Authored by Meghan Etsey MS3, Bethany Fenton MS3, Ariela Marshall MD on behalf of AMWA Gender Equity Task Force
Pain is a deeply personal experience, and research consistently shows that gender significantly influences its assessment and management. Despite medical advancements, women frequently face underdiagnosis and inadequate treatment of pain (Pieretti et al., 2016). Healthcare providers often dismiss or minimize women’s pain, labeling it as “emotional” or “psychosomatic” rather than physical (Samulowitz et al., 2017). These biases stem from deep-rooted stereotypes portraying women as overly emotional or “dramatic,” reinforced by the historical pathologization of their health concerns as “hysteria.” As a result, female patients are less likely to be taken seriously, leading to delayed diagnoses and ineffective treatment (Samulowicz et al. 2018). Addressing these disparities requires recognizing the intersection of gender, societal biases, and medical decision-making to ensure equitable pain management for all patients regardless of gender.
Gender bias manifests in many aspects of pain workup and management. In terms of workup, there are gender-based differences in the way pain scales are applied. A study by Wesolowicz et al. (2017) found that healthcare professionals were more likely to rate pain severity lower in women compared to men, even when the clinical symptoms were identical. These disparities are particularly concerning when it comes to medical conditions causing chronic pain, which disproportionately or exclusively affect women. For example, conditions such as fibromyalgia (75-90% of patients are women) and endometriosis (which exclusively affects those with a uterus), often go underdiagnosed or untreated due to this bias (Arout et al. 2018; Questions 2002). Just recently a female patient with a past medical history of fibromyalgia told one of us: “The doctors do not want to restart my amitriptyline. I know they don’t believe I have chronic pain, but the amitriptyline really helps.” It was heartbreaking to hear a patient say this about her condition and her experience with her physicians.
Biological factors play a significant role in how men and women experience pain, with women generally exhibiting higher pain sensitivity than men. According to the International Association for the Study of Pain (IASP), women tend to report more frequent, severe, and prolonged pain compared to men in experimental pain studies (International 2024). This disparity is linked to both hormonal influences, such as the fluctuations in estrogen and progesterone, and genetic factors that may affect pain perception. These biological differences contribute to the overall pain experience, which underscores the need for tailored pain management strategies that account for gender differences in pain perception and response.
Social and cultural factors also significantly influence how pain is perceived and treated in both men and women. Historically, pain tolerance has been associated with masculinity, with men being expected to “tough it out” or endure pain without expressing vulnerability. This societal expectation can result in men underreporting their pain or not seeking medical evaluation and treatment for pain. A study by Samulowicz et al. (2018) found that men were more likely to downplay their pain and avoid discussing it with their healthcare providers, which can delay diagnosis and appropriate treatment. Conversely, women are often expected to be more vocal about their pain, but they also face skepticism from healthcare providers. Women’s pain may be attributed to emotional causes or other inorganic causes, particularly when the pain is not easily explained by traditional diagnostic tools. This is evident in the way conditions such as endometriosis and pelvic pain are often minimized or dismissed, despite the fact that they can have debilitating effects on women’s lives. It often takes an average of seven to ten years for women with endometriosis to receive a proper diagnosis, highlighting the delayed recognition and treatment of pain in female patients. (Swift 2021).
Dr. Emma Johnson*, a practicing physician, shares her own experience as a patient dealing with gendered pain management: “I was experiencing excruciating pain due to a condition I later learned was endometriosis. I went to multiple doctors over the course of several years, and I was told each time that my pain was either psychological or just ‘part of being a woman.’ It wasn’t until I finally saw a female doctor who believed my pain was real that I received the proper diagnosis and treatment. I wonder how many other women suffer because their pain is not taken seriously in the same way.” Dr. Johnson’s experience is a poignant reminder of how gendered assumptions can have a profound impact on the quality of care that patients receive, particularly in relation to pain management. Her testimony highlights the importance of listening to patients and recognizing their pain as valid, regardless of gender.
Gender bias in pain management can also influence treatment choices. A study published just last year showed that female patients were less likely to be prescribed analgesics, both opioids and nonopioids, than male patients in the emergency department, even when reporting the same level of pain on the pain score (Guzikevits et al., 2024). Additionally, studies have shown that women were more commonly prescribed sedatives postoperatively for pain compared to the men who were given pain medication (Calderone 1990). This discrepancy may be related to underlying assumptions that women’s pain is psychological in nature, rather than physical. Moreover, under-prescription for women may contribute to the opioid epidemic, as some may seek alternative sources to obtain opioids instead of receiving prescribed opioids from their physician.
