The ‘gender puzzle’ of alternative medicine and holistic spirituality: A literature review

"I Felt Like I Was Cut in Two": Postcesarean Bodies and Complementary and Alternative Medicine in Switzerland

In neoliberal cultural contexts, where the ideal prevails that female bodies should be unchanged by reproductive processes, women often feel uncomfortable with their postpartum bodies. Cesareaned women suffer from additional discomfort during the postpartum period, and cesarean births are associated with less satisfying childbirth experiences, fostering feelings of failure among women who had planned a vaginal delivery. In Switzerland, one in three deliveries is a cesarean. Despite the frequency of this surgery, women complain that their biomedical follow-up provides minimal postpartum support. Complementary and alternative medicine (CAM) therapists address these issues by providing somatic and emotional postcesarean care. CAM is heavily gendered in that practitioners and users are overwhelmingly women and in that most CAM approaches rely on the essentialization of bodies. Based on interviews with cesareaned women and with CAM therapists specialized in postcesarean recovery, I explore women's postpartum experiences and how they reclaim their postcesarean bodies.

Spirituality in Oncology: Relations between Spirituality, Its Facets, and Psychological and Demographic Factors in Cancer Patients in Germany

INTRODUCTION

Cancer diagnoses are constantly increasing in clinical practice. Therefore, more and more patients are interested in how they can actively participate in the process of treatment. Spirituality represents a hidden issue of the population, which counts as a branch of complementary and alternative treatment. Therefore, the aim of our study was to investigate whether there are associations between spirituality and demographic and psychosocial factors, as well as religious beliefs, in cancer patients.

METHODS

We conducted a survey with 451 participants in 10 oncology centers between March and July 2021. A composition of the following 9 different questionnaires was used to collect data on spirituality, demographics, resilience, self-efficiency, life satisfaction, and sense of coherence: Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp12), General Life Satisfaction Short Scale (L-1), Resilienzskala Kurzform (RS-13), Sense of Coherence Scale - Leipziger Kurzform (SOC-L9), Allgemeine Selbstwirksamkeit Kurzskala (AKSU), Adolescent Food Habits Checklist, Likert-Scale of daily activities, questionnaire of the Working group Prävention und Integrative Onkologie (PRiO), and personal opinion on the cause of the disease. Calculated data and analyzed group differences using ANOVA Bonferroni were used to test associations between spirituality and the variables studied. For more detailed examination of spirituality, we took a closer look at the different components of spirituality - peace, meaning, and faith - and their relation to each other (three-factor spirituality analyses).

RESULTS

Higher spirituality scores in total as well as meaning, peace, and faith were each associated with higher levels of resilience and life satisfaction. Higher religious belief was found to be associated with higher spiritual attitudes. High personal self-efficiency was found in people with higher spiritual beliefs in general as well as higher meaning and peace. Meaning and peace emerge as essential components of spiritual well-being and show a stronger association with expressions of general spirituality than faith.

CONCLUSION

Spirituality takes a crucial role among the resources of life-threatening diseases. As such, further research is needed to expand and integrate patient options into a modernized concept of care. Our data indicate that higher spiritual well-being is associated with a more tolerant approach to illness. Thus, addressing spiritual needs in therapy is associated with better psychological adjustment to the individual situation and reduces negative distress. To promote spiritual needs in the future, cognitive as well as affective components of spirituality should be emphasized.

Diversity of attitudes towards complementary and alternative medicine (CAM) and vaccines: A representative cross-sectional study in France

How much does endorsement of complementary and alternative medicine (CAM) correlate with negative attitudes towards vaccines? One of the difficulties of analysing the relationship between attitudes to CAM and attitudes towards vaccines rests in the complexity of both. Which form of CAM endorsement is associated with what type of reticence towards vaccines? While the literature on the relationship between CAM and attitudes towards vaccines is growing, this question has not yet been explored. In this study we present the results of a survey conducted in July 2021 among a representative sample of the French mainland adult population (n = 3087). Using cluster analysis, we identified five profiles of CAM attitudes and found that even among the most pro-CAM group, very few respondents disagreed with the idea that CAM should only be used as a complement to conventional medicine. We then compared these CAM attitudes to vaccine attitudes. Attitudes to CAM had a distinct impact as well as a combined effect on attitudes to different vaccines and vaccines in general. However, we also found a) that attitudes to CAM provide a very limited explanation of vaccine hesitancy and b) that, among the hesitant, pro-CAM attitudes are often combined with other traits associated with vaccine hesitancy such as distrust of health agencies, radical political preferences and low income. Indeed, we found that both CAM endorsement and vaccine hesitancy are more prevalent among the socially disadvantaged. Drawing on these results, we argue that, to better understand the relationship between CAM and vaccine hesitancy, it is necessary to look at how both can reflect lack of access and recourse to mainstream medicine and distrust of public institutions.

