Medicalization of female life stages: a qualitative research.

This was a qualitative study using a descriptive phenomenological design. The study utilized a maximum diversity sampling technique, a purposive method often employed in qualitative research to gather the richest data on a phenomenon. The study recruited two participant groups: specialist physicians and non-physician females. The group of 15 specialist physicians included specialization in Gynecology and Obstetrics, Plastic Reconstructive and Aesthetic Surgery, and Dermatology, working in both public and private sectors. Additionally, 15 female participants over the age of 18, representing various life stages, were included. Altogether, these 30 individuals comprised the study's research group from Türkiye. Physician participants must be specialist physicians working in Obstetrics and Gynecology, Plastic and Reconstructive Surgery, or Dermatology at public or private hospitals in Türkiye. Female participants must be 18 years or older and have experienced at least one of the following life stages: menstruation, pregnancy, childbirth, assisted reproductive techniques, abortion, menopause, aesthetic procedures, aging, or non-malignant conditions. Interviews were conducted with individuals who were genuinely interested in contributing to the research and were willing to share their insights voluntarily, based on a foundation of trust. Participants are informed that they may be contacted again if necessary and that ongoing communication will be maintained. They are also made aware that they can withdraw from the study at any time without needing to provide a reason. The study uses in-depth interviews for data collection, divided into two sections: one for participants' descriptive information including their gender, age, education level, marital status, occupation, and professional experience, and another for questions related to the phenomenon being studied (Tables 1 and 2 ). The research design and interview questions undergo peer review and are refined through unstructured interviews with a specialist physician and a female participant. To avoid data loss, participants from these initial interviews are included in the final sample. Table 1 Interwiev guide BOX BOX. Interwiev Guide (for specialist physicians) The questions in this section are intended only for gynecologists 1. What are your views on the medicalization of women's menstruation? 2. What are your views on the medicalization of women's pregnancy process? 3. What are your views on the medicalization of women's birth process? Probe question: What do you think about off-label cesarean delivery? 4. Do assisted reproductive techniques medicalize women's lives? 5. What are your views on abortion (legal pregnancy under 10 weeks) as part of the medicalization of women's lives? 6. What are your views on the medicalization of women's menopause? 7. Probing question: Do you recommend any treatment during this period? The questions in this section are intended for dermatologists only. 1. What are your views on the medicalization of women's aging process? What might be the reasons that drive women towards anti-aging procedures? 2. What are the reasons that drive women towards anti-aging procedures? Probing question: For which type of procedures do women mostly apply to you? 3. What do you think about the increasing concern of women to stay beautiful and young? 4. How do the media and other communication channels influence women's behavior? The questions in this section are intended only for Plastic Reconstructive and Aesthetic Surgery physicians. 1. What are your views on the medicalization of women's lives by aesthetic operations? 2. What are the reasons that lead women to aesthetic operations? Probing question: For which reasons do women apply most frequently? 3. How do the media and other communication channels affect women's behavior in this direction? Table 2 Interwiev guide BOX BOX. Interwiev Guide (for female participants) What are your views on the medicalization of women's life? Which of the stages of women's life have you experienced? Regarding the phenomenon of menstruation; 1. Did you seek medical support during menstruation? 2. Can you tell us about the reasons that led you to seek medical support? 3. What are your views on the menstruation process? Regarding pregnancy and childbirth 1. Do you have a history of pregnancy and childbirth? 2. What are your views on the follow-up of your pregnancy period? 3. How was your mode of delivery? 4. Why did you prefer cesarean section? 5. What are your opinions about the birth process? Regarding the case of assisted reproductive techniques;   1. Did you benefit from assisted reproductive techniques? 2. Can you tell us about the process of applying for assisted reproductive techniques?  3. Probe question: What led you to this process? 4. What are your views on assisted reproductive techniques?  Regarding the case of abortion;   1. Do you have a history of abortion (pregnancy under 10 weeks)?  2. Can you tell us about your abortion process? Probe question: Why did you want to have an abortion?  3. What are your views on abortion? Regarding the phenomenon of menopause; 1. How was your menopause period? 2. Did you receive any medical support during this period? Probe question Can you tell us about the situation that led you to seek medical support? 3. What are your views on the menopause process? 4. Regarding the phenomenon of aging; 5. What are your views on aging? 6. What are your views on anti-aging practices? Regarding the phenomenon of aesthetics; 1. Have you had an aesthetic operation? 2. What is the situation that leads you to aesthetic operation? 