Do Different Genders and Ethnicities Feel Pain Differently?
Not everyone feels pain the same way, and sometimes the reason is biological. Although the link between genetics and pain may seem obvious, there may be more to the picture. Some doctors argue that it’s all about hormones; testosterone and estrogen cause sex differences which result in different coping strategies between men and women. Other theories are more sociocultural, incorporating the actual experience of pain in relation to the social world. More specifically, sociocultural factors such as gender and ethnicity may play a critical role in how pain is managed.
When conceptualizing gender and pain, it is helpful to think of pain as a combination of unique experiences, rather than a singular pain with a capital ‘P.’ According to Dr. Sudhir Diwan, a pain management specialist in New York City, women tend to show a higher threshold for pain while also showing higher expressions of pain. How could it be possible that women express pain more often if they seemingly handle it better than men? The answer may be in methods of management itself. For example, a recent study which tested gender differences in stress and coping in chronic kidney disease found that women are more likely than to use methods such as venting, positive reframing, and religious coping when managing their pain (Gemmel et al., 2016). The prevalence of pain and depression is also expected to be higher in women (Calvó-Perxas et al., 2016). Past studies additionally have shown that women feel pain more intensely than men (Ruau et al., 2012). It may not be that men and women necessarily feel all pain the same way; it may be that their reactions and coping styles differ.
But why do women and men cope with pain differently? There may be a more complicated story than mere genetics. To start, it might be due to a psychological process called socialization. Socialization is a lifelong process in which a person learns and adopts social norms, acceptable behaviors, and values which relate to their social identity. In other words, it’s all about learning what is more “socially acceptable.” Differences in pain management outcomes between men and women may therefore be due to the way in which men and women are told to deal with pain. According to Dr. Diwan, women often experience pain and suffering as adults in the same way as when they were children.
Throughout life, people receive both subliminal and explicit clear messages about how men and women should act. Dr. Matthew Lorber, the director of the Child and Adolescent Psychiatry Department at Lenox Hill Hospital, suggests that the “boy’s don’t cry” mentality ultimately prevents young boys from seeking pain treatment. As a result, gender differences in childhood pain management ultimately affect how pain manifests itself during adulthood. According to Dr. Lorber, the relationship between pain management and mental health can become dangerous if undiagnosed. Particularly, men who ignore symptoms of pain during childhood are at greater risk of clinical depression and chronic pain during adulthood. When coupled with genetic predispositions and biological functioning, these differences could yield significant problems for both men and women.
Studies which attempt to understand gender differences often oversimplify the concept of pain. Although certain studies suggest that women have a lower pain tolerance than men (Marcus, 2009), the reasoning behind this may have more to do with social stigma than genetics. We’ve all heard “Take it like a man” and “don’t be such a girl.” When internalized, these social messages have powerful outcomes which might impact how men and women experience and cope with pain.
These socialized norms may also have an effect on how pain is related to ethnicity. Studies have shown that African Americans, in comparison to non-Hispanic White people, show significantly intense chronic pain as well as pain-related disability (Edwards, 2005). One explanation for this difference is psychological; African-Americans are consistently more likely to catastrophize and use passive methods of coping, which are both linked to greater pain sensitivity (Rahim-Williams et al., 2012).
One potential reason for gender and ethnic differences in relation to pain might be stress. A common psychological theory, minority stress theory (Meyer, 2003) suggests that people with stigmatized identities (i.e. people of color, transgender people, people with disabilities) experience severe levels of stress, therefore resulting in poor mental and physical health outcomes. Therefore, it is no surprise that ethnic differences in relation to pain also relate to experiences of stress. According to Dr. Lorber, socioeconomic status plays a massive role in how people of different ethnicities experience and report pain. Although it may seem obvious, inaccessible medical care causes great health discrepancies between people of different socioeconomic backgrounds.
Whatever the reason for gender and ethnic differences, pain is a universal human experience which is complicated. Before jumping to conclusions which oversimplify differences in gender and ethnicity, it is important to consider pain as multidimensional. Rather than superimpose ideas about one race or gender being more susceptible to pain, for example, consider the different dimensions of pain and how they are different in certain contexts. Most importantly, pain should never be ignored, regardless of gender or ethnicity.