Is It Time to Re-Imagine “Women’s Health?

Women’s Health as a medical discipline developed in the 1960s partly in response to the historical exclusion of women in medicine and research and the ensuing significant gaps in clinical knowledge. Since then, Women’s Health helped to advance the care of cisgender women through research, education, and clinical practice. In recent years, however, physicians in Women’s Health have adapted their expertise in trauma-informed care, sexual health, and hormone management to provide care for transgender and non-binary individuals. As its members embrace inclusivity, Women’s Health is left with an unforeseen reckoning over its mission and purpose. While progress has been made, much work remains to be done: Women’s Health remains underfunded, under studied, and gender disparities in clinical care remain. In this column, we examine current efforts and unintended consequences to ask the question: Is it time to re-imagine Women’s Health?

Why We Still Need “Women’s Health”

Keeping Women’s Health in its current form acknowledges that the movement has not yet accomplished its stated mission—to mitigate disparities in clinical outcomes for cisgender women. Women and women’s diseases continue to be under-represented in biomedical research and health sciences curricula, despite recognized gender-based discrimination and gaps in quality of care. The COVID-19 pandemic highlighted these disparities; for example, the practice of excluding pregnant women in vaccine trials resulted in limited data to inform decision making in this high-risk population. While landmark studies, such as the Women’s Health Initiative and the Nurses’ Health Study, have been instrumental in providing evidence for sex-specific care, we question whether transitioning away from the female sex-specific language of Women’s Health to favor gender-neutral terminology could halt the gains made over the last 50+ years.

Women continue to receive differential clinical treatment compared to men, leading to poorer outcomes across a variety of disease states. Women’s symptoms are doubted or downplayed by physicians, often viewed as “dramatic” by clinicians.¹ Women face increasing restrictions on reproductive health care, despite continued increases in maternal morbidity and mortality, particularly for Black wome.² As the population of women in the United States grows larger, older, and their health is more medically complex, the need for a group of physicians with expertise in the care of women is critical. The desire to remain a field with terminology that is sex-specific and feminized devotes attention to both the work that has been done and the work that is yet to be accomplished.

Why It’s Time to Reimagine Women’s Health

There are two reasons why it may be time to reimagine the scope and terminology of Women’s Health. First, it may inadvertently lead instructors and learners to believe that these topics are only essential for certain clinicians. The development of curricular competencies for Women’s Health in 1996 increased recognition that a comprehensive education in Women’s Health is comprised of much more than just reproductive health.³ Unfortunately, this conceptualization of Women’s Health as a quasi-subspecialty led to fragmented educational efforts that failed to raise the minimum competency for all physicians. Standards for competency and expectations of learners who did not seek out Women’s Health programs remained unchanged. With its current trajectory, the Women’s Health movement may be creating a highly specialized workforce, but its small scale inadvertently allows the gender gap to remain in other areas of the healthcare system. To meet the needs of all patients, efforts must be expanded beyond the quasi-specialty Women’s Health has become.⁴

A second argument for reimagining the field recognizes that the boundaries of Women’s Health have become less clear in the wake of increasing conversations around gender identity and expression. Traditionally, Women’s Health providers have specialized knowledge and comfort with gender specific and trauma-informed care. Given this expertise, Women’s Health clinics have organically become a place for patients to seek gender-affirming care. However, while Women’s Health providers have expanded their scope, the language and clinical spaces utilized to represent their services has not evolved. Continuing to use language that ignores the breadth of work in these clinics may directly harm gender-diverse patients. Additionally, failing to evolve labels may perpetuate disparities in research, education, and access to care.

What Now?

Part of the challenge of re-envisioning Women’s Health arises from medicine’s historical over-reliance on strict binaries (e.g., healthy v. diseased, gay v. straight, male v. female). These binaries do not reflect the true nature of sex and gender and fall short when a more nuanced examination is needed. In the case of Women’s Health, the question arises: is a field with such a reliance on binaries still the best way to meet the patient’s needs? Consideration must be given to the power of words—and the current approach may need some course correction to reduce siloing and to ensure that the spirit of inclusivity in the current care is reflected in how Women’s Health presents itself to the world.

What is the right way forward? The terminology sex and gender-based medicine has been proposed for some current Women’s Health spaces and training programs. The discipline of “Sex- and Gender-Based Medicine” (SGBM) gained traction in the early 2000s.⁵ The pioneers of SGBM, like the pioneers of the Women’s Health movement, fought for standardization of sex-based funding, research, and education. Folding Women’s Health into “Sex- and Gender-Based Medicine” addresses the issue of narrowing Women’s Health training and educational efforts to those with interest. However, while eliminating “women” from the lexicon is more inclusive, this terminology risks inadvertently re-centering cisgender male health.

One thing seems clear: it is impossible to address this complex landscape with a simple label change. To accommodate a diverse patient population and the needs of all learners, Women’s Health must become more inclusive in its teaching, cultural competency, and narrative. Using gender-neutral language—such as spouse/partner, they/them, or chest/pelvis—in clinical encounters and teaching normalizes a gender-inclusivity mindset. Asking everyone about gender identity and chosen pronouns, and teaching trainees to do the same, invites a culture of acceptance of gender-diverse patients. All learners should be able to perform a competent, trauma-informed history and physical for all patients regardless of their gender identity.

There will be times and places where Women’s Health is still the most appropriate moniker, but the title Women’s Health must be up for discussion if it is no longer serving the community it is intended to represent. Engaging stakeholders, including patients, is the best path forward to re-brand, enhance, or develop clinical, educational, and research spaces. In addition, we need to demand prioritization and dedication to gender inclusion from policy makers, test writers, and national programming. These are areas in which SGIM members can actively engage in this dialogue, advocacy, research, and education. Some SGIM members are already engaged in this work. For example, the Sex and Gender Women’s Health Education Interest Group recently updated its name from the Women’s Health Education Interest Group. However, this work cannot just be limited to specific interest groups. Instead, SGIM as an organization should consider intentional approaches to minimize the siloing of expertise. Sex- and gender-specific knowledge should be valued in every space where cisgender women and gender minorities receive care. The Women’s Health movement requires an acknowledgment of the inclusivity already pursued now, and continued efforts to diffuse expertise across all clinicians and spaces so it may become unnecessary tomorrow.