Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings PMC

Sex, Gender, and Pain: A Review of Recent Clinical and Experimental Findings PMC

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Overall, each study reported sex differences in at least one pain outcome, but, similar to heat pain, discrepancies among pain outcomes occur between indices of cold pain within studies. For example, Jones et al205 observed sex-related differences for cold pain tolerance but not threshold. Based on the present set of studies, it appears that sex differences in cold pain are consistent, particularly for suprathreshold measures such as tolerance and pain ratings.

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  • Haploinsufficiency of SOX9 from the loss of function mutations or deletions results in campomelic dysplasia (Online Mendelian Inheritance in Man #114290), which is a well-known skeletal dysplasia showing congenital bowing of long bones with male-to-female sex reversal in two-thirds of affected individuals with 46,XY20).
  • Although this has been noted in previous reviews,127,327 a substantial increase in the number of studies has occurred, some of which have used more clinically relevant experimental pain models.
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  • Studies of laboratory pain provide additional evidence of hormonal influences on pain responses.

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Other forms of pain inhibition have included stress-induced analgesia (SIA), in which a laboratory stressor is used to reduce experimental pain, and exercise-induced analgesia. Assuming that basal pain sensitivity may reflect the activity of endogenous pain modulatory systems, it would be expected that females and males may also differ in endogenous pain modulation. The results from 7 studies that examined sex differences in experimental ischemic pain are presented in the lower portion of Table 5. Studies used several variations of the submaximal effort tourniquet test to induce ischemic pain. Overall, a majority of the studies reported no sex differences in threshold (6 studies), tolerance (5 studies), or pain ratings (2 studies) to ischemic pain.

  • Surgery and other invasive procedures are accompanied by acute pain, and some surgical procedures confer substantial risk for the development of chronic pain.214 Several studies have reported on sex differences in acute pain following a variety of surgical procedures (see Table 4).
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  • One topic that has received attention is the possibility of gender bias in the provision of pain treatment.
  • The experience of pain is endogenously modulated, and several experimental approaches to engaging pain modulatory systems are reviewed in this article.
  • Inevitably, these sex differences in clinical pain are driven by multiple biopsychosocial factors, which will be discussed below.

Furthermore, duplications of the SOX3 locus were detected in three cases of 46,XX testicular DSD10). SOX3 analysis can be considered the next step for the diagnosis of 46,XX SRY-negative testicular DSD with normal copies of SOX9. A family study recently reported that 46,XY persons with a 178 kb duplication in a region about 500 kb upstream of SOX9 were completely normal fertile males, whereas 46,XX SRY-negative persons in the same family with duplications were clinically infertile males6). In this report, two of the three paternal cousins of their probands are known as infertile and the two probands share the same paternal haplotype for the SOX9 region, confirming the possibility that the father was indeed the carrier of the same triplication. Therefore, we should investigate family members of 46,XX male patients caused by SOX9 duplication. The 46,XX testicular disorder of sex development (DSD), also known as 46,XX male syndrome, is a rare condition with an estimated prevalence of one in 20,000 males1).

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