A great deal of research shows that women and men perceive and experience pain differently, including acute and chronic pain. It’s been proven that women experience greater levels of pain than men in reaction to the same painful stimuli. Women also experience more distress and suffering in relation to pain. What you might be wondering is why this is the case! Let’s take a look at the factors involved.
Central pain processing and nerve density
There are thought to be different neural pathways in men and women, which mean that they physically pick up on outside stimuli differently. Essentially, gender differences in how their bodies perceive pain. This in depth study on the topic explains that, “There may be sex differences in peripheral afferent pathways, in the central networks which integrate and process noxious sensation, and/or in the descending, efferent systems which modulate nociception.”
We all have sensory neurons called nociceptors throughout our bodies. These send signals to the brain when there is potential damage to the body, and research shows that these are typically more sensitive in females: “there is an extensive literature from both humans and animals demonstrating that females have lower pain thresholds across multiple sensory modalities.”
The central nervous system processes pain differently in women and men. This study discusses research which used scans to monitor patients, to find out which areas of the nervous system were active in men and women during experimental stimuli. All of the results show that women and men process both acute and chronic pain differently. The study explains, “Research using fMRI has illuminated substantial sex differences in CNS (central nervous system) processing of pain stimuli and even of anticipation of pain stimuli “
Women also have an increased nerve density when compared to men. This article talks about a recent study, describing how they found that, “women averaged 34 nerve fibers per square centimeter of facial skin while men only averaged 17 nerve fibers.” More nerves equals being more sensitive to outside stimuli. However, many scientists feel that the physiological reason for why women experience more pain than men, has more to with central pain processing differences rather than nerve density.
Perception and description of pain
There are also significant differences in how women and men pay attention to, and therefore describe their pain experience. Women tend to be more self aware of experiences and sensations within their body. This is thought to be because, from a young age, their menstrual cycle attunes them to their bodily processes. Women are often more regularly visiting a medical professional for things like smear tests, which can contribute to making them more likely to take notice of symptoms. Men are more inclined to forget past medical experiences than women, while women tend to recall past medical experiences in more detail.
This awareness means that women take more notice when something is wrong and pick up on smaller symptoms. This has both benefits and downfalls. This awareness means that women are more likely to seek help for ill health sooner, meaning they can get it under control more quickly. Meanwhile men are less likely to seek help until much later, making treatment more complex when they do reach out. However, this also means that women are more inclined to worry about their health, and therefore are more susceptible to negative thoughts about their pain. Women are therefore more likely to be hypervigilant (meaning being overly focused on their pain) and to catastrophize (meaning worry excessively) about their pain.
How we perceive chronic pain has a big impact on pain levels and quality of life. Negative perceptions of pain, being hypervigilant and catastrophizing about pain can reinforce pain signals, essentially telling your brain that it should continue producing pain. It can also contribute to the stress and pain cycle. Negative thoughts often lead to maladaptive (unhelpful) behaviours which are actually detrimental to chronic pain management.
The hormones in a female body obviously differ from those within a male body. Hormones can have a significant effect on many factors, including how the body processes pain. The receptors for sex hormones, such as estrogen, progesterone and testosterone, are in the same areas of the nervous system as those which pick up and transmit pain messages. It therefore makes sense that hormones would have an influence on pain levels and how pain is processed.
Testosterone is anti-nociceptive, which means that it essentially blocks or lessens the effects of external painful stimuli. Levels of testosterone are much higher in men, which contributes to them experiencing less severe pain levels than women in response to the same stimuli.
The menstrual cycle has an impact on how women process pain. The hormones released at various stages of the menstrual cycle affect so many aspects, including mood and stress levels. As hormone levels change during the cycle, tissues, muscles and the skin respond differently to stimuli, becoming more or less sensitive. During the luteal phase (which is the stage of the menstrual cycle after ovulation before the period starts), pain sensitivity is heightened. During ovulation and just after the period, women also seem to be more sensitive to pain as this study discusses. Reproductive hormones can also increase inflammation within women. Inflammation is a big contributor to increasing pain levels and other associated symptoms of chronic pain.
Role beliefs and stigma
Women are more likely to report pain than men and to seek help. This could be attributed to gender stereotypes. Men are more likely to feel that they need to appear strong and ‘power through’ their pain, while women are more inclined to express their emotions and ask for assistance. This study explains that, “Boys are taught to be less expressive about illness and discomfort, to be more stoical, and to use more denial”.
These masculine and feminine roles often result in females being more likely to seek help, both from medical professionals and from loved ones, while men feel they need to bottle things up. This can result in women having more effective coping strategies for their chronic pain symptoms.
