Suffice it to say that in the battle of the sexes, pain is one skirmish no one wants to win. Yet research consistently shows that women are more likely to experience nearly every common type of pain, including fibromyalgia, migraines, irritable bowel syndrome, and temporomandibular joint disorder. (The guys beat the ladies on cluster headaches.) Even worse, given the same condition, women typically feel more pain than men. Many of the studies that helped reveal these gender differences were led by Roger Fillingim, Ph.D., a professor in the department of community dentistry and behavioral science at the University of Florida, in Gainesville, and author of the Concise Encyclopedia of Pain Psychology (Informa HealthCare, 2005). He sat down with Pain Solutions’ managing editor, Rachel Dowd.

PS: Are guys just not admitting they’re in pain? Fillingim: There is a social bias that says it’s more acceptable for women to report pain and distress. But if the answer is that everybody has the same amount of pain, it’s just that men aren’t talking about it, then I sure have wasted a lot of time.

You believe the gender difference in pain is the result of a mix of factors: Let’s start with biology. Women and men are exposed to different combinations and fluctuations in hormones, with estrogen higher in women and testosterone higher in men. Women have fluctuations in hormones throughout their post-puberty lives until menopause, when there is a dramatic change. That’s pretty different from what men experience.

So is estrogen to blame? It’s not that simple. I can’t tell you estrogen is bad and testosterone is good.

What about psychology? In questionnaires of how masculine or feminine people perceive themselves as being, higher masculinity scores are related to higher pain tolerance; higher femininity scores are related to lower pain tolerance. We know that, overall, mood disorders, including anxiety and depression, are more prevalent in women than men. We also know that anxiety and depression—independent of sex—are associated with increased pain. So if women are having more anxiety and depression, that may help explain some of the increased pain they experience.

But didn’t your research find that men who have pain were more anxious? The interesting finding was that when men find themselves in pain, greater anxiety amounts to more pain. Women who are anxious are anxious for reasons other than pain. It may be changes in their role, or they were anxious before they had pain so they’re still anxious. The men who are anxious are anxious because they have lots of pain. So anxiety-reduction techniques might be more helpful in controlling pain in men.

So this confirms that men turn into babies when they’re sick. There’s this line of thinking that men are at lower risk for pain, so we’re somehow better off. However, once we experience pain, we have no clue what to do. I refer to men in this regard as blunt objects: We motor along just fine, but when pain finally hits us with enough force, we’re at a disadvantage in managing the pain compared to women, who have a varied repertoire of ways to cope.

So your average woman feels more pain, but she deals with it better? Women report more coping in general, both good coping and bad coping. Women are more likely to “catastrophize,” but women also tend to use coping statements like “I can do this” more frequently; they tend to seek social support more often. It may be that women have dealt with more pain in their lives, so they’ve developed a variety of coping strategies, both helpful and not helpful.