Role of Gender in Health and Disease: Methods of Reporting and Interactions with Sex and Other Factors

Sex and gender are distinct terms that must be used correctly. Data regarding sex and gender may be collected using a 2-step method that separates biological sex and self-reported gender identity. The PhenX Toolkit, funded by the National Institutes of Health (NIH), is one tool that provides investigators with recommended standard data-collection protocols. Another tool is the Diversity Minimal Item Set questionnaire. Importantly, sex and gender interact: for example, pain has both biological aspects (sex differences in electrical, ischemic, thermal, pressure, and muscle pain sensitivity) and cultural aspects (gender factors in how people report pain and how physicians understand and treat pain in patients). Gender norms, identity, and relations all impact patient care. Gender norms, for instance, may influence how a person experiences pain, gender identity may influence a person's willingness to report pain, and gender relations may influence a physician's gendered expectations in relation to a patient's gendered behaviors. Clinicians may perceive women's pain to be psychological; as a result, women may receive more nonspecific diagnoses, wait longer for treatment, and receive more antidepressants and fewer analgesics than men. Research on gender-diverse people and pain is just now emerging. Resources for methods of reporting include The Lancet, Nature, and the Sex and Gender Equity in Research (SAGER) Guidelines. We must consider all relevant factors intersecting with sex and gender, including age, disabilities, educational background, ethnicity, family configuration, geographic location, race, sexuality, social and economic status, sustainability, and more.