The gender data gap is real. Here’s how we can fix it.
Much of our society—from public spaces and workplaces to safety standards and medical training programs—has been designed by men, using data collected by men about the the male experience. In research, this imbalance is known as the gender data gap.
As British journalist Caroline Criado Perez demonstrates in her recent book, Invisible Women: Data Bias in a World Designed for Men, much of our society—from public spaces and workplaces to safety standards and medical training programs—has been designed by men, using data collected by men about the male experience. In research, this imbalance is known as the gender data gap.
Unsurprisingly, it has left females at risk.
In one alarming example, University of Virginia researchers found that women were 47% more likely to be seriously injured and 17% more likely to die in a car crash—all because seat belts were designed for a generally taller and larger male form.1 In another, University of Pennsylvania researchers showed that women who go to the ER reporting acute abdominal pain wait 16 minutes longer, on average, than men who report the same level of pain.2
The good news is that things are finally starting to change. In 2014, the National Institutes of Health (NIH) announced a new policy requiring preclinical researchers to consider sex as an important biological variable.3 If you’re surprised that didn’t happen until halfway through President Obama’s second term, consider this: It wasn’t until 1993 that Congress mandated the inclusion of women and minorities in publicly sponsored clinical trials.
Despite this tangible progress, much work still needs to be done to close the gender data gap. One particular field of research seems poised to lead the way—the study of the human microbiome. We’re referring to the community of trillions of microorganisms and their genomes, that live in, on and around us. This includes 38,000,000,000,000 (that’s 38 trillion) bacteria, which make up 50% of our bodies by cell count.4
We now know that these microbes perform a critical role in supporting systemic health, aiding digestion, synthesizing key vitamins, producing beneficial metabolites and transmitting messages to the skin, brain, and other organs. We also know that the microbiome is primarily derived through maternal inheritance. This means that your first microbes—the ones that form the foundation of your immune and gastrointestinal systems—come from your biological mother, and her mother before her (and on and on).
It is impossible to understand the microbiome, then, without understanding the female body and experience. This has profound implications for the future of health care, and for scientific research in general. To that end, we’ve put together a list of the most important ways that microbes impact women’s health. As you read through them, keep in mind that this is just the tip of the iceberg when it comes to what we have discovered, and will continue to discover, about the microbiome.
1. Microbes Dominate the Female Body
If you think the microbiome is only relegated to the digestive tract, think bigger! There are distinct communities of microbes all throughout your body. The vagina, in particular, is home to a fascinating microbial environment. It’s one that must contend with—and protect itself from—everything from menstrual products and contraceptives to other humans and their many parts.
Unlike your gut microbiome, where the diversity of species is a reliable indicator of health, the vagina actually functions best when colonized by a single, dominant genus: Lactobacillus.5 Key species from this group work to maintain a low pH environment and fight infections. Turns out, poor vaginal microbiome health is linked to many pervasive issues, from bacterial vaginosis (BV) and urinary tract infections (UTIs) to sexually transmitted infections (STIs), and even preterm birth.
Many of these conditions have long been dismissed or discounted by doctors, resulting in ineffective care, and an absence of innovation in treatment. In fact, the standard of care for many vaginal conditions is antibiotics—which kill the vaginal microbiota along with the infectious bacteria, leaving the ecosystem imbalanced and unprotected. Now, pioneering scientists and researchers are examining how targeted probiotics—live microorganisms that modulate and balance the vaginal microbiota—could help prevent, or even potentially cure, these frustratingly common (and occasionally life-threatening) conditions.6 In fact, companies like LUCA Biologics, a women’s health company that emerged from Seed Health’s foundry in 2019, are developing a new class of living medicines that target the vaginal microbiome for urogenital and reproductive health. Using microbial therapies, they are working to address some of the most common microbiome-based women’s health conditions, including recurrent UTI, BV, and preterm birth. Thus far, research—which includes a years-long curation of a vaginal microbiome data bank across many identities and ages—and early test results are promising.
