Gender & Society in the Classroom: Health and Medicine
Organized by: Margaret Waltz, Case Western Reserve University
This section contains articles published in Gender and Society over the past two decades. Ordered chronologically, this guide covers topics including medicalization, reproduction, childbirth, stigma, and physician training. An overarching theme of these articles is how medicine and health influences and, in some ways, constructs our experience of gender while our gender also influences our health.
Today, phallocentrism is perpetuated by a flourishing medical construction that focuses exclusively on penile erections as the essence of men’s sexual function and satisfaction. This article describes how this medicalization is promoted by urologists, medical industries, mass media, and various entrepreneurs. Many men and women provide a ready audience for this construction because of masculine ideology and gender socialization. While there may be some advantages to this construction, there are major disadvantages to men in terms of the inevitable failure of the promised perfectible erection and the perpetuation of a falsely universalized and biologized vision of sexual experience. Any sexual interests of women in other than phallocentric sexual scripting are denied.
This article examines a select sample of popular magazines and self-help books to address the question: How is premenstrual syndrome (PMS) constructed discursively as a legitimate disease worthy of medical attention and public discussion? The author finds that some women have been active participants in the construction of PMS as a medical disease. In dparticular, she finds that accounts of women’s experiences of premenstrual symptoms figure prominently in the rhetorical legitimation of PMS as a medical phenomenon in the popular press and self-help books. At the same time, the author examines the gendered assumptions about gender, health, and normality that underlie how women’s “experiences” are incorporated into the construction of PMS. In particular, she asks whose experience is part of the medical legitimation of premenstrual symptoms and argues that the case of PMS illustrates the need for feminists to problematize biological as well as social experiences.
Recent changes in access to contraceptive and infertility treatments in the state of Illinois, and across the United States more generally, have heightened class cleavages in access to reproductive health care benefits in the United States. Using data gleaned from government testimonies, public documents, and telephone interviews, the authors found that poor women have broad access to contraceptive coverage but very little access to infertility treatments, while working-and middle-class women have increasingly broad coverage of infertility treatments but spare coverage of contraceptives. These findings suggest that while the extreme measures of the eugenics movement are less frequently in evidence, class differences in access to reproductive services lead to an equally dualistic, albeit unstated, fertility policy in the United States: encouraging births among working- and middle-class families and discouraging births among the poor, particularly those on Medicaid.
Health care professionals use strategies during the physical examination to stay in control of their feelings, the behaviors of their patients, and to avoid allegations of sexual misconduct. To investigate how health care practitioners desexualize physical exams, the authors conducted 70 in-depth interviews with physicians and nurses. Three desexualizing strategies were general ones, used by both male and female health care providers, and were employed regardless of the characteristics of the patients: engaging in conversation and nonsexual joking, meeting the patient clothed before the exam, and using medical rather than colloquial terms. Six strategies were used only in specific contexts or were used primarily by men or women. These gendered strategies include using a chaperone, objectifying the patient, empathizing with the patient, joking about sex, threatening the patient, and looking professional. The authors conclude that desexualizing the exam is gendered and, in some contexts, (hetero) sexualized. Using certain strategies bolsters stereotypes about gender and heterosexual relationships in the hospital.
The literature on gender and health typically addresses behavioral patterns when discussing men’s attitudes to health. Few of these studies explore men’s anxieties or presentations of self in relation to health problems, particularly for stigmatizing conditions such as sexually transmitted infections (STIs). Through direct observation and focus group interviews of health workers, clients, and students, this study explores African American men’s attitudes toward attending STI clinics in the Deep South. The men’s concerns about STI clinics center on realistic health or stigma-related concerns. Using a gender-relational analysis, three main sources of fear are identified in relation to attending the clinics: Gender anxiety (attacks on masculinity), social anxiety (damage to social reputation through stigma), and racial anxiety (AIDS as genocide). These fears present a barrier to STI care for African American men.
Teens’ experiences with reproductive health care have been ignored by both the “social problems” moral discourse on teen pregnancy and feminist critiques of medicalization. These perspectives are both gendered and racialized in ways that marginalize African American teen mothers. Interview data with 51 poor African American teen mothers suggest that their reproductive experiences occur within very different contexts than those that have inspired feminist criticisms of medicalization. Before their pregnancies, teens are largely denied access to formal health care services and reproductive information and knowledge, and once pregnant, like adult women, they alternately embrace and resist specific aspects of medical care. Their perspectives provide insights into women’s experiences with the formal medical system from an understudied social location, and their narratives expand our understanding of how women’s and girls’ sexuality is socially constructed as problematic and managed, controlled, and regulated in particular ways depending on their social locations.
