Sexism in Bleeding Disorders: Reframing the Conversation
By Julie Jaffray, M.D.
Sexism. The word brings on strong feelings for most people, yet it is a fairly common word to hear in the realm of medicine. With females now comprising the majority of younger physicians, the landscape is changing. However, in this historically male-dominated field, our basis of understanding human physiology and disease was and remains predominantly through the lens of male patients, and bleeding disorders are no exception.
As pediatric hematologist at Oregon Health & Science University, Kristina Haley, D.O., noted that the focus on boys and men within the bleeding disorders community was previously understandable since the consequences of incorrectly treating or diagnosing a male with hemophilia can be serious and thus focusing our attention on these patients seemed appropriate. Although, upon further discussion, Haley also made clear the toll this has taken on females.
“Recently, I have reconsidered this framework – as the consequences of treating or not treating heavy menstrual bleeding, post-partum hemorrhage, and even joint bleeds or muscle bleeds [in females] with bleeding disorders is also very significant – and no less significant than in males with severe hemophilia,” Haley said.
In the last year, a physician with her social media platform and Twitter handle, @shematologist, has brought to light sexism within the bleeding disorder community. Following these tweets, Angela Weyand, M.D., a pediatric hematologist from the University of Michigan, U.S., and Paula James, M.D., from the Queen’s University in Kingston, Ontario, Canada, published ‘Sexism in the management of bleeding disorders’ in Research and Practice in Thrombosis and Haemostasis (RPTH).
Weyand and James point out that sexism has been a long-standing issue within the bleeding disorder community, and the roots of this inequity are most likely due to the stigmatism of menstrual bleeding from both patients and providers. Even in the modern era, Weyand notes she hears concerns that “men will start feeling ostracized with all the discussion around periods.”
As we know, periods are a normal and vital part of human existence. Even the American College of Obstetrics and Gynecologists (ACOG) published a statement that after blood pressure, heart rate, oxygenation, temperature and pain, the evaluation of menstrual cycles should be the sixth vital sign when assessing overall health. Therefore, it is surprising that discussion of someone’s period tends to be more taboo than talking about urine, sputum, stool or even semen.
The Foundation for Women and Girls with Blood Disorders (FWGBD), a group dedicated to improving the education and awareness of blood disorders in females, has grown from a few passionate members to a large, international group leading educational events and multi-center studies. Weyand used the momentum from the FWGBD to use her social media platform to educate others through “tweetorials” regarding her passion for education on sexism and bleeding disorders. Weyand has also decided to broaden the focus of the patients in her bleeding disorders clinic from males with hemophilia, to include their mothers, sisters and aunts who may also be affected.
Haley has broadened her clinic as well with a goal to normalize menstruation by doing a “welcome to womanhood” visit with girls who have bleeding disorders. This visit gives these young girls a safe learning environment to discuss their upcoming menarche. Haley is also leading a research project through the American Thrombosis and Hemostasis Network (ATHN) to increase female-specific questions in their patient-centered database to identify opportunities to improve bleeding diagnoses and treatment for these patients.
Through the work of these physicians and the support from the FWGBD, ATHN and many other organizations and providers, the pendulum has started swinging. The goal is not for the extent that medicine, and specifically the bleeding disorder community, primarily focuses on women, but perhaps a more even distribution of scientific discovery and education between the sexes/genders and the normalization of discussing menstruation as the sixth vital sign.
Read Weyand’s article: Sexism in the management of bleeding disorder.
Watch the video RPTH Research Recap with Weyand.