3. What are your opinions about aesthetic operations? Interwiev guide BOX Interwiev guide BOX The interviews took place from September 2021 to December 2022. Prior to each interview, participants were informed about the topic, location, time, and expected duration, and appointments were scheduled accordingly. Interviews were held in both formal and informal settings, chosen collaboratively by the researchers and participants to ensure comfort and safety. Data collection involved note-taking and voice recording. Written informed consent was obtained from all volunteer participants, who also consented to having their interviews recorded and transcribed. Most interviews were conducted in person, though five were held online due to distance and scheduling constraints. Each interview lasted between 40 and 60 min. Notes were cross-checked with voice recordings and then promptly transcribed into Microsoft Word. Expert physicians were labeled as “DR” followed by their gender, while female participants were labeled as “W” followed by their age. For data analysis, MAXQDA Analytics Pro 2022 was used, applying the inductive content analysis approach by Elo and Kynäs [ 19 ]. The research design was meticulously followed, and an audit trail technique was employed. During the analysis, phenomena were coded individually, with similar codes for each phenomenon later combined into broader categories. To provide a concise and comprehensive description, interview data from specialist physicians and female participants were presented together. In the validity and reliability of the study, the criteria of credibility, transferability, trustworthiness, and confirmability were used in accordance with the principle of trustworthiness, which is one of the quality enhancing criteria of Guba [ 20 ] and Lincoln & Guba [ 21 ]. Contextual factors affecting the research, sampling, data collection methods used, time, etc. are detailed in the method section of the study. The stages of preparation, organization, and finalization were included in the content analysis process. The agreement between the coders (counsellor and student) was checked. The agreement was over 90%. In addition, after coding, categorizing and thematizing the collected data, three expert opinions were obtained from competent faculty members from different universities. Each category was supported by the participant’s statements. The reflective comments of the researchers were presented in the chapter of “ Conclusion and Discussion ” in the reporting phase. In the reporting of the research, the research findings were compared with similar studies conducted previously, along with existing theoretical and practical knowledge (Tables 3 and 4 ). Table 3 Physician participants' demographic information ( n = 15) Physician Participant Sex Age Field of Specialization Marital Status DR1 W 39 Dermatology Married DR2 W 39 Dermatology Single DR3 W 40 Dermatology Married DR4 W 38 Dermatology Married DR5 M 32 Plastic and Rec. Surgery Married DR6 W 37 Plastic and Rec. Surgery Married DR7 W 30 Plastic and Rec. Surgery Married DR8 M 37 Plastic and Rec. Surgery Married DR9 M 29 Plastic and Rec. Surgery Single DR10 M 35 Obst. and Gynecology Married DR11 M 57 Obst. and Gynecology Married DR12 M 45 Obst. and Gynecology Married DR13 W 36 Obst. and Gynecology Married DR14 M 49 Obst. and Gynecology Married DR15 W 42 Obst. and Gynecology Married Table 4 Female Participants' demographic information ( n  = 15) Female Participant Sex Age Education Degree Job Marital Status K1 W 52 Primary School Housewife Single K2 W 43 PhD Lecturer Member Single K3 W 43 PhD Lecturer Member Married K4 W 49 Associate degree Office Clerk Married K5 W 27 Bachelor’s degree Sports Trainer Married K6 W 26 Bachelor’s degree Housewife Married K7 W 62 high school graduate Housewife Single K8 W 35 high school graduate Housewife Married K9 W 51 Associate degree Office Clerk Married K10 W 55 PhD Lecturer Member Married K11 W 35 Associate degree Housewife Married K12 W 28 Associate degree Laborant Married K13 W 22 high school dropout Housewife Married K14 W 24 Associate degree Teacher Single K15 W 59 Primary School Housewife Married Physician participants' demographic information ( n = 15) Female Participants' demographic information ( n  = 15)

As a result of the content analysis, it was evaluated under 1 main theme, 2 sub-themes and 16 categories (Table 5 ). Table 5 Main theme, sub-theme, category and clustered codes Main Theme Category Subtheme Codes Causes of Medicalization Internal causes of medicalization 1) Medical Indication Medical indications [ 22 ] Psychiatric distress\PMS [ 3 ] Pregnancy-related complications Genetic anomalies of the baby [ 3 ] Complications related to childbirth Indications for abortion Maternal deaths from illegal abortions (sepsis, shock, maternal mortality) Mandatory situations Physiological impairment of the patient or spouse Early menopause [ 2 ] A physiological process Physical complaints (sweating, hot flushes) Menopause increases physical discomfort Physical changes (arthritis, joint pain, muscle pain, visual impairment) [ 3 ] A medical need Medical support needs [ 3 ] The necessity of transporting the birth to the hospital Loss of mother at birth Maternal mortality rate Infant mortality rate 2) Lack of Education Lack of education [ 4 ] Lack of awareness Misdirection Being seen as a disease by society 3) Patient Preference patient preference [ 21 ], maternal comfort [ 2 ], and non-medical indications due to patient preference [ 3 ] 4) Patient’s Psychological Reactions Desire to Be Cautious Expectation of Being Health, Anxiety [ 2 ] Fear of Normal Birth [ 4 ] Patient Anxiety [ 2 ] Psychological Distress Fear [ 3 ] Embarrassment, Depression [ 2 ] Emotional Change (Change in Emotion) [ 2 ] Fear of Aging Feeling Like Menopause Is A Disease [ 2 ] Thoughts of Lack During Menopause Feeling of Loss of Productivity During Menopause [ 2 ] Menopause Is a Difficult Process to Accept [ 5 ], Need for General Control [ 2 ] Fear Of Death, Need to Feel Safe 5) Negative Body Perception of Women Unhappiness [ 3 ] Psychologically Negatively Affected [ 4 ] Lack of Self-Confidence [ 2 ] People’s Self-Dislike Being Uncomfortable with A Part of Their Body That They Perceive as Defective [ 2 ] Feeling Ugly Dissatisfaction, Benchmarking Reducing Quality of Life Feeling of Illness Sense of Need Obsession with Appearance [ 5 ] The Idea That There Is a Medical Need for The Symptoms of Old Age Seeing Imperfections as A Disease 6) The Need to be Liked Need to Take Care of Oneself [ 4 ] Need to Feel Good [ 5 ] Desire for Beauty [ 5 ] Aesthetic Anxiety [ 2 ] Desire to Be Liked [ 5 ] Desire To Look Good [ 3 ] 7) Aging Resistance Resistance to Physical Changes [ 6 ] Unwillingness to Age [ 8 ] The Desire to Look Small Desire to Stay Young [ 3 ] Desire To Be Healthier [ 2 ] 8) Biological Structure of the Female Body The Female Body Needs Medicine More The Status of Womanhood External Causes of Medicalization 1) Unnecessary Medical Intervention Unnecessary Medical Intervention [ 4 ] Unnecessary Examination-Analysis Request [ 2 ] Lack Of Supervision 2) Physician’s Defensive Approach Periodic Follow-Up [ 3 ] Routine Controls, Defensive Medicine [ 6 ] Compensation Lawsuits [ 2 ] Patient Rights 3) Physician referral Physician’s Advice [ 4 ] Recommendation for Medical Support During Menopause [ 4 ] Possible Positive Effects Of Menopause Treatment 4) Facilitating access to medical facilities Increase in The Number of Physicians and Centers [ 3 ], Methods Developed in The Field of Assisted Reproductive Techniques [ 2 ], Supply of Therapeutic Drugs, Firm Pressure, Accessibility [ 2 ], Increased Accessibility [ 5 ] Increase in Applications [ 2 ] Dermo-Cosmetic Products on the Market, Development of Technology, Technological Advances in Medicine [ 2 ] Advancement of Medicine, Conditions That Used to Be Normal 5) Commercial dimension Commercial Dimension [ 5 ], Profit Gate, Commercial Perspective 6) Socio-Cultural Values Menstruation Is Seen as A Shameful Thing [ 5 ] Warn to Keep It Closed Menstruation Is Seen as Abnormal Menstruation Is Seen as an Abnormal Condition, Menstruation Is Seen as an Unknown Physiological Event, Infertility Is Seen as A Social Problem, Infertility Is Seen as A Deficiency (Female-Male Deficiency) Rather Than a Disease, The Role Pressure Imposed on Women By Infertility In Society 7) Social environment impact Environmental Influence [ 14 ], Negative Words of the Environment [ 2 ], Affect by Disturbing Looks, Social Pressure [ 3 ], Directing Social Perception [ 4 ], Uniform Perception of Beauty in Society [ 10 ], Perception of Thin Women as Beautiful Women, New Ideal Standards, Imposition of Beauty, Giving Importance to Visuality [ 4 ], Normalization Of Aesthetic Operations, Spouse Influence [ 2 ], Necessary for A Healthy Marriage (Infertility Treatment) (Divorce Rates, Desire For Children) 8) Media influence Social Media Effect [ 18 ], Social Media Posts of Physicians, Photo Sharing Effect [ 3 ], Television-Internet Effect ( 8 ) The numbers in parentheses represent the code frequency Main theme, sub-theme, category and clustered codes Causes of Medicalization Medical indications [ 22 ] Psychiatric distress\PMS [ 3 ] Pregnancy-related complications Genetic anomalies of the baby [ 3 ] Complications related to childbirth Indications for abortion Maternal deaths from illegal abortions (sepsis, shock, maternal mortality) Mandatory situations Physiological impairment of the patient or spouse Early menopause [ 2 ] A physiological process Physical complaints (sweating, hot flushes) Menopause increases physical discomfort Physical changes (arthritis, joint pain, muscle pain, visual impairment) [ 3 ] A medical need Medical support needs [ 3 ] The necessity of transporting the birth to the hospital Loss of mother at birth Maternal mortality rate Infant mortality rate Lack of education [ 4 ] Lack of awareness Misdirection Being seen as a disease by society Desire to Be Cautious Expectation of Being Health, Anxiety [ 2 ] Fear of Normal Birth [ 4 ] Patient Anxiety [ 2 ] Psychological Distress Fear [ 3 ] Embarrassment, Depression [ 2 ] Emotional Change (Change in Emotion) [ 2 ] Fear of Aging Feeling Like Menopause Is A Disease [ 2 ] Thoughts of Lack During Menopause Feeling of Loss of Productivity During Menopause [ 2 ] Menopause Is a Difficult Process to Accept [ 5 ], Need for General Control [ 2 ] Fear Of Death, Need to Feel Safe Unhappiness [ 3 ] Psychologically Negatively Affected [ 4 ] Lack of Self-Confidence [ 2 ] People’s Self-Dislike Being Uncomfortable with A Part of Their Body That They Perceive as Defective [ 2 ] Feeling Ugly Dissatisfaction, Benchmarking Reducing Quality of Life Feeling of Illness Sense of Need Obsession with Appearance [ 5 ] The Idea That There Is a Medical Need for The Symptoms of Old Age Seeing Imperfections as A Disease Need to Take Care of Oneself [ 4 ] Need to Feel Good [ 5 ] Desire for Beauty [ 5 ] Aesthetic Anxiety [ 2 ] Desire to Be Liked [ 5 ] Desire To Look Good [ 3 ] Resistance to Physical Changes [ 6 ] Unwillingness to Age [ 8 ] The Desire to Look Small Desire to Stay Young [ 3 ] Desire To Be Healthier [ 2 ] The Female Body Needs Medicine More The Status of Womanhood Unnecessary Medical Intervention [ 4 ] Unnecessary Examination-Analysis Request [ 2 ] Lack Of Supervision Periodic Follow-Up [ 3 ] Routine Controls, Defensive Medicine [ 6 ] Compensation Lawsuits [ 2 ] Patient Rights Physician’s Advice [ 4 ] Recommendation for Medical Support During Menopause [ 4 ] Possible Positive Effects Of Menopause Treatment Increase in The Number of Physicians and Centers [ 3 ], Methods Developed in The Field of Assisted Reproductive Techniques [ 2 ], Supply of Therapeutic Drugs, Firm Pressure, Accessibility [ 2 ], Increased Accessibility [ 5 ] Increase in Applications [ 2 ] Dermo-Cosmetic Products on the Market, Development of Technology, Technological Advances in Medicine [ 2 ] Advancement of Medicine, Conditions That Used to Be Normal Commercial Dimension [ 5 ], Profit Gate, Commercial Perspective Menstruation Is Seen as A Shameful Thing [ 5 ] Warn to Keep It Closed Menstruation Is Seen as Abnormal Menstruation Is Seen as an Abnormal Condition, Menstruation Is Seen as an Unknown Physiological Event, Infertility Is Seen as A Social Problem, Infertility Is Seen as A Deficiency (Female-Male Deficiency) Rather Than a Disease, The Role Pressure Imposed on Women By Infertility In Society Environmental Influence [ 14 ], Negative Words of the Environment [ 2 ], Affect by Disturbing Looks, Social Pressure [ 3 ], Directing Social Perception [ 4 ], Uniform Perception of Beauty in Society [ 10 ], Perception of Thin Women as Beautiful Women, New Ideal Standards, Imposition of Beauty, Giving Importance to Visuality [ 4 ], Normalization Of Aesthetic Operations, Spouse Influence [ 2 ], Necessary for A Healthy Marriage (Infertility Treatment) (Divorce Rates, Desire For Children) Social Media Effect [ 18 ], Social Media Posts of Physicians, Photo Sharing Effect [ 3 ], Television-Internet Effect ( 8 ) The numbers in parentheses represent the code frequency The main theme of the reasons for medicalization is grouped under two sub-themes: “internal and external reasons for medicalization”. The sub-theme of intrinsic causes of medicalization is formed by evaluating the factors towards women that lead to the medicalization of women’s lives. There are eight categories belonging to this sub-theme. The participant highlighted medical necessity as a key reason for medicalization, with 54 codes identified in this category (Table 5 ). “…While chatting with her, I mentioned numbness in my hands and tongue. I was about 2–2.5 months pregnant and told my doctor I might be at risk for embolism. The doctor immediately hospitalized me. I didn’t think much of it, but it was important. … During my first birth, after ten hours of labor and a low pain threshold, I had a C-section. I’m glad I did because the cord was wrapped around the baby’s neck, so there was a medical reason for it." (W3, 43) “…While chatting with her, I mentioned numbness in my hands and tongue. I was about 2–2.5 months pregnant and told my doctor I might be at risk for embolism. The doctor immediately hospitalized me. I didn’t think much of it, but it was important. … During my first birth, after ten hours of labor and a low pain threshold, I had a C-section. I’m glad I did because the cord was wrapped around the baby’s neck, so there was a medical reason for it." (W3, 43) Participants identified inadequate education and misleading health behaviors influenced by socio-cultural values as reasons for the medicalization of women's lives. Nine codes were categorized under "lack of education" (Table  5 ). “"Menstruation is one of the biggest women's health issues in Türkiye. The main reason? Lack of education. Dysmenorrhea and PMS are more intense and widespread here than in other countries. Dysmenorrhea is divided into two types: primary, seen in adolescence, and secondary, caused by conditions like fibroids, adenomyosis, and cysts. Primary dysmenorrhea stems mainly from a lack of timely, proper education" (DR11, M) ....’’ “"Menstruation is one of the biggest women's health issues in Türkiye. The main reason? Lack of education. Dysmenorrhea and PMS are more intense and widespread here than in other countries. Dysmenorrhea is divided into two types: primary, seen in adolescence, and secondary, caused by conditions like fibroids, adenomyosis, and cysts. Primary dysmenorrhea stems mainly from a lack of timely, proper education" (DR11, M) ....’’ The category of patient preference refers to situations where the patient's own will takes precedence over the physician's decision or guidance in medical procedures. This category contains 26 codes (Table 5 ). "I encounter many off-label caesarean sections, driven by maternal comfort and desire. While only four percent are medically indicated, our overall caesarean rate is fifty percent, reflecting that families choose it on their own. Still, I support elective caesareans; if the mother wants it, it should be done" (DR12, M). "I encounter many off-label caesarean sections, driven by maternal comfort and desire. While only four percent are medically indicated, our overall caesarean rate is fifty percent, reflecting that families choose it on their own. Still, I support elective caesareans; if the mother wants it, it should be done" (DR12, M). Participants believe that emotional and psychological factors influence women's orientation toward medical practices. The category of "Psychological Reactions of the Patient" includes responses related to this, with 33 codes in total (Table 5 ). "Although menopause is a natural process, accepting it can be challenging. After menstruating for 20 years, women may feel something is wrong or feel completely strange when they stop menstruating after age 50, leading them to seek medical advice" (DR14, M). "Although menopause is a natural process, accepting it can be challenging. After menstruating for 20 years, women may feel something is wrong or feel completely strange when they stop menstruating after age 50, leading them to seek medical advice" (DR14, M). The category of "Women's Negative Body Perception" relates to women's fixation on a body part they dislike or consider flawed, leading them to seek aesthetic procedures. This category contains 25 codes (Table 5 ). "I struggled with weight issues all my life, which led to women's health problems connected to my weight. Psychologically, I felt both ugly and sick. When I was diagnosed with early-stage diabetes, I realized I had to act. I felt like I was becoming ugly, sick, and mentally unwell. That same day, I researched and made a doctor's appointment without even consulting my husband. I decided to have the surgery no matter what, even if it killed me. In the end, while it seemed like I did it for my health, my real goal was to feel beautiful" (W12, 28). "I struggled with weight issues all my life, which led to women's health problems connected to my weight. Psychologically, I felt both ugly and sick. When I was diagnosed with early-stage diabetes, I realized I had to act. I felt like I was becoming ugly, sick, and mentally unwell. That same day, I researched and made a doctor's appointment without even consulting my husband. I decided to have the surgery no matter what, even if it killed me. In the end, while it seemed like I did it for my health, my real goal was to feel beautiful" (W12, 28). The need to be liked is a key reason, mentioned by both physicians and female participants, for why women pursue aesthetic and anti-aging procedures. This category contains 7 codes (Table 5 ). “As the reason that leads to anti-aging procedures; the change in the perception of