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Sex and Gender are Not the Same: Why Identity Is Important for People Living with HIV and Chronic Pain

Authors Strath LJ, Sorge RE, Owens MA, Gonzalez CE, Okunbor JI, White DM, Merlin JS, Goodin BR

Received 5 February 2020

Accepted for publication 2 April 2020

Published 24 April 2020 Volume 2020:13 Pages 829—835


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael Schatman

Larissa J Strath,1 Robert E Sorge,1 Michael A Owens,1 Cesar E Gonzalez,1 Jennifer I Okunbor,1 Dyan M White,1 Jessica S Merlin,2 Burel R Goodin1

1University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA; 2University of Pittsburgh, Department of Medicine, Divisions of General Internal Medicine and Infectious Diseases, Pittsburgh, PA, USA

Correspondence: Robert E Sorge Tel +1205-934-8563
Fax +1205-975-6110

Background: Sex differences in pain sensitivity have been well documented, such that women often report greater sensitivity than men. However, clinical reports highlighting sex differences often equate gender and sex. This is a particularly critical oversight for those whose gender identity is different than their genetic sex.
Methods: This preliminary study sets to analyze differences in pain responses between cisgender and transgender individuals living with HIV and chronic pain. A total of 51 African-American participants (24 cisgender men, 20 cisgender women, 7 transgender women) with similar socioeconomic status were recruited. Genetic sex, gender identity, depression and anxiety, pain severity, pain interference and pain-related stigma were recorded. Participants also completed a quantitative sensory testing battery to assess pain in response to noxious heat and mechanical stimuli.
Results: Transgender women and cisgender women demonstrated a greater magnitude of temporal summation for heat pain stimuli or mechanical stimuli compared to cisgender men. Specifically, transgender women reported greater mechanical summation than either cisgender women or cisgender men. Transgender women and cisgender women similarly reported greater chronic pain severity compared to cisgender men.
Conclusion: These data support the notion that gender identity may play a more significant role in pain sensation than genetic sex. These results further maintain that not only gender identity and genetic sex are distinct variables but that treatment should be based on identity as opposed to genetic sex.

Keywords: transgender, gender identity, sex differences, pain, quantitative sensory testing

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