"The healthcare system was designed to provide healthcare to the people who designed the system, " Nisha McKenzie says as she describes the roots of disparate outcomes in women's sexual health. 

McKenzie is the founder and owner of Women's Health Collective (WHC), a healthcare practice that creates an inclusive and affirming environment for female-identifying, non-binary and genderqueer individuals to manage their sexual health. In the battle against gender bias in healthcare, McKenzie is the warrior you want: she is one of three physician assistants in the nation certified as a sex counselor and one of two also to be a Nationally Certified Menopause Practitioner.

Before opening WHC, McKenzie worked at a family practice where she came up against the impact of gender bias in medicine (patients being treated with a lower quality of care based on their gender or gender identity). Her gentle voice grips with emotion when she speaks about the drive behind her practice. 

"I realized after a certain amount of time that women were not being heard," McKenzie said. "They had problems that they felt ashamed or scared or fearful to ask." 

Medical News Today reports that gender bias in healthcare is widespread and spans patient care, education and research. The impact ranges from the prevalence of misinformation feverishly exchanged in school hallways (anyone remember the "if you have sex in a pool, you won't get pregnant" rumor?) to misdiagnosis of painful and treatable conditions. 

Research shows that women with endometriosis spend an average of 7.5 years between first seeing a doctor regarding their symptoms and receiving a diagnosis. Pain or irregularities in menstrual cycles are often grouped as typical symptoms of being a woman; in a 2019 survey, 45% of women said they don't think their healthcare provider takes their pain seriously.

Sex. Ed.

These longstanding disparities have yielded generations of women who are disconnected, underinformed or misinformed about their bodies.

"I wanted to help these women," McKenzie said. 

After nine years at a family practice, she dove into sexual health care. She describes the journey as "groundbreaking."   

"There are so many marginalized groups that, in my sheltered upbringing in West Michigan, I hadn't realized, " she said. "I started to expand what I wanted to study and how I wanted to practice ... we cannot be blind to the difference among people and how that impacts how they receive care."

A 2018 study by the National Library of Medicine showed that individuals who identify as lesbian, bisexual, queer, and/or genderqueer faced barriers to getting their needs met, partially due to "provider lack of LGBTQ health competency relevant to reproductive health priorities and treatment." 

As we move further to the margins, implicit bias and lack of knowledge and trust between providers and patients grows. According to a report from the National Transgender Discrimination Survey, 19% of those polled reported being refused care by a provider solely due to being transgender. Half reported having to educate their providers about transgender care.

McKenzie's staff engages in regular training, including diversity, equity and inclusion, LGBTQIA+, and domestic violence. Additionally, WHC weaves inclusive gestures into their practice, from using inclusive language on their website, in patient materials and during intake and care to wearing pins and earrings depicting symbols of LGBTQIA+ allyship.

"I'm here trying to do my best to train myself and staff every day to leave our bias at the door to recognize first that we have it," she said. "Everybody does, and it doesn't mean anything negative unless you choose to ignore it."

WHC offers services to help women at all stages of life and health to feel sexually empowered, from women recovering from cancer, experiencing vaginal pain upon penetration or struggling with arousal — all issues that may be not discussed in the typical OBGYN setting. 

McKenzie notes that for providers, it all starts with self-awareness and empathy.

"Most providers care very much," she said, "But that doesn't seem to come across to patients. Unfortunately, so much of treatment is dictated by our system, and empathy is not worked into that system at all."

As more and more people seek out holistic approaches to healing, WHC supplements gynecological and sexual health treatment with yoga, reiki massage, personal training, therapy and more. McKenzie says these integrative care options acknowledge the myriad ways people heal.

"We can work together and say 'there's a whole human, and it's complex and there's a biological and a psychological and a social and a cultural and a religion and a relational component... we are all working toward the same mission with a different approach."

Ultimately, McKenzie's goal is to arm patients with the knowledge they need to be in-tune with and in charge of their sexual health.

"It's essential to help people take charge of their own health," she said. "Working in sexual medicine, I often tell people, 'this may be a lot of work.' You might come in for regular visits, sexual counseling, pelvic floor exercises ... but what you're going to get is all of these tools that expand the latitude of perception of your sexuality and sexual health."