beauty and the desire to be liked are the first ones that come to my mind” (DR4, F). “As the reason that leads to anti-aging procedures; the change in the perception of beauty and the desire to be liked are the first ones that come to my mind” (DR4, F). The category of "Resistance to Aging" includes codes related to measures and practices women use to combat aging and the medicalization of this process. There are 20 codes in this category (Table 5 ). "While we rarely encountered botox requests in the past, now we see at least one botox demand daily. Botox has become a standard part of medical treatment. There is strong resistance to aging, with PRP, mesotherapy, and laser methods increasingly used. Hair loss, once considered normal with age, is now met with resistance. Many older female patients refuse to accept hair loss and seek treatment" (DR4, F). "While we rarely encountered botox requests in the past, now we see at least one botox demand daily. Botox has become a standard part of medical treatment. There is strong resistance to aging, with PRP, mesotherapy, and laser methods increasingly used. Hair loss, once considered normal with age, is now met with resistance. Many older female patients refuse to accept hair loss and seek treatment" (DR4, F). Processes like menstruation, pregnancy, birth, abortion, and menopause directly impact the female body and are significant factors influencing it. This category includes three codes (Table 5 ). "I believe women visit doctors more frequently now because we value ourselves more. We want to be healthier and need more medical attention due to changes in our bodies during adolescence, marriage, pregnancy, and postpartum. Women generally require more medical care than men" (W8, 35). "I believe women visit doctors more frequently now because we value ourselves more. We want to be healthier and need more medical attention due to changes in our bodies during adolescence, marriage, pregnancy, and postpartum. Women generally require more medical care than men" (W8, 35). Among the factors that lead to the medicalization of women’s lives, the sub-theme of external causes of medicalization is formed by evaluating the factors that are not directly related to women themselves. There are eight categories belonging to this sub-theme. The category of "Unnecessary Medical Intervention" reflects female participants' views that physicians perform unnecessary surgical aesthetic procedures and request excessive examinations and tests to control the female body. This category includes 7 codes (Table 5 ). "Although birth itself doesn't require many tests, pregnancy often involves excessive tests like glucose screenings and detailed ultrasounds. I didn't undergo double or triple tests, nor did I have a glucose load. I found these tests unnecessary because, regardless of the results, my child is my child. I chose not to have tests for Down syndrome because I knew I would give birth no matter what" (W6, 26). "Although birth itself doesn't require many tests, pregnancy often involves excessive tests like glucose screenings and detailed ultrasounds. I didn't undergo double or triple tests, nor did I have a glucose load. I found these tests unnecessary because, regardless of the results, my child is my child. I chose not to have tests for Down syndrome because I knew I would give birth no matter what" (W6, 26). The "Defensive Approach of the Physician" category addresses the belief that physicians medicalize women's lives by ordering extra examinations and tests to avoid being sued. This category includes 13 codes (Table 5 ). "Everyone expects a healthy pregnancy with regular physician follow-ups and a healthy baby, but that's not always the reality. If a baby isn't healthy, people often sue the doctor. Judges and prosecutors ask if the physician performed all recommended tests—double screening, triple screening, amniocentesis, Nifty test, etc. If not, the physician is held responsible. Due to inadequate legal protection for doctors, many avoid managing risky pregnancies. Additionally, patient rights mean that if a patient requests a caesarean section, the doctor must comply" (DR11, M). "Everyone expects a healthy pregnancy with regular physician follow-ups and a healthy baby, but that's not always the reality. If a baby isn't healthy, people often sue the doctor. Judges and prosecutors ask if the physician performed all recommended tests—double screening, triple screening, amniocentesis, Nifty test, etc. If not, the physician is held responsible. Due to inadequate legal protection for doctors, many avoid managing risky pregnancies. Additionally, patient rights mean that if a patient requests a caesarean section, the doctor must comply" (DR11, M). Participants believe that physicians medicalize women's lives by recommending various medical practices or treatment methods. Some interviewed physicians provide such recommendations (Table 5 ). "I definitely recommend medical support during menopause. If a woman has regular exams, no breast issues, understands the risks of HRT, and keeps up with check-ups, I suggest hormone replacement therapy (HRT). HRT can have many benefits. Although recent studies suggest HRT may increase breast cancer risk, I would still recommend it and even consider breast tissue removal if needed" (DR12, M). "I definitely recommend medical support during menopause. If a woman has regular exams, no breast issues, understands the risks of HRT, and keeps up with check-ups, I suggest hormone replacement therapy (HRT). HRT can have many benefits. Although recent studies suggest HRT may increase breast cancer risk, I would still recommend it and even consider breast tissue removal if needed" (DR12, M). Participants cite the increase in physicians, hospitals, and medical centers, along with technological advancements and easier access to medical facilities, as reasons for the medicalization of women's lives. This category includes 20 codes (Table 5 ). "Botox treatments address unwanted wrinkles, which previously might have been left to the natural aging process due to limited options. Technological advances