Clinical associations for traditional and complementary medicine use among norwegian cancer survivors in the seventh survey of the Tromsø study: a cross-sectional study

BACKGROUND

Cancer survivors are a diverse group with varying needs that are patient-, disease-, and/or treatment-specific. Cancer survivors have reported supplementing conventional anti-cancer treatment with Traditional and Complementary Medicine (T&CM). Although female cancer survivors are reported to have more severe anticancer adverse effects, little is known about the association between anticancer treatment and T&CM use among Norwegian cancer survivors. The aims of this study are therefore to investigate (1) associations between cancer diagnosis characteristics and T&CM utilization and (2) associations between anticancer treatment and T&CM utilization among cancer survivors in the seventh survey of the Tromsø study.

METHODS

Data was collected from the seventh survey of the Tromsø Study conducted in 2015-16 among all inhabitants of Tromsø municipality aged 40 and above (response rate 65%), where inhabitants received online and paper form questionnaires. Data from the data linkage to the Cancer Registry of Norway for cancer diagnosis characteristics was also used. The final study sample was made up of 1307 participants with a cancer diagnosis. Categorical variables were compared using Pearson's Chi-square test or Fisher's exact test while independent sample t-test was used to compare continuous variables.

RESULTS

The use of T&CM the preceding 12 months was reported by 31.2% of the participants with natural remedies as the most reported modality of T&CM (18.2%, n = 238), followed by self-help practices of meditation, yoga, qigong, or tai chi, which was reported by 8.7% (n = 114). Users of T&CM were significantly younger (p = .001) and more likely to be female (p < .001) than the non-users, with higher use of T&CM among female survivors with poor self-reported health and being 1-5 years post-diagnosis. Lower use of T&CM was found among female survivors who received a combination of surgery with hormone therapy and those who received a combination of surgery with hormone therapy and radiotherapy. Similar usage was seen in male survivors, but not at a significant level. For both male and female survivors, T&CM was most frequently used by those with only one cancer diagnosis (p = .046).

CONCLUSION

Our results indicate that the profile of the Norwegian cancer survivor who uses T&M is slightly changing compared to previous findings. Additionally, compared to male survivors, more clinical factors are associated with use of T&CM among female cancer survivors. These results should serve as a reminder to conventional health care providers to discuss the use of T&CM with patients across the entire cancer survivorship continuum to promote safe use, especially among female survivors.

The Development of Guidelines for the Inclusion of Spirituality and Spiritual Care in Unani Tibb Practice in South Africa: A Study Protocol

Unani Tibb is a holistic form of medicine, which highlights the interconnectedness of mind, body and soul. Despite this, there is very little evidence of spiritual care practices by Unani Tibb practitioners in South Africa. This protocol outlines a proposed process for developing guidelines to integrate spirituality and spiritual care in Unani Tibb practice. In phase one, a document review will be conducted on spirituality and spiritual care in complementary and alternative medicine and Unani Tibb. A series of quantitative and qualitative enquiries will follow to obtain the perspectives of various stakeholders in the Unani Tibb profession. Phase two will rely on the findings of phase I to develop guidelines according to the Delphi method. Experts in the relevant fields will be soliciting their opinions on the nature and content of the proposed guidelines. The data will be analysed using descriptive statistical analyses, thematic analysis and narrative synthesis. Ethics clearance has been obtained from the ethics committee of the university.

