Your gender identity and biological sex can affect your GI ailments
According to the World Health Organization, “Sex refers to the biological and physiological characteristics that define men and women. Gender refers to the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women.”1
When it comes to your experience with gastrointestinal (GI) diseases and disorders, as well as your experiences in health care, both sex and gender can affect the outcome.
The Menstrual Cycle and IBS
You may have heard that irritable bowel syndrome (IBS) affects more females than males. What isn’t perfectly clear is why. IBS is a chronic, often debilitating, functional gastrointestinal disorder with symptoms that include abdominal pain, bloating, constipation, and diarrhea. Some research shows that females with IBS experience a change in symptoms at various stages of the menstrual cycle, leading researchers to believe that there may be a hormonal link.
Women often experience worse symptoms at different times in the menstrual cycle.12 During menstruation, the body produces a type of cyclic fatty acid compound with varying hormone-like effects, called prostaglandins. These are responsible for pain and inflammation and, in the case of menstruation, they signal the uterine wall to contract. However, some individuals (with or without IBS) produce more prostaglandins than others. In this case, the excess prostaglandins can move through the bloodstream and make their way to the bowel wall, where they cause the bowel to contract, leading to an increase in diarrhea with painful abdominal cramping. Taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help because they reduce the production of prostaglandins.
During the phase in the menstrual cycle that starts approximately two weeks before menstruation and ends just before menstruation (luteal phase), as well as during pregnancy, the body produces an increased amount of the hormone progesterone. One effect of progesterone is relaxing smooth muscle tissue. The purpose of this is to make sure that the uterus doesn’t contract and reject any potential or actual fertilized eggs. However, like with the prostaglandins, the effect doesn’t always stay in the uterus, and it can slow down peristalsis in the large intestine. This makes a prolonged transit time more common, increasing constipation but reducing diarrhea.3
One study found that those with IBS experience increased rectal sensitivity during menstruation, which might be a result of females with IBS responding differently to the variances in their hormone levels than those without IBS.3
Another key factor in IBS is stress, which doesn’t cause the syndrome but can exasperate symptoms. The hormonal changes around menstruation can lead to heightened stress in some individuals,4 further increasing symptom severity in IBS during this time.
Gastroesophageal reflux disease (GERD) occurs when the upper portion of the digestive tract is not functioning properly, and the lower esophageal sphincter malfunctions, allowing contents from the stomach, including food and digestive juices, such as hydrochloric acid, to push up into the esophagus. In GERD, this backflow is ongoing.
In a study published in 2011, researchers compared the ways that women and men experience GERD.5 They found that women were more likely to report feelings of heartburn and other symptoms when they spoke to their doctors, but when it came to objective measurements, such as ulceration of the esophagus and relaxed lower esophageal sphincter (LES) pressure, more men experienced these symptoms than women. The researchers believe that the increase in negative outcomes for men with GERD could relate to gender roles and what society considers normal for men and for women. They claim that men tend to disregard symptoms for longer than women do before going to the doctor for help, and that men are more likely to downplay the severity of their symptoms. On the other hand, women are more likely to seek treatment for their heartburn sooner, which helps prevent the serious complications from developing.
When it comes to IBS, research shows that women tend to experience a greater decrease in quality of life than men. Researchers believe that this could be due to social taboos and gender expectations, which dictate that women should be more shameful or secretive about bowel functions. This can cause women with IBS to drift toward social isolation due to fear of others finding out about their disease.6
IBD Outcome Affected by Sex
Inflammatory bowel disease (IBD) is a term that primarily refers to two diseases of the intestines: Crohn’s disease and ulcerative colitis. IBD is a complex disease that causes many debilitating symptoms such as chronic diarrhea, rectal bleeding, abdominal pain, anal fissures and fistulae, nutritional deficiencies, and a number of extra-intestinal manifestations resulting from inflammation, including organ, joint, and eye problems.
While the rates of women and men who develop IBD are very similar (Crohn’s disease is slightly more common in women; ulcerative colitis is evenly distributed), women and men tend to develop different extra-intestinal manifestations of the disease.
One study found that females typically experienced higher incidents of eye and skin complications and males had a higher prevalence of primary sclerosing cholangitis and ankylosing spondylitis.7 Another study found that women had a higher risk of perianal symptoms,7 and yet another found that women are more likely to report feelings of fatigue than are men.8 One study found that women who took oral birth control pills were more likely to develop IBD, especially Crohn’s disease.9 However, it is unclear why exactly most of these differences occur.
While GI diseases and disorders affect people of all genders, the ways it manifests vary depending on biological sex and gender role. The changes in female sex hormones throughout the menstrual cycle and pregnancy can be difficult to manage, but it is possible to eliminate at least some of the gender differences through social awareness. If you are experiencing GI symptoms, it is important to consult your physician, no matter your sex or gender. While occasional heartburn might seem like a minor issue, when it becomes chronic, as in GERD, it can lead to dangerous complications such as Barrett’s esophagus and esophageal cancer. Together, we should all work on decreasing the social stigma of IBS and other bowel diseases and disorders, because the symptoms are bad enough without the additional fear of social persecution.