in medicine and dermatology have created new needs. While dermo-cosmetics may contribute to medicalization, treatments like lasers for spots, acne scars, and skin tone correction are medical necessities, not just cosmetic procedures" (DR3, F). "Botox treatments address unwanted wrinkles, which previously might have been left to the natural aging process due to limited options. Technological advances in medicine and dermatology have created new needs. While dermo-cosmetics may contribute to medicalization, treatments like lasers for spots, acne scars, and skin tone correction are medical necessities, not just cosmetic procedures" (DR3, F). Participants note that physicians and health service providers may medicalize women's lives for profit through unnecessary examinations, tests, aesthetic surgeries, and various treatments. This category contains 7 codes (Table 5 ). "Many physicians are motivated by profit (excluding those who adhere to ethical standards). If I don’t perform a procedure, they believe someone else will and profit from it. Thus, oversight is crucial. Aesthetic and plastic surgery has become a major industry, with doctors on Instagram promoting it through videos. Both men and women, seen in TV series and films, now often have expressionless faces due to botox" (W12, 28). "Many physicians are motivated by profit (excluding those who adhere to ethical standards). If I don’t perform a procedure, they believe someone else will and profit from it. Thus, oversight is crucial. Aesthetic and plastic surgery has become a major industry, with doctors on Instagram promoting it through videos. Both men and women, seen in TV series and films, now often have expressionless faces due to botox" (W12, 28). Socio-cultural values that contribute to the medicalization of women’s lives are included in this category, which has 11 codes (Table 5 ). "In the past, menstruation was difficult to discuss; I even hid it from my mother. When she mentioned religious requirements, I would silence her, keeping it a secret. It was rarely talked about, even among women. I didn't fully understand it until we talked about it more openly as we grew older" (W10, 55). "In the past, menstruation was difficult to discuss; I even hid it from my mother. When she mentioned religious requirements, I would silence her, keeping it a secret. It was rarely talked about, even among women. I didn't fully understand it until we talked about it more openly as we grew older" (W10, 55). Most participants indicate that women seek medical services influenced by family, colleagues, social environment, and social perceptions. This category includes 50 codes (Table 5 ). "... Even though I was very young, I felt immense pressure from my surroundings. You can’t always explain that there’s nothing wrong with me or my husband, and people don’t understand anyway" (W14, 22). "... Even though I was very young, I felt immense pressure from my surroundings. You can’t always explain that there’s nothing wrong with me or my husband, and people don’t understand anyway" (W14, 22). "... There is definitely environmental pressure. Some people openly express it. As we discussed, improving appearance for a spouse or for job applications is influenced by social pressure. It varies by region and social or cultural background. For many, it's about looking better for their spouses and friends; for professionals, it's about their work environment and self-image. Women often seek treatment during separation from their husbands, which also depends on their surroundings" (DR1, F). "... There is definitely environmental pressure. Some people openly express it. As we discussed, improving appearance for a spouse or for job applications is influenced by social pressure. It varies by region and social or cultural background. For many, it's about looking better for their spouses and friends; for professionals, it's about their work environment and self-image. Women often seek treatment during separation from their husbands, which also depends on their surroundings" (DR1, F). This category includes responses to the question, “Do you think social media and other communication channels affect women’s behavior?” as well as explanations about the media participants use to discuss various phenomena. There are 30 codes in the "Media Influence" category (Table 5 ). "Social media constantly fuels the desire for aesthetic procedures and creates the impression that these surgeries are easy, instantly accessible, and guarantee perfect results" (DR5, M). "Social media constantly fuels the desire for aesthetic procedures and creates the impression that these surgeries are easy, instantly accessible, and guarantee perfect results" (DR5, M).

The strongest aspect of this study is its in-depth exploration of the perceptions and experiences of both physicians and women regarding the phenomenon of medicalization, conducted through individual interviews. A review of existing literature on medicalization reveals a lack of qualitative studies that capture the perspectives of both groups. This research, therefore, offers a comprehensive literature review, an in-depth analysis of findings, and original insights into the medicalization of women's lives. Additionally, it provides a comparative evaluation of the views of practitioners on the medicalization phenomenon, identifying both internal and external causes based on their positive and negative perspectives, thereby addressing a gap in the literature. However, accessing physicians for this research was challenging due to their demanding schedules and fatigue, which poses a limitation. While most interviews were conducted face-to-face, five were conducted online due to logistical constraints and the Covid-19 pandemic. Although these online interviews were successful, they may have introduced a selection bias. The study's findings are also limited to the sample, making it difficult to generalize to all physicians and women. Future research involving a larger and more diverse sample across different socioeconomic and cultural contexts could enhance the generalizability of the results.

