I believe in science.
I believe in the scientific method.
I do not believe in medical studies that have doctors rate a woman’s attractiveness. The title, so obscene I can barely type it, is:
Attractiveness of women with rectovaginal endometriosis: a case-control study (Fertility Sterility, September 2012).
The main outcome measure? A graded attractiveness scale.
I will absolutely concede that studying attractiveness is important from a psychological standpoint and so I believe in studies that try to contribute to our understanding of what we like and why, what turns us on, and why we make the choices we do with our sexual partners etc. These studies should be done, but by psychologists, not by OB/GYNs. And so I fail to understand how a small group of Italian doctors rating attractiveness of women with different stages of endometriosis contributes anything to medical science.
In this *cough* study, women with more advanced endometriosis were thinner (by BMI), had larger breasts (by a breast to under breast ratio), and were “judged” (I’m quoting here) by a group of doctors who viewed their pictures to be overall more attractive than their counter parts with less advanced endometriosis. Honestly, it makes me sick to type that. If some researcher asked me to participate in that study my first response would be, “Fuck off.” My second would be to report them to the institutional ethics board.
Now it is quite possible that there are some valid points about BMI, body habitus, and endometriosis. The lead researcher, Dr. Paolo Dr. Paolo Vercellini, an obstetrician and gynecologist at Universita degli Studi in MilanPerhaps, feels this greater degree of attractiveness, bigger breasts, and thinner body type could be related to estrogen levels. Estrogen does promote the growth of endometriosis, I’ll give him that. While that might give bigger breasts, estrogen isn’t exactly known as the weight-regulating hormone, if you know what I mean.
Dr. Vercellini is quoted as saying, “Several researchers believe that a general phenotype exists which is associated with the disease.” While I am not an endometriosis researcher, as I only treat women with pelvic pain I see many women every single day with endometriosis and I have yet to identify a severe-endometriosis phenotype. But, then again, I don’t ever consider my patients’ attractiveness, just, you know, their medical and social history, their physical findings, and response to treatments. And this quote about the “hot babe phenotype” with advanced endometriosis tells me that there was nothing pure about this study to begin with. If the goal were to look at BMI, or some other validated measurement of body habitus, the title of the article and main outcome measure wouldn’t be attractiveness.
If women with severe endometriosis truly do have a lower BMI there could be a multitude of reasons, some of which may actually be important, but this hypothesis is not answered by this study. In fact, this study of 31 women contributes nothing to the medical literature and Fertility Sterility should be ashamed they accepted it for publication. If they included it in their press release then they were just gunning for attention, which is even worse.
Objectifying women has no place in medicine. It is even more horrifying that such a publication comes from a department on OB/GYN.
What do you think? Is grading attractiveness a valid outcome measure in this kind of study?
Dr. Jen Gunter 
What do I think? I’m as appalled by this study as you are. Mysoginy masquerading as science, utterly disgusting and has no place in medicine.
Not sure why this is making the news just now in 2019, but it’s extremely important to note that this terrible study included 300 women, not 31.
I’ve only just become aware of this on Twitter, and honestly I just want to cry out of frustration. All those male GPs since my teens dismissing symptoms as my weakness and finding women’s issues “icky” so that I go undiagnosed until I insist on a laparoscopy at nearly 40. And they THEY inform me I have advanced disease and need hysterectomy/oophorectomy/bowel resection as if I don’t know that. Still delivered with a “but it’s not going to kill you, so it’s your choice to have surgery”. My male surgeon is horrid, I have no doubt he has rated my attractiveness, but he’s “the best in his field” so what choice do I have? Sorry for the rant, I’m furious!
As Italian woman suffering from endometriosis and as a scholar of philosophy and psychoanalysis, exponent of a scientific and artistic club, I would like to thank Dr. Jen Gunter, for her definite position in defense of the scientific method and in defense of the dignity of women and the patient in general.
Recently, in Italy enormous resonance has been given to a classification Expertscape, by Association of Palo Alto, California, with regard to the world’s leading experts in this field. Very welcome and illuminating Dr. Jen Gunter’s point of view also about this object.
I hope soon to be able to personally take contact with Dr. Jen Gunter, in the hope of having her intervention in the context of a eventual videoconference about the endometriosis, against any risk of return of medieval obscurantism.
Maria (Roma)
Thank you for speaking up against this truly sad excuse for a “research study”! The “research” got me pretty fired up.
