.
Read More
The incidence and potential pathomechanics of patellofemoral pain in female athletes.
Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005.
Temporomandibular joint and muscle disorder-type pain in U.S. adults: the National Health Interview Survey.
Sex and risk of hip implant failure: assessing total hip arthroplasty outcomes in the United States.
TMJ Disorders: Medline Plus.
Anterior cruciate ligament (ACL) injury: Medline Plus.
Hip replacement tutorial: Medline Plus.
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M
Men’s Health
As is the case with women’s health, many people tend to think of men’s health as it relates to the reproductive organs. However, just as in women’s health, men’s health is much broader. While many sex-based influences affect diseases/organs related to reproduction, such as prostate and testicular cancer, many sex-based factors influence diseases and organs unrelated to reproduction. Here are a few examples.
Osteoporotic fractures in men over 50 are common, yet they are under-recognized and often undertreated.
Systemic lupus erythematosus, or lupus, is often thought of as a women’s disease, yet this condition affects men too. What’s more, males with lupus often have more severe disease than females, and they are more likely than females to experience lupus-related kidney failure.
White male teens and young adults are 55 percent more likely to die of melanoma, the most serious type of skin cancer, than their female peers of the same age.
Onchocerciasis, the second leading cause of infectious blindness in the world, is more common in men, who work in contaminated rivers in the developing world. Onchocerciasis is thus an example of a gender-based health disparity, since it is caused by a behavior more common to males in certain societies, although it is treatable with antibiotics.
Read More
Men’s Health (MedlinePlus)
Osteoporosis in men (Nature Reviews in Endocrinology)
Osteoporosis in Men (NIH Osteoporosis and Bone Diseases National Resource Center)
Gender differences in the pathogenesis and outcome of lupus and of lupus nephritis (Clinical and Developmental Immunology)
Lupus (MedlinePlus)
Melanoma survival disadvantage in young, non-Hispanic white males compared with females (JAMA Dermatology)
Melanoma (MedlinePlus)
African programme for onchocerciasis control 1995–2015: Model-estimated health impact and cost (PLoS Neglected Tropical Diseases)
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O
Osteoarthritis
Osteoarthritis is a condition that accompanies aging, as the body’s bones and joints suffer wear and tear with time and lots of use. It is painful, and there is no cure. What’s more, osteoarthritis remains the leading cause of chronic disability in the United States, and it disproportionately affects post-menopausal women. Current treatment generally involves a mix of exercise, lifestyle modification (such as weight loss), and pain relievers. Researchers are hard at work looking for new clues about how to prevent and treat osteoarthritis. It is more common among women than men in every age group, but there are subtle differences worth knowing about.
The severity of osteoarthritis is usually significantly worse in women than it is in men.
In women, osteoarthritis typically affects certain joints such as the knees, hips, and/or hands.
Before age 45, more men than women have osteoarthritis, but after age 45, the condition is more common in women.
Black women are at greater risk than white women for developing osteoarthritis and for experiencing complications from the condition.
Black women and black men with osteoarthritis are much less likely to undergo total knee replacement when compared to white men.
ORWH was one of the co-founders of the Osteoarthritis Initiative, a longstanding, large, multi-center prospective clinical study of osteoarthritis of the knee. It involves researchers from other NIH components such as the National Institute of Arthritis and Musculoskeletal Diseases and the National Institute on Aging, universities, and the private sector. All the data is publicly available online. The Osteoarthritis Initiative has prompted many additional NIH-funded research studies that are ongoing.
Read More
Osteoarthritis (MedlinePlus)
Chronic Disease Prevention and Health Promotion: Arthritis(Centers for Disease Control and Prevention)
Race, sex, and total knee replacement consideration: role of social support (Arthritis Care Research)
Osteoarthritis Initiative (NIAMS)
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P
Prescription Painkiller Abuse
Women in America are dying from prescriptio-drug overdoses at unprecedented rates. Most of these deaths are caused by opioids, painkillers that are chemically similar to heroin and that have similar effects in the body and can be highly addictive. Examples include OxyContin, Percocet, and Vicodin. Research has shown that males and females do not respond in similar ways to opioids. Here are some facts about sex- and gender-based difference in prescription painkiller abuse.
Overall, men are more likely to die of a prescription painkiller overdose than women; however, since 1999, the percentage increase in deaths has been greater among women (400 percent in women compared to 265 percent in men).
For every woman who dies of a prescription painkiller overdose, 30 go to the emergency department for painkiller misuse or abuse.
According to the Centers for Disease Control and Prevention, the majority of people, both women and men, who misused prescription pain relievers (55 percent) received them free from a friend or relative, 17 percent got them using a doctor’s prescription, 4 percent bought them from a drug dealer, and a small fraction (less than a half-percent) ordered them online.
Animal studies showed that males and females have different physiological responses to coping with opioid withdrawal, suggesting the need for gender-appropriate addiction-treatment strategies.
Studies show that overall, women and men have similar perception of pain, but that pain perception varies significantly by trigger, such as cold, hot, pressure, ischemia[RH1], or other sensation.
Use of opioid drugs during pregnancy can produce drug-withdrawal syndrome in newborns. The proportion of babies born with this health burden tripled from 2000 to 2009.
Read More
Vital Signs: Prescription Painkiller Overdoses (Centers for Disease Control and Prevention)
Chronic pain treatment and addiction (National Institute on Drug Abuse)
Prescription Drug Abuse (MedlinePlus)
Addressing the Needs of Women and Girls: Developing Core Competencies for Mental Health and Substance Abuse Service Professionals (Substance Abuse and Mental Health Services Administration)
Gender effects on drug use, abuse, and dependence: a special analysis of results from the National Survey on Drug Use and Health(Gender Medicine)
Results from the 2010 National Survey on Drug Use and Health(SAMHSA)
Nonmedical Use of Prescription Drugs (The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women)
Pleiotropic opioid regulation of spinal endomorphin 2 release and its adaptations to opioid withdrawal are sexually dimorphic (Journal of Pharmacology and Experimental Therapeutics)
Sex differences in pain: a brief review of clinical and experimental findings (British Journal of Anaesthesiology)
Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009 (Journal of the American Medical Association)
Neonatal abstinence syndrome (MedlinePlus)
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S
Smoking • Stem Cells • Stroke
Smoking
Tobacco use is the leading cause of preventable disease and death in the United States and worldwide it carries a substantial health burden. Smoking is an unhealthy habit for both genders, but women and men experience different health risks, and they respond differently to techniques designed to help them quit. Here are some examples:
Quitting smoking at any age dramatically cuts a woman’s risk of death.
Women smokers have a higher breast cancer risk.
Women smokers who use oral contraceptives risk serious health effects such as blood clots, heart attacks, and strokes.
Smoking affects a woman’s eyes, putting her at higher risk for vision problems, such as macular degeneration and cataracts, later in life.
There is a strong relationship between the number of cigarettes a young woman smokes per day and the probability that she will have an ischemic stroke.
Quitting smoking is one of the best decisions a woman can make toward a healthier tomorrow for herself and her family.
While men are