Stigma both from society and from medical professionals can contribute to these role beliefs and affect how men and women seek treatment and deal with chronic pain. The way we cope with and manage our chronic pain has a big impact on quality of life and how severe our symptoms are. When we employ effective strategies, we can reduce our symptoms and live a full, functional life. This study states that, “males reporting more use of behavioral distraction while females rely more on social support and positive self-statements.”
In the doctor’s office men are less likely to be diagnosed with chronic pain, because many medical professionals view it as a ‘women’s illness’ and so may be reluctant to diagnose men as such. However men are taken more seriously in relation to health complaints in general than women, while women are often dismissed or thought of as ‘over exaggerating’. Men are more likely to be referred for tests to figure out what is causing their pain, while women are more likely to be repeatedly misdiagnosed. This study found that men are more likely to be given painkillers while women are more likely to be given sedatives or diagnosed with a mental health condition.
These differences in treatment are of course going to have an impact on each gender’s experience of pain. If men are less likely to seek treatment for their pain, they may struggle on silently for longer. However when they do seek treatment they are likely to be taken more seriously and given the treatment they need. Whereas while women asking for help early on should be a positive point, having their pain invalidated and not being given the treatment they need can actually contribute to stress and in turn worsen their experience of pain.
These roles of masculine and feminine are often ingrained into us as we grow up and what we learn from the world around us. Thankfully this is changing all the time and we are gradually creating a society that can break away from these gender roles, allowing people to be who they really are and express their true selves freely.
Women are more likely to struggle with anxiety and depression, being 2 to 3 times more likely to struggle with these disorders as this study describes. This has a significant impact on our levels of chronic pain. Mental illness can also feed into maladaptive (negative) thought patterns and behaviours. When we are mentally ill, we are less likely to keep up with treatment and to practice self care. We’re more likely to withdraw from activity and isolate ourselves socially, which can also contribute to physical deconditioning.
Women are more likely to have experienced trauma in childhood. Trauma at a young age has been linked in many studies to chronic pain in adulthood. This study explains one assumed reason behind this, stating, “This link may be driven by hypothalamus–pituitary–adrenal axis abnormalities and/or neuroendocrine dysregulation caused by the initial trauma”
Emotional trauma in childhood and through the formative years, as well as physical abuse, can lead to mental illness. As we mentioned earlier, the symptoms of mental illness can perpetuate and worsen chronic pain, contributing to the pain and stress cycle as well as making maladaptive pain coping behaviours more likely.
Women are also, “8 to 25 times more likely” to experience trauma and abuse in an adult relationship than men, as this study mentions, which again can perpetuate the chronic pain cycle. The same study goes onto explain the severity of the impact this trauma in adulthood can have: “interpersonal violence obviously results in more acute trauma and injury, as well as in more chronic symptoms such as headaches, chronic pain, menstrual symptoms, sleep disorders, gastrointestinal symptoms, and more somatization.”
Reaction to pain medications
Pain medications, most notably opioids, are processed differently within men and women. Women are more likely to get more effective pain relief from opioids than men. There are opioid receptors within the brain which process the medication and use it to modulate pain. There are 3 of these receptors for opioids, with one being the most researched and thought to be the most significant. Many studies have shown that this most important receptor is more active in women as this study conveys, “Human experiments consistently show that µ opioids have increased potency in females”
This means that women are likely to be able to take lower doses of opioids, which therefore results in fewer side effects. Meanwhile men may need to take a higher dose to get the same effect, and could end up struggling with multiple side effects.
What does this really mean?
These differences do not mean that women are weaker, or that men are stronger. Nor does it mean that men’s experience of pain is not severe or as valid as women’s. There are many variables which contribute to how an individual experiences pain and how it affects their lives. Pain is fundamentally subjective, and the levels of suffering that pain patients go through is dependant on many factors. These gender differences also do not mean that anyone’s experience of chronic pain is ‘lessened’ or invalid. Everybody’s experience is valid. Chronic pain is very real and debilitating, regardless of gender.
However the more the medical community understands the link between gender and how our bodies process pain, the more likely they are to develop appropriate treatments. Going forward as more research is done into gender differences, it should shape clinical practice for chronic pain so that pharmacological and psychological treatments can be tailored to give the optimum results for each individual. This study sums that point up nicely: “our findings suggest the need to tailor rehabilitative strategies differently for men and women”.
Stigma must be broken down so that both genders are given access to the treatments they deserve. Medical professionals must be educated in regards to how to treat patients with chronic pain in general as well as specifically how to treat men and women. Compassion, knowledge and validation must take the place of misdiagnosis, invalidation and untreated chronic pain.
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- Sari M. van Anders, Jeffrey Steiger, Katherine L. Goldey, (2015), “Effects of gendered behavior on testosterone in women and men” Proc Natl Acad Sci U S A; 112(45): 13805–13810
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Please note: This article is made available for educational purposes only, not to provide personal medical advice.