Women’s Health: When Gender Bias in Medical Diagnosis Delays Care

When symptoms are different: within a given pathology, women-specific symptoms are not recognized.

Certain pathologies do not manifest in the same way depending on sex. Yet, medicine has historically been built around a male model, considered the norm. The female gender, long underrepresented in clinical studies and little taken into account in research protocols, still suffers today from a unisex approach. Result: symptoms specific to women are poorly known both to patients and to doctors and therefore underestimated, or even dismissed during diagnosis.

The case of myocardial infarction is particularly striking: while it is often associated with intense chest pain, in women it can also manifest as  nausea, intense fatigue, shortness of breath or diffuse pain. These warning signals, little known by the general public and still insufficiently integrated into medical reflexes, are ignored by 8 out of 10 women in France and contribute to a delay in care which explains, in part, the higher hospital mortality among women (9.6%) than among men (3.9%).¹Arrêt cardiaque : les femmes ont deux fois moins de chance d’y survivre. (n.d.). (C) 2025 AXA Group Operations Spain S.A. All Rights Reserved. https://www.axaprevention.fr/fr/article/arret-cardiaque-les-femmes-ont-deux-fois-moins-de-chance-de-survivre²National Academy of Medicine | Inequality in the management of myocardial infarction among women in France. https://www.academie-medecine.fr/wp-content/uploads/2025/02/25.1.14-Rapport-Infarctus-myocarde-Femme-APRES-VOTE.pdf

Same symptoms, different readings: 3 gender biases to decipher

Medical biases: when gender influences the interpretation of symptoms

Beyond the biological differences between sexes, it is also the social representations of feminine and masculine – in other words, gender – that shape the way symptoms are perceived and interpreted by healthcare professionals.

In its report Taking into account sex and gender to better treat: a public health issue (2020), the High Council for Equality between Women and Men warns about the impact of gender stereotypes in medical practice: persistent biases that can wrongly guide a diagnosis, delay it, or even prevent it, affecting both women and men.³HCE | Taking sex and gender into account for better care: a public health issue. https://www.haut-conseil-egalite.gouv.fr/IMG/pdf/rapport_sexe_genre_soigner-v9.pdf

Let’s take the example of cardiovascular diseases: they remain perceived as “male” pathologies in the collective imagination, typically associated with the image of a pot-bellied, smoking and stressed fifty-year-old man. Thus, with identical symptoms, a woman complaining of chest tightness is three times more likely to be prescribed anxiolytics than a man, for whom the same clinical picture will more often trigger a referral to a cardiologist.⁴Klinge, I. (2010). Innovative changes in biomedicine: integration of sex and gender aspects in research and clinical practice. In VS Verlag für Sozialwissenschaften eBooks (pp. 231–242). https://doi.org/10.1007/978-3-531-92501-1_17

These inequalities do not only affect women. On the contrary, certain pathologies are perceived as feminine, such as depression or osteoporosis and are less diagnosed in men.

These biases – often unconscious – partly originate in the training of healthcare professionals, which still remains largely centered on male or gender-neutral models, with few tools to deconstruct gendered representations. According to a study published in The Lancet in 2019, less than 25% of medical faculties include modules on sex- and gender-related differences in their curriculum.⁵Thande, N. K., Wang, M., Curlin, K., Dalvie, N., & Mazure, C. M. (2019). The influence of sex and gender on health: How much is being taught in medical school curricula? Journal of Women S Health, 28(12), 1748–1754. https://doi.org/10.1089/jwh.2018.7229 This lack of training results in a cycle of ignorance and stereotyping, with serious consequences for patients.

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Social biases: when the social circle delays the first consultation

Gender biases, linked to the social representations of girls and women, are not limited to the medical field: they originate within the family circle and influence the first perceptions of children’s behavior. Thus, in young children with autism spectrum disorders, withdrawal and lack of social interaction will be more  likely mistaken  for  shyness and reserve in girls. These same behaviors are more often interpreted as a sign of communication disorder in boys, as they deviate from social representations of boys’ behavior supposed to be more expansive and dynamic. Therefore, parents and teachers are more likely to seek a medical consultation for boys than for girls.

Patient biases: when women minimize their symptoms

Finally, the delay in diagnosis is sometimes linked to the patients themselves. 70% of women report consulting a doctor only when they have no other choice, often because they prioritize the health of their loved ones.⁶AXA LIVE – 81% des femmes font passer la santé des autres avant la leur et s’oublient. Elles sont 42% à ne jamais surveiller leur cœur alors que les maladies cardiovasculaires tuent chaque jour 200 d’entre elles. (n.d.). https://axalive.fr/article/axa-prevention-sante-femmes-cardiovasculaire This tendency to delay consultations is also linked to a form of minimization of symptoms. As women are likely to feel so-called “normal” pain (dysmenorrhea, childbirth pain) during their lives, they may minimize chest pain. Thus, a study by the European Society of Cardiology showed that women take on average 37 minutes longer than men to call emergency services in the event of a heart attack.⁷European Society of Cardiology | Women having a heart attack wait longer than men to get help. https://medicalxpress.com/news/2018-12-women-heart-longer-men.html?utm_source=TrendMD&utm_medium=cpc&utm_campaign=MedicalXpress_TrendMD_1

Finally, the delay in diagnosis may also be linked to a concealment of symptoms. In the case of Alzheimer’s disease, women, who generally benefit from better language skills, manage to hide the early signs of the disease for longer. This phenomenon, associated with a less consideration of their complaints by certain doctors, delays their diagnosis and the establishment of appropriate care. This factor is also present in the diagnosis of autism in women. Unlike autistic men, they often develop more advanced imitation and social adaptation skills, allowing them to hide their difficulties. This ability to appear integrated, however, leads to significant psychological fatigue and may delay, or even prevent, the recognition of their condition. As a result, their difficulties, although real and disabling, are often perceived as less marked, leading to an increased risk of underdiagnosis or misdiagnosis.

The fight against diagnostic inequalities between men and women is a major public health issue. It is not a matter of pointing out individual responsibilities, but of recognizing the systemic mechanisms at work, in order to better deconstruct them.

Faced with this issue, first avenues have already been identified: strengthening the initial and ongoing training of healthcare professionals on sex- and gender-related differences, producing more sex-specific clinical data (with the help of AI), encouraging active listening to female patients, or raising public awareness of the diversity of symptoms.

Our team, specialized in health, can support you in exploring these avenues, in particular by capitalizing on our expertise in investigating patient pathways and our experience in women’s health. Do not hesitate to contact our team!

About the author,
Margot, consultant within Alcimed’s health team in France.