Imagine a scenario in which you are lying on an operating table and clinicians cannot implant a lifesaving device because it was not designed for a body like yours. Or you present to the emergency department with chest pain and are discharged because your symptoms do not match the “classic” pattern taught to generations of physicians. Error or systemic bias? Does a longstanding scientific framework still define a “standard” human body?

Historical Roots

The persistence of sex bias in medical research remains notable. To understand this imbalance, it is necessary to examine the origins of modern anatomy. Early anatomical texts, including those by Andreas Vesalius in the 16th century, relied almost exclusively on male bodies. Except for reproductive differences, female anatomy remained largely taboo. It is notable how the female body was described in this context.

“Woman as a mere deviation or even a ‘reversal’ of the male norm.”

During the 19th century, with the establishment of medical schools and the rise of anatomical dissection, this perspective became more entrenched. Limited access to cadavers, along with deeply rooted cultural views of women, reinforced this bias. The male body was regarded as universal, rational, and worthy of study, whereas the female body was seen as variable, emotional, and shaped by reproductive biology.

Clinical Consequences

Even when women were included in medical studies, this often occurred through a pathologic lens. Concepts such as hysteria and the “wandering uterus” shaped medical thinking. Although this has improved since the 20th century, disparities persist. Examples include continued preference for the male body in surgical practice and medical education.

Bias affects not only theory but also everyday clinical practice. These patterns are closely linked to survival outcomes and should not be overlooked.

A well-established example involves symptoms of myocardial infarction. Men more often report radiating pain and left-sided chest discomfort, whereas women more commonly report fatigue, nausea, or jaw pain. Because these symptoms do not align with traditional teaching, women face increased risk for misdiagnosis or premature discharge, which may contribute to higher mortality rates.

Evidence of male preference is also seen in medical technology and safety design:

• Crash test dummies used in vehicle safety testing were historically modeled on male body dimensions. Instead of developing true female models, smaller versions of male dummies were used to represent women.
• In orthopedics, hip and knee prostheses often show poorer performance in women compared with men because original designs were based on male bone dimensions and joint alignment.

Drug Disparities

The situation in pharmaceutical research is concerning. Until the early 1990s, women were systematically excluded from clinical trials. Concerns about hormonal fluctuations and potential risks during pregnancy were cited, with the claim that these factors made data interpretation more complex. As a result, dosing, metabolism, and adverse effects of many medications were studied primarily in male participants, leading to clinically important gaps.

A classic example is zolpidem, a medication used for insomnia. In 2013, the FDA reduced the recommended dose for women after evidence showed that women experienced more pronounced and prolonged effects than men. More balanced representation in earlier trials could have identified this difference sooner.

Anatomy inclusion

It is incorrect to assume that sex differences are limited to reproductive organs. Differences are present in bones, muscles, blood vessels, fat distribution, and immune responses. The female skeleton is generally lighter and differs in pelvic and knee alignment. Tendons and ligaments respond differently to mechanical stress and hormonal influences, which affects injury risk and recovery time. Pain perception and response to analgesics also differ due to neurobiological variation.

Despite this, many current textbooks continue to present the male body as the standard.

Conclusion

A single standard model of anatomy does not reflect clinical reality. The concept of a “one-size-fits-all” approach to anatomy is no longer sufficient. The next generation of anatomists, physicians, and designers should account for gender-based biological differences and apply this understanding in clinical practice and education.

If the first step in medicine is to understand the body, an important question follows: Whose body is being taught? Medicine is entering an era that places individual variation at the center. It is now time for clinical models to evolve in ways that support this shift and enable its application in practice.

This story was translated from Univadis Germany, part of the Medscape Professional Network.