Mandy Mangler is a specialist in gynecology and obstetrics and serves as the chief physician of gynecology and obstetrics at two Berlin clinics. Her latest book, The Big Gyn Book, was published in December 2024.
BERLIN— This is what happens when women arrive at the emergency room in pain. They wait, on average, 30 minutes longer than men before receiving medical attention. When they are finally seen, they are given fewer painkillers than men, even when reporting the same level of pain. Their discomfort is more likely to be dismissed as psychosomatic. In life-threatening situations, they are even less likely to be resuscitated.
Numerous studies have confirmed these disparities.
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Though it may sound paradoxical, I do not believe that my colleagues and I intentionally treat female patients worse than male patients.
Instead, the core issue is that there is still so much we doctors simply do not know about the female body — such as how women experience and react to pain. The healthcare system was built on patriarchal values, designed predominantly by men for men.
Until the 1990s, women were rarely included in drug trials, and even today, they make up only about 25% of study participants. For a long time, researchers claimed that incorporating the female cycle into clinical trials was too complex. Even animal testing was (and still is) largely conducted on male specimens.
These facts should not serve as an excuse: doctors who refuse to update their approach are knowingly engaging in malpractice. The gender health gap— referring to disparities in medical treatment based on gender — is enormous. Just how enormous? Let’s consider an imaginary future scenario.
Like any other
Safa is 25 years old. She lives in the year 2060 and works as an engineer in a technology company. In her professional world, everyone is recognized for their talent and competence, regardless of gender. But she is aware that this was not always the case.
As an adult, she often recalls a school lesson about a study conducted nearly 40 years earlier, which found that patients had better surgical outcomes when operated on by female surgeons — especially women treated by female doctors. Yet, at that time, male doctors were still generally trusted more than their female counterparts.
Now, looking back, Safa finds the whole story almost unbelievable. It took intense debate before researchers finally understood why female doctors often achieved better results: they tended to approach patient care more holistically and were less prone to reckless decision-making. Eventually, these practices became standard, leading to an overall improvement in medical care.
Later that day, while at work, Safa receives a video call from her gynecologist regarding her blood test results. A week ago, she had a self-managed abortion. Over the past few decades, contraceptive methods have become significantly more advanced and gender-inclusive.
Medical therapies often have to be individualized to work because women have different physical challenges
The male contraceptive pill is now commonplace, and most men are happy to have control over their reproductive choices. Safa had been using free contraception successfully for years, but an unexpected pregnancy led her to opt for a medical abortion, which was supervised remotely by her doctor. The necessary medication was mailed to her home, and her gynecologist was available throughout the entire process.
While the doctor talks to her about her blood values, Safa remembers stories from her grandmother about how abortions used to be illegal, even enshrined in the penal code. She almost can’t believe it. To her, an abortion is a stigma-free medical procedure like any other.
Individualized medicine
Safa doesn’t really care what gender a person is, what organ is in the pelvis, whether it’s a vulva or a penis. But the society in which she grew up has long since understood that, from a medical point of view, it does matter.
Medical therapies often have to be individualized to work because women have different physical challenges. They often have a menstrual cycle, they can become pregnant, and they experience the cessation of regular cycles, menopause. Recognizing how much the female cycle affects a woman’s health was a hard-earned medical milestone.
Safa and her friends work and train depending on their menstrual cycle: for example, in the second half of their cycle, they avoid risky sports because the water retention in the body increases the risk of injury.
In 2060, the fact that people menstruate is normal in the public perception, no longer a taboo to be ashamed about: it’s part of a healthy and strong society. In 2060, it has also become clear that the rough classification of people by gender was only the first step towards a personalized medicine that can provide better quality treatment for everyone, with therapies that are tailored precisely to each individual.
Safa grew up knowing she is largely responsible for her own health, and she values preventative care. Her society provides everything necessary to maintain well-being: access to nutritious food, exercise, preventative screenings, and vaccinations. Virtually everyone in her generation has been vaccinated against HPV — the virus responsible for cervical cancer. This includes men, as they can transmit the virus and are also susceptible to related cancers such as throat and anal cancer.
Predictions and probability
Safa is thrilled for her best friend, Charlotte, who is pregnant. Thanks to AI-assisted algorithms, the risks associated with childbirth have been drastically reduced. These algorithms analyze vast amounts of data on past births, allowing doctors to make highly accurate predictions and tailor their approach to individual patients. As a result, maternal and infant mortality rates have plummeted.
In 2060, pregnancy and birth are no longer considered a pathological process.
Safa is surprised that these innovations were not introduced when her mother was young: the technology was already there. In Safa’s decade, the medical staff can predict with a high degree of probability during the birth how the birth will go for the pregnant woman and the child, and they know what needs to be done to support both safely and empathetically.
In 2060, pregnancy and birth are no longer considered a pathological process; they are not treated like an illness, but like the physiological process that they are. Unlike her mother, Charlotte is not afraid of giving birth; she looks forward to it.
Male body remains default
That could be the future, but let’s be honest about it: a lot needs to be done for this scenario to become a reality. And yet, Safa’s story is neither exaggerated nor crazy: these goals are achievable.
In 2025, most medical diagnostics and treatments are still designed with male bodies as the default. Medicine tailored to the female body — considering factors like lower average weight or hormonal fluctuations — is still in its infancy. As a result, the medical care women receive remains subpar.
The situation is even worse for conditions unique to women. Polycystic ovary syndrome (PCOS) affects around 10% of women, yet its causes remain unclear, and standardized treatments are lacking. There is also no universal diagnostic method for endometriosis, a disease that seems to be increasingly common.
The orgasm gap, menopause and miscarriages are issues today’s society often prefers to ignore.
In Germany, it takes an average of nine years to receive an endometriosis diagnosis — nine years often filled with unbearable pain. Myomas, benign uterine tumors, are frequently treated with complete hysterectomy, despite the uterus’s role in female sexuality (it’s proven that uterus stimulation makes it easier to reach orgasms) and overall well-being.
Today we know that they play an important role even after regular menstruation and into old age. Removing the ovaries prophylactically is just as if, in a prostate operation, the testicles were removed at the same time — and for no real reason.
In order to better diagnose and treat the three most common benign diseases in women, more investment and more political prioritization will be needed. This is lacking. Neither a midwife nor a gynecologist was involved in the Federal Ministry of Health’s hospital reform commission. Yet, childbirth is more common than heart attacks and strokes combined.
The orgasm gap, menopause, miscarriages, sexual and domestic violence: these are issues today’s society often prefers to ignore.
Society also has a choice on all of these issues. It decides whether it wants to continue to be gender inequitable or whether it wants to stand up for giving everyone the same chance of high-quality healthcare. Everyone benefits from personalized medicine that is tailored to each individual and enables better health. Striving for this future is a matter of survival for all people, but especially for women and other marginalized groups.
