Key Facts:
Women's health is often thought of in terms of breasts, wombs and ovaries. But what about the rest of the woman?
A UNSW Sydney researcher says narrowing women's health to 'bikini medicine' – issues that occur between the breasts and the pubic bone – has left women underserved in nearly every other area of health, including disease, ageing and chronic illness.
Professor Bronwyn Graham, a psychologist and the inaugural national director of UNSW's Centre for Sex & Gender Equity in Health and Medicine, says women's health challenges have long remained under-researched and undertreated.
"Australia is still decades behind its international counterparts when it comes to building health systems that account for sex and gender differences," Prof. Graham says.
Australia recently launched a series of high-profile strategies – the National Women's Health Strategy, the LGBTQIA+ 10-Year Action Plan and the National Women's Health Advisory Council – to improve outcomes for women and gender-diverse people.
Yet, says Prof. Graham, much of the medical system is fundamentally skewed – because it was built for, tested on and validated through men.
"We need to attend to sex and gender at every stage of the health and medical pipeline," she says.
"From the very basic fundamental research on cells and animals through to human clinical trials and healthcare delivery, we've systematically ignored half the population."
A legacy of exclusion
Until the 1990s, women of reproductive age were largely and actively excluded from clinical trials. This was partly due to a period of overcaution that followed the thalidomide disaster of the late 1950s and early 1960s – when pregnant women across the globe were prescribed the drug for morning sickness. Consequently, thousands of babies either died in-utero, or were born with severe birth defects.
Ironically, the tragedy was caused by insufficient testing of the drug on women before it was put to market. And today, medical treatments and drugs are still approved without a thorough understanding of how they affect women's bodies.
Prof. Graham says although policies mandating female participation in US clinical trials were introduced in the late 1990s – with changes in Canada and Europe happening at the same time – Australia still has no enforceable policy requiring researchers to consider sex and gender in clinical trials.
"The National Health and Medical Research Council only recently issued a statement encouraging a consideration of sex and gender," Prof. Graham says.
"But it's not a mandate. There's no requirement in funding applications to even show this – and that is where the real change needs to happen.
"There are very few instances where single sex studies could be justified."
Costly ignorance
Women are today more likely than men to be misdiagnosed, experience adverse drug reactions and receive less effective treatment for common conditions – and not just reproductive ones.
Prof. Graham says even over-the-counter pain medications and anaesthetics are generally tested on men but marketed and used as 'sex-neutral'.
"We're still using drugs and interventions that were made before the 1990s – and they've never been tested on women," she says.
Even CPR mannequins lack breasts, she says, which affects how health professionals and first responders are trained to save women's lives.
"We still think of the male as the default human," says Prof. Graham.
"When it comes to doing things like administering CPR, people feel less confident when treating a woman," she says.
"There may be physiological differences that change their techniques – and these aren't being factored into the training.
"There is bias baked into everything – research, education, funding, even the tools we use."
Retrofitted for women
The current model of evidence-based medicine is "actually mostly evidence-based for men," says Prof. Graham.
The clitoris – which is an entire organ in itself – remained absent from anatomy until 1998, when Australian neurologist Professor Helen O'Connell fully mapped it – in her spare time, unfunded.
But the lack of female anatomy in medicine extends further. Common conditions that affect all people – like heart disease or depression – manifest differently in women, Prof. Graham says. Yet treatment guidelines don't reflect these differences.
Prof. Graham says while funding for conditions like endometriosis and ovarian cancer is finally increasing – and rightly so – focusing solely on reproductive health reinforces the myth that women's health is a niche topic.
"And even then, women are more likely to die from reproductive cancers than men are from male-specific cancers," she says.
"This is largely due to later detection and less investment in early testing."
When 'bikini medicine' is an afterthought
In 2009, Professor Louise Chappell from the Australian Human Rights Institute at UNSW was diagnosed with what appeared to be a non-invasive breast cancer. She had a mastectomy, which was performed alongside reconstructive surgery.
What she didn't know at the time was that the balance struck between her breast and plastic surgeons – both men – prioritised the best cosmetic result.
