By Edmund Keogh, University of Bath
It’s a commonly held belief that women are better able to tolerate pain than men. The reasoning behind this is often that women are built to withstand pain because of how frequently they experience pain in their lives from events such as periods and childbirth. On the other hand, when a typical man gets a cold he’s often laughed at for suffering a bout of “man-flu”.
There are clear and consistent gender differences in the perception and experience of pain. But are such views really a helpful way of thinking about men and women’s pain? After all, men will never experience period pain or childbirth, so why are we speculating how they would cope in such a situation? Why do we dismiss male pain responses as exaggerated and trivial, and what effect does the normalisation of women’s pain have on treatment?
If we’re really to understand the differences, we need to move beyond simplistic generalisations.
Science fact not fiction
Surveys and clinical studies have confirmed that women actually experience more pain, with greater frequency and intensity. They take more painkillers, suffer more from common pain-related conditions such as migraine headache and musculoskeletal disorders, and visit their physician more often with pain-related complaints. Interestingly, there may also be gender differences in responses to some analgesics, including possible side effects.
However, lab-based studies also find men demonstrate a higher pain threshold (the point at which you first detect pain) and higher tolerance to pain, compared to women. This doesn’t mean that men are immune from pain and pain-related suffering – of course not – but they do point to women being particularly vulnerable to pain. However, there is still a lot we don’t know around the impact this has and how this may affect pain treatment.
Subjective and biological
Pain is subjective – and diagnosis requires you to say how much pain you are in, where it is located and so on. So the gender differences reported in some studies, like the ones above, could therefore be down to a reporting bias – in that men simply don’t like to admit to being in pain and only turn to their physician when it gets really bad. Men are still often expected to suppress certain emotions and action, such as crying for example, and these beliefs may also affect how pain is expressed, viewed and responded to.
But explanations for such gender differences in pain are more than a social construction based on gender stereotypes. There is evidence that there are biological mechanisms at work, especially hormonal factors. For example, gender differences in the incidence of some painful conditions, such as temporomandibular disorder, which affects the jaw joint, and headache, are more pronounced during the reproductive years. Research has also shown that pain sensitivity, the disruptive effects of pain, as well as symptoms associated with certain pain conditions, can all vary across the menstrual cycle. Explanations are therefore going to be multifaceted, and will reflect both biological and psychosocial influences.
Despite these gender differences being consistently reported in research, there is still considerable inertia in the wider scientific community around the issue. Historically, females have been excluded from clinical trials and even today, few studies are actually designed with gender differences in mind. “Female pain” is often seen as normal, and ironically this could be why it has not been taken more seriously. Worryingly, many studies that do acknowledge gender differences statistically control for them, rather than look at them as an important outcome in their own right.
Steps are being made to change this indifference to gender but unfortunately this is being done more by stick than by carrot. Some national funding agencies stipulate that studies need to consider possible male-female differences, and some leading academic journals require authors to report relevant analysis.
It’s also equally important that when we find similarities as well as differences between men and women these are reported as well. There is, after all, going to be variability within the sexes, which point to other moderators of pain, such as age.
We also need to go beyond mere description – we not only need to know when differences occur, but why they occur, and what the implications might be. Pain affects all our lives, with the staggering costs associated with pain and its treatment predicted to rise. Knowing more about how we all experience pain and the different types of pain we have needs to be fully considered, rather than trivialised, ignored or left to stereotypical preconceptions to define.
Edmund Keogh receives funding from Reckitt Benckiser Healthcare (UK) Limited, and Engineering and Physical Sciences Research Council.