For Exercise, Relaxation, or Spirituality: Exploring Participation Motives and Conformity to Masculine Norms among Male and Female Yoga Participants

Yoga is a traditional practice from India with the potential to promote physical activity and health. Participation worldwide remains low, particularly among men. To better understand yoga participation parameters, with a special focus on what influences male participation, this study examined gender differences in participation motives and conformity to masculine norms. It also explored these factors across three participant subgroups who differed in their engagement with the physical and the more psycho-spiritual aspects of yoga. A total of 546 yoga participants (138 males, 399 females, 9 others), 18–73 years old, completed an online survey that included an adapted version of the Exercise Motivation Inventory–2 and three subscales from the Conformity to Masculine Norms Inventory–46. Results showed significant gender differences in participation motives and conformity to masculine norms. Females were more motivated by positive affect, health/fitness, nimbleness, mind–body integration, and coping/stress management, whereas males were more motivated by supplementary activity and competition/social recognition. These differences should be considered in tailoring messages to promote uptake and continued participation. Furthermore, males were more likely than females to conform to emotional control and heterosexual self-presentation masculine norms. Future research may examine how differences in masculine norm adherence influences uptake, particularly among men.

Nurturing the Female Body: Notions of Wellbeing in Womb Yoga

Alternative therapies which aim to enhance women's wellbeing have been accused of contributing to healthist and postfeminist agendas which rest upon a neoliberal logic. I critically engage with this issue here through an ethnographic study of womb yoga, a women's alternative therapy developed in the UK. I argue that while being commercial and emphasizing personal responsibility, womb yoga largely works against the current neoliberal optimization ideal. Womb yoga practitioners dismiss goal-oriented self-management and discipline, and avoid a simple reproduction of gender stereotypes by deflecting care away from other-directedness and opening the interpretation of femininity to the imaginative and experiential realms.

A cross-sectional workforce survey of three traditional and complementary medicine professions in Ontario, Canada

BACKGROUND

Workforce studies about traditional and complementary medicine (T&CM) occupations in industrialized countries are scant; and, these occupations' position within the broader occupational workforce remains unclear. This study aims to address these gaps using a comparative approach.

METHODS

Naturopaths, traditional Chinese medicine (TCM) / acupuncture practitioners, and homeopaths in Ontario, Canada were surveyed regarding their demographics, practice characteristics and self-reported income. Results were compared with parallel data from within and outside of Ontario.

RESULTS

Study response rate: 23.3% (n = 1205). While predominantly female (57.9%), Ontario's TCM/acupuncture profession was less feminized than the naturopathic (77.1%) and homeopathic (78.3%) groups. Naturopaths were significantly younger than, and reported fewer years of clinical experience than, the other two groups. About half of TCM/acupuncture practitioners, and almost one-third of homeopaths had trained outside of Canada, predominantly in East and South Asia, respectively. More TCM/acupuncture practitioners (58.9%) and homeopaths (57.6%) had multilingual clinical practices than naturopaths (19.1%). Homeopaths worked fewer hours and saw fewer patients per week than the other occupations. Self-reported mean incomes varied across groups, with naturopaths earning more on average ($63,834, SD $57,101) than did TCM/acupuncture practitioners ($45,624, SD $44,081) or homeopaths ($29,230, SD $41,645). Holding other variables constant, internationally-trained practitioners reported earning one-third less than their Canadian-trained counterparts.

DISCUSSION & CONCLUSIONS

Study findings echo occupationally-specific data from other industrialized jurisdictions; and, affirm that different T&CM occupations have distinctive demographic and practice characteristics. The demographic makeup of Ontario's TCM/acupuncture and homeopathy occupations suggests a role for these groups in delivering culturally-responsive care within Asian ethnic communities. T&CM practitioner incomes, in particular for internationally-trained practitioners, fell below the provincial population income median, and in many cases below the poverty line. T&CM occupations' relative socio-political marginality may be impacting clinicians' ability to earn a viable living.

Bodily intimacy and ritual healing in women'stantric retreats

Alternative health care and holistic spiritual practices have become increasingly popular in many Western countries, especially among women, who often claim them to be deeply transformative. This paper presents an ethnographic study of women's tantric retreats in Northwest Europe that aimed to help women reconnect with their vital sexual energy, rediscover the sacredness of their female bodies, and possibly heal from damaging and even traumatic experiences regarding their femininity and sexuality. It draws on Turner's influential view on ritual as a liminal space in order to account for the transformative potential of these workshops. Specifically, it applies Hinton and Kirmayer's flexibility hypothesis, which suggests that healing rituals shift people's mode of being-in-the-world, including their cognitive, emotional, and physical state or stance, towards openness to new ways of being. First, it highlights different ontological domains where shifts took place, notably somatic state, self-image and relationality. Subsequently, it identifies the main modalities that were used for enabling transformation: the embodiment of the metaphor of the goddess/the divine as present in each woman and the use of intimate, loving touch and meditative awareness. The process of transformation and healing elucidated in this way engaged the physical, emotional and cognitive levels as interacting dimensions, relying foremost on the activation of a vital energy that both gave participants a deep sense of self and connected beyond the self.

