Ask Val Arkoosh about the possibility that she could become the first Pennsylvania woman elected to the U.S. Senate, and she’ll probably counter with a different historical factoid.

“I would also be the first woman physician ever, from either party,” she said Thursday, cradling a cup of chai tea as rain poured down outside a Bucks County café.

Arkoosh had just toured a therapeutic horse-riding center in Pipersville, where military veterans struggling with PTSD ride horses and synchronize their breathing with the animals’ for calm.

“It’s a known medical fact that when you’re focused on breathing you can’t focus on anything else,” Janet Brennan, the founder of Shamrock Reins and a former nurse, told Arkoosh.

“That’s absolutely right,” said Arkoosh, who spent years as an anesthesiologist.

The early campaign stop — at a female-owned nonprofit, supported by an all-female therapy staff — took place as the Democratic field in one of the country’s most competitive Senate races is coming into focus. Arkoosh, chair of the Montgomery County Commissioners, is the lone woman with an established political profile running in the Democratic primary.

That’s not something she’s shying away from — but it’s not something she’s particularly highlighting, either. There’s a long, seemingly no-win history of women grappling with how much to emphasize their gender in a political system where they are the minority — and a political culture where they face different expectations than men. Hillary Clinton was criticized for not focusing enough on the historic nature of her presidential candidacy in 2008. She did that more in 2016 but still lost.

Although Arkoosh says it’s “about time the commonwealth elected a woman,” she’s quick to add that the race is about a lot more than that: the economy, climate, health care, and more.

Lt. Gov. John Fetterman of Braddock and State Rep. Malcolm Kenyatta of Philadelphia are also seeking the Democratic nomination, and U.S. Rep. Conor Lamb of Allegheny County is widely expected to join them. Incumbent Republican Sen. Pat Toomey isn’t seeking reelection.

» READ MORE: Democrats are waiting for Conor Lamb as Pennsylvania’s 2022 Senate race takes shape

Being one of the only women in male-dominated spaces isn’t new for Arkoosh, who is 60. It was like that in medical school, when she was the chair of Drexel’s anesthesiology department, and now, as the first woman to lead Montgomery County since it was founded in 1784.

“I think of it some days as my preexisting condition,” Arkoosh said with a smile. “It’s just been something I’ve been dealing with for as long as I can remember. It’s not annoyance or anything, it’s just like, ‘Yes, I’m a woman, but there’s all these other things, too.’”

Pennsylvania ranks in the bottom half of states for gender representation in politics. The state has never elected a female U.S. senator or governor. There are four women, all Democrats, in a congressional delegation of 18 — up from zero women just three years ago. The state legislature is about 26% female.

So far, no woman from either party is running for governor next year. Kathy Barnette, a Montgomery County Republican who ran unsuccessfully for Congress last year, is seeking the GOP Senate nomination.

Arkoosh got a major boost in June from Emily’s List, a group that backs Democratic women and plays an influential role in Democratic politics. It endorsed her after U.S. Reps. Madeleine Dean and Chrissy Houlahan said they wouldn’t run, leaving Arkoosh as the only prominent woman.

Her supporters see a critical moment to break the glass ceiling.

“If we don’t do it now, it’ll be at least another decade,” said Christine Jacobs, Arkoosh’s campaign treasurer and the executive director of Represent PA, which works to elect Democratic women. “Because whoever’s elected governor, chances are they get reelected, and Senate’s up every six years.”

Arkoosh says she transitioned from a career in medicine to politics because her patients needed more help than she could provide in an exam room. She saw kids with asthma aggravated by air pollution, pregnant moms who had to take two buses for a grocery trip, and countless insurance claims denied.

“I couldn’t fix those things as a doctor,” she said.

» READ MORE: The 2020 election established Montgomery County as a powerful Democratic stronghold

Arkoosh got a master’s degree in public health from John’s Hopkins Bloomberg School of Public Health, which she completed while practicing medicine part time and caring for three young children. That led to a job with the National Physicians Alliance, where she advocated for passage of the Affordable Care Act.

She lost her first congressional campaign in 2014 before being appointed to the Montgomery County Commissioners that year. She won reelection to a full term, and has been chair since 2016.

Montgomery is the third most populous and second-wealthiest county in Pennsylvania. It’s also increasingly emerged as a Democratic powerhouse in recent years, which could be an advantage for Arkoosh — though what kind of following the county-level job gives her remains to be seen.

Being the only woman who’s a major Democratic candidate could also help.

“It’s no guarantee that you’ll win, but it gives you a base of support with a slice of the electorate,” said Mike Mikus, a Democratic strategist who ran the early part of Katie McGinty’s 2016 Senate campaign. McGinty won the primary but lost to Toomey in the general election.

“In the end, these primaries are not going to be determined by gender or race,” Mikus said. “It’s going to be the message, who raises the money, who runs a well-organized campaign.”

Arkoosh has already faced questions about McGinty’s loss and what it might portend for her prospects. She largely waves those off.

“As I talk to voters, this is not what’s on their mind,” she said

Mikus put it more bluntly. “It’s so misogynistic to assume that because one woman ran five years ago that a woman running today is the exact same person. They have vastly different backgrounds.”

Allyson Schwartz, who represented Montgomery County for 10 years in Congress and lost in the 2014 primary for governor, also rejected any comparison.

“Men have run and lost over and over and over again and very few men get asked ... ‘Can a man still win?’” Schwartz said. “We have elected women to attorney general, treasurer. Women can absolutely win statewide.”

Arkoosh is also quick to note that history could be made in several ways in the race. Kenyatta would be the state’s first Black senator and its first openly gay one. He has highlighted the slate of all white men who have held the seat.

Research shows that women are far more likely to vote based on a candidate’s party than gender. But several supporters said the combination of her qualifications and the lack of women among top state officials could help Arkoosh. She has early support from several women whom she helped get into politics.

“It was all new to me,” said Nicole Phillips, who’s running for judge in Montgomery County. “You’re being vetted, and you realize you’re being asked what are my qualifications, sometimes overtly in ways the men are not. She was helpful to me making sure my message was clear.”

Delaware County Councilwoman Christine Reuther, one of three women who led Democrats to control of the governing body in 2019, credited Arkoosh for helping her as a candidate. She said Arkoosh become a leader in the wider Philadelphia region during the pandemic.

“I didn’t necessarily agree with every decision she made, but you can see she’s doing the work, taking the hits, and owning her decisions,” Reuther said. “That’s what I want in an elected official.”

» READ MORE: No endorsement is too small for Malcolm Kenyatta

At the coffee shop, Arkoosh called governing during COVID-19 the hardest thing she’s ever done. She proudly shared, as perhaps only a woman would feel the need to, that she had only one emotional breaking point last year.

She was in a Zoom meeting after she’d learned her twins’ high school graduation would be virtual, she recalled. Someone asked her about the status of local graduations. That’s when the gravity of what the pandemic had stolen from her own kids — no prom, no senior skip day — hit her, as she tried to answer through tears.

A flurry of supportive messages followed, with people thanking her for showing emotion, and sharing their own struggles. Arkoosh said the moment demonstrates the importance of having different perspectives in the Senate.

“We will get better legislation and better impact for our communities if the laws that are passed reflect everyone,” she said. ”And we do have very few women there, so we do need to do better.”