Pain: A Women's Health Issue?

There are several female specific pain conditions, including chronic pelvic pain, which is a particular problem for women, as well as vulvodynia or vaginal pain, and pain after breast cancer treatment which certainly affects exclusively women.  It’s important to recognize, though, that pain as a woman’s health issue goes beyond just the conditions that affect only women.  There are also important sex differences in a variety of pain dimensions.  For example, pain is often more severe in women.  It’s certainly more common in women which justifies pain for inclusion as a woman’s health condition.

There are multiple reasons why women are at increased risk for chronic pain disorders. Taking the biopsychosocial model of chronic pain and applying it to sex and gender differences in chronic pain, we recognize that there are a variety of biological processes that clearly differ between women and men, not the least of which would be differences in sex hormones, higher estrogen and progesterone levels, but also women being subject to fluctuations in hormone levels throughout their menstrual cycles and then a fairly precipitous drop in hormone levels as they enter later life.  Hormones do make a big difference, as do other biological factors, including genetic factors and functioning of different pain control systems like the endogenous opioid system.  But we’re remiss if we don’t also recognize the psychosocial factors that can contribute to sex differences in pain; mood disorders tend to be more common in women than men and those are risk factors for chronic pain and for increased severity of pain.  Also, pain coping seems to differ between genders and kind of stereotype gender roles – the masculinity and femininity and gender related concepts of pain.  Is it okay to express pain?  What does pain mean when I experience pain?  All of these sort of gender roles and social roles seemed to vary between women and men and also contribute to the gender differences that we see in chronic pain.

There are several things that the primary care physician should consider in the context of women and pain.  The first thing is to recognize that women are at greater risk for pain, so the provider shouldn’t be surprised to hear women bring up pain as a clinical issue more frequently than men.  Another point is that the provider needs to listen to the symptoms that women are experiencing, to understand the pain that women are experiencing, validate their pain experience, and then provide whatever treatments will meet the goals of the patient.  Understanding what women want to get out of treatment is critical.