What Is The Relevance Of Gender Within Medical Care?

Our work is driven by our mission to provide accessible and gender-informed sports-related concussion guidance. But what, you may be asking, is the relevance of gender within medical care? 

What Are the Differences? 

Women have remained under-represented within sports medicine for far too long, with a meta-analysis of 171 sports concussion studies revealing that 80.1% of participants included were males and 40.4% of studies excluded women entirely [1]. 

Emerging research is working to combat this androcentric bias in medicine. Concussion studies have begun to highlight that women may often experience more severe symptoms following sports-related concussions [2], with longer recovery periods [3]. These findings become even more stark when considering women also report greater incidences of such injuries [4][5]. 

Why Do These Differences Exist? 

Biomechanical. Differences in head and neck stability are thought to create gender disparities in susceptibility to sports-related concussion injuries [4][5]. A study conducted with adolescent football athletes found significant negative correlations between neck strength and header acceleration, concluding that individuals with weaker necks sustained greater impacts [6]. Given that women, on average, possess lower neck strength [4], this research implies that in response to an equivalent magnitude head-impact collision, women are more likely to sustain a severe concussion compared to men [5]. 

Neuroanatomical. Controversial and currently debated research suggests women may possess higher levels of interhemispheric communications, with increased fibers crossing the corpus callosum [7]. Given concussions cause concentrated strain to this brain tissue, neuroanatomical differences are often used to explain gender differences exhibited in concussion outcomes [8]. Additionally, women possess more non-myelinated neuronal activity in the brain, meaning neurotransmission is more vulnerable to damage [9]. Taken together these differences may explain the more significant sports-related concussion outcomes seen in women. However, further research is required in this potentially harmful area, given ongoing neuroscientific debates surrounding the potential structural gender differences in the brain [10][11]. 

Hormonal. Progesterone is considered a neuroprotectant [12]. Research suggests that following head impact injuries during conditions of high progesterone, women can experience a sudden reduction in hormonal concentrations and, consequently, poorer outcomes – including longer recovery [4] and more severe symptomology [13]. Given that women possess consistently higher progesterone levels, compared to men, this research may explain gender-differences in concussion outcomes [13]. 

Research, therefore, highlights multiple factors that may contribute to womens’ longer and more severe concussion symptomology. These insights validate that androcentric research cannot be applied across sexes. 

So Why Does This Matter? 

1. Lack of Representation in Concussion Protocol 

As alluded to above, over the past months, we have conducted an extensive review of 256 studies pertaining to gender differences in concussion outcomes and spoken to published experts in the field. This deep dive into currently emerging research has uncovered the clear and distinct differences often exhibited between genders following a sports-related concussion. 

However, despite these data-driven insights, current governing bodies and government-issued guidance fail to recognise gender differences within their protocol - distributed to all levels of play but often relied upon more heavily by under-resourced grassroots teams. 

The consequence of a lack of inclusive support can be devastating. This failure to recognise that women athletes may experience longer recovery and more severe symptomology following concussions increases the risk of premature return-to-play, second-impact syndrome, and longer-term neurological damage. 

2. Growth in Women's Sport 

At the end of 2023, the UK Government published its new sports strategy ‘to get 3.5 million more people active by 2030, including 1.25 million more women’ [14]. This effort aims to create sustainable growth in women's football following the historic achievements of the Lionesses at the 2022 Football Euros final, watched by 17.4 million individuals [15]. These pledges, alongside organic growth in women's sports - seen by media coverage nearly tripling over the last five years [16] - indicate predicted growth in women's sports.  

As such, the time to act is now to ensure that gender-informed guidance is provided to protect the brains of all athletes! 

References:  

1. D’Lauro, C., Jones, E.R., Swope, L.M.C., Anderson, M.N., Broglio S., and Schmidt, J.D. 2022. Under-representation of female athletes in research informing influential concussion consensus and position statements: an evidence review and synthesis.  British Journal of Sports Medicine, 56(17), pp.981-987.  

