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Gendermedizin

Geschlechtsspezifische Aspekte in der klinischen Medizin

Gender medicine

Sex- and gender-specific aspects of clinical medicine

  • Leitthema
  • Published:
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Gendermedizin berücksichtigt individuell und altersabhängig das biologische und psychosoziale Geschlecht und stellt einen Brückenschlag zur personalisierten Medizin dar. Die Gendermedizin untersucht Unterschiede und Gemeinsamkeiten in der Prävention, Wahrnehmung und Präsentation von Krankheiten sowie im Therapieerfolg zwischen beiden Geschlechtern (geschlechtsspezifische Medizin). Dabei sind neben genetischen Unterschieden, Unterschieden bei den Geschlechtschromosomen, Hormonen und im Stoffwechsel auch die Umwelt, Kultur und gesellschaftliche Einflüsse maßgeblich. Außerdem findet lebenslang eine fortlaufende Wechselwirkung zwischen körperlichen und psychosozialen Faktoren statt, die das Wohlbefinden bestimmen. Epigenetische Modifikationen belegen den Effekt von Umweltfaktoren auf körperliche Funktionen mit langfristigen gesundheitlichen Auswirkungen. Durch fetale Programmierung kann die Gesundheit der Nachkommen schon in utero geschlechtsabhängig geprägt werden. Schmerzempfinden und Stressantworten unterscheiden sich meist deutlich zwischen den Geschlechtern. Insgesamt sind Frauen im Lebenszyklus stärkeren körperlichen Veränderungen unterworfen, die mit unterschiedlichen gesellschaftlichen Rollen und seelischen Belastungen einhergehen. Frauen entwickeln häufiger Depressionen und funktionelle Einschränkungen. Bei Männern werden „weiblich konnotierte Erkrankungen“ wie Depressionen und Osteoporose weniger oft erkannt. Deutliche Geschlechterunterschiede finden sich in der Medizin bei Veränderungen des Immunsystems und bei chronischen Krankheiten wie Übergewicht, Typ-2-Diabetes, Hypertonie und Herz-Kreislauf-Erkrankungen. Frauen manifestieren häufiger Autoimmunerkrankungen und Schmerzsyndrome sowie im Alter neurodegenerative Veränderungen. Männer haben eine kürzere Lebenserwartung, weisen aber gleichzeitig anteilmäßig mehr gesunde Lebensjahre auf. Letzteres dürfte zu einem größeren Teil auf psychosoziale und weniger auf biologische Unterschiede zurückzuführen sein, was auch gesundheitspolitische Maßnahmen impliziert. Eine moderne klinische Medizin berücksichtigt individuelle Risikofaktoren auf Basis von geschlechtssensitiven Gesundheitskonzepten mit dem Ziel einer besseren Lebensqualität von Mann und Frau.

Abstract

Gender medicine studies sex- and gender-based differences in the development and prevention of diseases, the awareness and presentation of symptoms, and the effectiveness of therapy. Gender medicine is part of personalized medicine, considering differences in biological and psychosocial factors individually. There are differences in genes, chromosomes, hormones, and metabolism as well as differences in culture, environment, and society. Lifelong interactions between physical and psychosocial factors will influence the health and ill-health of men and women in different ways. Epigenetic modifications provide evidence of the impact of environment and lifestyle during vulnerable phases on biological processes, effecting future generations. Maternal lifestyle and environmental factors during pregnancy can impact the health of offspring in later life already in utero in a sex-specific way. Pain, stress, and coping styles differ between men and women. Women experience more dramatic physical changes during their lifetime, which are associated with specific burdens and psychosocial alterations. Women with multiple roles and responsibilities suffering from stress develop depression more frequently. However, men are often not diagnosed and treated appropriately in cases of depression or osteoporosis, diseases that are typically considered “female.„ There are prominent differences between men and women in medicine regarding the immune system, inflammation, and noncommunicable diseases such as obesity, type 2 diabetes, hypertension, and cardiovascular disease. Women experience more often autoimmune diseases and suffer more frequently from (chronic) pain, neurodegenerative changes, and functional disabilities. Men have shorter life expectancy but relatively more healthy years of life, which is in greater part ascribed to psychosocial determinants. State-of-the-art clinical medicine comprises individual risk factors based on sex- and gender-sensitive health programs in order to improve the health-related quality of life for men and women.

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Interessenkonflikt

A. Kautzky-Willer gibt an, dass kein Interessenskonflikt besteht. Dieser Beitrag ist eine Übersichtsarbeit und beinhaltet keine Studien an Menschen oder Tieren.

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  1. Endokrinologie und Stoffwechsel, Gender Medicine Unit, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    A. Kautzky-Willer

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Kautzky-Willer, A. Gendermedizin. Bundesgesundheitsbl. 57, 1022–1030 (2014). https://doi.org/10.1007/s00103-014-2011-7

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