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DreamGF ensures that these features are available to users who are of legal age and adhere to the platform’s guidelines and terms of use. Moreover, gonadal steroids exert both organizational and activational effects, which refer to long-term developmental influences versus transient effects in adulthood, respectively. The impact of sex hormones on pain responses can be broadly dichotomized into peripheral versus central nervous system effects, which are discussed below. Kroner-Herwig and others231 assessed the distribution and characteristics of headache in German children aged 7 to 14 years using International Classification of Headache Disorders-II criteria to classify headaches into migraine or tension-type. They found that, similar to migraines, boys have an earlier onset to nonmigraine headache than girls. The prevalence of nonmigraine headache was similar for girls and boys of elementary school age years with increasing prevalence for girls during adolescence.

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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). Unfortunately, there is little standardization in the pain measures used or the time frame for assessing postoperative pain. There are no population level studies of postoperative pain; consequently, we review selected studies in clinical populations. LeResche243 reviewed several studies of temporomandibular joint pain that demonstrated a higher prevalence in women than men across the lifespan. Studies from Finland,322,352 Germany,159 Sweden,267 Turkey,309 the United States,326 Nigeria,302 and Brazil25 have drawn similar conclusions for tooth pain, jaw joint pain, and other orofacial pain conditions.

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• Even though electrical pain was reported for only 3 studies, it strongly favors the hypothesis that women are more sensitive to this pain modality in comparison to men.
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• In complex sampling designs, weighting adjustments can account for some bias, but whether this has occurred is seldom described in the papers we have reviewed.
• Epidemiologic studies of pain typically report point prevalence (currently in pain), period prevalence (ie, experiencing pain during the past month or year), or lifetime prevalence.
• We will review several large studies that compared the prevalence of headaches, musculoskeletal pain, and abdominal pain in children and adolescents.

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The prevalence increased with age for both sexes with greater increases for girls. The epidemiology of chronic pain in children has been reviewed by McGrath,272 but differences between boys and girls were only briefly discussed. We will review several large studies that compared the prevalence of headaches, musculoskeletal pain, and abdominal pain in children and adolescents. Another issue concerns geographic or cultural characteristics of the reference population.

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.

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