The concept of medicalization, a central focus within health sociology, and the lifestyles shaped by this concept, attract interest from various scientific disciplines [ 1 ]. As modern medicine advances and new diseases are defined, the influence of medicine over our lives continues to grow [ 2 ]. Technological advancements and media influence have accelerated the spread of medical discourse, with medicalized aspects of daily life increasingly focusing on issues related to women [ 3 ]. Medicalization involves treating a normal biological process or behavior as a medical issue [ 4 ]. The stages of a woman's life are classified as menstruation, pregnancy, childbirth, postpartum period and menopause [ 5 ]. Like many definitions in the literature, the stages of women’s life in terms of health are classified as birth, infancy and childhood, adolescence, youth, fertility, menopause and post-menopause, and old age [ 6 ]. Premenstrual and menstrual period, reproduction, pregnancy, childbirth, menopause, ageing, aesthetic, cosmetic interventions, body measurements, and sexual life can be given as examples of the areas of women’s life that are considered to be medicalized [ 7 ]. Today, the concepts of health and a healthy life are often associated with having a physically attractive and fit appearance. "Being healthy" is socially valued and considered a status symbol [ 8 ]. Popular discourse builds the perception that ageing is one of the biggest disasters that can happen to a person. The bodies of the most of the society are used through healthy living, healthy nutrition, sexuality, aesthetics, and beauty campaigns. The wellness obsession, the overwhelming role of the pharmaceutical industry, social media and ligitations are among the factors responsible for the recent development of medicalization [ 9 ]. Mass media and various media channels, key players in the process of medicalization, are highly effective at influencing large audiences. Through numerous advertisements featuring medical content, the media promotes a new understanding of health, providing guidance on how to avoid illness and offering products designed to achieve this [ 10 ]. As a result, people are taught not how to handle illness when it occurs, but rather how to take preventive measures before becoming sick, effectively turning them into consumers. The individualization of health, the fact that the female body has a biological structure that is more suitable for medicalization [ 11 ], and the new understanding of health that tries to prevent the disease before the disease comes [ 12 ] makes it necessary to examine the behaviors of women as indispensable individuals for family and society. Physicians play a crucial role in the phenomenon of medicalization. This process extends beyond traditional medical interventions to include everyday occurrences that are treated as medical issues, even when there is no actual medical need [ 13 ]. In addition, interventions and discourses concerning women's bodies are deeply rooted in traditional gender roles. Within these roles, men are often associated with success and power, whereas women are frequently linked to beauty and attractiveness. As a result, societal expectations create a perceived necessity for women to be beautiful and attractive. Consequently, women's perceptions of their bodies are largely shaped by societal standards of beauty [ 14 ]. Therefore, beauty and health issues, which are particularly significant for women, are both medicalized and individualized. From the onset of pregnancy to delivery, medicalization practices contribute to increased interventions in low-risk pregnancies, excessive testing, and a rise in cesarean sections [ 15 ]. This medicalization extends beyond reproductive health; for instance, the American Society of Plastic Surgery's global report [ 16 ] indicates that 85.7% of all aesthetic procedures are performed on women. The prevalence of procedures like liposuction, breast augmentation, eyelid surgery, tummy tucks, and breast lifts highlights the extent of medicalization in women's lives. While existing studies on medicalization primarily examine its conceptual definitions and contributing factors, there is a notable lack of research on how these medicalized experiences impact individuals' feelings, particularly beyond certain demographic groups [ 17 , 18 ]. Therefore, more phenomenological research is essential, as cultural context and health policies significantly influence medicalization behaviors within specific geographical areas.This study aims to explore the medicalization of these issues throughout various life stages of women from the perspectives of both specialist physicians and women themselves. This study aims to make a significant contribution to the literature by incorporating the experiences of both women and physicians in the medicalization process, thereby enhancing our understanding of the motivations behind medicalization.

This study investigates how medicalization affects women’s lives, highlighting both theoretical perspectives and personal experiences. It finds that education, cultural norms, environmental factors, beauty standards, and social media all play significant roles in shaping women’s behaviors. Key influences on physicians' actions include patient preferences and concerns about malpractice. The study outlines specific risks for women at various life stages and recommends developing care policies and integrating them into clinical practices.

