Today, women face a variety of challenging health issues, both physical and psychological which, in the past, have not received equal treatment when compared to men's health. According to Healthy People 2020, “health equity is the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities." Health disparities affect people who have experienced obstacles to accessing healthcare based on factors such as gender, age, race, ethnicity, religion, or any disability. Women have suffered more significant challenges in receiving timely and effective healthcare for some of the most common diseases that affect them.
Cardiovascular disease in women
Cardiovascular disease is the leading cause of death in women in the United States. Even though heart disease is a significant cause of mortality for women, they are still undertreated and under-diagnosed as well as less aggressively treated for risk factors that may lead to heart failure. Heart failure is a debilitating disease, and most women who are given the diagnosis have approximately a five-year survival rate. Overall, women make up about 50% of all heart failure cases with black women being disproportionately affected. Many times women who are older seek medical attention for dyspnea, fatigue, peripheral edema, or physical decline, but their symptoms are not taken seriously and put off as part of the aging process. Failure to follow up during these early stages of cardiac disease delay treatment and decrease patient outcomes. The initial history evaluation and examination is crucial in correctly diagnosing and beginning an effective treatment regimen. When compared to men, women tend to react differently to certain medications such as statins, and because they tend to have more comorbidities at the time of evaluation, diagnosis and treatment can be much more difficult. Therefore, it is imperative that all women complaining of cardiac symptoms, or those who are at high risk, be evaluated for cardiac disease immediately to reduce mortality rates.
Sexually Transmitted Infections
Young women bear the brunt of many sexually transmitted infections (STI) including HIV, gonorrhea, genital herpes, trichomoniasis, and human papillomavirus (HPV). Because of the mode of transmission, the epithelial cells lining the vagina and cervix are exposed to the seminal fluid of the male increasing the risk of contracting an STI and making it much higher than in males. Also, contracting one STI increases a woman’s chance of becoming infected with HIV. Due to a woman’s internal anatomy and reproductive structures, STIs place them at high risk for more chronic, lifetime, medical disorders. STIs, if left untreated, can cause infertility, pelvic inflammatory disease, and cancer. These infections can also cross over the placenta or pass into breast milk, thereby infecting the unborn or newborn child. Screening tools used by nurses and physicians including a sexual and social history are essential in assessing a woman’s risk of having or contracting an STI. If detected and treated early, complications from these diseases can be prevented.
Autoimmune Diseases in Women
Autoimmune diseases are characterized by acute and chronic systemic inflammation in which a dysregulated immune system causes damage to a specific organ(s). The increased health burden of these diseases, which disproportionately affect women, is a significant cause of morbidity and mortality among female patients. They are much more common in women than men, occurring in mid-to-later life. Approximately 90% of cases of systemic lupus erythematosus and scleroderma and 75% of rheumatoid arthritis patients are women. While treatments for rheumatoid arthritis have rapidly expanded over recent years with good results, therapies for systemic lupus erythematosus and scleroderma have not and are still treated with immunosuppressive and anti-inflammatory medications that have a wide range of unpleasant and toxic side effects. Comorbidities for women with these diseases include cardiovascular disease as well as osteoporosis due to, not only the disease process but exposure to long-term use of corticosteroids. It has been shown that autoimmune diseases as an entire collective rank in the top 10 leading causes of mortality in women under the age of 75. The impact of autoimmune diseases in women who are approaching and who have entered menopause is unclear since the treatments for these diseases have significantly prolonged the lifespan of those who suffer from them. Research ascertaining the impacts of hormonal regulation and menopause is now a priority in the investigation and study of these complex diseases.
Cancer in Women
The most common types of cancer in women include breast, colon, cervical, endometrial, lung, skin, and ovarian. With the media coverage and information from medical groups, cancer has become a much-maligned household name that everyone recognizes and has some understanding. In women, hearing the words “breast cancer” immediately strikes fear because of the many implications including possible mastectomy, body image issues, psychological factors as well as the harrowing treatments required with this diagnosis. Since breast cancer is the most common type of cancer in women, the best defense is prevention. Yearly mammograms and self-breast exams are crucial in detecting breast cancer early so that it can be successfully treated.
Endometrial cancer is another common cancer usually seen in women over the age of 55. Risks of this cancer include taking estrogen without progesterone or taking tamoxifen for breast cancer as well as early onset of menstruation, late menopause, infertility, or not bearing children. According to the American Cancer Society, those women, who are genetically predisposed to get hereditary non-polyposis colon cancer, should be offered an endometrial biopsy screening yearly after the age of 35. While the PAP smear is excellent for diagnosing cervical cancer, it does not detect endometrial cancer which requires a biopsy for diagnosis.
Cervical cancer is caused by the sexual transmission of the human papillomavirus (HPV) and can affect any woman who is or ever has been sexually active. It occurs more often in women who smoke, has HIV or AIDS, has poor nutrition, and in those who do not get regular gynecologic and PAP smear exams. Again, as with breast cancer, preventive measures are the key to detecting this disease early in its pre-cancerous stages before it develops into cancer. Cervical cancer screening should begin at the age of 21 and continue through until age 65 when the screenings can stop. Those women, who have had a hysterectomy where both their uterus and cervix were removed, do not need to be tested. Testing is for HPV is recommended every five years between the ages of 30-65. Women who have been vaccinated for HPV still need to have routine cancer screenings performed.
Domestic Abuse and Its Devastating Effects
Unfortunately, domestic abuse is an all-too-real problem that women face daily. According to the National Coalition Against Domestic Violence, every nine seconds a woman is assaulted or beaten, and 1 in 3 women have been the victim of some form of violence from their intimate partner at some point in their lives. Domestic abuse is not just physical and usually begins as emotional abuse and progresses from there. It can also involve sexual abuse. Domestic violence can be insidious in nature causing physical and emotional ailments such as depression, suicidality, post-traumatic stress disorder, anxiety, and chronic pain. Sometimes it is difficult for the woman to admit or know that she is being abused, and it takes the compassionate care of a good therapist or social worker to treat these women. Resources, such as protection and safe housing for the woman and her children, immediate medical help if needed, and ongoing psychological counseling should be offered immediately to try to stop the cycle of abuse.