Ask the Doctor: How Men and Women Experience Pain Differently

Editor’s Note: Dr Mailis-Gagnon will be writing for CARP Action Online on a semi-regular basis. Should you have any questions about pain please write to us at [email protected]. We will try to integrate some of your concerns in Dr. Mailis- Gagnon’s future columns.

In this column and a few more future columns I will tackle special populations and groups and the different ways in which they relate to pain. I will start by talking the different ways men and women experience pain.

We have spent many years pursuing equality of the sexes. At the same time, over the last couple of decades, scientists have agreed to investigate and accept potentially important differences between men and women. What they have learned is that men and women experience and process pain very differently.

Recent studies show that women generally experience more recurrent pain, more severe pain and longer lasting pain than men and present with higher rates of several conditions such as: headache, neck, shoulder, knee and back pain where the female to male ratio is around 1.5:1; for orofacial pain conditions the ratios are about 2:1; for migraine headache the ratio is 2.5:1; and for fibromyalgia the gender ratio is over 4:1.

Up until the age of 65, women are more likely to experience pain than men, particularly when it comes to pain in multiple regions of the body. On the other hand, men experience multiple painful conditions at higher rates than women. Examples of these conditions include: cluster headache, coronary heart disease, gout, ankylosing spondylitis, duodenal ulcer, pancreatic disease and others.

We also know that men and women use health care services differently. While women use these services all types of diseases, including pain services, men are more reluctant to do so. Women are also more likely to comply with their doctor’s advice. One study showed that women were 3.6 times more likely to listen to the advice of their doctors when the doctor prescribed certain activities than men were.

This is no surprise to me as I know how men feel about “going to the doctor” far too well from a cultural point of view (I was born and raised in Greece before I came to Canada many years ago), as well as from all the clinical experience I have had with my patients.

What may account for the observed differences in prevalence of pain conditions, attitudes and behaviours of men and women? The bio-psycho-social model of pain that I referred to in early columns, serves me well in exploring this topic as well. To understand the differences between men and women, we should look then at biology, psychology as well as our environment.

From the biological point of view one of the most obvious factors behind sex differences and pain, relates to our anatomy and our hormones. The sex (gonadal) hormones in male and female animals as well as in humans are called androgens (secreted primarily by the testes in men) and estrogens (secreted by the ovaries primarily in women).