The 46,XX testicular disorder of sex development (DSD), also known as 46,XX male syndrome, is a rare form of DSD and clinical phenotype shows complete sex reversal from female to male. The sex-determining region Y (SRY) gene can be identified in most 46,XX testicular DSD patients; however, approximately 20% of patients with 46,XX testicular DSD are SRY-negative. The SRY-box 9 (SOX9) gene has several important functions during testis development and differentiation in males, and overexpression of SOX9 leads to the male development of 46,XX gonads in the absence of SRY. In addition, SOX9 duplication has been found to be a rare cause of 46,XX testicular DSD in humans.
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- Human brain imaging represents another methodology that holds promise for facilitating mechanistic and translational advancements, and increased application of imaging to enhance understanding of sex differences in pain and analgesia is strongly recommended.
- However, more females (33%) reported reduced activities of daily living due to pain compared with males (15%).
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Recently, questionnaires have been developed based on the analysis of the characteristics of pain (ie, pain descriptors) that discriminate pain due to a definite neurological lesion. Torrance et al409 estimated the prevalence of pain of predominantly neuropathic origin using a random sample of 6000 adults from family practices in three United Kingdom cities using a 5-item neuropathic pain scale developed by Bennett.28 Females (6%) showed greater prevalence of neuropathic pain (lasting longer than 3 months) compared with males (3%). Using a large representative sample of the French population, Bouhassira et al44 assessed neuropathic pain using their symptom-based screen for pain with neuropathic qualities43 and found higher 3-month prevalence in females (8%) compared with males (6%). Neither study reported sex differences in the effects of age, pain intensity, or depression.
Cognitive/affective factors are important determinants of pain responses and likely contribute to sex differences in pain.289,335 The cognitive and affective mechanisms that have been investigated most widely in the context of sex and gender differences include coping processes, catastrophizing, and affective factors (eg, anxiety, depression). The following sections discuss the evidence regarding sex differences in the associations among psychological factors and pain report. A study of third- and fifth-grade children in Finland found that 32% reported a weekly musculoskeletal pain with significantly more girls reporting pain in chest (7%, 4%) and in the upper back (8%, 5%) compared with boys.278 Sex-related differences were not found for the lower back and neck pain.
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