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The term ‘bikini medicine’ originally highlighted the narrow reproductive focus of women’s health research, but has since broadened into a much-needed campaign for equitable inclusion of women across all aspects of health care. Continued use of this patronising pejorative term may paradoxically diminish rather than augment the overall push for better women’s health. So it’s time to abandon the bikini and in the 21st century seek sex- and gender-specific medicine for the whole person.
‘Bikini medicine’ was a term devised, ironically and astutely, by the legendary (though still living and working) American cardiologist Dr Nanette Wenger in the early 1980s. The term was coined to highlight the narrow focus of women’s health research at the time, directed largely towards the female reproductive tract and breasts, the organs supposedly covered by a bikini. Wenger was a pioneer in her specialty, and the first to recognise and report that coronary heart disease (CHD), previously understood as a major cause of mortality chiefly among middle-aged men, and therefore worth researching, was also a significant cause of mortality in women. Wenger’s use of a scanty and sexualised garment as a metaphor for women’s reproductive health research and care was a bold step that illustrated the huge discrepancies in health and healthcare she had noticed between male and female subjects in the latter part of the 20th century, as well as her awareness of male domination of both clinical practice and medical research. Simply put, ‘bikini medicine’ refers to a mistaken belief that ‘women’s health’ need refer only to sexual and reproductive organs.
To negate this, the campaign ‘Beyond Bikini Medicine’ has been hailed as a powerful and growing movement for change. Its use across both the medical literature and the lay media has since broadened into a much-needed campaign for equitable sex and gender responsive approaches, not just for research but for health policy, innovation, service provision and education.
Beyond reproductive organs
Outside the reproductive organs, it is now well established that women have different presentations, predispositions and trajectories across hundreds of diseases. They are not just smaller versions of men, yet clinical guidelines, drugs, research and development, provider attitudes, and even cell lines and animal studies, are still predominantly based on the male, with consequent underfunding of sex- and gender-tailored research, technology, and in particular health services. Australian researchers, most notably from the George Institute for Global Health, have been influential in highlighting the need to address this unmet gender gap across the board. Redressing the 25% more time women spend in poor health, in contrast to men, would, according to recent World Economic Forum (WEF) reports, boost the global economy by one trillion dollars (United States) annually by 2040.
“‘Bikini medicine’ has marginalised women in every area of health” headlined a recent MJA Insight+ article. While a media-savvy catch cry, the term itself can be criticised for being patronising, outdated, and indeed pejorative, implying an entrenched Western sexist stereotype that has not changed since Wenger introduced it. Paradoxically, continued use of this term even as ‘Beyond Bikini Medicine’ may diminish rather than augment the overall push for better women’s health.
Firstly, many female reproductive conditions are systemic not local, with manifestations well outside the so-called ‘bikini’ organs. Polycystic ovary syndrome (PCOS) has substantial metabolic and endocrinological sequelae, endometriosis is increasingly recognised as an inflammatory disorder that may appear at many sites, just about every body system is deranged in pre-eclampsia, hyperemesis gravidarum can be lethal, and peri-menopause affects all major organ systems, while premenstrual syndrome/dysphoric disorder has debilitating neuropsychological as well as physical manifestations. Next, reproductive disorders such as gestational diabetes, preterm delivery, stillbirth, PCOS and endometriosis, and hypertensive disorders of pregnancy carry significant long-term cardiometabolic risks including mortality, likely through genetic predisposition across the life course. Indeed, even within its organ remit, ‘bikini medicine’ implies a focus centred on the reproductive years while the disease burden of the equally numerous decades women spend in later life is underestimated.
The ongoing gender health gap
The gender health gap spans three groups: disorders that affect women disproportionately, differently, or uniquely. Of these, the first (among others, autoimmune diseases, migraine, depression and osteoporosis) is by far the largest, with unique reproductive conditions next estimated at around 10%, according to the WEF’s 2024 report. Another report from the WEF finds that about a third of the gap is made up of just nine conditions, seven of which are reproductive (breast cancer, cervical cancer, maternal hypertensive disorders, post-partum haemorrhage, menopause/perimenopause, premenstrual syndrome and endometriosis); closing this could prevent almost 27 million disability-adjusted life years annually. Yet it is across the whole spectrum that research into female dominant compared to male dominant conditions is underfunded, and there are cogent macroeconomic and social arguments for investing in pan-women’s health across the life course. Rather than balkanise the components, an equitable whole-of-woman approach is needed. This would assist both obstetricians and gynaecologists in embracing a whole-of-patient approach, and other specialists in appreciating gendered health perspectives inclusive of their reproductive context. In this light, it is instructive to see a recent $15M international grant on cardiovascular disease in postmenopausal women co-led by an Australian gynaecologist.
Nanette Wenger has spent seven decades convincing her colleagues to look ‘beyond bikini medicine.’ Hers was the first and the strongest voice to call for equitable inclusion of women in research in medicine, particularly but not only in cardiovascular medicine including CHD. But ‘bikini medicine’ as a medical term has outlived its use-by date. In the 21st century, it is better to unite around sex- and gender- specific precision medicine for the whole woman, than dwell on an oversimplistic and trivialising catchphrase.
Nicholas M Fisk AM is an emeritus professor in the faculty of medicine and health at UNSW. He was professor of obstetrics and gynaecology at Imperial College London, 1992-2007, executive dean of medicine and health sciences at University of Qld, 2010-2016, and then DVC Research & Enterprise at UNSW Sydney until 2024.
Caroline de Costa was professor of obstetrics and gynaecology at James Cook University, Cairns, 2004-2021, and is now an adjunct research professor at The Cairns Institute of JCU.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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