User:WhatamIdoing/Sex and gender in medical articles

Sex and gender in medical articles

We might need to write some advice for medicine-specific content that goes beyond what has already been written. If you have ideas about what would be helpful, please post your suggestions on the talk page.

Existing pages and prior discussions

What the sources recommend

This is a quick collection of links to external style guides and other sources that recommend one or more approaches to the question of how to describe sex-specific medical content when the affected people are gender-diverse.


Source	Type	Approach	Examples
Gender Inclusive Language in Perinatal Services: Mission Statement and Rationale by Brighton and Sussex University Hospitals	Style guide	Gender-additive	pregnant women and people
Do we need the word ‘woman’ in healthcare? in Postgraduate Medical Journal.	Opinion	Women-centered	pregnant women
Why I’ll Keep Saying ‘Pregnant Women’ by Helen Lewis	Article	Women-centered	pregnant women
The Imperative for Transgender and Gender Nonbinary Inclusion in Obstetrics & Gynecology	Opinion	Gender-inclusive	pregnant people
Position Statement and Guideline: Infant Feeding and Lactation-Related Language and Gender from Academy of Breastfeeding Medicine	Style guide	Audience-dependent choices	lactating (instead of breastfeeding) mothers and gestational parents
Intentional Inconsistency as Gender-Neutral Language Evolves and Inclusive Language Promotes Equity: The Power of Words in Journal of Midwifery & Women's Health	Editorial	Prefers people-centered language to de-sexed biological reductionism ("the uterus contracts"), against medicalization ("patients"), against one-size-fits-most rules. Author's choice in each article.	pregnant women or pregnant people or pregnant women and people
Manuscript Preparation and Style Guide from Journal of Midwifery & Women’s Health	Style guide
AMA Manual of Style from American Medical Association	Style guide	Uncertain/unstated beyond rejecting sexist practices (such as assuming all nurses are women)
SAGER guidelines (full, summary)	Style guide	Uncertain/unstated (argues for better practices in research)
Transgender language reform: some challenges and strategies for promoting trans-affirming, gender-inclusive language in Journal of Language and Discrimination	Article	Gender-inclusiveness by avoiding unnecessary precision Unambiguous labels for specific populations	affected parents people assigned female at birth vs people who are perceived as women vs everyone with a cervix (rather than the ambiguous word women)
Effective Communication About Pregnancy, Birth, Lactation, Breastfeeding and Newborn Care: The Importance of Sexed Language in Frontiers in Global Women's Health	Opinion	Woman-centered	pregnant women

Common models:

gender-specific (e.g., women or trans men, but not females or people; usually woman-centered)
sex-specific (e.g., females instead of women)
gender-neutral
- gender-inclusive through strategic vagueness (e.g., people, patients)
- gender-inclusive through biological reductionism (e.g., people with a uterus, the uterus contracts)
gender-additive (e.g., women and other people who menstruate)
varying language (e.g., some sentences are gender-specific and others aren't)
separate content for trans people

Things we probably can't affect

Trans people are a tiny minority.
- Even by the most inclusive estimates of trans people, there are at least twice as many Black men (or Indian men, or Chinese men) in the world as there are trans men. Would it be DUE in a common health condition to specifically mention trans men if we're not mentioning these other, larger groups of men?
Some readers struggle to read English. For them, the common word "men" may be easier to read than the more technical word "males".
Because of our demographic numbers, Wikipedia editors primarily write from the POV of middle-class Americans. Other cultures understand gender in other ways.
Whatever we do, someone will feel left out.
- Example: Using gender-neutral language in Breast cancer will make some women feel erased; using woman-specific language will make some trans people and some men feel erased.
- Goal: Let's avoid letting the perfect be the enemy of the good. We can do it better, even if we can't do it perfectly.
Good editors have different human values. For example, one editor may be more concerned about underrepresented minorities, and another may be more concerned about educational value. This can result in good editors disagreeing about the best approach.
- Some values that can be reflected in language choice: simple language, precision, inclusion of minority groups, person-centered language, biomedical-centered language, not erasing women, not erasing trans people
Most articles currently use a mix of styles. Wikipedia:Nobody reads the directions, so no matter what we recommend, that will probably continue to be the case.
There will always be POV pushers. Some editors will fear that if guidelines permit any variety or deviation from the model they prefer, then the entire encyclopedia will end up being written in the "wrong" style.

Open questions

Do we need additional advice?
What do Wikipedia editors recommend?
Should our advice be based primarily on reliable sources or on editors' opinions?
If we advise editors to consider the advice in external style guides, which kinds of external guides should be preferred?
Should each article use consistent terminology throughout? What are good reasons for terminology to be inconsistent within an article? (Examples of real-world works that use a mixture of gender-inclusive and single-gender terms within a single short article: UNFPA, CDC)
If an editor changes single-gender language to gender-inclusive language, is that editor responsible for ensuring that they are not introducing original research? Or do we assume that this type of change is OK unless there is a consensus among editors that the change does introduce original research?