This study contributes to health and medical sociology by examining how various stages in women's lives like menstruation, pregnancy, childbirth, reproductive technologies, abortion, menopause, and aging are often viewed as medical issues. It underscores that women’s unique biological differences and greater exposure to risk factors throughout their lives [ 23 ] make the medicalization of the female body particularly relevant. In the study, "medical indication" was the most common reason cited for medicalizing various conditions. Participants considered medical intervention necessary for situations like caesarean sections for safety, menstrual pain, infertility, risky pregnancies, and early menopause. Physicians also noted that cosmetic procedures, including those for potential cancer risks, have become more prevalent, with many praising their benefits for self-confidence and productivity. However, the dominant medical authority and the information gap between patients and doctors complicate the distinction between genuine medical needs and elective procedures, even turning natural events like childbirth into medicalized processes without giving women full choice [ 24 ]. The study highlights that women often experience fear, anxiety, and embarrassment related to childbirth, leading some to prefer cesarean sections. These psychological factors drive individuals to seek medical interventions, with some psychological reactions being recognized in medical literature, such as "tokophobia" (pathological fear of childbirth) [ 25 ]. Research shows a clear link between fear of labor and a preference for cesarean section [ 26 ], aligning with the study’s findings. Expert physicians also consider fear of childbirth a valid medical indication, complicating the distinction between genuine medical needs and psychological concerns. While medicalization is sometimes criticized [ 22 , 27 , 28 ], it has both positive and negative aspects [ 29 ]. Studies suggest medicalization can be beneficial or detrimental, and it’s important to differentiate between useful medicalization and over-medicalization [ 4 ]. Women’s emotional and psychological states can lead to various forms of medicalization throughout their lives. Abiç & Vefikuluçay Yılmaz [ 30 ] suggest that some physical and psychological issues during menopause are harmful and should be treated. Barlas et al. [ 31 ] found a link between body perception, dysfunctional attitudes, and depression in patients undergoing cosmetic surgery. Many individuals globally now opt for elective aesthetic procedures as part of "self-improvement" or "appearance investment" in areas they dislike on their bodies [ 32 ]. In Kurtdaş's [ 14 ] study, beauty for women is generally associated with concepts such as self-worth, happiness, self-confidence, respect, success, feeling special, health, and fulfilling the essence of womanhood, all of which are considered highly significant. Women's feelings about beauty are shaped by gender roles. While some feminists argue that this perception of beauty has been co-opted as a tool of control by patriarchal power, others suggest that women are attempting to reclaim autonomy from the pressures of the patriarchal system through beauty practices [ 33 ]. Some female participants in the study reported that negative body perception, particularly dissatisfaction with certain body parts, can become obsessive, prompting them to seek various interventions to alter or eliminate these areas. This aligns with İnan and Yığman’s [ 34 ] findings that individuals with high body dissatisfaction are more likely to pursue aesthetic surgery. Kucur et al. [ 35 ] also noted psychological disorders in patients who underwent rhinoplasty. Physicians, reflecting the views of these participants, observed that negative body perception undermines self-confidence, leading women to seek cosmetic procedures in social contexts like dissatisfaction with themselves or during a divorce. Additionally, fears of aging, death, and other emotional changes influence health behaviors across different life stages, including pregnancy, childbirth, menopause, and plastic surgery. Arslantaş et al. [ 36 ] found that women opting for cesarean delivery without medical reasons often cite factors such as lack of information, inadequate psychological support, and fear of childbirth. Psychological, emotional, and socio-cultural factors drive individuals toward surgical procedures [ 37 ]. These include body dysmorphia, body image issues, low self-esteem, a desire to appear attractive, eating disorders, life dissatisfaction, and a sense of competition or ridicule. The study confirms this, with both female and physician participants noting that women often seek anti-aging and cosmetic surgeries to enhance their appearance and gain social approval. Such procedures help individuals alter and perfect disliked aspects of their bodies, aiming for a more admired appearance in their social circles [ 38 ]. In the study, only one woman over fifty acknowledged aging, while others denied feeling old and took measures to counteract aging signs. Botox and facelifts are commonly viewed by women as routine and minor procedures associated with aging. An expert physician notes that Botox is increasingly regarded as a medical treatment, indicating its normalization and perceived necessity. This suggests that repeated use of such procedures transforms individuals into health consumers. Patients have legal rights, including the right to choose their treatments. Both groups of participants frequently discussed patient preference in relation to aesthetic and anti-aging procedures, though this concept also applies to areas like pregnancy, childbirth, and infertility treatments. Women influence the medical interventions they receive based on their preferences, but these are also shaped by external factors such as socio-cultural influences, social media, physician attitudes, environment, and education. Dömbekci Akman & Öztürk [ 39 ] found that social media, social environment, mental health issues, physician guidance, and cultural factors significantly impact decisions about rhinoplasty, aligning with the findings of this study. Education plays a crucial role in shaping women’s health behaviors [ 40 , 41 ], as seen in numerous studies. Insufficient education, combined with socio-cultural factors, often leads to misguided health practices. In many societies, inadequate education about menstruation results in ongoing tension, fear, and discomfort for female adolescents. Johanson et al. [ 42 ] suggest that, especially in regions with advanced private medical practices, physicians have begun applying complex delivery precautions, such as intravenous infusions and oxytocin, to normal deliveries over the past two centuries. This includes routine fetal monitoring and epidural analgesia for pregnancies without complications. Female participants in the study view some of these additional screening tests as unnecessary, while physicians implement them partly to protect themselves legally through defensive medicine [ 43 ]. This practice involves performing or avoiding certain procedures to mitigate legal risks. Interviews reveal that women generally trust physicians’ recommendations, regularly using prescribed medications and adjusting their lives based on doctors' guidance, indicating a significant influence of medical advice on women’s lives. Participants identified several factors contributing to medicalization, including the growing number of physicians and medical centers, advancements in treatments, increased availability of drugs and dermo-cosmetic products, and easier access to medical facilities. They also noted that commercial interests in health institutions and physicians' practices drive medicalization, particularly in aesthetic surgery. The health market is now influenced by supply and demand, with modern medicine increasingly operating as a market-driven service rather than a basic social need [ 3 ]. The media, especially social media, significantly contributes to medicalization [ 12 , 13 , 44 ]. Odabaşı [ 38 ] found that media representations of plastic surgery often feature celebrities and focus on female beauty. Interviews reveal that social media promotes a "uniform beauty" standard, with younger individuals increasingly influenced by idealized images. The portrayal of aesthetic procedures as quick, painless, and perfect leads to widespread societal beliefs and pressures. Consequently, social media posts by physicians and medical institutions may present misleading information, pushing women to conform to these beauty standards and increasing the medicalization of their lives.

Supplementary Material 1. Supplementary Material 1.