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 normalization of women’s pain have on treatment?

If we’re really to understand the differenc­es, we need to move beyond simplistic gener­alizations—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.

Scientific inertia

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 trivialized, ig­nored, or left to stereotypical preconcep­tions to define.

Edmund Keogh is a Reader in Psychology at the Uni­versity of Bath.

By Edmund Keogh