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Now is finally the time to give our site a shot, because you’ll never want to miss another minute of raunchy footage from Tube 18 Sex. Although these studies do not confirm that dopamine influences sex differences in pain perception, it seems plausible that hormonal influences on dopaminergic function could contribute to sex differences in pain. Smith et al379 showed that women in a high estradiol, low progesterone state, reported less pain and displayed increased pain-related brain μ-opioid receptor binding than women in a low estradiol state. The studies reviewed above have examined sex differences in self-reported pain, which may be influenced by reporting biases or differences in interpretation or application of pain scales. However, several studies have also examined sex differences in physiological responses to pain, such as pupil dilation,111 muscle reflexes, and cerebral activation. A number of investigators have used more dynamic models of pain to evaluate sex differences.

• For example, in response to a laboratory public-speaking stressor, males exhibited a greater stress-related reduction in heat pain, whereas females showed a greater reduction with ischemic pain.45 Sternberg et al387 reported that cold pain was reduced in males during video game competition, whereas pain was more substantially reduced by physical exercise in females.
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Other forms of pain inhibition have included stress-induced analgesia (SIA), in which a laboratory stressor is used to reduce experimental pain, and exercise-induced analgesia. Assuming that basal pain sensitivity may reflect the activity of endogenous pain modulatory systems, it would be expected that females and males may also differ in endogenous pain modulation. The results from 7 studies that examined sex differences in experimental ischemic pain are presented in the lower portion of Table 5. Studies used several variations of the submaximal effort tourniquet test to induce ischemic pain. Overall, a majority of the studies reported no sex differences in threshold (6 studies), tolerance (5 studies), or pain ratings (2 studies) to ischemic pain.

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46,XX male syndrome was first described in ), and the Chicago consensus renamed of this syndrome as 46,XX testicular DSD in ). Most patients have normal male phenotypes at birth, and are usually diagnosed in late adolescence because of delayed puberty, gynecomastia, or infertility2). Approximately 15% of XX males have hypospadias, cryptorchidism, or more severe genital ambiguity13). All 46,XX males are infertile owing to the absence of the azoospermia factor region in the long arm of the Y chromosome14,15).

• Overall, each study reported sex differences in at least one pain outcome, but, similar to heat pain, discrepancies among pain outcomes occur between indices of cold pain within studies.
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Several studies have addressed whether physical or psychological interventions differentially influence pain responses in men versus women, and these studies are summarized in the lower portion of Table 10. The majority of these studies (5/6, 81%) indicate that females exhibit more efficient pain inhibitory responses compared with males. For example, using an isometric handgrip exercise, pressure pain threshold was elevated in females but not males, suggesting that exercise-induced analgesia was greater in females.226 However, sex-related differences in pain modulation may be dependent on the type of stressor and pain modality. For example, in response to a laboratory public-speaking stressor, males exhibited a greater stress-related reduction in heat pain, whereas females showed a greater reduction with ischemic pain.45 Sternberg et al387 reported that cold pain was reduced in males during video game competition, whereas pain was more substantially reduced by physical exercise in females.

Overall, each study reported sex differences in at least one pain outcome, but, similar to heat pain, discrepancies among pain outcomes occur between indices of cold pain within studies. For example, Jones et al205 observed sex-related differences for cold pain tolerance but not threshold. Based on the present set of studies, it appears that sex differences in cold pain are consistent, particularly for suprathreshold measures such as tolerance and pain ratings.

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