Pain is the primary reason that people of either sex seek medical care. Most of the time, a person who ends up in the ED is in pain—whether it’s from an acute condition like heart attack or appendicitis, a trauma injury like a broken bone, or something not yet diagnosed like Margaret’s vulvar pain. Pain is the way our bodies tell us that there’s something wrong.
You might think that because it’s present across the spectrum, pain would be treated equally regardless of sex or gender. But this is demonstrably untrue. In fact, the way people receive care for pain is sharply divided between the sexes.
Women are less likely to receive adequate treatment for their pain. They are less likely to receive pain medication in a timely manner and at an appropriate dose. And they are more likely than men to receive a psychiatric diagnosis when they report pain symptoms.1 (Yes, the anxiety misdiagnosis rears its head again here.)
It’s been demonstrated that women have both a lower pain tolerance and a lower pain threshold than men. They are more likely to have higher pain scores than men for the same conditions, are more likely than men to report both acute pain and chronic pain, and are more likely to seek treatment for their pain.
Such facts are often tossed around in medical circles to minimize women’s pain—to write women off as overly sensitive or brand them as attention-seeking—but I have the opposite view. I think the flaw is in our knowledge, research, and protocols. The fact is, we don’t fully understand the differences in how men and women experience pain—so expecting the genders to be equivalent is an exercise in faulty reasoning.
The only tools we have to evaluate pain are subjective. Yes, we can measure vital signs—like heart rate, breathing rate, and blood pressure—but these aren’t reliable indicators of pain. They only get us in the ballpark. The rest of our pain evaluation protocols include pain scales (“On a scale of one to ten, your pain is…”) and visual analog tools (“Pick the emoji that corresponds to your pain level”). These are communication tools but hardly useful for gathering objective data.
Even the research quoted to prove that women have a lesser pain tolerance than men was based on observing people of different sexes whose hands and arms were plunged into buckets of ice water or whose fingers were attached to electrical stimulation equipment.2 Women described the pain as having reached “intolerable” levels before men did and therefore were determined to have a lower pain tolerance than men, who stayed with the sensation longer. However, does this behavior actually determine tolerance? Or do women simply have more sensitivity on multiple levels to sensation that might result in the loss of life or limb? Were women’s brains making the connection that “this pain might damage me,” evaluating the possibility of lasting repercussions, and retreating from the pain based on a series of connected mental and physical factors? Or were they simply less tolerant of the cold? It’s impossible, at this juncture, to guess with any certainty, but these are interesting questions.
Furthermore, it’s been my observation and Furthermore, it’s been my observation and experience—and this, too, is subjective—that women are, for the most part, simply more attuned to their own bodies than men are. This may be a function of our biological ability to bear children (and our need to sense their growth within us) or simply the way our nervous systems are wired. Whatever the reason, women are more likely to notice symptoms when they first appear and seek treatment more frequently and earlier than men—as if they are hearing their bodies whisper, “Something’s not right.” Men, on the other hand, seem to be more likely to ignore symptoms and/or resist seeking treatment, in part because of the persistent gender-based expectation that they will “act manly” and “suck it up.” This is supported by sports literature around concussions; men will often refrain from telling their coaches about possible head injuries because they don’t want to be taken out of the next play.
Unfortunately, I’m in the minority with my viewpoint on gender differences. In the eyes of far too many practitioners in my field, it’s a clinical fact that women simply are more likely to report pain—aka, more likely to “complain”—than men; therefore, their pain is often treated as less serious. As you can imagine, this has significant consequences for women, particularly those with chronic pain or pain disorders.
I consider it a big part of my job to educate other medical providers about the sex and gender differences we do understand about pain and pain pathways and—since pain is such a huge factor in when, why, and how people seek medical treatment—to help them take these differences into account when serving their patients. It’s our responsibility to be open to new data about the differences in pain responses, pathways, and treatments between the sexes and to change our approach accordingly—even if that means challenging our own long-held beliefs.
- Laura Kiesel, “Women and Pain: Disparities in Experience and Treatment,” Harvard Health Blog, October 9, 2017, https://www.health.harvard.edu/blog/women-and-pain-disparities-in-experience-and-treatment-2017100912562; Roger B. Fillingim et al., “Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings,” Journal of Pain 10, no. 5 (2009): 447–485. doi: 10.1016/j.jpain.2008.12.001; Bruce Becker, MD, and Alyson J. McGregor, MD, MA, “Article Commentary: Men, Women, and Pain,” Gender and the Genome, 46–50. https://doi.org/10.1089/gg.2017.0002.
- Justin L. Hay et al., “Determining Pain Detection and Tolerance Thresholds Using an Integrated, Multi-Modal Pain Task Battery,” Journal of Visualized Experiments 110 (2016): 53800. doi: 10.3791/53800.