Addressing gender disparities in pain management requires healthcare providers to undergo training to recognize and challenge biases regarding pain, understanding how societal factors influence pain experiences for men and women. Providers should adopt a more empathetic, evidence-based, and informed approach to ensure that all patients receive appropriate care. Additionally, research must continue exploring both the biological and socio-cultural factors that affect pain perception and treatment. As Florence Nightingale emphasized, healthcare providers must observe and listen to patients’ pain, recognizing its emotional, social, and gendered dimensions. By challenging stereotypes and providing personalized, compassionate care, we can create a healthcare system where all patients receive the effective treatment they deserve.
*Name has been changed to preserve anonymity.
References
- Arout, C. A., Sofuoglu, M., Bastian, L. A., & Rosenheck, R. A. (2018). Gender differences in the prevalence of fibromyalgia and in concomitant medical and psychiatric disorders: A national Veterans Health Administration study. Journal of Pain Research, 11, 1751-1760. https://pmc.ncbi.nlm.nih.gov/articles/PMC6425926/
- Guzikevits, M., Choshen-Hillel, S., Gileles-Hillel, A., & Shalvi, S. (2024). Sex bias in pain management decisions. Proceedings of the National Academy of Sciences, 121(24), e2401331121. https://doi.org/10.1073/pnas.2401331121
- International Association for the Study of Pain. (2024). Sex and gender differences in pain and pain management. Retrieved February 17, 2025, from https://www.iasp-pain.org/resources/fact-sheets/gender-differences-in-chronic-pain-conditions/
- Pieretti, S., Di Giannuario, A., Di Giovannandrea, R., Marzoli, F., Piccaro, G., Minosi, P., & Aloisi, A. M. (2016). Gender differences in pain and its relief. Annali dell’Istituto Superiore di Sanità, 52(2), 184-189. https://doi.org/10.4415/ANN_16_02_09
- Questions and answers about fibromyalgia. J Pain Palliat Care Pharmacother. 2002;16(3):91-8. PMID: 14640361.
- Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2017). “Brave men” and “emotional women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. BMC Health Services Research, 17(1), 563. 10.1155/2018/6358624
- Swift, B., Taneri, B., Becker, C. M., Basarir, H., Naci, H., Missmer, S. A., Zondervan, K. T., & Rahmioglu, N. (2021). Prevalence, diagnostic delay and economic burden of endometriosis and its impact on quality of life: Results from an Eastern Mediterranean population. Human Reproduction, 36(3), 589-596. https://doi.org/10.1093/eurpub/ckad216
- Wesolowicz, D. M., Clark, J. F., Boissoneault, J., & Robinson, M. E. (2017). The roles of gender and profession on gender role expectations of pain in health care professionals. BMC Health Services Research, 17(1), 741. 10.2147/JPR.S162123
- Zolotow, A. R., & Keane, C. E. (2016). Social expectations and gender bias in the reporting of pain. Pain Medicine, 17(7), 1181-1187.
About the Authors
Meghan Etsey, MS3
Meghan is a third year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Bethany Fenton, MS3
Bethany is a third year medical student from St. George’s University. She holds a Master of Science in Nutritional Sciences from the University of Kentucky and received a Bachelor of Science in Dietetics from Eastern Kentucky University. She worked as a critical care dietitian for ten years prior to pursuing medical school. She is also a member of the Gender Equity Task Force and Sex and Nutrition and Medicine Working Group Committees within the American Medical Women’s Association. When she’s not studying, you can find her spending time with her husband and cats, using her Holga camera for experimental photography, lifting weights at the gym, playing board games, and reading science fiction novels.
Ariela Marshall, MD
Dr. Ariela Marshall is a Harvard-trained physician and an internationally renowned advocate, career development advisor, and mentor. Dr. Marshall specializes in bleeding and clotting disorders, especially as they relate to women’s health. She has worked at Mayo Clinic and the University of Pennsylvania and currently practices part-time as a consultative hematologist at the University of Minnesota. In addition to her clinical work, Dr. Marshall is a highly respected leader, mentor, and speaker. She is an active leader with the American Society of Hematology (where she led efforts to found the Women in Hematology Working Group and currently holds seats on the Women in Heme Working Group, Committee on Communications and Media Experts Subcommittee) and American Medical Women’s Association (leading the Infertility Working Group and holding seats on the Gender Equity Task Force). She is the Chief Innovation Officer at Women in Medicine and the Curriculum Chair at IGNITEMed, which are both 501(c)(3) nonprofit organizations dedicated to promoting career development for women in medicine. She speaks regularly on a national and international scope to discuss her efforts to advance career development and mentorship for physicians, gender equity, fertility/infertility awareness, parental health and wellbeing, reproductive health and rights, and work-life integration.