Speaking to the Association of American Medical Colleges, Martha Gulati, MD, a cardiologist at the Smidt Heart Institute at Cedars-Sinai in Los Angeles revealed that when she gives lectures at medical schools about sex differences in heart and cardiology care, many students are learning for the first time that there is still a huge disparity between the sexes in medical education.

She says: “Often, male biology is taught as the ‘default’ and learning about how female biology is different — from organ systems to hormones to cellular differences — is considered ‘special interest’.”

We have known this for a while in some formats. For example, the first time human blood was ever used to test the absorbency of menstrual products was, uh… two years ago.

Additionally, a lot of what we know about heart attacks only really pertains to men. Heart attack symptoms can actually look very different for women and the warning signs we most frequently hear about don’t tend to be as common for women.

“I think that’s where we can try to solve things,” Gulati says.

“In medical education, [students] need to be educated on sex differences, not just about heart disease, [but for] every organ system, there should be a component about what is the same, what differs, and what is unknown. Students need to leave medical school understanding these differences.”

Agreed. We could start small, though, and learn that a lot of the time, painkillers are less effective for women…

A small 2021 study found that Ibuprofen is tends to reduce pain in men more than women. This same study revealed that prednisone, a type of corticosteroid, was associated with more intolerable adverse effects in female participants and that they were less willing to agree to a dose increase.

To understand why this is may have happened, Medical News Today spoke with Dr. Meera Kirpekar, clinical assistant professor of anaesthesiology, perioperative care, and pain medicine at NYU Langone.

Dr Kirpekar revealed that, until 2016, over 80% of pain studies had only involved male participants — whether humans or rats. Unlike males, females undergo continuous hormonal fluctuations throughout their lives that impact their pain sensitivity.

Factoring in these changes, she noted, may have been difficult in earlier research settings, ultimately leading prospective female participants to be largely left out of study cohorts.

“As a result, most pain data we have exists around male-based pain signalling. In 2016, the National Institutes of Health made it a requirement for grant applications to justify their choice of the sex of animals used in research, so female subjects began to be included in pain studies.”

Unfathomable, to be honest.

When asked to explain what may lie behind the different responses to pain in males and females, Dr. Kirpekar noted that oestrogen could play a huge part in female pain tolerance: “Oestrogen, a hormone that controls the development of the uterus, ovaries, breasts, and regulates menstruation.

Depending on where that oestrogen is located and how much [of it] there is, it can either worsen pain or make it better. Testosterone, which is the hormone involved in developing the penis, testes, and prostate, can dull pain.

“And in fact, some patients with chronic pain may even take testosterone treatments. So women can have worsened pain because of their high oestrogen levels. And men with low testosterone can process pain similarly to women.”

Let’s hope the well overdue advances in medical testing provide a pathway to more personalised pain management.