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Sex differences in pain
Abstract
Are there sex differences in pain? For experimentally delivered somatic stimuli, females have lower thresholds, greater ability to discriminate, higher pain ratings, and less tolerance of noxious stimuli than males. These differences, however, are small, exist only for certain forms of stimulation and are affected by many situational variables such as presence of disease, experimental setting, and even nutritive status. For endogenous pains, women report more multiple pains in more body regions than men. With no obvious underlying rationale, some painful diseases are more prevalent among females, others among males and, for many diseases, symptoms differ between females and males. Sex differences in attitudes exist that affect not only reporting, coping, and responses to treatment, but also measurement and treatment. So many variables are operative, however, that the most striking feature of sex differences in reported pain experience is the apparent overall lack of them. On the other hand, deduction from known biological sex differences suggests that these are powerful sex differences in the operation of pain mechanisms. First, the vaginal canal provides an additional route in women for internal trauma and invasion by pathological agents that puts them at greater risk for developing hyperalgesia in multiple body regions. Second, sex differences in temporal patterns are likely to give rise to sex differences in how pain is "learned" and stimuli are interpreted, a situation that could lead to a greater variability and wider range of pains without obvious peripheral pathology among females. Third, sex differences in the actions of sex hormones suggest pain-relevant differences in the operation of many neuroactive agents, opiate and nonopiate systems, nerve growth factor, and the sympathetic system. Thus, while inductive analysis of existing data demonstrate more similarities than differences in pain experience between females and males, deductive analysis suggests important operational sex differences in its production.
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“However, because females on the whole have fewer experiences that inure them to fear of self-injury (e.g., exposure to guns, physical fights, violent sports, etc.), and because they have lower pain and fear tolerance than males (Berkley, 1997), they may be less able to develop the acquired capability for suicidal behavior than are males.”
From The interpersonal theory of suicide. (2010) · cites this paper as Berkley, 1997
In the citing paper
“Basic research in laboratory environments show that women are more sensitive to pain [14–16]”
From Chronic pain and sex-differences; women accept and move, while men feel blue (2017) · cites this paper as [14]
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Metadata
- Authors
- Berkley, K. J.
- Affiliations
- Florida State University (US)
- Corresponding author
- Berkley, Karen J.
- Venue
- Behavioral and Brain Sciences
- Publisher
- Cambridge University Press (CUP)
- Published
- 1997-09
- Volume
- 20
- Issue
- 3
- Pages
- 371-380
- ISSN
- 0140-525X (ISSN-L)
- 1469-1825
- OpenAlex
- W2168132586
- Cited by
- 1,125
- References
- 0
- Citations by year
- 2026: 8 · 2025: 17 · 2024: 30 · 2023: 31 · 2022: 42 · 2021: 32 · 2020: 27 · 2019: 32 · 2018: 28 · 2017: 30 · 2016: 39 · 2015: 33 · 2014: 44 · 2013: 48 · 2012: 39
- FWCI
- 14.24
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavioral and Brain Sciences (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- sex differences in pain, pain perception, pain threshold, pain tolerance, sex hormones, hyperalgesia, opioid system, nerve growth factor, sympathetic nervous system, pain coping, pain reporting
- MeSH terms
- Adult, Female, gamma-Aminobutyric Acid, Humans, Male, Middle Aged, Nerve Growth Factors, Pain, Pain Measurement, Sex Characteristics, Sex Factors, Gonadal Steroid Hormones, Sympathetic Nervous System
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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