Gender medicine: its historical roots.

Gender medicine as a subject began with Bernadine Healy's 1991 article 'The Yentl Syndrome' which showed that women had worse outcomes following heart attacks since their symptoms are different from men. Since then gender-specific clinical research protocols have been progressively included so that evidence for guidelines can be better informed such that women are then less disadvantaged and care become more personalised. This paper traces back the historical roots of gender bias in medicine in Western culture, which is reflected in the pictorial arts and writings of each historical period, beginning with Hippocrates. It describes the changes that have led to attempts at improving the place of women, and the treatments of disease, on an equal footing with men, precipitated by Healy's paper.

O processo de construção da Política Nacional de Atenção Integral à Saúde do Homem / The National Mens Health policy making process

Resumo O artigo analisa o processo de construção da Política Nacional de Atenção Integral à Saúde do Homem, com vistas a reconhecer a participação dos diversos agentes sociais na formulação dessa política pública. Para tanto, busca identificar os eventos que precederam a construção do documento, as estratégias utilizadas para promover a participação dos diferentes grupos de interesse e os mecanismos para pactuação e tomada de decisão. Foram analisados documentos institucionais, referências acadêmicas, e realizadas entrevistas com agentes participantes do processo. Identificou-se que a intenção da política surge a partir da atuação da Sociedade Brasileira de Urologia. O Ministério da Saúde aproximou do processo político outros agentes, mas a leitura biomédica manteve-se predominante. A forma de participação dos agentes pautou-se na transmissão de conhecimento, com pouco espaço para o enfrentamento de conflitos na construção da política, apesar de o documento final ser divulgado como expressão de consensos. Houve silenciamentos das contradições e disputas que permearam a definição de saúde do homem.

Abstract This paper analyzes the National Men's Health policy-making process to recognize the participation of the various social stakeholders in the formulation of this public policy. To this end, this work seeks to identify the events that preceded the construction of the document, the strategies used to promote the participation of different interest groups and the mechanisms for the agreement and decision-making process. Institutional documents, academic references and interviews with agents participating in the process were analyzed. We identified that the Policy's intention emerged from the action of the Brazilian Society of Urology. The Ministry of Health drew other agents closer to the political process, but the biomedical perspective prevailed. The agents' participation built on knowledge transfer, with little room for confronting conflicts in the construction of politics, although the final document had been released as an expression of consensus. The contradictions and disputes around the definition of men's health have been silenced.

Negociando saberes e poderes: a Política Nacional de Atenção Integral à Saúde do Homem e a Sociedade Brasileira de Urologia / Negotiating knowledge and power: the National Policy for Comprehensive Men’ s Healthcare and the Brazilian Society of Urology

Resumo O objetivo do artigo é evidenciar as negociações e disputas entre saberes e poderes na história da Política Nacional de Atenção Integral à Saúde do Homem, a partir da criação da Área Técnica de Saúde do Homem, instituída em 2008 no Departamento de Ações Programáticas Estratégicas no Ministério da Saúde. Acompanhamos a posição da Sociedade Brasileira de Urologia no processo de constituição da política. Recuperamos a disputa colocada em discurso tendo como referência as entrevistas realizadas com gestores do Ministério da Saúde e com o representante auxiliar do Fundo de População das Nações Unidas no Brasil. Nas aparições do sujeito de direitos à saúde, analisamos a visibilidade do corpo masculino nos signos das resistências às intervenções do biopoder.

Abstract The aim of this article is to demonstrate the negotiations and disputes between different kinds of knowledge and power in the history of the Brazilian National Policy for Comprehensive Men’s Healthcare based on the creation in 2008 of the Technical Area for Men’s Health within the Ministry of Health’s Department of Strategic Programs. We observed the Brazilian Society of Urology’s position as the policy was being drawn up, including the discourse adopted, based on interviews held with managers from the Ministry of Health and the assistant representative of the United Nations Population Fund in Brazil. We analyzed the visibility of the male body in signs of resistance to the interventions of biopower in the expression of the right to health.

[Negotiating knowledge and power: the National Policy for Comprehensive Men's Healthcare and the Brazilian Society of Urology]. / Negociando saberes e poderes: a Política Nacional de Atenção Integral à Saúde do Homem e a Sociedade Brasileira de Urologia.

The aim of this article is to demonstrate the negotiations and disputes between different kinds of knowledge and power in the history of the Brazilian National Policy for Comprehensive Men's Healthcare based on the creation in 2008 of the Technical Area for Men's Health within the Ministry of Health's Department of Strategic Programs. We observed the Brazilian Society of Urology's position as the policy was being drawn up, including the discourse adopted, based on interviews held with managers from the Ministry of Health and the assistant representative of the United Nations Population Fund in Brazil. We analyzed the visibility of the male body in signs of resistance to the interventions of biopower in the expression of the right to health.

