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This suggests sex differences in central processing of nociceptive information. Table 7 also presents information about 3 studies that examined sex differences in spatial summation. Unlike temporal summation, no differences have been observed between males and females with spatial summation of heat pain88,238 or cold pain.268 Lack of sex differences might be related to the fact that spatial summation was either measured or reflected only for pain threshold in these studies, and sex differences in suprathreshold measures are often more robust than for threshold. Moreover, sample sizes were relatively small in all of these studies, which may have reduced the ability of these studies to detect sex differences. Nonetheless, the currently available data suggest no sex differences in spatial summation of pain, though additional studies with larger sample sizes would increase confidence in this conclusion. Finally, sex differences in temporal summation have also been demonstrated in clinical samples.

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First, without compelling scientific justification limited research to one sex or the other, both preclinical and human studies should routinely include subjects of both sexes. The NIH requires this for human studies; however, nonhuman pain research continues to eschew females.32,283 Given that the clinical pain conditions to which preclinical research is intended to apply are female-predominant, one could argue that preclinical research that excludes females is incomplete at best and invalid at worst. Moreover, clinical studies, which typically include participants of both sexes, should consistently analyze for sex differences and report the findings, whether positive or negative. This would help overcome publication biases, which could overestimate sex differences based on the reduced likelihood of reporting negative findings. Another important conceptual and analytical concern is the distinction between qualitative and quantitative sex differences.

Several authors have reported pain prevalence for multiple sites within the same sample and allow a less biased opportunity to compare the magnitude of sex differences across pain sites. A nationwide study of Swedish students in grades 3, 6, and 9 compared the 7-day prevalence of headache, abdominal, and musculoskeletal pain.49 Girls were more than twice as likely as boys to suffer from headaches (17%, 8%). Abdominal pain was experienced weekly by 10% of the girls and 5% of the boys with sex differences significant only in grades 6 and 9. There were no sex differences for musculoskeletal pain, but prevalence increased with age for girls. It provides a platform for users to engage in intimate conversations and explore their sexuality in a safe, private, and controlled environment.

Because of strong interests in public health, most epidemiological data on pain conditions come from Europe and particularly the Scandinavian countries. However, we have attempted to select studies from a range of geographic regions and cultures. Attention, memory, and spatial ability are key cognitive functions affected by testosterone in humans. Preliminary evidence suggests that low testosterone levels may be a risk factor for cognitive decline and possibly for dementia of the Alzheimer’s type,[47][48][49][50] a key argument in life extension medicine for the use of testosterone in anti-aging therapies. Much of the literature, however, suggests a curvilinear or even quadratic relationship between spatial performance and circulating testosterone,[51] where both hypo- and hypersecretion (deficient- and excessive-secretion) of circulating androgens have negative effects on cognition. Male sex differentiation is known to require a delicate dosage balance among male determining genes, including SOX9.

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• Several studies have examined potential sex differences in outcomes of treatments for back pain.
• A study of third- and fifth-grade children in Finland found that 32% reported a weekly musculoskeletal pain with significantly more girls reporting pain in chest (7%, 4%) and in the upper back (8%, 5%) compared with boys.278 Sex-related differences were not found for the lower back and neck pain.
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The findings appear to indicate that females exhibited an increase in their pain tolerance when given the expectation that women would tolerate the pain for a longer time, whereas males showed similar pain tolerance regardless of expected tolerance time. Another study examined the effects of high versus low monetary incentives on pain tolerance among females and males, anticipating that high external incentives would produce stronger effects among females, because males possess higher endogenous motivation to tolerate pain.257 However, the incentive manipulation had no effect on pain tolerance for females or males. In addition to the above findings addressing sex differences in responses to μ-opioid agonists, others have investigated analgesic responses to mixed-action opioid agonist-antagonists among women relative to men.

A number of recent studies have tested for sex differences in chronic musculoskeletal pain at any site. In one study, women reported significantly higher ratings of worst and current pain intensity but there were no differences on the rating for least pain.351 We review evidence regarding several specific types of musculoskeletal pain, including back pain, widespread pain/fibromyalgia, and osteoarthritis. Research regarding sex and gender, differences in pain has increased substantially in recent years. As Fig 1 depicts, publications regarding sex, gender, and pain have increased at a much greater rate over the past 25 to 30 years relative to the pain field in general.

We have attempted to thoroughly, if not comprehensively, review the recent literature regarding sex differences in clinical pain, experimental pain sensitivity, and response to pain treatment, and several conclusions can be confidently drawn from the available evidence. First, the prevalence of most common forms of pain is higher among women than men, and women report greater pain after invasive procedures than men, though these findings are less consistent. Second, compared with men, women display enhanced sensitivity to most forms of experimentally induced pain (with the exception of is-chemic pain).

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Using this approach, Hamberg and colleagues177 found that when the neck pain case was a woman, female and male medical students were more likely to provide nonspecific somatic diagnoses, address psychosocial variables in the history, and to prescribe analgesic and psychoactive medications. This review of recent clinical and epidemiologic findings generally indicates that women are at increased risk for many chronic pain conditions, and women tend to report higher levels of acute procedural pain. These sex differences appear smaller (or nonexistent) in children and appear to emerge or increase in magnitude during adolescence. Inevitably, these sex differences in clinical pain are driven by multiple biopsychosocial factors, which will be discussed below. We have previously suggested that sex differences in nociceptive processing, which would be manifested in responses to experimentally induced pain, represent one potentially important contributing factor.