The gonadal hormones are not only necessary for reproduction; in reality there is no body region or circuit that is not affected by them. Scientists may not know the exact mechanisms by which sex hormones influence pain perception, but to cite a few, sex hormones may affect metabolism (this has implications for medication use), the immune system, trauma-induced inflammation and the nervous system.
Beyond hormones, research has shown that women metabolize and react differently to certain drugs as well, and this may be due to differences in our genes. Of note, biological mechanisms (i.e. gonadal hormones) become less apparent in the post•menopausal years.
How about our psychological make-up, how does it underlie differences between men’s and women’s approaches and attitudes towards pain? In general, men and women have different coping strategies when it comes to stress. Men are known to concentrate more on problem-solving strategies while women pay more attention to interpersonal and emotional aspects of the situation.
Pain is certainly a stressor to the body and mind and our different coping strategies influence pain perceptions. Interestingly, not only do men and women feel pain differently, but they also express their pain differently to others. Studies show that when it comes to pain, women rely more on social and emotional support than men. When evaluating a painful situation, more men than women feel that they are “in control” of what is happening to them and they report low levels of pain and less “catastrophizing” (see my previous column on fibromyalgia and catastrophizing as an example).
Catastrophizing is defined as the tendency to interpret an experience as a “disaster” and comes together with feelings of lack of control, excessive worry about the future and a sense that life is “too much to bear”. As research studies have shown “catastrophizing” contributes significantly to increased pain perception and affects how well we respond to pain treatments. Women tend also to report more psychological distress than men in general. Depression, anxiety and other mental health conditions (some of which are more prevalent in women) further contribute to the different ways men and women experience pain.
We are now coming to the third pillar of my analysis. What about psychosocial and environmental influences that affect pain perception, such as our family, the place where we live, work and socialize and our cultural background? I use the word “sex” to refer to biologically determined aspects of our existence as men and women, while I use the term “gender” to refer to socially and culturally shaped traits such as femininity and masculinity, which are socially modifiable.
Gender and ethnicity/culture are parts of our personal identity. While being a man or a woman is a matter of biology, our social environment contributes to shaping our gender. Some psychologists propose that we develop our sense of male or female gender through learning processes such as modeling, imitation, reinforcement and punishment. Others insist that we acquire our female or male gender by conforming to cultural stereotypes for these traits.
Gender traits may develop early in life or later on, depending on the circumstances. When it comes to pain and the way we react to it, there is no question that gender role expectations and social role modeling of pain may interact early in life. Gender stereotyping plays an important role in shaping our own ideas about our manliness or femininity and also in shaping our reaction to the opposite sex.
