An In-Depth Look at Mandy Mangler's Groundbreaking Big Book of Women's Health

Like all medical specialties, gynaecology has long been a thoroughly male-dominated are of knowledge. In the German-speaking world, it was not until the early 20th century that women gained full access to universities. And although 77 per cent of gynaecologists are female, making gynaecology the specialty with the highest proportion of women practitioners, when it comes to the positions at the top of the ladder (the heads of gynaecology departments, professors, and clinic directors), 81 to 87 per cent are held by men. And there has never been a single woman at the helm of any of the professional associations for gynaecology in the Germanspeaking world. Which means that even in gynaecology, for years, perhaps even decades, the training, the therapeutic guidelines, and the prevailing medical opinions in the field have all been primarily shaped by men. This has serious consequences for the way that the profession views its patients, for their health outcomes, and for their own self-image. “Nowhere in medicine is there more power over women’s bodies than in gynaecology,” noted the former vice chair of the German Association of Women Physicians, Prof. Gabriele Kaczmarczyk, who also worked for many years at the Charité hospital in Berlin as the equal opportunity officer.
 

In medicine as a whole, for a long time, there was a prevailing assumption that the differences between men’s and women’s bodies were so negligible, that women could be viewed scientifically as slightly smaller men. This presumption led to the situation that up until the 1990s, most pharmaceutical studies simply excluded women as test subjects – too great was the fear that they could fall pregnant during the course of the study, with the medication posing a risk to the unborn child. Since then, things have begun to change, but we are still a long way away from reaching an accurate representation of women in this area. It takes more effort to assess the results of female subjects in these studies, because it is necessary to take into account a woman’s menstrual cycle, and to differentiate between pre- and post-menopausal women, and between those using hormonal contraception and those who do not. In fact, in order to achieve reliable findings, you would actually need to include more women in such studies than men.

Women’s bodies are not only anatomically different from men’s bodies, they also exhibit immunological, genetic, and hormonal differences – each of which have impacts on every area of medicine. Which is why women need a branch of medicine that is tailored to them. The fact that knowledge about the differences between male and female anatomy is not consistently applied in the broader field of healthcare can be life-threatening. A classic example of this is the fact that women are more likely to die after suffering a heart attack than men because they exhibit different symptoms. And because these symptoms are less well known, the seriousness of their condition is often not recognised by emergency room staff, which means they do not receive the treatment they require with the adequate urgency.

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