Same Pain. Different Treatment?

The gender pain gap — and why the same symptom may not always lead to the same healthcare

Pain is an unusual symptom.

You can measure someone's temperature.

You can count their heart rate.

You can see some injuries on an X-ray.

But if somebody tells you:

“This hurts.”

At some point, medicine has to rely on what that person is telling you.

There isn't a blood test that can tell us precisely how much another human being hurts.

Pain is experienced by the person inside the body, and that makes listening an important part of assessing it.

But what happens if the person describing that pain is a woman?

Research increasingly suggests that sex and gender can influence several parts of the pain story: who experiences pain, how pain is experienced and expressed, how it is interpreted by others, and in some settings, how it is treated. A major 2025 review by pain researcher Edmund Keogh concluded that biological, psychological and social factors all contribute to sex- and gender-related variation in pain, while also emphasising that significant gaps remain in what we understand.

This collection of inequalities is often described as the:

gender pain gap.

It sounds deceptively simple.

The reality is anything but.

So, is there actually a gender pain gap?

This is probably the first question we should ask.

Because gender pain gap is one of those phrases that can become so familiar that we stop asking exactly what it means.

There isn't one universally agreed number that measures it.

Instead, the term is used to describe a collection of observed differences involving the prevalence and experience of pain, assessment of symptoms, access to pain relief and treatment, and historic gaps in the evidence base itself.

And the size — and sometimes even the direction — of those differences can vary according to the condition, healthcare setting and treatment being studied.

The latest reviews therefore don't support an overly simple story in which women always receive worse pain care than men in every situation. They support something more nuanced: sex and gender can influence pain and pain care, but the mechanisms are multiple, interacting and still incompletely understood. 

That distinction matters.

Because we're not looking for a slogan.

We're trying to understand what actually happens.

What happens when women and men arrive with pain?

This is where the evidence becomes particularly interesting.

In 2024, researchers examined emergency-department records involving 21,851 patients presenting with pain complaints in Israel and the United States.

They found that female patients were less likely than male patients to receive prescriptions for pain-relieving medication.

Importantly, the difference persisted after researchers adjusted for patients' reported pain scores and numerous patient, clinician and emergency-department variables.

It didn't disappear when the doctor was a woman either.

Both male and female physicians prescribed less pain-relieving medication to female patients in the datasets studied.

Researchers also found that women's pain scores were 10% less likely to be recorded by nurses and that female patients spent, on average, an additional 30 minutes in the emergency department. In a separate experiment, nurses shown otherwise comparable clinical scenarios rated the female patient's pain as less intense than the male patient's pain.

That is a striking finding.

But one study should never become an entire argument.

Which is why something published in August 2026 is particularly interesting.

And we're still finding it in 2026

Researchers recently analysed 106,888 helicopter emergency medical service missions in Germany, covering cases between 2012 and June 2025.

Initial pain severity was comparable between women and men.

Yet women received analgesia less frequently: 62.0% of female patients compared with 66.9% of male patients.

The difference was larger for opioid analgesia: 50.0% compared with 57.1%.

The difference was observed across pain-severity groups.

Again, this does not mean that every woman in pain is undertreated.

Nor does an observational study prove exactly why the difference occurred.

But alongside other research, it gives us a very good reason to keep asking the question.

There is another complication: women and men may experience pain differently too

This is where the story becomes much more complicated than:

“Doctors don't believe women.”

Women and men aren't simply biologically identical groups receiving different healthcare.

Sex itself can influence pain.

A major new meta-analysis published in 2026 examined 90 studies of pain threshold, pain tolerance and pain intensity. Across the studies included, males had higher pain thresholds and tolerance and reported lower pain intensity than females on average.

But there is an enormous caveat.

The size of the difference varied according to things such as the type of painful stimulus and whether participants were healthy or clinical populations. The researchers also found widespread conflation of sex and gender in the underlying research, making it difficult to determine precisely which was responsible for the differences observed.

So:

there appear to be genuine sex-related differences in pain.

But explaining those differences is considerably harder.

Sex and gender aren't interchangeable

This distinction is important.

Biological sex can influence mechanisms involved in producing, transmitting and regulating pain.

Gender, meanwhile, can influence social expectations, behaviour, communication and the way somebody else's pain is interpreted.

And those things can interact.

As Keogh's 2025 review explains, biological, psychological and social factors are all potentially relevant to differences in pain experience. The review also warns that research still faces significant conceptual and methodological problems when trying to separate the effects of sex from gender.

Which means the scientifically accurate answer to:

“Why is there a gender pain gap?”

isn't one satisfying sentence.

It is:

we're still working that out.

Bodies are inconvenient like that.

Pelvic pain has a particular problem

This is where the subject becomes especially relevant to Oui.

Pelvic pain doesn't belong neatly to one organ.

It can involve the reproductive system.

The bladder.

The bowel.

Muscles.

