This suggests sex differences in central processing of nociceptive information. Table 7 also presents information about 3 studies that examined sex differences in spatial summation. Unlike temporal summation, no differences have been observed between males and females with spatial summation of heat pain88,238 or cold pain.268 Lack of sex differences might be related to the fact that spatial summation was either measured or reflected only for pain threshold in these studies, and sex differences in suprathreshold measures are often more robust than for threshold. Moreover, sample sizes were relatively small in all of these studies, which may have reduced the ability of these studies to detect sex differences. Nonetheless, the currently available data suggest no sex differences in spatial summation of pain, though additional studies with larger sample sizes would increase confidence in this conclusion. Finally, sex differences in temporal summation have also been demonstrated in clinical samples.
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There were no significant differences between girls and boys regarding type of headache; however, they did find that girls experience recurrent headaches more than boys. Other studies, however, find the prevalence of tension-type headaches to be higher in girls. For example, in a sample of children from Sweden, Laurell et al236 reported the 1-year prevalence of tension-type headache among girls as 12% and 8% for boys.
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Several authors have reported pain prevalence for multiple sites within the same sample and allow a less biased opportunity to compare the magnitude of sex differences across pain sites. A nationwide study of Swedish students in grades 3, 6, and 9 compared the 7-day prevalence of headache, abdominal, and musculoskeletal pain.49 Girls were more than twice as likely as boys to suffer from headaches (17%, 8%). Abdominal pain was experienced weekly by 10% of the girls and 5% of the boys with sex differences significant only in grades 6 and 9. There were no sex differences for musculoskeletal pain, but prevalence increased with age for girls. It provides a platform for users to engage in intimate conversations and explore their sexuality in a safe, private, and controlled environment.
The SRY gene plays a critical role in the initiation of testicular differentiation in males18). In XY embryos, SRY, which is normally located on the Y chromosome, induces the gonadal primordia to develop into testes. If a fetus is conceived from a sperm with an SRY-bearing X chromosome, it will develop as a male despite not having a Y chromosome.
This section was not included in Table 10 since only a limited number of studies have addressed this issue. Experimental manipulations have also been used to examine the influence of gender roles on pain perception. Levine and DeSimone248 reported that men reported less cold pressor pain in the presence of a female versus a male experimenter, whereas pain ratings for females were not influenced by experimenter sex. Similar findings were reported by Gijsbers and colleagues,160 who found that males showed a higher pressure pain threshold when tested by a female versus a male experimenter, whereas females’ pain threshold was not influenced by the sex of the experimenter. In addition to those alluded to above, several subsequent reviews of this rapidly expanding literature have been provided, often focusing on particular segments of research regarding sex, gender, and pain. We will conclude with a synopsis of the current state of the literature followed by a discussion of important issues to be addressed in future research.
To complete the translational continuum, it is important to determine whether sex-related genetic associations such as these discovered in the laboratory setting will extend to clinical populations. Human brain imaging represents another methodology that holds promise for facilitating mechanistic and translational advancements, and increased application of imaging to enhance understanding of sex differences in pain and analgesia is strongly recommended. Since our two previous reviews127,327 a large number of studies using widely varying methodologies have investigated sex differences in experimental pain sensitivity. Based on the overall findings, it can be concluded that females are more sensitive to painful stimulation as assessed in the laboratory. From the pattern of results, it is difficult to pinpoint any specific mechanism(s), because the sex differences appear relatively consistently across multiple stimulus modalities. However, the recently developed literature on pain in response to intramuscular injections of algesic substances reveals robust and unanimous differences, suggesting that deep, tonic stimuli that mimic clinical musculoskeletal pain may be particularly sensitive to sex differences.