We often hear people complain about pain and try to empathise. But it is difficult to ascertain the extent of pain a person is enduring. We assess it by how they describe it: a “light” headache, a “severe” one, a “tolerable” back pain. These adjectives hardly help, as understanding pain is complex. Irrespective of the actual intensity, the way it is perceived depends on the ability of the individual to tolerate it. The sex of the individual also plays a role in pain perception. Men and women deal with pain differently.
Multiple research projects are going on across the globe trying to understand pain as it helps us manage it. Occasionally, they show interesting and contradicting results. However, based on observational studies so far, experts unanimously agree that females are prone to feel more pain and tolerate it better too. There are many factors that govern this difference. However, there are still grey areas in the scientific understanding of pain.
Factors influencing pain perception and tolerance
Anatomical and neural factors
Men and women differ anatomically in several ways. One major difference is in the neuronal density.
“Females have more nerve receptors. This greater nerve density leads to increased perception of pain compared to males. For example, if you consider the facial skin, females on average have 34-40 nerve fibres compared to the 17-20 found in males,” states Dr Smruti Bhonsle, pain management consultant at Hinduja Hospital, Mumbai.
The higher density of nerve fibres in women means they register more pain.
The role of hormones
The quantity of sex hormones present in males and females vary. It also differs with age – before puberty, during the reproductive age and after menopause and andropause. These variations contribute to pain perception and tolerance.
“Before puberty, there is no major difference in the amount of testosterone present in male and female,” says Dr Deepak Chaturvedi, an endocrinologist at AMAAYA Clinic, Mumbai. “Thus, whatever difference in feeling pain can be observed at that age could be due to social construct or psychological reasons.”
Hormone levels are different in the reproductive age.
“This is the period when the testosterone increases in men leading to muscle mass. Physiological role of testosterone is to increase pain threshold. Similarly in females, the estrogen increases the pain threshold,” says Dr Chaturvedi, before explaining the different hormones that contribute to pain tolerance in male and females.
“Women have repeatedly proven that they have high tolerance to pain during menstruation cycles or at the time of pregnancy,” adds Dr Chaturvedi. “Progesterone does not play a significant role in the difference of pain perception in male and females even if it has anti-inflammatory, analgesic, diuretic, calming, and relaxing properties. In the first half of the menstrual cycle, the progesterone in a female is similar to a male. In the second half of the cycle, progesterone increases in females. But there’s no evidence that women have a higher threshold for pain perception or tolerance at this time. Dehydroepiandrosterone, a hormone that is present in slightly higher quantities in men compared to women has calming, analgesic and immunomodulatory effects. But there is no evidence to prove that it provides a higher pain threshold or tolerance in male compared to females.”
“Anxiety and depression, more common in women, are again age and hormone (estrogen/progesterone) related. This could also increase pain sensitivity in females,” adds Dr Bhonsle.
Post andropause, the level of testosterone falls and it can be observed that there is no significant difference in pain perception or tolerance.
Psychosocial and cultural factors of pain
‘Men don’t cry’ is a common notion across cultures. Boys, while growing up, are encouraged or conditioned to not express pain. Though it does not mean men feel less physical pain, it changes the way their mind helps them cope with it.
“When there is a purpose driven focus action, the whole focus of the body is on that specific action,” explains Dr Amitabh Ghosh, psychiatrist and trauma therapist from Mumbai. “At that time the perception of pain will be very less. For example, if there is a death in the family, the men become busy organising several things to distract themselves and thus the focus will be on solving the problem at hand rather than feeling the emotions.”
Pain coping strategies make a difference
Major studies have looked at differences in pain among men and women to get a better understanding of its perception. But that is not simple as pain tolerance and perception differs between individuals of the same gender. It is a highly individual experience.
For instance, it is not accurate to say that since society influences the way men think and act when experiencing pain, they feel less pain. A woman can be conditioned the same way too. Many are, in fact. Carrying the pain and memory of a major childhood trauma through one’s life is common. This happens irrespective of gender.
“Even coping strategies are important. For someone who has learnt to cope with stress, their pain perception will be different compared to someone who has no coping strategies,” says Dr Ghosh.
Takeaways
- To understand the difference in pain perception in men and women, it is important to consider the factors that are involved in pain like anatomical, neuronal, hormonal, psychological, cultural and social factors.
- Coping strategies make a difference when it comes to pain perception and tolerance.