"I just wanted to live and be safe," she says. At the time, her sons were aged three and six.
In the rush of surgery, tissue was left behind. Years later, cancer had spread through to her lymph nodes and major organs.
Today, she says she approaches life each day at a time.
"Treatment works, until it doesn't work," Prof. Chappell says. "And I've been fortunate to take advantage of cutting-edge breast cancer research.
"But I'm well aware that not all female coded cancers receive the same attention."
Her oncologist, Conjoint Associate Professor Rachel Dear, also at UNSW, is part of what she describes as an "amazing medical team."
But her overall experience has fuelled a sharper critique: "There is blatant sexism in medicine."
When she found a lump under her arm after her mastectomy, she was called a "very anxious patient." She remembers being made to feel "stupid".
"Doctors aren't even aware of the symptoms of some women's cancers," she says.
Prof. Chappell is now writing a book on her experiences with cancer alongside UNSW sociologist Dr. Naama Carlin, who was diagnosed with triple-negative breast cancer while 28 weeks pregnant. Both women were close to Associate Professor Siobhan O'Sullivan, who endured misdiagnoses before dying from advanced ovarian cancer.
"Many areas of women's health are still poorly researched and easily dismissed," Prof. Chappell says.
She says these experiences reflect systemic blind spots in medicine – where women's symptoms are often overlooked, certain women's cancers under-studied and even basic lab research relies on male cells.
"We did what we were told by our doctors. But there is a power dynamic in medical relationships still. It's a real issue."
Today, she campaigns for better recognition of gender in medicine.
"As an example, we still don't know why some antidepressants work for hot flushes in menopause," she says. "And that's because we don't know why – or how – women's bodies regulate temperature during menopause."
Invisible populations
The Centre for Sex and Gender Equity in Health and Medicine is a collaboration between UNSW, the George Institute for Global Health, Deakin University and the UNSW Australian Human Rights Institute. It was formed with the aim, Prof. Graham says, of "bringing Australia up to speed with international progress in recognising that sex and gender are fundamental components of health."
The focus of the Centre spans all – not just cisgender women, but people with intersex variations, trans people, those from gender-diverse communities, as well as men and boys, who also suffer from gendered assumptions in healthcare.
One of the Centre's major initiatives for 2025 is a nationwide audit of health and medical education curricula, funded by the Department of Health, Disability and Ageing. It aims to determine whether – and how – Australian universities incorporate sex and gender into their medical course offerings. They are currently not required to teach any of difference.
One of the most urgent issues to address under the assessment is how little is known about health outcomes for LGBTQIA+ communities.
"In medical studies, the data is typically collected in a binary way. There's not a great differentiation between sex and gender," Prof. Graham says.
"Medical students aren't aware that the evidence they're learning is biased.
"They're taught to treat everyone as if sex and gender don't matter – unless it's reproductive."
Prof. Graham says the clinical data for the LGBTQIA+ communities is rarely collected – or analysed – in ways that differentiate between sex, gender and sexual orientation.
She says when studies do include non-binary or LGBTQIA+ people, those findings are often excluded from published results – making it difficult to develop effective and inclusive treatment guidelines.
"We can't improve care for communities we're not even counting."
A case for change
Prof. Graham says there's growing enthusiasm from medtech and pharmacy companies to develop more inclusive treatments and devices, because better-targeted products simply make good business sense.
"When devices and drugs are designed to work for all people, they're more effective, safe and more valuable," she says.
With significant momentum behind women's health in Australia and strong public support for progressive reforms, Prof. Graham believes the time is ripe for change – especially as countries like the US face a backlash against equity-focused research.
"What's happening in the US is catastrophic for research," she says.
"Grants are being pulled for simply using the word 'women'. These are grants for ovarian cancer or studies of brain changes in pregnant women.
"But here in Australia, we've elected a government with a clear mandate for progress. This is our moment."
She is optimistic about the impact of the Centre's work.
"If you take sex and gender into account, your research is just better. It's more accurate, more reproducible, more useful.
"This isn't just about fairness – it's about good quality science and good quality healthcare."
