Gender role in pain perception and expression: an integrative review

Nascimento, Michele Gomes; Kosminsky, Maurício; Chi, Michele

doi:10.5935/2595-0118.20200013

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REVIEW ARTICLE • BrJP 3 (1) • Jan-Mar 2020 • https://doi.org/10.5935/2595-0118.20200013 linkcopy

Gender role in pain perception and expression: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND AND OBJECTIVES: Gender seems to play a role in influencing the response to experimental pain, although this influence is not very clear yet. Therefore, the objective of the present review was to investigate the contribution of the gender construct (gender identity/role) in the experience of pain through the selection and analysis of clinical studies on the subject.

CONTENTS: A search was carried out in the databases Medline (via Pubmed), LILACS (via BVS), and PsycINFO. The search used the following descriptors: gender identity, pain, gender role combined by the Boolean operator AND/OR (gender identity) AND pain AND gender role AND pain, in English, Portuguese and Spanish. At the end of the selection, 11 studies were included for this review. All the investigations recovered on the subject are clinical laboratory studies. Regarding the influence of the gender identity and its role in pain perception, most of the studies (91%) show that this variable was a contributing factor to the differences observed in perception (tolerance/pain threshold) and the need to communicate the pain.

CONCLUSION: In experimental pain, a higher degree of femininity or female social roles are associated with lower thresholds and less tolerance to pain, as well as a greater natural tendency to communicate pain sensation. These results are independent of the type of stimulus, ethnicity, or sexual orientation.

Keywords:
Gender and health; Gender identity; Pain

Authors	Study design	n (M/W)	Gender assessment	Pain assessment	Applied stimulus	Results
Vigil, Rowell and Lutz²⁰	Prospective, nonrandomized clinical trial	172 (W) Heterosexual, lesbian and bisexual	Masculinity/Femininity self-identification	VAS	Ischemic	Among heterosexual women, attraction to more feminine romantic partners was associated with lower pain scores. In the group of lesbians and bisexuals with greater masculinity, higher pain and tolerance thresholds were observed.
Alabas, Tashani and Johnson²¹	Prospective, nonrandomized clinical trial	175 124 Libyans (62/62) 51 British (25/26)	GREP	VAS	Pressure/ischemic	Males had lower scores for pain sensitivity and lower propensity to report pain, as well as higher pain tolerance.
Alabas, Tashani and Johnson²²	Prospective, nonrandomized clinical trial	114 (56/58)	GREP	VAS	Thermal (cold)	Despite cultural differences, they did not influence responses to pain. Libyan (African) women were more likely to report pain, more sensitive and less tolerant. Libyan men showed greater tolerance and thresholds for cold pain.
Defrin, Eli and Pud²³	Retrospective, nonrandomized clinical trial	548 (210/338) 341 Jews 105 Arab Muslims 102 Arab-Christians	GREP	VAS	-	Regardless of the religious ethnic group, the "typical" man considered woman to be more sensitive to pain. Men considered themselves less likely to report pain.
Fowler et al.²⁴	Prospective, randomized clinical trial	89 (45/44)	BSRI/PAQ	Short-Form of the McGill Pain Questionnaire	Thermal (cold)	Sex and gender roles interacted in such a way that men reported lower pain sensitivity and less anxiety, but only when prepared with a female gender role.
Defrin, Shramm and Eli²⁵	Prospective, nonrandomized clinical trial	72 (33/39)	GREP	HPT/ HPTL	Thermal (heat)	Individuals with greater masculinity had greater pain tolerance and less need to report pain.
Reidy et al.²⁶	Prospective, nonrandomized clinical trial	195 (65/130)	Hypermasculinity Index		Electric	Pain tolerance was significantly and positively related to traits of aggression in men, unlike women.
Myers et al.²⁷	Prospective, nonrandomized clinical trial	240 (120/120)	Child Sex Role Inventory	VAS	Pressure/ t h e r m a l (cold/heat)	For boys, but not among girls, there was a significant negative correlation between masculinity and pain scores; as the masculinity score increased, pain self-reports decreased.
Robinson et al.²⁸	Prospective, nonrandomized clinical trial	67 (37/30)	GREP	VAS	Thermal (heat)	The propensity to report pain was a significant predictor of the magnitude of temporal summation, regardless of sex. Women showed greater temporal summation to thermal stimuli.
Wise et al.²⁹	Prospective, nonrandomized clinical trial	148 (61/87)	GREP	VAS	Thermal (heat)	Expectations related to male gender were predictors of higher pain thresholds and pain tolerance, regardless of gender.
Myers et al.³⁰	Prospective, nonrandomized clinical trial	104 (54/50)	BSRI	Tolerance time in seconds	Thermal (cold)	Although the gender role was a predictor of pain tolerance, it was not a predictor of pain differences between the sexes.

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[TFN1] VAS = visual analog scale; GREP = Gender Role Expectation of Pain; BSRI = Bem Sex Role Inventory; PAQ = Personal Attributes Questionnaire; HPT = Heat-Pain Threshold; HPTL = Heat-Pain Tolerance Limit.