Gastroenterology · Medical Literature
[Comment] All in her head: dismantling medical misogyny in disorders of gut–brain interaction
Abstract
Gender is a crucial determinant in the navigation of a multi-tiered health-care system. Medical misogyny and medical misogynoir, as applied to women of colour, encompass systemic biases, discrimination, and neglect of women's health, and are rooted in historical and patriarchal viewpoints. We know that structural sexism within health care leads to poor outcomes, but how does medical misogyny manifest in gastroenterology practice, specifically as it relates to the management of disorders of gut–brain interaction (DGBIs)?
Clinical relevance
How does medical misogyny — including its compounded form, medical misogynoir, affecting women of colour — manifest in the clinical management of disorders of gut–brain interaction (DGBIs), and what does it mean for gastroenterology practice? __SNAPSHOT__ {"studyDesign":"Expert commentary / opinion piece — not a primary research study, systematic review, or meta-analysis; no original data collected or analyzed","setting":"Not applicable (commentary); authorship affiliated with patient advocacy and academic gastroenterology organizations in the United States","sampleSize":"Not applicable — no patient sample; this is an opinion/narrative commentary","population":"Conceptual focus on women — particularly women of colour — who navigate healthcare systems for DGBI (e.g., irritable bowel syndrome, functional dyspepsia, and related Rome IV diagnoses); no specific inclusion or exclusion criteria applied","intervention":"Not applicable — the commentary describes and critiques systemic gender bias in clinical practice rather than testing an intervention","comparator":"Not applicable","primaryOutcome":"Not applicable — the piece poses a conceptual research question regarding the manifestations of medical misogyny in gastroenterology DGBI care; no prespecified outcome was measured","followUp":"Not applicable","fundingSource":"Not reported; senior author (Ruddy) is affiliated with Ardelyx, Inc. (industry); potential conflicts of interest should be considered when interpreting advocacy framing"}
Key findings
This is an expert opinion commentary, not an empirical study; therefore, no original statistics, effect sizes, p-values, confidence intervals, or NNT/NNH values are reported. The authors argue that medical misogyny — defined as systemic bias, discrimination, and neglect rooted in historical patriarchal frameworks — is operative within gastroenterology, specifically in DGBI management. They introduce the term 'medical misogynoir' to describe the compounded burden faced by women of colour at the intersection of gender and racial bias. The central thesis is that structural sexism in healthcare leads to measurable harm, and the commentary situates DGBI as a particularly vulnerable domain because these conditions are predominantly diagnosed in women, carry a high burden of psychosocial stigma, and are historically prone to dismissal as psychosomatic or functional. The commentary does not generate new data but draws on a broader literature base (referenced indirectly via the abstract). Supporting empirical context from concurrent literature includes: population-based data from the Rome Foundation Global Epidemiology Study showing higher DGBI prevalence in women across all Rome IV categories, driven especially by IBS, functional dyspepsia, and constipation (ScienceDirect/Gastroenterology 2026, not reported in this commentary directly); a multicenter observational study showing diagnostic delay for IBD was significantly longer in women than men (12.6 vs. 4.5 months for Crohn's disease, P=.008; 6.1 vs. 2.7 months for ulcerative colitis, P=.008), with women more frequently misdiagnosed at every level of care (Sempere et al., Inflamm Bowel Dis 2023 — cited contextually, not within this commentary). These external data points provide empirical grounding for the commentary's assertions but are not presented or analyzed within this piece itself.
Practice implications
This commentary establishes a conceptual and advocacy framework rather than empirical evidence. It raises important professional questions about whether clinicians unconsciously attribute DGBI symptoms in women to psychological causes more readily than in men, and whether women of colour face compounded disadvantage. What the piece does NOT establish: (1) causal or quantitative relationships between provider bias and clinical outcomes in DGBI specifically; (2) prevalence data for misogynistic encounters in gastroenterology encounters; (3) effectiveness of any intervention to mitigate medical misogyny in practice. The target population — women with DGBIs, particularly women of colour — are systematically underrepresented in clinical research and underserved in practice, which is itself one of the commentary's key arguments. Findings are not directly applicable to individual patient management decisions, but are highly relevant to clinical training, institutional culture, and research agenda-setting. The paper is intentionally advocacy-oriented and authored by clinician-researchers with patient advocacy affiliations, which should inform interpretation. IMPORTANT LIMITATION: Only the abstract was available for this summary; the full text of the commentary, including specific arguments, cited evidence, and any proposed practice recommendations, was not accessible for review. __LIMITATIONS__ 1. Publication type: This is an expert opinion commentary — the lowest tier of the evidence hierarchy. No primary data were collected, no research methodology was employed, and no statistical analysis was performed. 2. Abstract-only access: The full text was not available; the summary is necessarily incomplete and may mischaracterize nuances of the authors' arguments. 3. Conflict of interest: One author (Ruddy) holds an appointment at a pharmaceutical company (Ardelyx, Inc.); one author (Aswani-Omprakash) is CEO of a GI patient advocacy non-profit (SAIA). These affiliations may shape framing and emphasis. 4. Scope of claims: The commentary appears to extrapolate from a broader medical misogyny literature to gastroenterology/DGBI without necessarily providing DGBI-specific empirical evidence — this cannot be fully assessed without full-text access. 5. Generalizability: Commentary is written from a predominantly U.S.-centric patient advocacy and academic perspective; applicability varies considerably across healthcare systems, cultures, and regions. 6. Lack of operational definitions: Terms such as 'medical misogyny' and 'medical misogynoir,' while conceptually meaningful, are not operationalized in ways that permit rigorous clinical measurement from the abstract alone. 7. Gender binary framing: The abstract refers to 'women' without addressing non-binary or transgender patients who may similarly experience bias in DGBI care. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This Lancet Gastroenterology & Hepatology commentary by Taft, Aswani-Omprakash, and Ruddy argues that medical misogyny — including its racialized form affecting women of colour — is a clinically meaningful driver of disparate care in DGBI, a condition disproportionately affecting women. While it generates no original data and should be read as an expert opinion piece, the arguments are well-situated within a broader literature documenting gender-based diagnostic delay and symptom dismissal in gastroenterological conditions. Clinicians should use this commentary as a prompt for reflection on implicit bias in DGBI encounters, recognition of how psychosomatic attribution may be gendered, and support for culturally sensitive training reforms — without treating its assertions as empirically established causal claims.