Nerves.

The pelvic floor.

Sometimes several of them at once.

And one of the best-known examples of persistent pelvic pain is endometriosis.

Current NICE guidance on endometriosis tells healthcare professionals to suspect the condition when symptoms include chronic pelvic pain, period-related pain affecting daily life, deep pain during or after sex, cyclical gastrointestinal symptoms and cyclical urinary symptoms, particularly blood in the urine or pain when urinating. The diagnostic recommendations were substantially updated in November 2024.

And there is a particularly important detail in that guidance.

A normal scan doesn't necessarily mean nothing is wrong

NICE explicitly says:

do not exclude endometriosis simply because abdominal or pelvic examination and ultrasound are normal.

Referral may still be necessary.

It even says that laparoscopy can be considered where endometriosis is suspected despite a normal ultrasound or MRI.

That illustrates a much broader principle.

Sometimes somebody is clearly experiencing a symptom before medicine has identified its cause.

Those are not the same thing.

An unexplained symptom is not an imaginary symptom.

What happens when “normal” becomes a dangerous word?

There is another difficulty surrounding pain in women's health.

Some forms of pain have become culturally normalised.

Periods hurt.

Women get cramps.

Pelvic pain happens.

And yes, some discomfort can be common.

But there is a point where:

“this can happen”

quietly becomes:

“therefore you should tolerate it.”

Those are very different statements.

NICE specifically identifies period-related pain that affects daily activities and quality of life as one of the symptoms that should prompt consideration of endometriosis.

That wording matters.

Because perhaps the important question isn't simply:

“Do your periods hurt?”

It is:

“What is this pain doing to your life?”

Common does not mean trivial.

The problem with “How bad is it from 1 to 10?”

Pain scales are useful.

But they aren't laboratory measurements.

My seven isn't necessarily your seven.

And somebody who has experienced severe pain repeatedly for years may describe it very differently from somebody experiencing severe pain for the first time.

Interestingly, current NICE guidance on endometriosis explicitly tells healthcare professionals to recognise that every person's experience of pain is unique and may be expressed differently, both verbally and non-verbally.

Perhaps that means we sometimes need more questions than:

“What's your pain out of ten?”

What does the pain stop you doing?

Can you sleep?

Can you walk?

Can you work?

Can you study?

Can you eat normally?

Can you use the toilet normally?

Has your behaviour changed because you're trying to avoid triggering the pain?

Has something changed?

And perhaps most importantly:

is this different from what is normal for you?

Being believed shouldn't depend on performing pain correctly

There is no universal way that somebody in severe pain behaves.

Some people cry.

Some become quiet.

Some become angry.

Some joke.

Some carry on working.

And some become remarkably good at functioning through pain because they have been doing it for years.

Someone can be laughing and still be in pain.

Someone can be articulate and still be in pain.

Someone can be scrolling through their phone and still be in pain.

Someone can arrive looking perfectly put together and still be in pain.

And somebody who has lived with pain for years may calmly describe a level of pain that would completely overwhelm somebody encountering it for the first time.

Coping with pain is not evidence that the pain isn't severe.

This is one reason the person's history matters alongside examinations, scans and laboratory results.

The evidence base itself has had a gender problem

There is another part of this story that happens long before somebody walks into a hospital.

Historically, pain research disproportionately studied male animals.

A landmark review examining preclinical studies published in the journal Pain between 1996 and 2005 found that 79% used male animals only.

That figure needs its historical context: it shouldn't be read as meaning that 79% of pain research today still excludes females.

But the underlying problem matters.

Because researchers now have evidence that sex can influence pain sensitivity and potentially the mechanisms underlying pain. The 2026 meta-analysis of 90 studies found significant average sex differences across pain threshold, tolerance and intensity, while simultaneously highlighting how frequently researchers have conflated sex with gender.

If researchers disproportionately study one sex and then assume the results automatically describe human bodies, something important can be missed.

But what about the UK?

This is another place where we should be careful.

Much of the striking evidence about differences in pain treatment comes from healthcare systems outside Britain.

We shouldn't simply take a finding from an American or German healthcare setting and announce that exactly the same effect has been demonstrated throughout the NHS.

A 2026 UK review specifically examining the gender pain gap concluded that women are disproportionately affected by chronic pain and that evidence exists of differences in pain management, but it also highlighted something important:

UK-specific evidence about the gender pain gap remains limited. 

I think that is worth saying.

A lack of UK research doesn't prove that there is no inequality here.

But neither should we pretend that international findings automatically tell us precisely what happens in every NHS clinic or hospital.

Good advocacy shouldn't require exaggerating the evidence.

This isn't as simple as “doctors don't listen to women”

I think this distinction is incredibly important.

It would be very easy to finish this article by finding examples of women whose pain was dismissed and concluding:

medicine doesn't believe women.

But healthcare is more complicated than that.

Pain is subjective.

