More research is needed to further characterize the contribution of gender roles to the relationship between sex, gender, and pain. The results from 22 studies that examined sex differences in experimental heat pain are presented in the upper portion of Table 6. All of the studies used some form of contact heat with the exception of one study that used hot water immersion.360 Also, the forearm was the most common site for stimulus application. The vast majority of studies reported that females were more sensitive to heat pain than males. For the studies examining behavioral measures of heat pain sensitivity, 81% (12/17), and 94% (15/16) of the studies reported lower thresholds and tolerances, respectively, in females. Females were also found to rate heat pain as more intense and unpleasant in the majority of studies that included a suprathreshold protocol (7/9, 78%), and one study found that females required lower temperatures to evoke moderate pain.411 Overall, the hypothesis that heat pain sensitivity differs as a function of sex has been supported.
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Sex differences in experimental pain have been evaluated using a wide range of stimulus modalities including pressure, electrical, ischemic, thermal, and other models of experimental pain (eg, chemical). Dynamic models of experimental pain have been used to engage systems underlying summation and inhibition of pain. Pain sensitivity has been assessed by a number of different outcome measures including behavioral indices of threshold (defined by time or intensity to the first sensation of pain) and tolerance, and self-report measures of pain intensity and unpleasantness. Previous reviews have concluded that females are more sensitive to pain compared with males.127,327 The following review will determine whether more recent studies continue to support this conclusion.
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- Most patients have normal male phenotypes at birth, and are usually diagnosed in late adolescence because of delayed puberty, gynecomastia, or infertility2).
Riley and colleagues326 found that for most orofacial pain symptoms, significant sex differences in pain ratings were found within the middle aged (45- to 64-year-old) cohort but not the older (65+) group. A Dirty Talk AI is an AI-powered chatbot that allows users to engage in a realistic sexting experience to its users beyond traditional AI chat applications. Dirty Talk AI allows users to indulge in naughty conversations with AI characters and send text messages expressing their desires and fantasies. Taken together, these findings from studies of musculoskeletal pain indicate that regardless of site or time frame, females consistently are more likely to report musculoskeletal pain than males, though these differences may be less consistent for low back pain. There is limited evidence for increased pain intensity among women with the possible exception of OA, where greater pain severity among women is more common. There is limited evidence that women with musculoskeletal pain are more likely to be depressed than men.
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- 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.
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It can be classified into two subgroups, SRY-positive or SRY-negative, according to the presence or absence of the sex-determining region Y (SRY) gene. Approximately 80% of patients with 46,XX testicular DSD have SRY on one of two X chromosomes, which results from abnormal chromosomal translocation during gametogenesis. However, the remaining 20% of individuals with 46,XX testicular DSD are SRY-negative, and the cause of this condition is largely unknown1). Most individuals with 46,XX testicular DSD with SRY have normal genitalia and are usually not diagnosed until puberty does not proceed normally. However, SRY-negative individuals are more likely to have ambiguous genitalia than SRY-positive individuals. Therefore, 46,XX SRY-negative individuals showing complete male genitalia are quite rare2).