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The available research indicates a potentially important contribution of gender roles to sex differences in responses to experimentally induced pain, with masculinity and femininity predicting higher and lower pain sensitivity, respectively. The exact mechanisms mediating the association of gender roles and pain responses have yet to be elucidated. An important question is whether these findings simply reflect gender-related response biases (ie, men under-report and/or women over-report pain) or might they reflect gender-based differences in endogenous pain modulation?

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• Kroner-Herwig and others231 assessed the distribution and characteristics of headache in German children aged 7 to 14 years using International Classification of Headache Disorders-II criteria to classify headaches into migraine or tension-type.
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Sex differences in experimental pain have been evaluated using a wide range of stimulus modalities including pressure, electrical, ischemic, thermal, and other models of experimental pain (eg, chemical). Dynamic models of experimental pain have been used to engage systems underlying summation and inhibition of pain. Pain sensitivity has been assessed by a number of different outcome measures including behavioral indices of threshold (defined by time or intensity to the first sensation of pain) and tolerance, and self-report measures of pain intensity and unpleasantness. Previous reviews have concluded that females are more sensitive to pain compared with males.127,327 The following review will determine whether more recent studies continue to support this conclusion.

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Two PET studies reported that males and females process thermal pain differently, though both the methodology and the pattern of results differed substantially between studies. Paulson et al312 found that females reported more pain than males in response to a 50 °C contact heat stimulus, with an accompanying higher level of activation in the contralateral thalamus and anterior insula. Derbyshire et al91 tailored a laser heat stimulus to produce comparable pain levels in men and women and found that males showed greater activation in some brain regions (eg, parietal cortex, SII, PFC, insula), whereas females showed greater activation in others (eg, perigenual cortex, cingulate cortex). Clearly, additional studies are needed to further characterize differences in pain-related brain activity between males and females.

• In Korea, less than 10 SRY-positive 46,XX patients have been reported, and there are no reports of 46,XX testicular DSD resulting from SOX9 duplication9).
• In 1992, an important publication by Karen Berkley32 highlighted the importance of sex-related issues in neuroscience research.
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