Do Women Really Have a Higher Pain Tolerance?

According to International Association for the Study of Pain (IASP) qualifications, pain is described as an "unpleasant sensory and emotional experience associated with—or resembling that associated with—actual or potential tissue damage."

Even though sensory stimuli are usually physical, a component of the pain experience is influenced by beliefs, attitudes, personality and social factors. Whether gender is a factor, and to what extent, remains debated. A significant part of the difficulty in ascertaining answers to those questions is the fact that pain is difficult to describe and measure objectively between individuals—even with the same stimulus.

The culture of pain

How patients communicate their pain is crucial. While medical professionals depend on patients to rate their pain level on a numerical scale, the metric isn't always reliable and needs to be supplemented hand in hand with direct, transparent communication.

Shenique Ranger, PMHNP, a board-certified psychiatric nurse practitioner at an urban health center, said in her 20 years of practice working in the field of pain management, women do not necessarily exhibit a higher pain threshold than men, as popular culture suggests. Ranger added that in her experience, the way pain is interpreted and discussed can vary by individual and also be related to cultural background.

For example, "experienced" pain and "described" pain may be discordant, in that some people openly talk about pain more than others, which doesn't necessarily mean they are not suffering or have a higher threshold. One female patient with a chronic condition cited her upbringing by a nurse, and later being a nurse herself, as the reason for her open communication with doctors. She was taught that "pain is a manifestation of something being wrong," and should therefore be discussed: She lived in a culture that openly talked about pain. This led her to be a better advocate for herself and receive better care.

Sex-based pain tolerance

Because a tremendous amount of the healthcare industry involves pain management, understanding how women and men respond to pain is important for researchers, doctors and patients alike. Research on sex-based pain management centers on three factors: biological, psychological and social.

Biological factors include evidence such as the quantity of certain sex hormones in the bloodstream. Estrogen is linked to an increased pain experience, while testosterone is connected to increased tolerance to pain. Given that women tend to have higher estrogen levels than men and men tend to have higher testosterone levels than women, this would suggest a higher threshold for men. Additionally, there are internal regulation mechanisms that contribute to women and men experiencing pain in different ways, making it hard to generalize on any one group's experience of pain: These internal regulation mechanisms vary by individual and by episode of pain.

Psychological factors may include conditions like anxiety and depression, which are linked to elevated experiences of pain, though not universally. However, in the general population, a depression diagnosis is associated with chronic pain conditions in both men and women.

Social factors affecting the perception of pain tolerance for women and men are nuanced. Other than childbirth, society expects men to be physically stronger and thus not complain about pain. This means women are more likely to report chronic pain, while men—even if they do consult a doctor because of discomfort—underreport pain intensity.

So, who really has a higher tolerance for pain?

Studies don't seem to support the anecdotal evidence that women can handle more pain than men. Women historically have carried the mantle of being emotionally strong and able to weather all life's ills, so perhaps this perception has been transferred to physical pain tolerance, as well.

As with many issues, tolerance to pain in both sexes is layered and nuanced. In most instances, it's the individual case that matters. Most importantly, we should recognize that pain is complex and a lot more work needs to be done to fully understand and treat it, with the ultimate goal of alleviating people's suffering.