Why Do We Use the Words “Sex” and “Gender”?
The words “sex” and “gender” will come up in my writing often. This post will draw out the differences, specifically from a health and medicine perspective.
One place of many we might look at to begin to understand the difference between sex and gender is at the very beginning. Shortly after the birth of a particularly fortunate child, the hospital room is lined already with plush toys and singing, perfumed cards. Overhead, tinseled balloons bob as the nurses rush in and out. The mother cradles her baby, tucking in a rose-colored blanket just a little tighter. In fact, one notices as one looks around that the toys are the same shade of subdued pink. The cards are accented with it, and the metallic balloons reflect the color onto the windows and walls. The room drips with saturation. No one is alarmed; after all, the baby is a girl.
When the doctor pronounces, “It’s a girl!” weeks in advance of the delivery, how does a particular image from the ultrasound come to mean that the baby will be swaddled in a kaleidoscope of pinks from the moment of birth? We will explore this incident using the Institute of Medicine’s definitions of sex and gender.
In 2001, the Institutes of Medicine (IOM, and now the National Academy of Medicine) published Exploring the Biological Contributions to Human Health: Does Sex Matter? This report was commissioned to determine whether and in which situations sex and gender were critical to understanding human health. It concluded, unsurprisingly, that sex and gender do matter and “acknowledged the potentially broad scope that a comprehensive analysis of sex and gender differences in health would have.”
The IOM defined sex as “the classification of living things, generally male or female according to their reproductive organs and functions assigned by chromosomal complement.” In other words, sex is the result of what chromosomes an individual has. Humans are typically chromosomally XX and developmentally female or they are chromosomally XY and developmentally male. Though sex is, for the large majority of cases, one or the other, individuals can have varying chromosomal make-ups and physical presentation.
The IOM defined gender as “a person’s self representation as male or female, or how that person is responded to by social institutions based on the individual’s gender presentations. Gender is rooted in biology and shaped by environment and experience”. The definition has been expanded upon by the World Health Organization (WHO): “Gender is related to how we are perceived and expected to think and act as women and men because of the ways society is organized.” So while sex is a product of chromosomal identity, gender is societally defined and does not always correspond to sex.
In fact, if we return to the baby’s room that is painted over in pink and anticipate the toys that people assume the baby will like, the words that people will use to describe the baby, and the activities the baby might be expected to be attracted to, we might begin to see that gender is in part societally conditioned from the moment of birth. There are certain ways the child is “perceived and expected to think and act” by society, as the WHO puts it, as soon as the doctor pronounces, “It’s a girl!”
I recognize that sex and gender must be differentiated and accounted for in health and medicine. I also recognize that this blog post is an imperfect, incomplete explanation of sex and gender. There remains much more to be said, debated and researched and I hope to have begun a conversation.
I do want to clarify that though this blog focuses on women’s health, it aims more broadly to encourage focus in research on people who are not adequately accounted for by the current health care system. I intend to convey that medical research must push harder to include more people who are not male and not men, including women and transgender people, among others. I encourage researchers to analyze data with sex and gender in mind.
