White men have dominated the medical profession, and until the 1990s, most clinical studies that have led to important guidelines in disease prevention and management have enrolled only white male subjects. The findings of these studies have been assumed to apply to women or minority men in a comparable way. There are accounts of female physicians practicing obstetrics in ancient Greece and Rome. However, with the arrival of male midwives in later times, women's presence faded from obstetrics and medical practice, and their practice remained limited to rural areas where physicians were scarce. In modern history, one of the first women to practice medicine did so by concealing her sex. For example, the sex of Canada's first known female physician, Dr. James Miranda Barry, a British military officer and surgeon in the mid-1800s, was not known until after her death. Simultaneously, however, history noted the founding of the First Medical College of Women by Elizabeth Blackwell (1868). In the Western Hemisphere, men had no presence in birthing rooms until the 17th century and there was a general discomfort with the physician-patient (male-female) relationship. It is recalled that in Victorian society, a doctor performing a pelvic examination had to look into the eyes of the patient, or close in space, rather than looking at the patient's naked body. In Chinese society, women used dolls to indicate the location of symptoms, so the physician would not have to see or touch her body. Such levels of discomfort persist to this day, especially in certain cultures, and many women in the United States choose female physicians and report greater satisfaction with them. In the 19th century, women joined the health care workforce by entering the nursing profession, which initially included both men and women. Florence Nightingale, considered one of the founders of nursing, developed the profession based on "hermetic virtues" including cleanliness, patience, order, and service. Feminists have claimed that this approach was responsible for the subordination that nurses (mostly female) were expected to display to physicians (mostly male) and for the development of sexism in the nursing profession. During the 20th century, nursing became a predominantly female field, and this is believed to have contributed to the low status and pay the profession received, relative to other medical professions. The role and status of midwives also declined despite the fact that the training and practice of midwifery was becoming more professional and regulated. This was due to a dramatic fall in the number of home births (from 90% in 1900 to 10% in 1950). This shift from home births to hospital deliveries occurred simultaneously with a steady decrease in the proportion of births attended by midwives (from 40% in 1915 to 11% in 1935), and an increase in male predominance in the specialty of OB/GYN. With the natural childbirth movement, the profession experienced a rebound in the 1970s. More recently, the role of certified nurse midwives has been expanding into the primary care sector. Women began attending medical schools in the mid-19th century. In 1900 women accounted for 6% of physicians. This ratio did not change until the 1960s due to the fact that women who did attend medical schools were excluded by quotas. One of the medical schools was sued back in the 1970s by the Women’s Equity Action League, and had to stop this phenomenon, while in 2000, nearly half of medical school students who were accepted were female. Little wonder that women’s health concerns made it into medical school curriculum. Dr. Antonia Novello was appointed in 1990 and held the position as the first woman and first minority group member to hold the office of Surgeon General. Despite this progress, only eight U.S. medical schools had female deans in the late 1990s. Although the ratio of female to male medical students has been steadily increasing, there are many indications that medical schools are ill-equipped to educate women. Even at the most renowned medical schools, female students report sexist attitudes and insensitive comments from their male teachers, such as women in medical schools being underrepresented due to "unresolved penis envy." To this day, women experience difficulty being accepted as true professionals by both their peers and their patients. The dominance of men in the OB/GYN specialty has undoubtedly shaped women's health, as they approach birth, conception, and the female body. First came the overdiscrimination of pregnancy and childbirth that in turn has been responsible for a dramatic increase in the use of procedures in the practice of obstetrics. This is best evidenced by the high rates of cesarean delivery (up to one in four deliveries in the 1980s in the United States); gynecological surgery also evolved. Several strategies were developed to address psychological ill-health in women. The practice of "preventive" oophorectomy originated in the belief that it prevented ovarian cancer, particularly, but not exclusively, in women with a strong family history of breast or ovarian cancer. Unfortunately, the effectiveness of this procedure in cancer prevention, and the costs and benefits of surgical menopause have not been studied with rigor, even though a considerable proportion of hysterectomy procedures also entailed oophorectomy. This procedure can be compared to castration, and the decision to undergo such drastic therapy must be evaluated in light of the potential physical and emotional consequences and the availability of other treatment options.