Research-related attitudes among Chinese medicine students at a Canadian college: a mixed-methods study

BACKGROUND

Previous studies have suggested that American Chinese medicine students' research interest declines as their training progresses. Many students further express low confidence in the congruence ('model validity') of bioscientific research methods in relation to the Chinese medicine paradigm. However, prior research has not assessed the impacts of research-related coursework on student perspectives in this regard.

METHODS

First-, second- and third-year Chinese medicine students were surveyed regarding their research-related views. Final year students were re-surveyed after completing the research course. Qualitative analyses of the participating students' coursework were also undertaken.

RESULTS

Over 80% of all participants showed high research interest and engagement, and viewed research as both relevant to clinical practice and important for the profession's socioeconomic legitimation. Male students were significantly more likely to view scientific evidence as improving the quality of Chinese medicine care (p = 0.021). A view that conventional research methods have low model validity for Chinese medicine interventions was higher among third year students than those in their first or second years of study (p = 0.001). Research coursework appeared to increase self-assessed research interest and skill. Concern regarding model validity was strongly evident in student coursework.

CONCLUSION

Research-related curricular interventions in the Chinese medicine field should directly address model validity, as it is of significant interest to a majority of students.

The incorporation of self-spirituality into Western organizations: A gender-based critique

Based on a review of existing qualitative research, this study proposes a gender-based interpretation and critique of the incorporation of self-spirituality into mainstream organizations. The article’s findings show that the enactment of self-spirituality in organizations often evokes experiences of tension or objection. The basic premises of self-spirituality culture are concerned with the authentic self and the emphasis on the individual’s awareness of his or her body, thoughts, and feelings is, in fact, a manifesto of the legitimate sources of ‘knowing’ at work. This premise is radically different from rationality as a fundamental principle of knowing and organizing. Self-spirituality further proposes an alternative to workplace relationships, which is based on a radical equality. I argue that these perceptions are embodied in gendered power relations—the relationship between the feminine self-spirituality and the masculine secular organizations. Two main modes of incorporation of self-spirituality into organizations were identified: the ‘domesticated masculine mode of incorporation’, which is presented as a ‘joining force’ in achieving main organizational values, and the ‘feminine’ modes of the incorporation of self-spirituality, which presents a revolutionary alternative to organizations. As for the viability of these modes of incorporation for creating change, self-spirituality in its domesticated masculine mode of incorporation appears to align itself with organizations public domain. In contrast to this, the two ‘feminine’ modes of incorporation create the possibility for self-spirituality to be lived by individuals as an ‘individual wisdom’. The study contributes to organization research by identifying ways in which radical alternatives may be incorporated into organizations.

Medicine is Patriarchal, But Alternative Medicine is Not the Answer

Women are over-represented within alternative medicine, both as consumers and as service providers. In this paper, I show that the appeal of alternative medicine to women relates to the neglect of women's health needs within scientific medicine. This is concerning because alternative medicine is severely limited in its therapeutic effects; therefore, those who choose alternative therapies are liable to experience inadequate healthcare. I argue that while many patients seek greater autonomy in alternative medicine, the absence of an evidence base and plausible mechanisms of action leaves patients unable to realize meaningful autonomy. This seems morally troubling, especially given that the neglect of women's needs within scientific medicine seems to contribute to preferences for alternative medicine. I conclude that the liberatory credentials of alternative medicine should be questioned and make recommendations to render scientific medicine better able to meet the needs of typical alternative medicine consumers.

Gender specific association between the use of complementary and alternative medicine (CAM) and alcohol consumption and injuries caused by drinking in the sixth Tromsø study

BACKGROUND

Alcohol is consumed almost worldwide and is the most widely used recreational drug in the world. Harmful use of alcohol is known to cause a large disease-, social- and economic burden on society. Only a few studies have examined the relationship between CAM use and alcohol consumption. To our knowledge there has been no such research in Norway. The aim of this study is to describe and compare alcohol consumption and injuries related to alcohol across gender and different CAM approaches.

