MARS V VENUS: Painful comparisons

By Lucy Atkins

A Finnish study has broken new ground that women experience more severe symptoms of rheumatoid arthritis than men. After studying 6,000 people, researchers found that when the chronic joint disease was at exactly the same stage, women suffered worse pain, swelling and exhaustion.

We often make glib assumptions about the differences between how men and women respond to health complaints.

Designed to endure the agony of childbirth, women are often thought to have higher pain thresholds, while men are frequently teased about coping poorly with colds.

But how much solid evidence is there of a disparity in how the genders are affected by illness?

It is well-known that women in many countries tend to live longer than men (current figures for the UK have it at four years). Women visit their doctors more and smoke and drink less than men, and their hormones help protect them from heart disease until menopause. We also know that some diseases affect men more than women, and vice versa.

Relatively little, however, is known about how differently men and women's bodies deal with the same illnesses, once they have them.

A Finnish study has broken new ground by showing that women experience more severe symptoms of rheumatoid arthritis — the chronic joint disease — than men. When researchers studied 6,000 people, they found that women had worse pain, swelling and exhaustion than men, when the disease was at exactly the same stage.

"Hormones probably play a big part in this," says Professor Alan Silman, clinical director of the Arthritis Research Campaign. The female hormone, oestrogen, increases inflammation, exacerbating the painful swelling of joints.

Differences between the male and female body build might also be to blame. "Men have a greater muscle mass than women and strong muscles allow the body to function more efficiently, thereby minimising the strain on joints," says Silman. And women's weight distribution is usually lower than men's, which puts more pressure on the hips and knees.

The tables are turned, somewhat, when it comes to chickenpox. Caught in adulthood, it can be dangerous, with around 25 to 30 people in the UK dying from it each year. Research published in the British Medical Journal in 2002 found that adult men are twice as likely to die from chickenpox as women.

Little is known about why this is, but Nigel Higson, a GP who has a special interest in virology, says chickenpox, like the other childhood disease mumps, can certainly do things to men that it doesn't do to women.

"Chicken-pox and mumps can cause orchitis — a swelling of the testicles," he says. "This can lower sperm production and cause permanent scarring that will damage fertility for life."

Asthma, on the other hand, is more life-threatening to women than it is to men. In 2006, 850 women died from asthma in the UK, compared to 349 men. Women were also significantly more likely to be hospitalised because of the condition.

This could again relate to hormones. Until puberty, more boys than girls develop the condition, but once sex hormones kick in, girls take over.

“There is some evidence linking oestrogen and progesterone to sensitivity of the airways,” says Dr Elaine Vickers, research relations manager at Asthma UK, while testosterone seems to have the opposite effect. Other studies suggest that women on hormone-replacement therapy are 40 to 50 per cent more likely to become severe asthmatics.

When it comes to pain tolerance, perhaps surprisingly, “women seem to be more sensitive than men,” says Dr Jane Quinlan, consultant in anaesthesia and pain management at the John Radcliffe Hospital in Oxford. “In trials they respond more readily to pain stimuli and report more severe levels of pain than men.”

One explanation is that, when in pain, the body produces its own opioids (natural painkillers), endorphins and enkephalins, and oestrogen seems to lower the amount of them in the body.

However, pain perception is also bound up with our emotions, and it is possible that women simply interpret pain as more threatening or distressing than men.

How, then, do they cope with childbirth? “The magnitude of pain in labour is not in question," says Quinlan. "It's just that women cope better with this extraordinary pain because it is both expected, and finite.”