2. Microbes Interact With Hormones & Synthesize Vitamins
Your microbiome isn’t static: it shifts daily, depending on what you eat, where you are, and what you do.7,8 At various life stages, your microbiome will also evolve and adapt. One of the most dynamic ways the female body changes is during pregnancy, which induces shifts in your oral, skin, breast milk, vaginal, and gut microbiomes.9
A recent study demonstrated a link between the increased progesterone produced during pregnancy and relative abundance of Bifidobacteria, showing how the two work in tandem to facilitate pregnancy and possibly assist in the transfer of beneficial bacteria to the fetus.10
Another study showed that certain strains of bacteria can also support folate production,11 an essential vitamin that supports reproductive health, and is especially critical for fetal development during pregnancy. While this shouldn’t replace folic acid supplements for pregnant women, it offers a new path to understanding the potential of microbes in impacting cellular and reproductive health.
3. Microbes Help Prevent Pregnancy Complications
About 1 in 10 babies in the U.S. is born prematurely each year. While medical developments have enabled many premature babies to live long, healthy lives, there is still an association between preterm birth and some conditions like respiratory distress, digestive issues, and developmental delays that could persist past childhood.12
Recently, as part of the NIH’s Human Microbiome Project (HMP), researchers discovered a strong link between the health of the vaginal microbiome and preterm birth. Specifically, they found that women whose vaginal ecosystems were dominated by Lactobacillus crispatus displayed a significantly lower risk for preterm birth. Furthermore, researchers identified that certain inflammation-associated microbes were also correlated with preterm labor, and women that gave birth before term were more likely to have inflammatory markers in their vaginal fluid.13 (Note: Correlation does not mean causation—research on the health of the vaginal microbiome and childbirth is ever-evolving and ongoing, you should always speak in-depth with your OB/GYN, if concerns arise.)
4. Microbes Support Cardiovascular and Skin Health
In one of the most staggering examples of the gender data gap, women are 50% more likely to be misdiagnosed after a heart attack, largely due to a lack of understanding in the medical community about how cardiovascular symptoms manifest in the female body. Additionally, women are also more likely to survive a heart attack if they are treated by a female doctor.14
Supporting and maintaining cardiovascular health through diet and exercise are vital for preventative health, but recent studies have demonstrated that certain strains of beneficial bacteria can also maintain healthy cholesterol levels already in the normal range.15
This showcases another key aspect of microbes as they relate to women’s health—the roles they play and benefits they deliver go far beyond sexual and reproductive health. That includes the skin, which, like the vagina and the gut, has its own distinct microbiome. Recent studies have shown that beneficial bacteria can support healthy looking skin in a variety of conditions—acne, eczema, rosacea—through the gut-skin axis.16,17,18
5. Microbes Help Stabilize Women’s Health Long Term
The physical changes the female body undergoes during menopause can be enormous and challenging.19 Yet, menopause remains an incredibly underfunded and understudied area of medical research. Considering the many medical advancements that are helping us live longer, active lives well past menopause, this is a population that demands care and study.
As hormone production changes, so too does the microbial composition of the vagina, leaving postmenospausal women at a higher risk of vaginal infections such as vulvovaginal candidiasis (a yeast infection), BV, and UTI.20,21 These risks can sometimes be further exacerbated by antibiotics, currently a common treatment for women suffering from these conditions.
Fortunately, solutions are on the horizon. Just as live biotherapeutics have been shown to help prevent and treat vaginal infection in reproductive-age women, probiotics have been shown to be effective for postmenopausal women, too, indicating just how vital the changing microbiome is in keeping women healthy throughout their lives.22
The human microbiome offers a new lens through which to study the unique biochemistry and physiology of the female body. It provides a roadmap for the medical community towards greater inclusivity and better health outcomes. It inspires scientists, researchers, and innovators to tackle problems that are unique to women, and uncover solutions that are designed for women. It also invites you to play an important role in the future of women’s health. The power to close the gender data gap isn’t solely in the hands of medical pioneers and health professionals. Educating yourself about your microbiome is a radical act, to help you better understand and advocate for your body and health. If small groups of educated and determined women can take on industry giants that spend billions of dollars to keep harmful products on the market,23,24 there’s no limit to the change that we, the collective, may bring—in symbiosis.
