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Women are more likely to experience many forms of chronic pain, but there is no single explanation—and no rule that every woman feels pain more intensely than every man. Differences can reflect biology, hormones and life stages, particular conditions, and social factors that affect whether pain is recognized and treated. Hormones may matter, but they do not explain every pain pattern.
Are there sex differences in pain?
Population patterns suggest that women experience many types of chronic pain more often than men. Research also examines differences in how pain is processed and relieved. These are group-level findings, not a reliable way to predict an individual’s pain or response to treatment.
In a 2024 summary of pain research, the U.S. National Institutes of Health quoted study author Dr. Fadel Zeidan: “This study provides the first clear evidence that sex-based differences in pain processing are real and need to be taken more seriously when developing and prescribing treatment for pain.” The finding supports taking biological differences seriously; it does not mean that sex alone determines how pain feels or which treatment will work. NIH, “Sex differences in how the body reduces pain,” October 29, 2024.
Sex-related biology and gender are related but distinct. Biology can influence pain mechanisms, while gendered expectations and social experiences can influence how a person describes pain, how others interpret it, and what care they receive. Neither category describes every woman’s experience.
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Do hormones or menstrual cycles always make pain worse?
No. Hormones and life stages can affect pain, but the sources do not establish a universal pattern in which estrogen or a particular point in the menstrual cycle always increases pain. The effects can vary by person and by condition; a cycle-related symptom pattern should not be treated as proof of a diagnosis.
Menstrual pain is common, but its frequency does not make severe or disruptive pain something that must simply be endured. The International Association for the Study of Pain (IASP) reports that up to 90% of adolescents and young women describe some menstrual pain, and that 30–40% experience pain severe enough to affect school or work attendance. These are figures reported in IASP’s 2024 fact sheet; the underlying studies were not reviewed here, so they should be understood as the organization’s reported estimates rather than as a newly assessed prevalence study. IASP, “Pain In Women,” December 2, 2024.
Which conditions can cause pelvic or sexual pain?
Symptoms can overlap, and a symptom by itself does not identify its cause. Two examples illustrate why the pattern and its effect on daily life matter:
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1Fix the driver behind crashes, sound loss and screen glitches2Clear out junk files and repair common Windows errors3Scan for outdated or missing drivers - takes under a minute| Possible issue | Patterns described by the sources | Important qualification |
|---|---|---|
| Endometriosis | Painful or debilitating cramps; pelvic, intestinal, or lower-abdominal pain; pain during or after sex; and painful bowel movements or urination during menstrual periods. | NIH says symptom severity does not reliably correspond to the number, location, or extent of lesions. Researchers do not fully understand why endometriosis causes pain. |
| Pain during sex | Pain may be associated with gynecologic conditions, vaginitis, vaginismus, childbirth-related injury, pelvic inflammatory disease, endometriosis, or adhesions. | There are multiple possible causes, so pain during sex alone cannot establish which one is responsible. |
NIH describes endometriosis as affecting approximately 1 in 10 women, an estimate reported by IASP in its 2024 fact sheet. That population estimate does not show whether an individual’s symptoms are caused by endometriosis. NIH, “Endometriosis”; IASP, “Pain In Women,” December 2, 2024.
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ACOG reports that nearly 3 out of 4 women experience pain during intercourse at some time in their lives. The page does not state a publication year for this estimate; it is not a measure of how many people have a particular underlying condition. ACOG, “When Sex Is Painful”.
How do hormones fit into endometriosis care?
Hormone therapy is one treatment approach for endometriosis-associated pain. Symptoms may improve with hormonal treatment, persist in some circumstances, or return after treatment stops. A response to hormones does not by itself confirm endometriosis, and the source does not establish that hormonal treatment is suitable for everyone. Treatment decisions need to account for the suspected cause and the person’s circumstances.
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Why can pain be overlooked or treated differently?
IASP identifies sexism and gender bias as concerns in both pain research and clinical practice. These concerns matter because what researchers study and how clinicians interpret or respond to a patient’s account can shape what is known about pain and how care is delivered. They do not mean that every clinician responds in the same way.
NIH’s 2024 research summary also describes disparities in pain management and reports that opioid painkillers are less effective in females. This is a population-level research finding, not a prediction that a particular medicine will or will not help a particular person. It is a reason to assess treatment response rather than assume it from sex alone. IASP, “Sex/Gender Biases in Pain Research and Clinical Practice,” April 11, 2024; NIH, “Sex differences in how the body reduces pain,” October 29, 2024.
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When should someone seek an evaluation?
ACOG advises seeing an obstetrician-gynecologist or another health professional for frequent or severe pain during sex. Evaluation can take account of medical and sexual history, symptoms, and an examination to help determine the cause. ACOG, “When Sex Is Painful”.
For a visit about pelvic or menstrual pain, a concise record of when pain occurs, where it is felt, how severe it is, and how it affects everyday activities can help describe the pattern. Mentioning whether pain is linked to menstruation, sex, bowel movements, or urination gives a clinician relevant context; it does not replace evaluation or establish a diagnosis.
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