METHODS

The data used in this study is based on questionnaire data gathered from the sixth Tromsø Study conducted between 2007 and 2008. Information on CAM use and alcohol consumption was available for 6819 women and 5994 men, 64.8% of the invited individuals. Pearson chi-square tests and independent sample t-tests were used to describe the basic characteristics of the participants and to calculate the differences between men and women regarding these variables. Binary logistic regression analyses were used to investigate the associations between the different CAM approaches and alcohol consumptions and injuries caused by drinking.

RESULTS

Women who drank alcohol more than once a month were more likely to have applied herbal or "natural" medicine and self-treatment techniques (meditation, yoga, qi gong or tai-chi), compared to those who never drank, and those who only drank monthly or less. For women, an association was also found between having experienced injuries caused by drinking and use of self-treatment techniques and visit to a CAM practitioner. No association was found between amount of alcohol consumed and use of CAM approaches. For men, an association was found between injuries caused by drinking and use of herbal or "natural" medicine.

CONCLUSION

The findings from this cross-sectional study suggests that women who drink frequently are more likely to use "natural" medicine and self-treatment techniques. Both men and women who had experienced injuries because of their drinking were more likely to have used CAM approaches.

Statutory Regulation of Traditional Medicine Practitioners and Practices: The Need for Distinct Policy Making Guidelines

The World Health Organization (WHO) has called for the increased statutory regulation of traditional and complementary medicine practitioners and practices, currently implemented in about half of nations surveyed. According to recent WHO data, however, the absence of policy guidelines in this area represents a significant barrier to implementation of such professional regulations. This commentary reviews several key challenges that distinguish the statutory regulation of traditional medicine practitioners and practices from biomedical professional regulation, providing a foundation for the development of policy making parameters in this area. Foremost in this regard are the ongoing impacts of the European colonial encounter, which reinforce biomedicine's disproportionate political dominance across the globe despite traditional medicine's ongoing widespread use (particularly in the global South). In this light, the authors discuss the conceptual and historical underpinnings of contemporary professional regulatory structures, the tensions between institutional and informal traditional medicine training pathways, and the policy challenges presented by the prospect of standardizing internally diverse indigenous healing approaches. Epistemic and evidentiary tensions, as well as the policy complexities surrounding the intersection of cultural and clinical considerations, present additional challenges to regulators. Conceptualizing professional regulation as an intellectual property claim under the law, the authors further consider what it means to protect traditional knowledge and prevent misappropriation in this context. Overall, the authors propose that innovative professional regulatory approaches are needed in this area to address safety, quality of care, and accessibility as key public interest concerns, while prioritizing the redress of historical inequities, protection of diverse indigenous knowledges, and delivery of care to underserved populations.

The Consumption of Conventional and Nonconventional Medicines in an Italian Province: The Influence of Sociodemographic Factors and Health Beliefs

Many studies have investigated the factors that influence the consumption of medicines. This article aims to compare how these factors affect both conventional medicines (prescription and over-the-counter (OTC) medicines) and nonconventional ones, also named as complementary and alternative medicines (CAM). A questionnaire was administered to a purposive sample of 4,074 inhabitants of the province of Mantua, Italy. Logical regressions were used to identify the variables influencing frequency of use. The consumption frequency of various types of medicines was associated not only with demographic aspects (such as gender, age, and education level) but also with everyday treatment strategies (such as self-medication habits and use of the Internet for medical aims) and health beliefs. From this last point of view, the use of conventional and nonconventional medicines is guided by 2 principal therapeutic attitudes, one aimed at removing all pathological aspects from everyday life and the other at contextualizing health problems within a broader philosophical search.

“Power From Within” and Masculine Language: Does New Age Language Work at Work?

This study investigates the use, by women, of New Age spirituality (NAS) language in the workplace. Quantitative and qualitative data collected in New Zealand and Israel show that women reported using NAS language more than men, and that NAS language are generally silenced. Results show that if not calculated correctly, women’s use of NAS can lead to the loss of social capital and cultural capital in the workplace. In addition, women use NAS language as a set of ideas that shape the way they behave, as a form of “power from within,” and as “spiritual capital.” The article draws out some implications for theory on language and power in the workplace, by showing that silenced languages may remain alive within people, directing responses and actions, and for feminist research, by suggesting that women’s spirituality should be considered as a factor in explaining the interpretation and negotiation of workplace challenges, by women.

