Chapter 1 12 ‘gendering’ is embedded in our daily lives by means of social cues and responses through which gendered performances are constructed and reproduced. This social process is a central part in the development of social identities and senses of self and facilitates the development of cognitive gender schemas through which behaviours and social interactions are interpreted and (self-)regulated. Best practice in the study of gender in medicine is to consider gender as a multidimensional performative concept, covering, at least, gender identities, gender norms and gender relations.27 As (bio)medical knowledge is mostly constructed through empirical research based on a positivist inquiry paradigm, it relies heavily on quantitative methodologies.28 The availability of survey-based instruments to measure gender in medicine has increased in the last 20 years, however, most of them have been developed with a restricted study population of US-American students and in the field of psychology, focusing on binary representations of masculinity and femininity.29 Furthermore, the underlying assumptions of the concepts under investigations are often not defined. For example, when researchers ask about participant’s ‘gender’, they often imply ‘gender identity’ while offering two mutually exclusive possible response options: “man/male” or “woman/female” .30 This operationalisation lags behind the current thinking in biological and social sciences, as both sex and gender are considered multi-layered, variable and non-binary.30–32 While continued and valuable efforts are being made to quantitatively measure gender dimensions in (bio)medicine, a prerequisite for all these endeavours remains a thorough understanding of social theory on how gender is performed. Because gender is relational, constructed through human interaction and social processes, gender negotiations can be seen as situated performances.33 To understand and measure gender as a situational, multi-layered construct, its analysis requires careful focus and contextualisation and therefor one-size-fits all measures might be less suitable to capture the impact of gender on people’s health. There is a need to understand what role gender plays in the illness experiences and disease expressions of particular patient populations to help inform the design of gender-sensitive measures and interventions in medicine that are contextually relevant and capable to inform population and personalised care management. Investigating the impact of gender in the context of Parkinson’s disease Parkinson’s Disease (PD) provides a valuable model condition for chronic (neurological) disorders to study the impact of different gender dimensions because the disease is common, with an incidence and prevalence that are rising due do demographic changes and possibly other factors.34 The clinical phenotype of PD encompasses a wide range of non-motor and motor features and neuropsychiatric features for which sex/gender differences are reported but the concrete and interrelated impact of specific sex- and
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