Pain – a matter of gender?

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

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.

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.

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.