Sex Differences in Health: Evidence and Explanations 383or magnify the problem in response to pain,
and catastrophic thinking (i.e., feeling helpless,
pessimistic) has accounted for some sex differ-
ences in pain reports (Hurley & Adams, 2008).
Social factors, too, may influence reports
of pain. Family members who experience and
frequently express pain may serve as “pain
models” for children. In one study, women re-
ported a greater number of pain models than
men, and pain models were associated with
reports of greater pain symptoms (Koutantji,
Pearce, & Oakley, 1998). Reports of pain are
also vulnerable to demand characteristics.
When college students were exposed to an
inert substance and led to believe that they
would experience physical symptoms, physi-
cal symptoms increased for women and men
only when a same-sex confederate displayed
those symptoms (Mazzoni et al., 2010).
Gender roles affect pain reports. The
male gender role is associated with strength
and emotional inhibition, both of which are
consistent with minimizing reports of pain.
During childhood, boys learn they should be
tough and not admit pain. We applaud the
male athlete who “plays through the pain.”
Greater identification with the male role has
been associated with higher pain tolerance
(Pool et al., 2007; Reidy et al, 2009), whereas
feminine traits have been associated with
greater pain reports (Bernardes, Keogh, &
Lima, 2008). One study showed that gender
stereotypes regarding men’s and women’s
willingness to express pain (i.e., the idea that
men are less willing than women) accounted
for women’s greater reports of pain compared
to men in response to a laboratory pain stim-
ulus (Robinson et al., 2004). Reports of pain
are also vulnerable to the demand character-
istics of the situation. In one study, the sex of
the experimenter was manipulated and in-
fluenced pain reports (Gijsbers & Nicholson,
2005). Men had higher pain thresholds in the17 countries—developing and developed—
women report more chronic pain conditions
than men (Tsang et al., 2008). When women
and men present with these disorders, women
report more severe pain, longer-lasting pain,
and more frequent pain than men (Hurley &
Adams, 2008). Even among adolescents (ages
11 to 19) who seek treatment for pain, females
reported more severe pain than males without
reporting any more depression or disability
than males (Keogh & Eccleston, 2006).Explanations
Although sex differences in pain perception
are far from clear, this has not stopped in-
vestigators from speculating about the cause
of differences. Biological factors have been
thought to play a role because women suffer
from more painful disorders than men and
because women are more responsive than
men to some classes of painkillers. Women
obtain greater relief than men from some opi-
ates, such as morphine (Cairns & Gazerani,
2009). Sex differences in pain also have been
linked to different parts of the brain being
activated in women and men (Derbyshire
et al., 2002). Hormones may play a role in the
pain conditions to which women are more
vulnerable (e.g., rheumatoid arthritis) and
may play a role in why women respond dif-
ferently from men to some analgesics.
Psychological factors also have been
linked to sex differences in pain. Women re-
port more negative emotions, such as anxiety
and depression, which have been shown to in-
fluence pain reports (Keogh, 2009). There also
appear to be sex differences in coping with pain.
Women are more likely than men to seek sup-
port when in pain, whereas men are more likely
than women to distract themselves from pain
(Keogh & Eccleston, 2006). Women also are
more likely than men to think catastrophicallyM10_HELG0185_04_SE_C10.indd 383 6/21/11 8:54 AM