Nonspecific Feelings Expected and Experienced during or Immediately after Electroacupuncture: A Pilot Study in a Teaching Situation

BACKGROUND

Some feelings elicited by acupuncture-type interventions are "nonspecific", interpretable as resulting from the placebo effect, our own self-healing capacities-or, indeed, the flow of qi. Expectation is thought to contribute to these nonspecific effects. Here we describe the use of two innovative 20-item questionnaires (EXPre₂₀ and EXPost₂₀) in a teaching situation.

METHODS

Respondents were acupuncture students or practitioners on electroacupuncture (EA) training courses (N = 68). EXPre₂₀ and EXPost₂₀ questionnaires were completed before and after receiving individualised treatment administered by colleagues. Respondents were also asked about their prior experience of EA or transcutaneous electroacupuncture stimulation (TEAS).

RESULTS

Respondents expected significantly more items to change than not to change, but significantly fewer were experienced as changing. Increases in given questionnaire items were both expected and experienced significantly more often than decreases. "Tingling", "Relaxation", and "Relief" or "Warmth" were most often expected to increase or were experienced as such, and "Pain" and "Tension" to decrease or experienced as decreasing. Expectations of change or no change were confirmed more often than not, particularly for "Tingling" and "Tension". This was not the result of the personal respondent style. Cluster analysis suggested the existence of two primary feeling clusters, "Relaxation" and "Alertness".

CONCLUSIONS

Feelings experienced during or immediately after acupuncture-type interventions may depend both on prior experience and expectation.

The use of ayurvedic medicine in the context of health promotion--a mixed methods case study of an ayurvedic centre in Sweden

Background

Ayurveda has its historical roots in India, but has also been internationalised, partly via migration and partly through an increased interest in alternative medicine in the West, where studies point toward increased use. However, there is to date scarce knowledge about the use and experiences of ayurveda in Sweden.

Methods

We have conducted a case study of a center for ayurvedic healthcare in Sweden. We have collected information on client background data from the center’s documentation, and compiled data from all clients who visited the centre for ayurvedic consultation during spring 2014. In total, 55 individuals were included in the study, and 18 of them were chosen for individual semi-structured interviews, to gain a deeper understanding of their motives for seeking, and experiences of ayurvedic health care. The material was analysed and compiled through a mix of qualitative and quantitative methods.

Results

Among the 55 clients, 91 % were female the mean age was 47 years, and 64 % gave a specific illness as a reason for seeking ayurveda. The most common illnesses were respiratory, musculoskeletal, circulatory, tumor, and cutaneous illnesses. The qualitative results showed that ayurveda was being used in combination with other methods, including various diets, other alternative medicine methods and conventional medicine. Some participants recounted having sought ayurveda as a complement to conventional medicine, or in cases when conventional medicine had been experienced as insufficient in terms of diagnosis or treatment. However, some participants experienced it as difficult to follow the ayurvedic life-style advice in the midst of their everyday life. Many participants reported positive experiences of pulse diagnostics, which was the main diagnostic method used in ayurvedic consultation. Some reported concrete, physical improvement of their symptoms.

Conclusions

This study points towards important aspects of participant experience of ayurveda, that may be subject to further research. The positive effects experienced by some clients should be studied more systematically in order to discern whether they are specific or non-specific. In addition, interesting knowledge may be gained through further study of the reported positive experiences of pulse diagnosis.

Complementary medicine as a path toward empowerment of Arab-Palestinian women in Israel

Arab-Palestinians in Israel compose a traditional minority population that previously relied on traditional folk medicine and religious healing. Today some among this minority population are adopting imported complementary medicine. We interviewed Arab-Palestinians of the first generation of complementary medicine practitioners. Their decision to study complementary medicine constitutes a path toward empowerment, providing healers with an aura of modernity, enabling integration into the predominantly Jewish Israeli medical establishment to gain professional recognition as experts, and to acquire a sense of belonging. Practicing complementary medicine provides financial independence, liberation, and self-fulfillment and an opportunity to help female patients break through constraining barriers.