Tuesday, July 20, 2010

Which is the Correct Term - Sex, Gender, Both?? How Medicine Can't Yet Accurately Answer The Question

Two dots, the Area Under the Curve, a Venn Diagram, a Double Headed Arrow - How to define sex and gender?
Standard Definitions: 
Sex The biologic definition is one that refers to the classification of living things, generally as male or female according to their reproductive organs and functions assigned by chromosomal complement. The biologic definition various from the psycho-social, the cultural and other approaches.
Gender The biologic definition refers to a person’s self-representation as male or female, or how that person is responded to by social institutions based on the individual’s gender presentation. Gender is rooted in biology and shaped by environment and experience. Current work is now moving to gender being defined as agency (the ability to take an action and do something) versus expression (as in nurturance or able to express emotional experiences) rather than male/female.
Sex/Gender Definition – In health care these are complex concepts that are influenced by cultural, social and political contexts-which cannot be equated or reduced to simply biology and culture.
Sex/Gender Health Differences – a field of study that examines different health outcomes as a result of sex and gender resulting in essential information about disease activity, susceptibility and provides important clues in pathophysiology (what processes are not working correctly) and in developing new devices and treatments. Sex hormones are only one of multiple factors that contribute to sex and gender differences.

 1. Sex can be viewed as a polar entity (for purposes of this current discussion, will defer on a discussion on trans health - although it reinforces the continuum approach.) Just as with computer codes - "0" and "1", male and female can be considered discrete, autonomous endpoints. A way to categorize into piles. Gender, in Medicine, is often framed as the environment's impact of femaleness or maleness. Yet, information about neuroplasticity of the brain reveals that our world can physically (neurologically) change us. So our experiences creates biologic change within us. That is good news when it comes to rehab after a stroke, but this influence can be even more subtle. So, reductionistically, sex and gender can be mathematical data points.
     So, that's one definition and framework but there are more.Sex/gender can also be viewed as 2) biospsychosocial, 3) cultural, 4) intersectional, 5) on a continuum, 6) interchangeable.
2. Biopsychosocial - that Venn Diagram - looks at the psychoanalytic components of sex/gender. What are the social and cognitive processes? How does self-labeling and identity formation play a role?
3. Cultural - the ultimate in contextual, there are those that argue that culture is a lens for all that we do and how we see ourselves, hence sex/gender are cultural elements
4. Intersectional - this one is a bit more complex. It is based upon the intersection of biology and culture whereby power and resources are available differentially. The 'haves and have nots' of sex/gender. A great example is aging. When we talk about the issues of elderly, we are more often talking about issues of women (as women sadly outlive men!) But we are also talking about issues of poverty. The endpoint of the 73 cents to a dollar of economic disparity for the same work, results in aging women having scarce resources. We see this in an elderly lady choosing food over medications, for example. In case the 'haves not' seem inherently and uniquely female, recognize that one of men's 'have nots' is a tradition of accessing health care!
5. Continuum - this definition focuses upon the variability and range of sex/gender in manifestation and expression. It also warns that our polar, on/off switch of sex/gender can blind us to fluidity and genetic diversity.A good example is that of Kinsey and sexuality - prior to his work, heterosexuality and homosexuality where viewed as two discrete things (back to the scientific on/off switch) As a result of scientific inquiry, the continuum of sexual attraction was uncovered.
6. Interchangeable - in some fields, sex and gender are viewed as synonymous and interchangeable.

So, what's the 'right' answer in Medicine? The answer is, we don't yet know. Clearly, uterine cancer is a sex-specific issue. Intimate partner violence appears to be a gender based issus. But the role of sex and gender in science, despite the field being 20 years old, is still not well delineated. The right answer may be that sex/gender include all of the definitions and that we need critical work to flesh out the impact and answers.


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