Biological Susceptibility to STDs
Anatomy/Physiology
o Abnormal discharge and painless lesions are more likely to go
unnoticed by women – particularly internal lesions.
o Mechanics of vaginal sex – more extended contact with the pathogen
after sexual exposure.
o Chlamydia and gonorrhea infect columnar cells. Since the bacteria
have easier access to these cells when they are on the outside of the
cervix, this makes younger women biologically more at risk for STDs.
Older women too can have a cervical ectopy condition, which also
puts them at higher risk for STDs.
o Women are far more likely to be asymptomatic.
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o Menstrual cycle – appears to influence risk of upper tract infection in
women.
Transmission
o Data suggests that transmission of STDs that cause a discharge or
residue in genital secretions (e.g. HIV, Hepatitis B, GC, CT) are
generally more efficient from male to female than female to male.
Pregnancy
o Pregnancy – immunological, anatomical and microbiological change
that affect risk of STDs. Host defenses are normally depressed during
pregnancy. This immune suppression often affects the course of
genital tract infections.
o Gestational changes – may increase susceptibility to cervicitis but
tend to protect the upper tract from infection
Gender norms/sexism
Relationship dynamics
o Women are more concerned about their male partner’s reactions if
they introduce condom use
o One study found that women often switch to ‘pregnancy prevention’ or
other reasons for safer sex that are more acceptable to both their
partner and themselves
o More young women report forced or coerced first sexual encounter
Structural sexism
o Historically, health care systems have added to the gender
differences in access to STD care.
o Provider bias: One example has been the failure to identify HIV
infections in women compared with men because of a different
threshold of suspicion by providers.
o Female (Reality) condoms (and dental dams) are only options for
female-controlled STD prevention. They are expensive and not
readily available.
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Cultural norms in female sub-groups
o Women are more likely to use over the counter douches, vaginal
yeast products and other intravaginal preparations as home remedies
for symptoms of STDs; thus increasing the severity of the symptoms
of STDs due to delayed or inaccurate diagnosis or treatment.
o Women who have sex women report lower perceived risk in terms of
acquiring STDs.
o Competing priorities (children’s health, home-based work, single
parenthood) in some households and communities may diminish a
woman’s ability to seek healthcare, particularly for asymptomatic or
preventive health issues.
o Gender Role: sexuality related beliefs, attitudes, values, norms,
behaviors.