Long before a woman has an explanation for her pain, she may have learned to organize her life around it. Persistent pain can affect how people work, rest and participate in everyday life. When symptoms go unexplained, not knowing can become a burden of its own.
Pain is complex. Biological processes, including hormonal influences, interact with psychological and social factors to shape how it is experienced. Understanding that complexity is essential to effective care. Yet gaps in research and longstanding assumptions about women’s bodies can influence how their symptoms are interpreted, including whether pain is investigated or accepted as something they should expect.
“The more important question for us to be asking is not whether women can tolerate more pain, but why we expect them to.”
— Dr. Tania Di Renna
We spoke with Dr. Tania Di Renna, a physician and researcher at Women’s College Hospital and Medical Director of the Toronto Academic Pain Medicine Institute (TAPMI), about why women’s pain is too often minimized, common assumptions about pain tolerance, and what earlier recognition and more coordinated care could make possible.
Q: Why does women’s pain so often get dismissed or minimized?
Dr. Di Renna: Historically, women’s pain has been understudied and misunderstood. For decades, pain research largely focused on male populations, creating significant gaps in our understanding of how women experience pain and how to effectively diagnose and treat it. We’re still dealing with the consequences of those gaps today.
Women’s pain is also frequently normalized, particularly when it comes to conditions like endometriosis and chronic pelvic pain. Many women are told that painful periods are normal or that their symptoms are related to stress or anxiety. This can lead to delayed diagnoses, inadequate treatment and patients feeling like their experiences aren’t being taken seriously.
At the Toronto Academic Pain Medicine Institute (TAPMI), we see patients who have spent years trying to find answers. Many come to us carrying the burden of untreated pain and the emotional weight of not being believed. That’s why listening to patients and validating their experiences is such an important part of improving pain care.
Q: We hear a lot that women have a “higher pain tolerance.” Is that actually true?
Dr. Di Renna: Not necessarily. Research suggests that women, on average, have lower pain thresholds and tolerate less experimentally induced pain than men, although these differences vary depending on the type of pain being studied. We need to remember that when researchers study pain tolerance using experimentally induced pain, they use controlled tests, such as applying heat, cold or pressure to see when someone begins to feel pain and how much they can tolerate. These studies suggest that men, on average, tolerate certain types of pain longer than women. However, these brief laboratory tests are very different from living with chronic pain, which is influenced by many biological, emotional and social factors.
Pain is complex and influenced by biology, hormones, psychological factors and social expectations. Estrogen and progesterone influence how pain is processed, sometimes increasing and sometimes decreasing sensitivity, while testosterone may have pain-reducing effects.
The more important question for us to be asking is not whether women can tolerate more pain, but why we expect them to. Women live with painful conditions that are dismissed and inadequately investigated more often than men.
Ultimately, pain should be assessed and treated based on the individual’s experience, not assumptions about their sex or gender.
Q: What would it look like if the healthcare system took women’s pain seriously from the start?
Dr. Di Renna: Taking women’s pain seriously means recognizing that patients shouldn’t have to spend years searching for answers before receiving the care they need. We need to listen to their experiences and intervene before pain becomes severe or chronic.
For too long, healthcare has focused on treating pain once it becomes debilitating. At Women’s College Hospital, we’re working to shift that approach by identifying risk earlier and focusing on preventing chronic pain from developing or worsening. For example, our team at TAPMI is developing tools to help primary care providers identify symptoms of endometriosis in adolescents and young adults, with the goal of reducing untreated pain and improving quality of life.
Improving pain care also requires a more coordinated approach. Chronic pain is complex and often requires expertise from multiple disciplines. TAPMI brings together pain physicians, physiotherapists, psychologists and other specialists to develop comprehensive, individualized care plans that address patients’ needs.
At TAPMI and Women’s College Hospital, we’re focused on rebuilding trust and creating true partnerships with patients. We’re moving from a culture of dismissal to one of listening, and that shift is an important step toward better pain care for women.
Further reading: Research on sex, gender and pain
- Graziano TA, et al. (2026). A Meta-Analysis of Sex Differences in Pain Threshold, Tolerance, and Intensity. Pain Management Nursing.
- Racine M, et al. (2012). A systematic literature review of 10 years of research on sex/gender and experimental pain perception. Pain.
- Athnaiel O, et al. (2023). The Role of Sex Hormones in Pain-Related Conditions. International Journal of Molecular Sciences.
- Alabas OA, et al. (2012). Gender role affects experimental pain responses: A systematic review with meta-analysis. European Journal of Pain.