It is well known that the prevalence of chronic musculoskeletal pain is higher in women than in men [1
]. Furthermore, most studies on laboratory pain demonstrated that women report higher pain intensity, especially regarding mechanical stimuli [2
], and demonstrate lower pain thresholds [4
]. With respect to other modalities of pain stimuli, findings are more controversial [8
The mechanisms of the enhanced sensitivity to mechanical stimuli in women are not yet fully understood. However, the influence of gonadal hormones has been empirically substantiated [12
Hypotheses associating the differences between sexes with psychosocial factors have also been advanced [13
]. The concept of gender roles assumes that a female or male identity is mainly determined by cultural and social norms or differential reinforcement of behaviour. Thus, the behaviour of expressing one’s pain could be shaped by social norms and reinforcement. A plausible assumption is that females willingly reveal their pain and receive positive social feedback, whereas males are not encouraged or even punished for expressing their pain [14
]. Some studies supported the influence of role stereotypes on pain. For instance, male participants revealed less pain when being tested by female experimenters wishing presumably to appear as a “tough guy” in front of an attractive woman [15
]. Therefore, we would expect individuals endowed with a distinct feminine role concept to express more pain.
Only a few studies so far have examined the relation between gender role and experimental pain and reported some controversial results. Otto and Dougher [7
] found that in men masculinity correlated with the mechanical pain threshold level. Myers et al. [16
] showed gender role identity to be associated with pain tolerance, but not with the pain threshold. Sanford et al. [17
], furthermore, reported femininity, but not masculinity to correlate with pain tolerance. On the contrary, Fillingim et al. [18
] did not find any influence of gender role on thermal pain sensitivity in women.
We intended to re-examine the effect of sex and gender on pain sensitivity to mechanical stimuli in a laboratory environment. Gender role was conceptualised in line with Bem’s conception of androgyny (BSRI; [19
]). According to Bem [19
], it is defined by the two independent dimensions of “masculinity” and “femininity”. Hence, females and males can have a more female or, respectively, male self-concept according to the difference between the values on the feminine and the masculine scale. We assumed that gender role predicts pain responsiveness in addition to sex. An interaction between both factors was also expected.
Furthermore, we wanted to examine whether psychological trait characteristics act as a mediator between sex or gender and pain. As potential mediators we selected the following variables because there was evidence that they correlate to pain: depressive symptoms
]), fear of pain
]) and pain coping strategies
]). They were reported to also differ between females and males (DE: [31
]; CA: [32
], CO: [33
]; FoP: [34
Various pain parameters (threshold (PT), intensity (PI), unpleasantness (PU), sensory and affective quality of pain (SP, AP)) were assessed. The following assumptions were examined:
- Both gender role and sex and their interaction explain differences in pain responsiveness (two main effects and an interaction effect in a two-factorial analysis of variance).
- The selected psychological variables correlate with sex and gender as well as pain and are, assumingly, mediators of the effects of sex and/or gender.