Case Study

SVEUICH a n d Phwee ysical Specific Concerns Health:

. Some

Heart Disease

bane en cvery? a l V S : women will develop

lar disease), and 2 di o e r e o ) cardiovascular mortality in

women exceeds that in men (Miller and Best,

2011). Women also have more severe first strokes at an older age than men, require longer hospitalization, and remain disabled

(Wor ld Heart Federation, 2012). Women appear to be diagnosed with heart disease at later stages, to have their illness treated less

aggressively by physicians, and to require different medical and surgical treatment f rom men. Even risk factors such as cho es

torol and triglyceride levels appear to P

266

=

"ay a

W ?

OMEN?S RELATIONSHIPS, WOMEN?S SELVES

d i f f e r e n t r i s k s

trials for cardi according to gender.Clinical

on symptom ovascular disease (CVD) focus females and S more typical o f males t han

m e n than provide more information about F t h women (Adler, 2010). Moreover, 8

Of the 10 drugs most recently taken o f f the marke t had more adverse effects in wome? than men (U.S. General Accounting Office,

2001). Awareness o f the dangers o f heart DYdisease to women is underestimated

both professionals and women themselves.

W o m e n develop chronic diseases such as

coronary artery disease well before meno- pause; hence, prevention of heart disease

must begin young, and early detection an awareness is needed to more effectively

manage women wi th cardiovascular disease

(Raymond, Greenberg, and Lieder, 2005).

Box 9.5 W I N D C H I L L F A C T O R

cancer

The most common type o f cance; a reast cancer (which ye TOng

w o m e n is b en), although i t varies s h y

occurs 11 m tial ly amongd i f f e r e n t ethnicgroups, Ag t t

the majority o f cancers, the risk of breag

cer increases wi th age. This may be due i long-term effecto f exposure to enviro the ral and other toxins. Al though scientist, en.

activists have urged greaterinvestigatioy,

the role of environmental factors, a major « 0

in the focus o f research has not yet occurs

(Gray, 2008). Nonetheless, more attention Ki

asbeen given to breast cancer, largely bec A s e

o f women?s efforts to demand more funds fo

breast cancer awareness and research, espe.

c ial ly related to prevention (see Box 9.5),

When my grandmother had hers removed,

She complained of thecold. We wandered down the windy beach in the evening- You don?t think of that beforehand. She crossed her arms over the flat plains

O f her chest as she spoke. Our walks were always after the sun had gone down. Post radiation, the bright light of day was forbidden. Her cool, dark bedroom was foreverfringed with the hats she would take off and toss.

Within the mahogany dresser drawers I glimpsed the bulky white contraptions She strapped on each morning After shooing us out and closing the door. Even her daughters were left outside.

My aunt had to forfeit only one. Do you want to see?

she asked, six months after the surgery. She pulled open her soft, pink nightgown revealing herself.

WOMEN'S HEALTH 267

she andI both looked, curiously, I shrugged, was nonchalant, Butprivatelyt h o u g h t

at I could have done the job just as well myself plindfolded w i th a dull hatchet,

My aunt buttoned up her flannel. |?m too small to need a prosthesis, But there are times I look down at myself and i t seems like someone has made the bed and left o f f a pillow.

Now i t has come down to you, drift ing though the air, the water, the years,

w h o k n o w s .

Before surgery, you write on the good one: N O ! D O N O T R E M O V E !

