Publications

Sex and Gender Differences

Research conducted during the past decade is revealing differences in health and disease between women and men.⁽¹⁾ There are differences in the ways in which the symptoms of disease manifest in women in men, the rate at which diseases develop and the course that they follow, as well as differences in how women and men respond to treatments. An important goal of research is to develop gender-appropriate treatments and interventions. This is also true in the treatment of substance abuse in women and men. Below are just a few of the areas in which research of the past decade has uncovered differences between women and men's health.

Researchers have identified several important differences in the speed with which men and women infected with HIV develop AIDS. For example, an HIV-infected woman with half the viral load as an infected man will develop AIDS as quickly. In one study, although the initial level of HIV-1 RNA was lower in women than in men, the rates of progression to AIDS were similar. In treating women patients infected with HIV, CD4+ lymphocyte count, rather than viral load, should be used to determine eligibility for antiretroviral therapy.⁽²⁾

Research reveals that cigarette nicotine dose is a less important influence on the subjective and, under some conditions, reinforcing effects of smoking in women than in men. Therefore, harnessing social support to foster abstinence is important in treating women, as is the possibility that smoking-associated environmental cues may be more influential in smoking behavior in women than men.⁽³⁾

Studies show that biological and psychosocial factors contribute to the higher vulnerability of women to major depression. The biological-psychosocial origins of depression in women may require a multidimensional approach to treatment. ⁽⁴⁾

Type 2 diabetes is more prevalent among women than men, making prevention and early detection particularly important in the treatment of women. Major areas of health care concern for women with diabetes include cardiovascular disease, mental health, infections, and contraception and fertility.⁽⁵⁾

Studies of the anatomy of the brain reveal that, after correcting for cranial volume, men and women had identical volumes of amygdala and hippocampus, as well as dorsal prefrontal cortex. However, women had larger orbital frontal cortices than men, resulting in highly significant difference in the ratio of orbital gray to amygdala volume. The larger volume of cortex devoted to emotional modulation may relate to behavioral evidence for sex differences in emotion processing.⁽⁶⁾

Endnotes

1. Pinn VW. Sex and gender factors in medical studies: Implications for health and clinical practice. JAMA 2003; 289:397-400.

2. T. Sterling et al. Initial plasma HIV-1 RNA levels and progression to AIDS in women and men. N Engl J Med 2001; 344:720-25.

3. Hoffman DE, Tarzian AJ. The girl who cried pain|: a bias against women in the treatment of pain. J Law, Medicine & Ethics 2001; 29:13-27.

4. Desai HD, Jann MW. Major depression in women: a review of the literature. J Am Pharm Assoc (Wash) 2000; 40(4):525-37.

5. Campaigne BN, Wishner KL. Gender-specific health care in diabetes mellitus. J Gend Specif Med 2000; 3:51-58.

6. Gur RC, Mozley LH, Mozley PD, Resnick SM, Karp JS, Alvai A, Arnold SE, Gur RE. Sex differences in regional cerebral glucose metabolism during a resting state. Science 1995; 267: 528-31.