Meu encontro com os outros: memórias de José de Albuquerque, pioneiro da s políticos governança políticas urbana sexologia no Brasil

A sexualidade como função fisiológica e o desejo sexual como necessidade orgânica primária. A educação sexual – para homens e mulheres – como estratégia para solucionar não só o problema das doenças venéreas, mas outros como a desarmonia conjugal e as perversões sexuais. A legitimação e institucionalização da andrologia, a ciência do homem. A crítica à abstinência sexual socialmente imposta às mulheres solteiras e viúvas. Essas eram algumas das ideias defendidas pelo autoproclamado sexólogo e andrologista brasileiro José de Albuquerque, médico que, embora tenha enfrentado tabus, levantado polêmicas e causado rebuliço na elite carioca nos anos 1930, ficou esquecido ao longo das décadas seguintes. Mas agora esse importante personagem da história da sexualidade no Brasil volta à cena com a publicação de sua autobiografia até então inédita. Enfim, para além das peripécias de uma vida bastante agitada e de uma singular trajetória profissional, a autobiografia desvela aspectos interessantíssimos do desenvolvimento das ciências médicas no Rio de Janeiro do entreguerras. Nela, aparecem seus principais personagens, a vida em suas escolas e o universo de sua prática, afirmam os organizadores. Sua leitura na segunda década dos anos 2000 permite colocar em uma nova perspectiva a própria história da sexualidade no Brasil, um campo que hoje, como nos anos 1930, continua tensionado por inúmeros dilemas, conflitos e impasses.

[A history of men's health--on the origin of a field of research]. / Männergesundheitsgeschichte--Zur Entstehung eines Forschungsfeldes.

This contribution traces the conditions surrounding the emergence and development of a new field of research since the millennium. It primarily presents research initiated by the Stuttgart Institute for the History of Medicine: starting with the (re)discovery of sources and the setting up of bodies of sources for a gender-sensitive, patient-oriented history of health (autobiographies, diaries, correspondence) it moves to issues such as health lifestyles, workers' masculinity, the use of medical services, health experiences during particular stages of life such as childhood or youth, as well as prevention, healthcare, mental health and the gender gap in life expectancy. In conclusion the article discusses possible theoretical frameworks and perspectives.

[Masculinity and Meat Consumption--Historical Approchaes to a Current Health Issue]. / Männlichkeit und Fleischkonsum--historische Annäherungen an eine gegenw rtige Gesundheitsthematik.

In current health debates meat is often discussed as a health risk. Statistically, men consume more meat than women. Therefore they often appear as an especially vulnerable risk group. Based on current discussions about an increased health risk for men because of an above-average consumption of meat, this paper outlines aspects of the historical development of the relationship between masculinity and meat consumption from the 19th to the 21st century and emphasizes the importance of cultural constructed gender expectations for the eating habits of many men.

[Accident cause masculinity?--Gender-related issues of accident victims between prevention and coping in Kaiserreich and Weimarer Republik]. / Unfallursache Männlichkeit?--Geschlechterspezifische Aspekte bei Arbeitsunfallopfern zwischen Prävention und FolgenbewäItigung in Kaiserreich und Weimarer Republik.

Occupational accidents in industrial workplaces are a specific health problem for man. Therefore it seems adequate to use masculinities as a category of research in this field. For the Kaiserreich and the Weimarer Republik it shows that male workers relating to their danger awareness and behavior, prevention, accident causes and coping strategies are settled in an area of conflict between a hard workplace environment and the family. On the basis of health practices of the accident victims it appears that there are different forms of labor masculinities. They have an important influence on all levels of an occupational accident from the endangerment to the success of the treatment. Through a critical use of the category academic void can be shown and alternative explanatory models can be offered.

[Migrants' masculinity and health. Taking care for one's health and coping with sickness of German migrants in the US in 19th and early 20th centuries]. / Männlichkeit und Gesundheit im Kontext von Migration. Praktiken der Gesundheitsfürsorge und KrankheitsbewäItigung deutscher Migranten in den USA im 19. Jahrhundert und frühen 20. Jahrhundert.

In 19. and early 20. centuries several million emigrants from German speaking countries entered the United States of America. How migrants coped with sickness, how they preserved their health and to which ressources and institutions of help they had access is yet an academic void. Using Ego-documents--letters, autobiographic texts and diaries--of near-illiterate men this paper will analyse 'healthy lifestyles' and practices of coping with sickness and contrast them with recent research findings in the field of 'mens' health'. Thereby the recent concept of ,male health-idiots' will be challenged in historical perspective.

["Should the staff's attitude towards the patients remain unchanged, I will not guarantee anything." Protest masculinity and coping of "rebellious patients" at the Heidelberg University Psychiatric Hospital on the eve of deinstitutionalization]. / "Sollte sich die Einstellung des Personals gegenüber den Patienten nicht ändern, garantiere ich für nichts mehr!" Protestmännlichkeit und KrankheitsbewäItigung von "aufsässigen Patienten" der Psychiatrischen Universitätskinik Heidelberg am Vorabend der Psychiatriereform.

This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved "sexually inappropriate", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients" has to be interpreted as individual coping strategies.