- Bose, D., Segui-Gomez, ScD, M., & Crandall, J. R. (2011). Vulnerability of Female Drivers Involved in Motor Vehicle Crashes: An Analysis of US Population at Risk. American Journal of Public Health, 101(12), 2368–2373. https://doi.org/10.2105/ajph.2011.300275
- Chen, E. H., Shofer, F. S., Dean, A. J., Hollander, J. E., Baxt, W. G., Robey, J. L., Sease, K. L., & Mills, A. M. (2008). Gender Disparity in Analgesic Treatment of Emergency Department Patients with Acute Abdominal Pain. Academic Emergency Medicine, 15(5), 414–418. https://doi.org/10.1111/j.1553-2712.2008.00100.x
- Miller, L. R., Marks, C., Becker, J. B., Hurn, P. D., Chen, W., Woodruff, T., McCarthy, M. M., Sohrabji, F., Schiebinger, L., Wetherington, C. L., Makris, S., Arnold, A. P., Einstein, G., Miller, V. M., Sandberg, K., Maier, S., Cornelison, T. L., & Clayton, J. A. (2016). Considering sex as a biological variable in preclinical research. The FASEB Journal, 31(1), 29–34. https://doi.org/10.1096/fj.201600781r
- Dunn, A. B., Jordan, S., Baker, B. J., & Carlson, N. S. (2017). The Maternal Infant Microbiome. MCN: The American Journal of Maternal/Child Nursing, 42(6), 318–325. https://doi.org/10.1097/nmc.0000000000000373
- Amabebe, E., & Anumba, D. O. C. (2018). The Vaginal Microenvironment: The Physiologic Role of Lactobacilli. Frontiers in Medicine, 5. https://doi.org/10.3389/fmed.2018.00181
- Green, K. A., Zarek, S. M., & Catherino, W. H. (2015). Gynecologic health and disease in relation to the microbiome of the female reproductive tract. Fertility and Sterility, 104(6), 1351–1357. https://doi.org/10.1016/j.fertnstert.2015.10.010
- David, L. A., Maurice, C. F., Carmody, R. N., Gootenberg, D. B., Button, J. E., Wolfe, B. E., Ling, A. V., Devlin, A. S., Varma, Y., Fischbach, M. A., Biddinger, S. B., Dutton, R. J., & Turnbaugh, P. J. (2013). Diet rapidly and reproducibly alters the human gut microbiome. Nature, 505(7484), 559–563. https://doi.org/10.1038/nature12820
- Vangay, P., Johnson, A. J., Ward, T. L., Al-Ghalith, G. A., Shields-Cutler, R. R., Hillmann, B. M., Lucas, S. K., Beura, L. K., Thompson, E. A., Till, L. M., Batres, R., Paw, B., Pergament, S. L., Saenyakul, P., Xiong, M., Kim, A. D., Kim, G., Masopust, D., Martens, E. C., . . . Knights, D. (2018). US Immigration Westernizes the Human Gut Microbiome. Cell, 175(4), 962–972.e10. https://doi.org/10.1016/j.cell.2018.10.029
- Nuriel-Ohayon, M., Neuman, H., & Koren, O. (2016). Microbial Changes during Pregnancy, Birth, and Infancy. Frontiers in Microbiology, 7. https://doi.org/10.3389/fmicb.2016.01031
- Nuriel-Ohayon, M., Neuman, H., Ziv, O., Belogolovski, A., Barsheshet, Y., Bloch, N., Uzan, A., Lahav, R., Peretz, A., Frishman, S., Hod, M., Hadar, E., Louzoun, Y., Avni, O., & Koren, O. (2019). Progesterone Increases Bifidobacterium Relative Abundance during Late Pregnancy. Cell Reports, 27(3), 730–736.e3. https://doi.org/10.1016/j.celrep.2019.03.075
- Strozzi, G. P., & Mogna, L. (2008). Quantification of Folic Acid in Human Feces After Administration of Bifidobacterium Probiotic Strains. Journal of Clinical Gastroenterology, 42(Supplement 3), S179–S184. https://doi.org/10.1097/mcg.0b013e31818087d8
- U.S. Department of Health and Human Services. (2018, October 29). Preterm labor and birth: Research activities and scientific advances. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Retrieved March 22, 2022, from https://www.nichd.nih.gov/health/topics/preterm/researchinfo/activities