And draw ar rows to the bad one.

a a

iSource: From Women?s Studies Quarterly a31, nos. 1 and 2 (Spring/Summer 2003): 185-6. Copyright © 2001 by Charlotte McCaffrey, by permission o f the . a e 4Femini aww f e rmin is tpress .org . ¢ Feminist Press at the City University o f New York,

A variety of possible factors causing higher risk for cancer have been investigated. I t is not clear whether, or to what extent, either dietary f t or obesity increases the risk of breast can- ver Alcohol consumption has been impli- cated, but questions remain about how the age

at onset of drinking or amount of drinking is related to risk (Porzelius, 2000). Guidelines for the use of hormone replacement therapy (HRT) have been modified to reduce their potential harm to women (Boston Women?s

Health Book Collective, 2011). The incidence of breast cancer has gone

up dramatically in recent years. I f detected efore it has spread to other areas, i t can

often be treated effectively. Performing test self-examinations, though no lon-

8 recommended, contributes to awareness

of possible changes in a woman?s body and can be important for this reason. Access to

healthcare practitioners is necessary as physi- cians or nurse practitioners may detect breast cancers through manual examination, which should be performed at regular gynecologi- cal examinations. The most commonly used

technology today to detect breast cancer is mammography, which uses radiation to take an image to see if there are any abnormal tis- sue masses. Cancers of the ovaries, uterus,and cervix cannot be detected by self-examination. Early detection of cervical cancer is possible, however, by use of a Pap smear, which detects abnormalities in sampled cells. HPV vaccines

now provide protection against the most common types of virus that cause most cervi-

cal cancers.

~ eS E Y

OMEN'SRELATIONSHIPS, WOMEN?S SELVESWi ,

Sexual}y Transmitted Disea .

Including HIV/AIDS se Infections

L o r women o freproductive age (15-44 years)

to r for ?tie t h e single greatest risk fac- in H I V / A n tl i ty and death, as it mayresul t dj DS or other sexually transmitted Ciseases (STDs). STDs are quite prevalent

in the world today. They are a major cause of infert i l i ty and can contribute to blindness

a n d brain damage as well as to difficulties in childbearing. Chlamydia infection is the most

c o m m o n bacterial sexually transmitted disease in the United States, and the rate for women is 2.5 times the rate among men (CDC, 2010).

Untreated chlamydia, which is largely asymP- tomatic in women, can result in pelvic inflam-

matory disease, which in turn may cause

infert i l i ty in at least 24,000 women annually in the United States as well ectopic preg-as

nancy and chronic pelvic pain (CDC, 2010). ,The human immunodeficiency v i s

the precursor of AIDS, is transmitted through enital secretions or through blood. At the

end o f 2010, an estimated 34 million people worldwide?38.6 million adults and 3.2 mil- lion children younger than 15 years?were living with HIV/AIDS. Approximately 70% of them (29.4 million) live in sub-Saharan

Africa; another 17% (7.2 million) live in Asia.

Approximately 50% of adultsliving with HIV / _ AIDS worldwide are women (Seager, 2009).

Numbers continue to rise among adolescents.

One particular consequence for women with these diseases is that they can transferthem to their fetuses unless medication is available

during pregnancy. Approximately 40,000 new H I V infections

occur each year in the United States, about 70% among men and 30% among women. Of newly infected women, approximately 64% are black, 18% are white, 18% are Latinas, and approximately less than 1% involves other racial/ethnic groups. Approximately 75% of women were infected through heterosexual sex and 25% through injection drug use (CDC,

\

2001). AIDS, like other sexually ,, diseases, 1S avoidable for adults wh ashing trol over their own bodies.Protected. haveco t a Se usslatex or a female condom) is the mon effective alternative(although Lostcon?

alternatives, using fantasy and magn © sey have also been recommended),Althon?®

dom use has consistently risen amon? °D- Americans, some women do engage ha Young

relations without using condoms, The , 8 0 they give include inconvenience, sham

refusal by their male partners (Hinkle ¢ and 1992). Older women are particularly t a l , as they may have recently begun havin Tisk

§ N e w

sexual partners after many years of mary; in the case of heterosexual women, ang age,

mabe uncomfortable addressing safer sey

cerns as well as believing i t is not relevane

them. Older women living with are to

often-overlooked population. an

In sub-Saharan Africa, where problems of nat

H I V transmission are acute, women runhigh

risks of abuse by male partners for insistin on condom use. There, poverty forceslarge numbers of women into sex work and extreme

vulnerability to exposure to AIDS and abuse,

Women's lower status also may prevent them

from having the control to protect themselves from H I Vtransmission.Many young women

in sub-SaharanAfr ican countries have stated

that their first experience o f sexual inter- course was forced (UN AIDS, 1998). Similar data exist in the United States. Issues such as

lack of knowledge, inaccessibility, and lack of concern for one?s own safety are some of the

reasons for the lack o f contraception use.

