Psychosocial contributions to sex-correlated differences in pain

Sex-correlated differences in pain perception and behavior have been reported in several studies. Where such differences are found, they are most often in the direction of girls and women reporting more pain than is reported by boys and men. Although biologic, psychologic, and sociocultural factors act interdependently to influence pain responding, most efforts to explain sex-correlated differences in pain have focused on first-order biologic differences between the sexes. The current paper discusses empirical and theoretical literature addressing gender role socialization, cognitive factors, and affective factors associated with sex-correlated differences in pain. We affirm that there is convincing evidence that such psychosocial factors must be taken into account in research on sex-correlated differences in pain. We contend that the use of the dichotomous variable sex as a proxy for presumed biologic aspects of being female or male may obscure the contribution to sex-correlated differences that could be ascribed to the ways in which women and men are socialized with respect to pain perception and pain reporting.