- Fettweis, J. M., Serrano, M. G., Brooks, J. P., Edwards, D. J., Girerd, P. H., Parikh, H. I., Huang, B., Arodz, T. J., Edupuganti, L., Glascock, A. L., Xu, J., Jimenez, N. R., Vivadelli, S. C., Fong, S. S., Sheth, N. U., Jean, S., Lee, V., Bokhari, Y. A., Lara, A. M., . . . Buck, G. A. (2019). The vaginal microbiome and preterm birth. Nature Medicine, 25(6), 1012–1021. https://doi.org/10.1038/s41591-019-0450-2
- Greenwood, B. N., Carnahan, S., & Huang, L. (2018). Patient–physician gender concordance and increased mortality among female heart attack patients. Proceedings of the National Academy of Sciences, 115(34), 8569–8574. https://doi.org/10.1073/pnas.1800097115
- Razavi, A. C., Potts, K. S., Kelly, T. N., & Bazzano, L. A. (2019). Sex, gut microbiome, and cardiovascular disease risk. Biology of Sex Differences, 10(1). https://doi.org/10.1186/s13293-019-0240-z
- Saito, Y., Mihara, T., Maruyama, K., Saito, J., Ikeda, M., Tomonaga, A., & Kumagai, T. (2017). Effects of intake of Lactobacillus casei subsp. casei 327 on skin conditions: a randomized, double-blind, placebo-controlled, parallel-group study in women. Bioscience of Microbiota, Food and Health, 36(3), 111–120. https://doi.org/10.12938/bmfh.16-031
- Iemoli, E., Trabattoni, D., Parisotto, S., Borgonovo, L., Toscano, M., Rizzardini, G., Clerici, M., Ricci, E., Fusi, A., de Vecchi, E., Piconi, S., & Drago, L. (2012). Probiotics Reduce Gut Microbial Translocation and Improve Adult Atopic Dermatitis. Journal of Clinical Gastroenterology, 46, S33–S40. https://doi.org/10.1097/mcg.0b013e31826a8468
- Drago, F., de Col, E., Agnoletti, A. F., Schiavetti, I., Savarino, V., Rebora, A., Paolino, S., Cozzani, E., & Parodi, A. (2016). The role of small intestinal bacterial overgrowth in rosacea: A 3-year follow-up. Journal of the American Academy of Dermatology, 75(3), e113–e115. https://doi.org/10.1016/j.jaad.2016.01.059
- Mishra, G. D. (2003). Physical and mental health: changes during menopause transition. Quality of Life Research, 12(4), 405–412. https://doi.org/10.1023/a:1023421128141
- Hoffmann, J. N., You, H. M., Hedberg, E. C., Jordan, J. A., & McClintock, M. K. (2014). Prevalence of Bacterial Vaginosis and Candida among Postmenopausal Women in the United States. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69(Suppl 2), S205–S214. https://doi.org/10.1093/geronb/gbu105
- Fischer, G., & Bradford, J. (2011). Vulvovaginal Candidiasis in Postmenopausal Women. Journal of Lower Genital Tract Disease, 15(4), 263–267. https://doi.org/10.1097/lgt.0b013e3182241f1a
- Kim, J. M., & Park, Y. J. (2017). Probiotics in the Prevention and Treatment of Postmenopausal Vaginal Infections: Review Article. Journal of Menopausal Medicine, 23(3), 139. https://doi.org/10.6118/jmm.2017.23.3.139
- Kaplan, S. (2018, July 21). Bayer Will Stop Selling the Troubled Essure Birth Control Implants. The New York Times. https://www.nytimes.com/2018/07/20/health/bayer-essure-birth-control.html
- Kaplan, S., & Goldstein, M. (2019, April 17). F.D.A. Halts U.S. Sales of Pelvic Mesh, Citing Safety Concerns for Women. The New York Times. https://www.nytimes.com/2019/04/16/health/vaginal-pelvic-mesh-fda.html