In preparing my most recent blog post (about this travesty of a study), I happened upon this post. It truly was validating to read your take on it.
I have lived with endometriosis for 30 years (since I was 13 years old). I cannot tell you how upsetting I found this “study” – especially when I took the time to read all 7 pages of it. Endometriosis patients deserve better than studies like this.
Thanks again for speaking up about it!
Jeanne
Thank you for speaking up against this truly sad excuse for a “research study”! The “research” got me pretty fired up.
In preparing my most recent blog post (about this travesty of a study), I happened upon this post. It truly was validating to read your take on it.
I have lived with endometriosis for 30 years (since I was 13 years old). I cannot tell you how upsetting I found this “study” – specially when I took the time to read all 7 pages of it. Endometriosis patients deserve better than studies like this.
Thanks again for speaking up about it!
Jeanne
I have PCOS and Infertility sucks. I go to a fertility clinic and so considerably I have tried using 3 IUIs to consider and get expecting. The 1st IUI was lucrative unfortunately I lost the child 5 weeks in. In January Im going on to IVF and give that a test, I hope it will work considering Im managing out of solutions of this stage.
These are scientists and they have provided an interesting finding for evolutionary biologists. Fitness in one area — attractiveness — is offset by endometriosis which may reduce fertility and therefore impair fitness in another arena. It is an example of the evolutionary algorithm at work. The study is of value. It is a mistake to view every research paper through the narrow eyes of a clinician. Stop with the censorship. It is bad in art and literature, and bad in science.
It is ethically inappropriate to have physicians use a non validated “attractiveness” scale to judge patients. Period. Studies looking at attractiveness have a place when performed using appropriate validated scales and non clinicians judging the attractiveness.
This study is an ethical quagmire and scientifically adds nothing to the literature nor the study of endometriosis. And there is no was to control for the myriad of confounders. Although we now know that a select group of Italian GYNs find 44% of women without endometriosis (the control group) not very attractive or unattractive.
Yeah, it sure is an ethical quagmire. How could this study possibly inform clinical practice? Did you see this line in the Discussion?:
The lack of a ‘‘hard’’ main outcome may be considered a limitation of our study.
No, I am not kidding. Nothing like a little Inuendo in a peer reviewed paper.
In terms of the ‘attractiveness’ measure, the authors don’t explain why they used a 5-point scale when the earlier studies they cite use a 7-point bi-polar scale (Furnham et al, 1997) or 0 (least) to 20 (most) (Singh & Young, 1995).
My colleagues have also wondered if the raters used a ‘calibrated eye’??
I also wonder if the if the participants were fully informed i.e. told prior to consenting to the study that they would be rated for ‘attractiveness’ by four doctors.
Thank you for articulating everything I was muttering to myself as I read about this study last week.
Thank you! Your criticism of this unprofessional “study” is empowering, reminding us that medicine should be focused on do no harm. Who funded this study anyhow?
Nope. Not a valid outcome measure, unless it is a study assessing the fitness of docs to practice. Just what every woman wants to hear: ‘you are infertile- but DAMN if you aren’t hot!’
Doctor fail.
Grading attractiveness is NOT a valid outcome measure in this context. It seems pretty stoopid to me. This study is: a) an outcome of a tenure system that values ridiculous research over clinical skills and finely-honed clinical observations; b) “garbage” research published somewhere in order to raise the number count on a CV or grant application; c) group think; or d) getting to buy out of one’s clinical commitment in order to do (meaningless but entertaining masturbational) research. Take your choice. None of these is a sufficient justification for this kind of study. Do they have IRBs in Italy?
Best comment ever on my blog.
Thank you. The tag line on your blog says it all (“lasso of truth”) and is quite inspiring.
That’s what I was thinking. Tenure track had encouraged a lot of fluff research.
Please note that the ‘Small Italian Group’ is the leading team in endometriosis research all over the world. http://endo-update.blogspot.co.uk/2012/08/the-big-picture.html
They publish a lot. Defining leading is difficult as that is subjective.This is also not a well done study from a scientific method standpoint.
Regardless, assigning an endometriosis phenotype based on attractiveness does not advance the science of endometriosis. At all.
“Several researchers believe that a general phenotype exists which is associated with the disease.”
I smell a bozo here: male MDs trying to instil in people’s minds that attractive women are terminally ill, so as to ultimately keep them all for themselves (ill or not, as patients or as girlfriends). Clever. Very clever.
I think this is an excellent example of the dangers and shortcomings of statistical significance testing.