T o the woman, God said, "I will greatly multiply your pain in child bearing; in pain you shall bring forth children, yet your desire shall be for your husband, and he shall rule over you." Genesis 3:16 There is now a well-established body of literature documenting the pervasive inadequate treatment of pain in this country. 1 There have also been allegations, and some data, supporting the notion that women are more likely than men to be undertreated or inappropriately diagnosed and treated for

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... heir pain. One particularly troublesome study indicated that women are more likely to be given sedatives for their pain and men to be given pain medication. 2 Speculation as to why this difference might exist has included the following: Women complain more than men; women are not accurate reporters of their pain; men are more stoic so that when they do complain of pain, "it's real"; and women are better able to tolerate pain or have better coping skills than men. In this article, we report on the biological studies that have looked at differences in how men and women report and experience pain to determine if there is sufficient evidence to show that gender 3 differences in pain perception have biological origins. We then explore the influence of cognition and emotions on pain perception and how socialized gender differences may influence the way men and women perceive pain. Next, we review the literature on how men and women are diagnosed and treated for their pain to determine whether differences exist here as well. Finally, we discuss some of the underlying assumptions re-garding why treatment differences might exist, looking to the sociologic and feminist literature for a framework to explain these assumptions. We conclude, from the research reviewed, that men and women appear to experience and respond to pain differently, but that determining whether this difference is due to biological versus psychosocial origins is difficult due to the complex, multicausal nature of the pain experience. Women are more likely to seek treatment for chronic pain, but are also more likely to be inadequately treated by health-care providers, who, at least initially, discount women's verbal pain reports and attribute more import to biological pain contributors than emotional or psychological pain contributors. We suggest ways in which the health-care system and healthcare providers might better respond to both women and men who experience persistent pain. DO MEN AND WOMEN EXPERIENCE PAIN DIFFERENTLY? The question of whether men and women experience pain differently is a relatively recent one. Until about a decade ago, many clinical research studies excluded women, resulting in a lack of information about gender differences in disease prevalence, progression, and response to treatment. 4 Research on sex-based and gender-based differences in pain response has mounted over the past several years, partially motivated by 1993 legislation mandating the inclusion of women in research sponsored by the National Institutes of Health. 5 Three review articles summarized the research findings on sex-based differences in pain response through the mid-1990s, with most research focusing on sensory (often laboratory-induced) pain. Unruh examined variations between men and women in clinical pain experience through an extensive