2. Tanveer, S., Zecavati, N., Delasobera, E.B. and Oyegbile, T.O. 2017. Gender differences in concussion and postinjury cognitive findings in an older and younger pediatric population. Pediatric Neurology, 70, pp.44-49.  

3. Koerte, I.K., Schultz, V., Sydnor, V.J., Howell, D.R., Guenette, J.P., Dennis, E., Kochsiek, J., Kaufmann, D., Sollmann, N., Mondello, S. and Shenton, M.E. 2020. Sex‐related differences in the effects of sports‐related concussion: a review.  Journal of Neuroimaging, 30(4), pp.387-409.  

4. Mollayeva, T., El-Khechen-Richandi, G. and Colantonio, A. 2018. Sex and gender considerations in concussion research. Concussion, 3(1), Article CNC51.  

5. Sutton, M., Chan, V., Escobar, M., Mollayeva, T., Hu, Z. and Colantonio, A. 2019. Neck injury comorbidity in concussion-related emergency department visits: a population-based study of sex differences across the life span.  Journal of Women's Health, 28(4), pp.473-482.  

6. Gutierrez, G.M., Conte, C. and Lightbourne, K. 2014. The relationship between impact force, neck strength, and neurocognitive performance in soccer heading in adolescent females.  Pediatric Exercise Science,  26(1), pp.33-40.  

7. Zaidi, Z.F., 2010. Gender differences in human brain: a review. The Open Anatomy Journal,  2(1), pp.37-55.  

8. Solomito, M.J., Reuman, H. and Wang, D.H. 2019. Sex differences in concussion: a review of brain anatomy, function, and biomechanical response to impact. Brain Injury, 33(2), pp.105-110.  

9. Lorenz, B.R. 2022.  Investigating the Relationships between Menstrual Cycle, Progesterone, and Concussion in Female Athletes (Doctoral dissertation, University of Toronto).  

10. Schmied, A., Soda, T., Gerig, G., Styner, M., Swanson, M.R., Elison, J.T., Shen, M.D., McKinstry, R.C., Pruett Jr, J.R., Botteron, K.N. and Estes, A.M. 2020. Sex differences associated with corpus callosum development in human infants: A longitudinal multimodal imaging study. NeuroImage, 215, Article 116821.  

11. Shin, Y.W., Kim, D.J., Hyon, T., Park, H.J., Moon, W.J., Chung, E.C., Lee, J.M., Kim, I.Y., Kim, S.I. and Kwon, J.S. 2005. Sex differences in the human corpus callosum: diffusion tensor imaging study.  NeuroReport, 16(8), pp.795-798.  

12. Singh, M. and Su, C. 2013. Progesterone and neuroprotection. Hormones and Behavior, 63(2), pp.284-290.  

13. Wunderle, K., Hoeger, K.M., Wasserman, E. and Bazarian, J.J. (2014). Menstrual Phase as Predictor of Outcome after Mild Traumatic Brain Injury in Women. Journal of Head Trauma Rehabilitation, 29(5), pp.E1–E8.  

14. Department for Culture, Media, and Sport. 2024. Culture Secretary to drive forward growth of women’s sport [online]. Available from: https://www.gov.uk/government/news/culture-secretary-to-drive-forward-growth-of-womens-sport#:~:text=In%20December%202023%2C%20the%20Government,including%201.25%20million%20more%20women. 

15. BBC. 2022. Women’s euro 2022: Record global audience watched tournament in England [online]. Available from: https://www.bbc.co.uk/sport/football/62735293#:~:text=Domestically%2C%20the%20Lionesses'%20triumph%20was,UK%20so%20far%20in%202022. [Accessed 2 December 2023].  

16. Darvin, L. 2023. Media coverage for women’s sports has nearly tripled in five years, according to new research [online]. Available from: https://www.forbes.com/sites/lindseyedarvin/2023/10/31/media-coverage-for-womens-sports-has-nearly-tripled-in-five-years-according-to-new-research/