Prior research suggests that midlife husbands have worse health when they earn less than their wives; however, the mechanism(s) for this relationship have not been evaluated. In this study, the author analyzes 1,319 heterosexual married couples from the Health and Retirement Study to explore three theoretically grounded mechanisms. The author begins by assessing two well-established family relations theories (economic resource and marital dissatisfaction) to explore the mediating effect of marital power and relationship quality. The author then draws from gender relations theory, multiple masculinities literature, and cognitive dissonance research to test the possibility of a male breadwinner mechanism. The results demonstrate that family relations theories are insufficient explanations but provide strong support for the male breadwinner mechanism. Specifically, being the secondary earner is harmful for the health of highest-income men—who historically have the strongest expectation of male breadwinning. These findings suggest that stereotypes about male breadwinning can be dangerous for men’s health.
Research has consistently revealed gender differences in attitudes toward science and technology. One explanation is that women are more personally affected by particular technologies (e.g., biomedical interventions), so they consider them differently. However, not all women universally experience biomedical technologies. The authors use the concept of technological salience to address how differences in subjective implications of a technology might explain differences in women’s attitudes toward biotechnology. In a sample of U.S. women from the National Survey of Fertility Barriers, the authors examine how women with and without a biomedical barrier to fertility evaluate biotechnology for infertility, which, the authors argue, reflects differences in technological salience. For women with a biomedical barrier, various experiences, beliefs, and values impacted their attitudes; yet, most of these did not affect attitudes if women had not experienced a fertility barrier. Results suggest that technological salience contextualizes women’s attitudes toward these biotechnologies and may also have broader implications for other biotechnologies.
This article examines the regulation of Latina youth sexualities in the context of sexual and reproductive health care provision. In-depth interviews with health care providers working in two Latino-serving community health centers are analyzed for how they interpret and respond to the sexual and reproductive practices of their low-income Latina teen patients. The author finds that providers emphasize teenage pregnancy as a social problem among this population to the exclusion of other dimensions of youth sexualities and encourage Latina girls’ adherence to a life course trajectory that conforms to middle-class, heteronormative ideals as a solution to this problem. By relying on such understandings, providers construct meanings of sexual citizenship that require participation in bourgeois heteronormativity. These findings suggest that Latino-serving community health centers, their providers, and their teen patients could benefit from questioning the assumptions that inform providers’ appraisals of Latina youth and developing a more inclusive approach to Latina youth sexualities beyond a discourse of pregnancy prevention. Such efforts could allow community health centers to actively participate in disrupting the structural inequalities that shape their young patients’ lives.
Almost half of pregnancies in the United States are unintended, despite the availability of highly effective forms of birth control. Women often cite side effects as a reason for stopping hormonal birth control, and most research on the topic comes from a medical perspective. In this study, the author analyzes hormonal contraceptive side effects from a social perspective that highlights the link between cultural messages about gender and women’s contraceptive behavior. Drawing on data from interviews with 88 women, the author argues that the gendered emphasis on women’s appearance and emotionality shapes women’s perceptions about the seriousness of hormonal contraceptive side effects, like weight gain and emotional volatility, and their propensity to stop use as a result. Contrary to understandings of side effects as a purely medical aspect of use, the gender analysis elucidates the ways that particular side effects are imbued with social meaning that can undermine women’s goals to prevent pregnancy.
Prior studies note that gender- and race-based discrimination routinely inhibit women’s advancement in medical fields. Yet few studies have examined how gendered displays of deference and demeanor are interpreted by college-educated and professional Latinas/os who are making inroads into prestigious and masculinized nontraditional fields such as medicine. In this article, we elucidate how gender shapes perceptions of authority and competence among the same pan-ethnic group, and we use deference and demeanor as an analytical tool to examine these processes. Our analysis underscores three main points of difference: (1) gendered cultural taxation; (2) microaggressions from women nurses and staff and; (3) the questioning of authority and competence to elucidate how gendered racism manifests for Latina/o doctors. Taking demonstrations of gendered deference and demeanors are vital to transforming medical schools and creating more inclusive spaces for all physicians and patients. Conclusions are based on experiences reported in interviews with 48 Latina/o physicians and observation in their places of work in Southern California.
In this article, I argue that the medical conceptualization of gender identity in the United States has entered a “new regime of truth.” Drawing from a mixed-methods analysis of medical journals, I illuminate a shift in the locus of gender identity from external genitalia and pathologization of families to genes and brain structure and individualized self-conception. The sexed body itself has also undergone a transformation: Sex no longer resides solely in genitalia but has traveled to more visible parts of the body, implicating racialized aesthetic ideals in its new formulation. The re-imagining of gender identity as genetically and neurologically inscribed and the expanding locus of sex correspond to an inversion of the relationship between gender identity and the sexed body as well as shifts in medical jurisdiction. Whereas psychiatrists in the 1960s, ’70s, and ’80s understood gender as stemming from genital sex, the less popular idea that gender identity precedes the sexed body has gained traction in recent decades. If gender identity once derived from the sexed body, the sexed body must now be brought into alignment with gender identity. The increasing legitimacy of self-defined gender identity, the expanding definition of racialized sex, and the inversion of the sex–gender identity relationship elevates the role of surgeons in producing racialized and sexed bodies.