There have always been myths and fairy tales regarding the different ways in which men and women feel pain. Some statements are based on observation, assumption or even prevailing attitudes. For example, men are traditionally considered tough and robust when it comes to pain, because, as so-called «hunters», they were exposed to numerous dangers and were used to pain. Today, however, men are often made fun of for overreacting to little things like getting the sniffles. «If men had to give birth, humans would already be extinct by now» – this is probably one of the harshest accusations made by women against men. So, is the perception of pain a social issue or can it be explained medically? Are there any differences at all between men and women in terms of their perception of pain? The publication of the Federal Health Survey at the end of the 1990s1 marked the beginning of the era of gender-specific pain research.

According to this study, pain is generally a widespread discomfort in everyday life. However, women are more often affected by pain than men. Over a one-year period, 12% of men reported having had no pain, but only 6% of women did. Now, this could be due to different opinions on pain. But it isn’t. One person who deals with this phenomenon on a daily basis is Professor Hartmut Göbel. He is a neurologist and specialist in pain therapy, a qualified psychologist and head physician of the Kiel pain clinic. The reality is even clearer to him, in practice: 70% of patients are women and only 30% are men.

There are different observations regarding pain type. For example, tension headaches occur equally often in both sexes. But migraines are clearly experienced more often by women. It’s the same with back and neck pain, which are experienced more by women, with neck pain, in particular, being more common among them.2 According to a recent survey2 by the Robert Koch Institute, 66% of women have experienced back pain in the past 12 months (men: 56.4%) and 54.9% have experienced neck pain (men: 36.2%).

Anatomy, head or hormones

The causes of different pain sensations are a hot topic of scientific discussion. There does not seem to be just one physical component influencing the perception of pain. Anatomically, it should be noted that women have less musculature and muscle strength than men. This could play a role. Research has clearly highlighted the differences in the perception and processing of pain. Brain scans using positron emission tomography (PET) have shown that male and female brains react differently to the same pain stimuli. In women, the limbic system, which is responsible for the emotional nuance of pain, is activated more strongly than in men. The male brain shows increased activity in the cognitive and analytical areas of perception in response to pain stimuli.

Clearly, sex hormones also play a significant role. Hormonal changes during pregnancy lead to insensitivity to pain. The woman’s nervous system, under the influence of hormones, seems to be geared towards protecting her from pain to the maximum extent possible during pregnancy and childbirth. Women in ‘different circumstances’ are also particularly protected from migraines. Prof. Göbel reports that women who underwent gender reassignment surgery now experience significantly less pain as a result of testosterone therapy. It is not the absolute hormone level that seems to be relevant, but rather hormone fluctuations, as the Italian team Pieretti et al points out in a recent review.3

Lower pain thresholds for pressure and heat

The German Pain Society suggests that women rate the intensity of pain higher than men when a heat or pressure stimulus is applied.4 They endure the pain for less time and, for example, pull their arm away earlier after a pain stimulus than men, even though the pain stimulus was equally strong. Pain sensors seem to be more sensitive in women.

Women talk about pain differently

Men and women don’t just have different sensations of pain. They also talk about it differently. While men often find it embarrassing to openly show their pain, women are quicker to talk about their fear and irritation, and communicate these feelings to those around them. Women describe what their pain means to them and how it hinders them. Men, on the other hand, more often try to solve the problem themselves. They describe their pain and explain its origin.

Important for everyday clinical practice

Most women are generally also more open to asking for help. They seek support, are open to taking medication and go to the doctor earlier than men, according to a study by Scottish scientists.5 Men more often ignore pain and try to reinterpret its causes. They try to solve the problem themselves. Surprisingly, women are often not taken seriously when it comes to treating pain. Is it that they complain too much? In any case, for everyday clinical practice, it’s important to consider women carefully. They are more sensitive to pain – and they experience it more often and at stronger levels. As for men, they need to be asked more often where the pain is -– without making a big deal of it. Early and effective treatment – that does not necessarily need to be complicated – can help avoid chronic conditions.


Big little differences from A to Z: 10 things to know about gender medicine


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Hofmann, Annegret und Rolf

Frauenmedizin - Männermedizin. Der kleine Unterschied ist grösser als gedacht.
(Male and female medicine. The little differences are bigger than you think.)

Goldegg Verlag GmbH, 2021


Döll, Michaela

Frauenherzen schlagen anders: Warum Frauen in der Medizin falsch behandelt werden und wie sie die richtige Therapie bekommen. Das Buch zum Thema Gender-Medizin.
(Women’s hearts beat differently: Why women receive false medical treatment and how they can get the right therapy. The Book about Gender Medicine.)

mvg Verlag 2020


Vera Regitz-Zagrosek, Stefanie Schmid-Altringer

Gendermedizin: Warum Frauen eine andere Medizin brauchen.
(Gender medicine: Why women need a different kind of medicine.)

Scorpio Verlag, 2020


Donatella Lippi, Raffaella Bianucci, Simon Donell

Gender medicine: its historical roots.

Postgraduate Medical Journal, 2020 Aug;96(1138):480-486


Marek Glezerman

Gender Medicine.

Duckworth Overlook, 2017


Amber Dance

Why the sexes don’t feel pain the same way.

Nature 567, 448-450, 2019 


Jaunin-Stalder, Nicole und Mazzocato, Claudia

Hommes et femmes: sommes-nous tous égaux face à la douleur?
(Men and women: are we all equal when it comes to pain?)

Revue Médicale Suisse 2012;348


Vidal, Catherine und Salle, Muriel

Femmes et santé, encore une affaire d’hommes?
(Women and health: another men’s issue?)

Belin, 2017



Federal Health Survey of 1998). Bundesgesundheitsbl-Gesundheitsforsch – Gesundheitsschutz 2000;43: 424-431.


von der Lippe E, Krause L, Porst M, et al. Prevalence of neck and back pain in Germany. Results of the medical study BURDEN 2020. J Health Monitoring 2021;6(S3): doi: 10.25646/7854


Pieretti S, Di Giannuario A, Di Giovannandrea R, et al. Gender differences in pain and its relief. Ann. Is. Super. Sanita 2016;52(2):184–189.


Pogatzki-Zahn E. Schmerz bei Frauen und Männern (Pain in men and women)., accessed: 13/12/2021


Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth 2019;123(2):e273–e283.


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