Quite often, we hear of prejudice against women in medicine based solely off gender. While there is absolute truth to this, we would like to highlight the great advances that women in medicine have fought for not only as physicians, but also as patients and research subjects. This month, the United States celebrates the 100th anniversary of ratification of the 19th amendment to the Constitution, allowing women the right to vote, we dedicate this to all the women who tirelessly fought for us to advance to where we are today, both medically and non-medically.
Five advancements of women in medicine
1. For the first time in history, women outnumber men in medical school
According to the Association of American Medical colleges (AAMC), in 2019 there were 46,878 female and 45,855 male medical students. This milestone, however, was not without humble beginnings.
In October of 1847, Elizabeth Blackwell was accepted into the Geneva Medical college in New York. She had applied to 12 medical colleges without success. When the Geneva Medical college received her application, the admissions committee was unclear as to how to proceed. Therefore, they left the decision to the current 150 male medical students, stating that all must be in unanimous agreement to accept her application. It turns out the students thought this was a joke and, therefore, did unanimously agree to accept her only to see her arrive as a student a few weeks later. Fortunately, Elizabeth was allowed to stay but not without further obstacles to her education including the right to be attend the reproductive anatomy lesson. Nevertheless, she persevered, demonstrating that living well and proving others wrong is in fact the best revenge. On January 23, 1849, she became the first woman to receive a medical degree in the United States. Thank you for your courage, determination, and strong example, Dr. Elizabeth Blackwell.
2. Hysteria is no longer recognized as a medical condition
The word hysteria is derived from the ancient Greek word “hysterikos,” refers to diseases of the womb, and has been a medical diagnosis for 4000 years. It was used to describe multiple symptoms, including melancholy, anxiety, sexual desire, and fainting, which was explained by an overactive, “wandering uterus”. Until the 20th century, treatment consisted of physicians manually stimulating the genitals of female patients to the point of orgasm. While evidence is disputed, some consider that the inconvenience of utilizing this treatment manually lead to the invention of the electric vibrator. Fortunately, the American Psychiatric Association removed this as a diagnosis in 1952.
3. Birth control was illegal, and when it was legalized, only married women were given access. This is no longer the case.
In 1873, the Comstock act was passed. This act prohibited advertising, informing the public, and distributing birth control. The postal service was even allowed to confiscate birth control sold through the mail. Nurse Margaret Sanger pioneered in this field. She opened the first birth control clinic in 1916, which directly led to her arrest for informing people and distributing birth control. Nevertheless, she re-opened her clinic, despite repeated arrests. Her persistence and dedication ultimately led to the foundation of Planned Parenthood.
In 1965 Supreme Court case Griswold vs. Connecticut gave married couples the right to use birth control. It was not until 1972 that the Supreme Court legalized birth control for all citizens, regardless of their marital status, in the case Baird vs. Eisenstadt.
4. Spousal consent was required for tubal ligation
Given that tubal ligation is a very effective way to prevent pregnancy, it was commonplace for a woman’s husband to sign off on this procedure before it was performed. Women challenged this, particularly during the women’s movement of the 1970s. This has gone to Federal courts, which have ruled state spousal consent laws unconstitutional; however, the Supreme Court has never ruled on the issue officially. While women have made advancement with this, it is not in fact resolved; depending on the state, gynecologist, or hospital, it may not technically be illegal for spousal consent to be required.
Unfortunately, not only was a woman’s spouse required for consent for a tubal ligation, before the 1990s, it was also not illegal for a husband to rape his wife. Thus, not only could a husband impregnate his wife thru rape, he was immune from criminal charges, and had further control over her ability to obtain tubal ligation to prevent pregnancy.
5. Women are now allowed to be included in research
Have you ever wondered why a woman can present atypically for a heart attack? The original research was done in male patients. Female patients may present differently. However, the word atypical reflects the original data being from male subjects. Heart disease remains the number one cause of mortality in the United States. Common sense would dictate females be included in studies on heart disease. Nevertheless, they were not.
This approach has had devastating consequences. In one particular example, the exclusion of women from phase one and phase two clinical trials resulted in the approval of the drug thalidomide for all. Prescribed to pregnant women as an antiemetic, it resulted in limb deformities in thousands of children. Simply put, this defect was not caught during clinical trials, results were made generalizable when they were in fact not generalizable, and it was an error not without consequence.
This has been rectified. In 1993, it became Federal law to include women and minorities in research through the NIH Inclusion Policy.
While there are still disparities for women in medicine, as above, great advancements have been made. However, together we can continue advocating for equality in all aspects of medicine.
The author would like to thank Angela Creditt, DO for editorial assistance.
- Chambers, William, & Chambers, Robert. (1858). DR ELIZABETH BLACKWELL. Chambers’s Journal of Popular Literature, Science and Arts, Jan. 1854- Nov. 1897, (230), 350-352. https://cfmedicine.nlm.nih.gov/physicians/biography_35.html
- Dmytriw, A. (2015). Gender and Sex Manifestations in Hysteria Across Medicine and the Arts. European Neurology, 73(1-2), 44-50
- Maines, R., & American Council of Learned Societies. (1999). The technology of orgasm “hysteria,” the vibrator, and women’s sexual satisfaction (Johns Hopkins Paperbacks ed., Johns Hopkins studies in the history of technology ; new ser., no. 24). Baltimore, Md.: Johns Hopkins University Press.