Do the Sexes Experience Fibromyalgia Differently?

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Fibromyalgia syndrome affects approximately 10 million Americans with widespread pain, fatigue, insomnia, depression and other debilitating symptoms. While it affects people from all social statuses, races and ethnic groups, approximately 75-90 percent of fibromyalgia patients are women. Men with fibromyalgia struggle with this one-size-fits-all diagnosis because there are significant gender differences in how they experience the disease.

Men diagnosed with fibromyalgia tend to have all the same symptoms as women, but many report less pain and fewer symptoms and therefore receive less treatment. Studies show that men and women react to pain differently, respond to pain medication differently and receive different responses to their illness from doctors, friends and family members. Many men feel embarrassed to be diagnosed with a syndrome that's generally considered "a girl thing." Others are never properly diagnosed because many doctors aren't attuned to thinking about fibromyalgia from a man's perspective.

What are the Differences?

Scientists and doctors don't know what causes fibromyalgia or why more women have fibromyalgia than men, but gender differences in hormones, brain chemistry, immune systems and genetics may be key. 

Hormonal Factors. Women tend to report feeling more pain, and have a lower pain threshold than men in part because of how estrogen influences their neurological systems. Both men and women have testosterone, which is important for muscle tissue repair and reducing muscle fatigue. Since women produce less testosterone than men, they tend to report more fatigue with fibromyalgia.

Brain Chemistry. Gender differences in brain chemistry mean similar fibromyalgia symptoms may have different physical manifestations. For example, Serotonin is a neurotransmitter (brain chemical) that affects pain, sleep, mood, anxiety and depression--all key components of fibromyalgia syndrome. Some studies suggest that men and women transport serotonin differently, which may explain gender differences in how fibromyalgia affects pain levels, ability to sleep and mental health. Men with fibromyalgia tend to report more irritability and crankiness, but less insomnia while women report more anxiety and depression. 

Social differences. Women are traditionally more expressive and willing to discuss their pain, while men tend to repress it and "tough it out." That means more women go to the doctor for fibromyalgia symptoms than men and receive more treatment for their symptoms.

Fibromyalgia has been recognized as a legitimate neurological diagnosis for decades, but social stigma remains and many doctors still believe it's a predominantly psychological illness. Some women complain their symptoms are discounted or lumped in with other "female symptoms." Men on the other hand, have a hard time being taken seriously by their doctors  when they report fibromyalgia symptoms because it's still associated with being a "women's disease."  

Psychological Factors. The American Psychological Association says women tend to focus on the emotional aspects of pain while men focus on the physical sensations.  That may mean women feel more pain with fibromyalgia than men because they experience both physical and psychological pain where as men focus more on just the physical experience.  Women also tend to seek out emotional support through friends, family and professional therapists more frequently than men, which may help them cope with their symptoms. 

When it comes to pain management, studies indicate that men and women may respond differently to medications too, but the research is not clear.  What is clear is that fibromyalgia is a complicated syndrome for men or women made even more challenging by gender differences.

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American Psychological Association

August 12, 2010

All Pain Is Not the Same: Psychologist Discusses Gender Differences in Chronic Pain

National Pain Foundation

National Fibromyalgia Association