Women who engage in heterosexual inter-

course with an H I V carrier are at greater risk o f contracting H I V than are men who

have sexual intercourse with an HIV-positive woman. Female condoms, sometimes referred

as areto ?vaginal pouches? (because they inserted in the vagina), can help women exert

Whilegreater control over H I V transmission. these are available in some parts o f theworld,

they require practice to use correctly and can

i

sive: Microbicides appear to pro- expen means of female protection, and

n inues. cide Toh i n t them c o n

ea re

rectomy ayst? in the United States, hysterectomy, Cy e e of the uterus, is the most common ofc e r e nobstetrical procedure performed on sio® with over 600,000 performed each

ome? « third of all women over age 60 in eat | n°q States have had a hysterectomy, the \ mn U n e n the industrialized world (OBOS, pighest Sometimes the healthy ovaries of a l ) : over 45 are removed (oophorectomy) w o e n hysterectomy, which is inadvisable, as

during vies will continue to produce some hor- the O° feet menopause (Parker et al., 2009). mone nineteenth century, the uterus

_? thought to be the principal source of was en's ailments, its removal was the obvi-

_a e Although modern medical science

mects this idea, hysterectomies continue wo be performed on women with a healthy jrerus. Physicians have of fered to perform shis ?service? for women cit ing two primary reasons: it is aneffect ive form o f sterilization for those who no longer wish to bear chil- dren, and it is a preventive measure since the aterus may be the site o f cancer at some future ime. However, hysterectomies may have

long-lasting negative physical, emotional, and sexual effects for women. Nevertheless, as many as 70% o f hysterectomies performed in the United States may be recommended

inappropriately. Alternative procedures, such as localized treatments and surgery to remove only fibroids, are available but may not be made known to women (OBOS, 2011).

Osteoporosis

Osteoporosis, a process l inked to estro- gen changes, is associated w i th a decrease in bone density and occurs in all humans

WOMEN?S HEALTH 269

of osteoporosis may occur in the form of unnecessary or too frequent bone density Screenings and subsequent treatment wi th medications prescribed for women who are not at risk of osteoporosis. Prevention, in the form of adequate calcium intake as a child and young woman and weight-bearing exercise throughout life, is too often ignored. The rate of occurrence is difficult to gauge, but it is greatly accelerated in some women after menopause, resulting in bone ailments and a highly increased vulnerability to bone

fractures. O f the estimated more than 25 mi l- lion Americans affected by osteoporosis, 80%

are women (Galsworthy, 1994). The risk o f osteoporosis, however, is not uniform among women: African Americans and some African

groups rarely show symptoms o f this disease (Doress-Worters and Siegal, 1994; Stoppard, 1999). Osteoporosis is a major cause o f physi- cal disability in older women (twice as com- mon as for older men) (Galsworthy, 1994).

Alzheimer?s Disease

American women are at the epicenter of Alzheimer?s disease, the most common form

of dementia characterized by loss o f men- tal ability severe enough to interfere w i th activities o f daily l iving. Its physiological cause is still unclear. Sixty-five percent of all

those wi th Alzheimer?s are women (3.3 mi l - lion), and 60% (6.7 mil l ion) o f caregivers

for persons wi th Alzheimer?s are women. By mid-century, as many as 8 mi l l ion women in the Uni ted States wi l l have Alzheimer?s dis-

ease (Skelton, 2010).

Women and Mental Health

Gendered Differences

In the realm of mental health, the intercon- nections between perceptions of health, diag- noses of the causes of illness, and women?s

after the age of 35. Increased medicalization place in society seem unavoidable. From the