Gender in urology

Abstract

The sex-gender debate has emerged from the USA as a political movement of the late 1960s and 1970s and addressed the question: What makes a woman a woman and what makes a man a man? Biological conditions (sex) or sociocultural aspects (gender)?However, the concept of gender, especially the importance of a proper understanding of the sex/gender relations, did not find entrance into the medical discourse until the twenty-first century when the medical community discovered that 'women are not small men' and that medicine, therapeutic strategies, medication and most diagnostics were aimed and proofed only at men [1]. The aspirin story elucidates the importance of gender issues. In the US physician study, aspirin showed an outstanding protective effect in cardiovascular system, and the study was discontinued due to ethical factors [2]. Since that time, aspirin was the most sold medicine worldwide; however, it was not tested in a single woman. Today, we know that aspirin only reduced the risk of stroke, but not of myocardial infarction in women [3]. After checking for gender, aspirin is only recommended to high-risk female patient under the age of 65 years [4].The need to regard differences and similarities in men and women as medical research and clinical practice leads to the formation of a 'personalised medicine' that not only considers all individual risk factors of a human being (e.g. race, ethnicity, lifestyle factors, personal history, genetic predisposition) but also acknowledges gender-and sexrelated differences in health behaviour, aetiopathogenesis and treatment [5].Nonetheless, it is still a challenge to define gender medicine clearly: the theoretical problem lies in the juxtaposition between gender as a sociocultural process and medical and therefore biological hypotheses-despite the initial ambition of gender-related research to separate the two terms and their meaning.Yet, diseases are more sex-and gender-conditioned than long time expected. They have major consequences on the practice of medicine, on outcomes and on choice and efficacy of therapy [6]. At first, endocrine and reproductive systems were the logical areas to observe the effects of gender on medicine. But for some time now, it has been common sense that women and men also differ in diseases such as diabetes, various cardiovascular syndromes and many more [1].With that in mind, it is hardly surprising that urology plays a special role within gender medicine: among the urinary organs, urology states the male genital apparatus as explicit organ of its discipline. Non-professionals often call urology even the 'medicine for men', in contrast to gynaecology being the 'medicine for women'. To understand these attributions and to extend interdisciplinary coworking (in areas such as female urinary incontinence), it is important to integrate gender research as an inseparable component of the urologic field [7].The current World Journal of Urology's special issue acknowledges both the correlation of gender with urology and the significance of gender m...