Diseases overlap.

Tests have limitations.

Some serious conditions initially resemble benign ones.

Clinicians frequently have to make decisions with incomplete information.

And bias does not require somebody consciously thinking:

She's a woman, therefore I don't believe her.

The 2024 emergency-department study is particularly interesting because the difference in prescribing appeared among both male and female physicians.

Bias can exist within expectations, habits, research, diagnostic pathways and assumptions about how particular patients are expected to behave.

So perhaps the more useful question isn't:

“Which doctors are biased?”

It is:

“Where can bias influence what happens next?”

We also shouldn't turn pain into a competition

Talking about women's pain does not require pretending that men's pain is always taken seriously.

It isn't.

Men can delay seeking healthcare.

Men can struggle to communicate pain.

Social expectations about stoicism and masculinity can influence how some men respond to symptoms.

And recognising inequalities affecting women does not require dismissing anybody else's experience.

The point isn't:

Women's pain matters more.

It is:

All pain deserves to be taken seriously regardless of who is experiencing it.

“We don't know” can be an entirely reasonable answer

Medicine cannot always explain pain immediately.

Sometimes investigations are normal.

Sometimes several specialties become involved.

Sometimes the diagnosis emerges only over time.

And sometimes medicine genuinely does not yet have a satisfactory explanation.

There is nothing inherently wrong with a healthcare professional saying:

“I don't know.”

Sometimes it may be the most accurate answer available.

The problem comes when:

“We haven't found the cause”

quietly becomes:

“Therefore there isn't really a problem.”

Those are completely different conclusions.

Endometriosis provides an excellent real-world example. Current NICE guidance explicitly recognises that a normal examination and ultrasound do not exclude the disease and that further referral or investigation can still be appropriate.

Uncertainty should sometimes lead to more curiosity, not less.

So where does this leave the gender pain gap?

Perhaps with something slightly less catchy, but much more useful.

There isn't one single gender pain gap with one number, one cause and one solution.

Instead, the evidence points towards several overlapping issues.

Women experience many painful conditions disproportionately.

Sex can influence aspects of pain biology.

Gender can influence expectations and communication.

Some large studies have found differences in the assessment and treatment of

women's pain.

Research itself has historically contained important sex biases.

And we still don't understand all of the mechanisms involved.

That's a more complicated story.

But it is also a more interesting one.

And perhaps closing those gaps doesn't begin with assuming that every painful symptom has a sinister explanation.

It doesn't mean ordering every possible investigation.

It doesn't mean assuming every difference between women and men is discrimination.

It begins with something much more fundamental.

When somebody says:

“This hurts.”

Take the symptom seriously enough to ask:

“Why?”

Sometimes investigations will be reassuring.

Sometimes the answer will be straightforward.

Sometimes the explanation will take time.

And sometimes medicine will have to say:

“We don't know yet.”

But:

“We don't yet know why this hurts”

is very different from:

“Therefore it doesn't.”

Pain is information.

And the person experiencing it is part of the evidence.

Oui. Together, we can.

A note from Oui

Oui exists to raise awareness, share reliable information and make difficult health conversations easier to have. It does not provide individual medical advice or diagnosis.

Pain can have many causes, and the presence, absence or severity of pain cannot by itself diagnose a particular condition.

If you develop new, severe, persistent or changing pain, or are concerned about symptoms you are experiencing, seek advice from an appropriate healthcare professional.

References & Further Reading

Keogh E. (2025). Sex, gender, and pain: Evidence and knowledge gaps. Current Opinion in Psychology, 63, 102006. This is particularly useful for understanding why biological, psychological and social factors need to be considered together — and why substantial uncertainties remain. Read the Keogh review

Graziano TA, Orphanos O, Ortiz J, Shook NJ. (2026). A Meta-Analysis of Sex Differences in Pain Threshold, Tolerance, and Intensity. Pain Management Nursing, 27(4), e649–e667. Ninety studies were included; importantly, the authors also identified extensive conflation of sex and gender in the underlying literature. Read the PubMed record

Guzikevits M, et al. (2024). Sex bias in pain management decisions. Proceedings of the National Academy of Sciences, 121(33), e2401331121. The study analysed 21,851 emergency-department records from two countries alongside an experimental study of pain perception. Read the full PNAS study

Schmidt A, et al. (2026). The gender pain gap in prehospital analgesia: the role of patient and provider gender — an analysis of 106,888 helicopter emergency medical service missions. BMC Medicine, 24, 426. Read the open-access study

O'Brien J. (2026). Understanding the gender pain gap affecting women in healthcare. Nursing Standard, 41(4), 69–73. Particularly useful for its UK perspective and acknowledgement of the limitations of the UK-specific evidence base. Read the PubMed record

NICE. Endometriosis: diagnosis and management (NG73). Originally published in 2017, with diagnostic recommendations substantially updated in November 2024. Read the current NICE guideline