{"paper_id":"4a50f8df-81fd-48c9-87e4-d44c1222e0fb","body_text":"Kashef and Tsitskari  CVIR Endovascular            (2023) 6:30  \nhttps://doi.org/10.1186/s42155-023-00376-9\nEDITORIAL Open Access\n© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which \npermits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the \noriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or \nother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line \nto the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory \nregulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this \nlicence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/.\nCVIR Endovascular\nInterventional radiology in woman’s health: \nroom for improvement\nElika Kashef1 and Maria Tsitskari2*   \nIt is with great pleasure for us to present to you this \nexciting edition of CVIR Endovascular with a focus on \nwomen’s health.\nThe two-tier system of healthcare for males vs females, \nresulting in health inequities affecting individual health \nseeking behaviour, poorer outcomes and delayed diagno -\nsis, has long been recognised. This is a complex topic and \nthe root cause of it is multifaceted, however in the 1960’s \nfollowing the thalidomide scandal, there was a ban on \npregnant women as well as women of child bearing age to \npartake in any trials. Although this was aimed to protect \nwomen, what it did end up doing was to side line half the \npopulation from important clinical trials which has led to \npoor recognition of disease patterns and worse outcomes \nfor the female population.\nCaroline Criado Perez, in her book, ‘Invisible Women: \nExposing Data Bias in a World Designed for Men’ , [1] \nhas gathered various statistics that show how women \nare treated unevenly. She has argued that the data shows \nthat healthcare is “systematically discriminating against \nwomen, leaving them chronically misunderstood, mis -\ntreated and misdiagnosed” .\nGender bias and discrimination occurs at many levels \nthroughout the healthcare system, from the interactions \nbetween patients and doctors to the medical research \nand policies that govern it. In 2018 a study on patients \nwith chronic pain concluded that doctors often view \nmen with chronic pain as “brave” or “stoic, ” but women \nas “emotional” or “hysterical. ” The study also found that \nwomen’s pain was more likely to be treated as a symptom \nof a mental health condition, rather than a symptom of a \nphysical condition [2].\nLess is also known about conditions that only affect \nwomen, including common gynaecological conditions \nthat can have severe impacts on health and wellbeing. \nAs an example, we now know that pelvic pain is poorly \nunderstood and women with pelvic pain have been \nunder-diagnosed and at times dismissed for decades. \nEndometriosis was once considered a condition that \noccurs in women in their mid-30’s but we now see the \ndisease pattern emerging in younger age groups due to \nthe increased utilisation of imaging.\nLuckily, we have moved forward from that period and \nsince 1993 women have been included in trials and stud -\nies globally.\nAs a result, we have emerging data on all aspects of \npathologies that effect men and women, but also condi -\ntions that are specific to the female cohort.\nIn this edition we focus on a few key conditions affect -\ning women.\nDrs Mailli and Ratnam will review the evidence for \nuterine artery embolization focusing on three chal -\nlenging aspects—post procedure fertility, symptomatic \nadenomyosis and large volume fibroids and uteri which \nremains an important topic [3].\nProf Hemingway, who published the first ever English \nlanguage paper on ovarian vein embolization, will look \nthrough the journey of treatments available for pelvic \ncongestion syndrome, a disease that is often undiagnosed \nin women with pelvic pain [4]. The lack of diagnosis \nseems to be related to limited awareness by both physi -\ncians and patients, in combination with limited data in \nthe literature.\n*Correspondence:\nMaria Tsitskari\nmariadote@hotmail.com\n1 Imperial College Healthcare NHS Trust, London, UK\n2 Mediterranean Hospital, Limassol, Cyprus\n\nPage 2 of 2Kashef and Tsitskari  CVIR Endovascular            (2023) 6:30 \nDr Roberts, will discuss fallopian tube recanalization \ntechniques and outcomes [5] and Dr O’Sullivan will fin -\nish the edition with review on deep venous stenting in \nwomen [6].\nThese topics are all equally important and many have \nbeen under recognised for decades. Pelvic congestion \nsyndrome remains a condition that some clinicians do \nnot believe in and never get treatment. Many patients \nhave to undergo laparoscopy for infertility prior to con -\nsideration for fallopian recanalization and in many coun -\ntries fibroid embolization is still not offered to patients as \nof one of their treatment optional when discussing inva -\nsive interventions.\nThis edition will highlight how far we have come in \nthese common conditions and this will hopefully not \nonly demonstrate an exciting overview of results and \noutcomes to date, but also to inspire and motivate our \nyounger interventional radiologists to instigate and con -\ntribute to new trials and carry the banner for the next \ngeneration.\nFor generations women despite making up 50% of the \npopulation have lived with a healthcare system that was \ndesigned by men, for men. In this postpandemic era we \nshould work together to elevate the importance of wom -\nen’s health across the entire health industry. Women par-\nticipation in studies should always be analysed also as a \nseparate group and differences in outcome between men \nand women should be taken seriously. Also, more stud -\nies focusing on women health issues should be under -\ntaken. It is for instance now clear that coronary disease in \nwomen is sometimes completely different as in men. The \nlessons we have learned have the power to transform the \nfuture of healthcare and ultimate, enable better care for \nwomen worldwide.\nAcknowledgements\nNot applicable.\nAuthors’ contributions\nEK and MT equally contributed in writing the manuscript. All authors read and \napproved the final manuscript.\nFunding\nNo funding received.\nAvailability of data and materials\nNot applicable.\nDeclarations\nEthics approval and consent to participate\nNot applicable.\nConsent for publication\nNot applicable.\nCompeting interests\nThe authors declare that they have no competing interests.\nReceived: 27 December 2022   Accepted: 2 May 2023\nReferences\n 1. Caroline Criado Perez. Invisible women: data bias in a world designed for \nmen. New York: Abrams Press; 2019.\n 2. Samulowitz A, Gremyr I, Eriksson E, Hensing G.  “Brave men” and “Emo-\ntional women”: A theory-guided literature review on gender bias inhealth \ncare and gendered norms towards patients with chronic pain. Pain Res \nManage. 2018;2018:6358624. https:// doi. org/ 10. 1155/ 2018/ 63586 24.\n 3. Mailli L, Patel S, Das R, et al. Uterine artery embolisation: fertility, adeno-\nmyosis and size – what is the evidence? CVIR Endovasc. 2023;6:8. https:// \ndoi. org/ 10. 1186/ s42155- 023- 00353-2.\n 4. Kashef E, Evans E, Patel N, et al. Pelvic venous congestion syndrome: \nfemale venous congestive syndromes and endovascular treat-\nment options. CVIR Endovasc. 2023;6:25. https:// doi. org/ 10. 1186/ \ns42155- 023- 00365-y.\n 5. Roberts A. Fallopian tube recanalization for the management of infertility. \nCVIR Endovasc. 2023;6:13. https:// doi. org/ 10. 1186/ s42155- 023- 00356-z.\n 6. O’Sullivan G, Smith S. Deep venous stenting in females. CVIR Endovasc. \n2023;6:14. https:// doi. org/ 10. 1186/ s42155- 023- 00354-1.\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in pub-\nlished maps and institutional affiliations.","source_license":"CC-BY-4.0","license_restricted":false}