[Health Education for Men by the Federal Centre of Health Education: A Contribution to the Presentation of Men as unaware of Health? (1970-1990)]. / Männerspezifische GesundheitsaufkIärung durch die BZgA: Ein Beitrag zur Verfestigung des Gesundheitsdefizitdiskurses? (1970-1990).

This article offers a close consideration about the gender-specific contents of health education campaigns in the Federal Republic of Germany from 1970 to 1990. By using educational publications issued by the Bundeszentrale für gesundheitliche Aufklärung (BZgA), it is shown which breaks and continuities emerged and which kinds of role models are thereby conveyed. Whereas the health education of the 1950s and 1960s was characterised by a didactical approach towards men and women, this changed as from the 1970s. By deconstructing exemplary education campaigns and including internal files of the BZgA, it can be shown, that the societal discourse on the feminism in the FRG contributed to the fact, that during the 1970s the switch has been made to an increased use of positive role models. However, within the men-specific health education there was no break; the health deficiency discourse was still applied in many and diverse ways in order to describe male health behaviour and knowledge.

["But there are also men!" Gender-specific health education and prevention in the GDR from the 1950th to the 1970th]. / "Männer gibt es doch auch!" Geschlechterspezifische Gesundheitserziehung und Prävention in der DDR in den 1950er bis 1970er Jahren.

The notions of femininity and masculinity in the GDR health propaganda and their effects on the health consciousness and behaviour of the population in the GDR are the key topics of this article. The main questions of the first part are, if women and men were equally represented in educational materials and had to fulfil the same norms and expectations. The second part deals with ego-documents, primarily petitions to the Ministry of Health, as well as reports and evaluations from the local health authorities that shall help to answer the questions of male and female health behaviour. Additionally they can provide an insight into the views and actions of patients. Other factors such as the educational level, matters of milieu and regional peculiarities that have impact on the health status and behaviour will be discussed at the end of the article.

A historical perspective on the male sexual case history.

The contemporary sexual medicine case history is grounded in the Biopsychosocial Model and its recognition that the past influences one's current interpretation of symptoms. However, the thread of this model can be found throughout the case studies of the early pioneers of sexology. These early investigators began with examinations of homosexual men, slowly moving toward awareness that male sexuality comprises a continuum, while striving to place sexual behavior in a biologic context. Their perspectives served to establish the groundwork for the emerging construct of sexuality and helped shape current methods for identification of sexual function concerns.

La investigación histórica y el debate actual sobre la salud masculina: el caso de Alemania / Historical research and the current debate about men’s health: the German case

El discurso actual sobre la salud masculina remite con demasiada insistencia a una imagen obsoleta y monolítica de la masculinidad contrastando de manera simplista el colectivo "hombres" con el de las "mujeres". Sin embargo, el análisis histórico hace muy evidentes los notables cambios que se han producido en la salud de los hombres, tanto en lo que se refiere a sus actitudes como a sus comportamientos, desde la revolución industrial; así, por ejemplo, se ha transformado no solamente la vida profesional y el mundo del trabajo, sino también la relación entre la masculinidad y el comportamiento de riesgo a lo largo de la vida y, asimismo, la evaluación médica de ciertos comportamientos de alto riesgo como fumar. Las diferencias en la esperanza de vida entre hombres y mujeres merecen una explicación más precisa y menos simplista. Desde una perspectiva histórica de longue-durée, también es un mito que los hombres guarden silencio en asuntos de salud (AU)

The current discourse on men's health refers too insistently to an obsolete and monolithic pattern of masculinity contrasting "men" with "women" in a simplistic manner. However, historical analysis shows the remarkable changes that have occurred in the health of men, both in terms of their attitudes and their behaviors, since the industrial revolution; so, for example, the relationship between masculinity and risk behavior throughout life, the professional life and the world of work, and also the medical evaluation of certain high-risk behaviors such as smoking. Differences of the life expectancy between men and women deserve an explanation more accurate and less simplistic. From a historical perspective of longue-durée, it is also a myth that men keep silent on matters of health (AU)

Historical revolutions in sex therapy: a critical examination of men's sexual dysfunctions and their treatment.

History, recent and ancient, presents innumerable methods intended to ensure or restore male sexual performance. Although these methods have regularly claimed to be "revolutionary," they have often been remarkably similar, and of questionably efficacy. This article provides a critical account of key historical trends in the treatment of male sexual dysfunctions in order to contextualize and critique the current treatment field. The author uses historical analysis to contextualize contemporary sex therapy techniques, arguing that even clinically verified contemporary revolutions, such as the advent of Viagra and similar drugs, may not present broadly efficacious standalone cures. Using critical historical analysis to illustrate the limitations of single-method treatments, the article argues for the value of comprehensive, biopsychosocial therapy methods. A common tendency--to seek a 'magic bullet' solution to sexual dysfunctions--is apparent throughout history, the author argues. While Viagra differs biomedically from historical treatments, it may appeal to the same logic, raising the question of whether it constitutes a truly revolutionary development in treatment. The article concludes with a set of recommendations regarding the implementation of biopsychosocial practice in sex therapy.