Medical Research Now Includes Women
Part of the difficulty identifying health issues that are different for women has been that until recently, health research in non-reproductive areas primarily involved male subjects.  Differences between the sexes in incidence and presentation of illnesses were not addressed.  Women were not routinely included in studies of disease treatment as there was concern over the potential effects of a new treatment on a woman’s reproductive ability or damage to a fetus if she was pregnant, as well as concern about the difficulty addressing the potential impact of a woman’s monthly hormone cycle.  This began to change when, during the early 1970’s, attention was focused on the mechanisms for conducting clinical research and the fact that study of women was rare.  However, a1985 report from the US Public Health Service indicated that little was known about women’s health, beyond reproductive issues.  In 1986, the National Institutes of Health (NIH) encouraged the inclusion of women in clinical research protocols.  A follow-up government study in 1990 indicated that this had not been achieved on a consistent basis.  The Office of Women’s Health Research was created in 1993.  In 1994, the NIH revised their guidelines, requiring that NIH-supported research include women in research protocols, when appropriate.

We Are Very Different
Differences between men and women can be found for almost all organ systems and disease processes studied thus far.  For example, women are more prone to develop lung cancer from smoking than are men.  For the same amount of tobacco smoked, women have a 20-70% increased risk of cancer.

The Female Heart
Normal heart function and the development of heart disease are also different for women. For example, the size and shape of the heart are different.  In addition, the conducting system- the electrical impulse leading to a heart contraction- is different, leading to a higher resting heart rate in women.  Although estrogen does have an effect on the function of the heart, the basic proteins that constitute the heart muscle have fundamental    differences between the sexes.  In addition, the symptoms of heart disease are different, for reasons not yet identified.  While men typically complain of chest pain as an initial symptom of a heart attack, women may have less specific symptoms, such as fatigue, difficulty sleeping, or increased anxiety.

Osteoporosis and ACL Injuries
There are also substantial differences between the sexes in the development and disease processes of the bones and joints.  Bones in men tend to be larger and thicker, due at least in part to the effects of testosterone.  With aging and the loss of sex hormones, bone becomes more fragile.  Since men start out with a larger reserve of bone, they are less likely than women to develop osteoporosis, and consequent low-energy fractures, with aging.  However, young women are also at risk for developing osteoporosis and fractures, if they develop what is known as the “female athlete triad”, consisting of eating disorders (usually anorexia nervosa), amenorrhea (interruption of normal menstrual cycle), and osteoporosis.

Female athletes are also at greater risk of injuring their knee anterior cruciate ligaments (ACL) than are men.  This ligament runs between the 2 large bones that make up the knee (femur and tibia) and prevents excessive motion between these 2 bones.  There has been significant speculation and research into the cause of this increased incidence, especially as women typically sustain this injury without contact during a sporting event. 

Sex-Based Biology
The current interest in medical research is in so-called sex-based biology or gender-based medicine. Studies of normal development and the pathophysiology of disease are beginning to include sex-specific data.  This may lead to more information to explain differences in incidence and response to treatment between the sexes.  The goal of this research is to allow better understanding of disease, for both men and women, and to allow interventions to potentially be tailored for a specific gender, to better prevent or treat disease.

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