Problems to be solved

What can we do, when a source seems to apply to "biological males", but the source only says "men"? Because trans people are tiny minorities (especially among older adults and in LMICs), the source may be based on studies that did not include any trans people.
- Is it a NOR violation to know what the source meant when it wrote "men", and to write that in your own words?
- What if the source explicitly provides the clarification, but the rest of it uses a different word (e.g., the source says "appears exclusively in biological males" in the first section, but the rest of the source says "men")? Is it UNDUE for the Wikipedia article to specify "biological males" (even once) if that source mostly uses a simpler word?
- More generally, Wikipedia:No original research says that "Rewriting source material in your own words while retaining the substance is not considered original research", but many editors seem to be unaware that using synonyms, simpler English words, etc., is not a violation of that policy.
Some terms, such as women and mothers, have multiple meanings. For example, mother can be used to mean "a genetic ancestor who is a biological female" (e.g., egg donors), "a person who is/was pregnant" (e.g., gestational carriers, birth mothers), and "a person who mothers a child" (e.g., adoptive mothers, stepmothers, MTF parents).
- Do you need to specify which definition you're using in the Wikipedia article?
- To what extent should the "biomedical" parts of an article maintain the sex–gender distinction? To what extent should they be written in a gender-neutral and de-sexed way?

Possible advice

Blind substitution of gender-inclusive or de-sexed language causes inaccurate articles.
- 20% of people is not the same as 20% of women.
- If the research was done on cis-gendered biological females, or on a typical population sample that is overwhelmingly cisgender, the results may not apply to trans women, trans men, intersex women, or non-binary individuals.
- Using gender-inclusive language early in an article often suggests that subsequent statements apply to all genders, but some of these subsequent statements may be accurate for cisgender women only.
When presenting the view of a specific person or organization, it is often best to use the language that the named source used. However, in a small number of cases, it may be necessary to change the wording for clarity and encyclopedic style.
- If the World Health Organization writes that "In Malawi, most mothers breastfeed for almost 2 years", then it's usually best to follow their chosen language and use the word mothers when describing what the organization said. Even if you are personally certain that the statement is true and verifiable, avoid writing that "the WHO said that most mothers and birthing trans parents in Malawi breastfeed for almost two years", because the named organization did not use that language.
Paraphrasing, including paraphrasing that removes a reference to sex or gender while staying true to the meaning of the source, is not original research.
- Disney's roller coaster warning signs say, in part, "For safety, you should be in good health and free from high blood pressure, heart, back, or neck problems, motion sickness, or other conditions that could be aggravated by this adventure. Expectant mothers should not ride." If that were being used as a source, it would be okay to paraphrase the information as "People who are pregnant or who have high blood pressure, heart, back, or neck problems, motion sickness, or other medical conditions are advised against riding roller coasters" or "Safety warnings advise against riding roller coasters in case of pregnancy, high blood pressure, heart disease, back problems, neck problems, motion sickness, or other medical conditions". Policy does not require editors to separately specify that "Mothers who are pregnant and people who have high blood pressure, heart, back, or neck problems, motion sickness, or other medical conditions are advised against riding roller coasters" just because that's the language in the source.
Changing the scope of a claim when substituting words can lead to claims that are not supported by any reliable source in the world, including those not currently cited in the article. When the substance of the claim does not match any possible source, then this would be a violation of Wikipedia:No original research.
- For instance, if sources support the claim that "breastfeeding protects mothers from developing breast cancer", it is original research to change this to "breastfeeding protects mothers and trans fathers from developing breast cancer". Making this statement would require the existence of at least one published, reliable source, anywhere in the world, in any language (even if not cited in the article; even if currently unknown to editors), that says breastfeeding protects trans fathers from breast cancer. (When the cited source does not say this, then it's a case of {{failed verification}}, not a case of original research.)
Wikipedia articles are encyclopedia articles and should have an encyclopedic style and tone. They are based upon reliable sources but do not closely follow the diverse and non-encyclopedic styles of the sources. Encyclopedia articles should have an encyclopedic tone instead of carefully matching the style and wording of scientific papers, news articles, medical textbooks, and other sources.
Use terminology correctly: biological sex ≠ genetic sex ≠ anatomical sex; gender identity ≠ gender role ≠ gender expression.
Do not adopt a strictly gender-neutral approach to heavily gendered subjects such as Pregnancy or Breastfeeding. Do not use cisgendered language for any trans-specific content.