J Behav Med (2011) 34:139147

DOI 10.1007/s10865-010-9291-7

Concept priming and pain: an experimental approach

to understanding gender roles in sex-related pain differences
Stephanie L. Fowler Heather M. Rasinski
Andrew L. Geers Suzanne G. Helfer
Christopher R. France

Received: April 12, 2010 / Accepted: August 25, 2010 / Published online: September 28, 2010
Springer Science+Business Media, LLC 2010

Abstract Prior research has found that sex differences in

pain are partially due to individual variations in gender
roles. In a laboratory study, we tested the hypothesis that
the presence of covert gender role cues can also moderate
the extent to which women and men experience pain.
Specifically, we varied gender role cues by asking male
and female participants to write about instances in which
they behaved in a stereotypically feminine, masculine, or
neutral manner. Pain and cardiovascular reactivity to the
cold pressor task were then assessed. Results revealed that,
when primed with femininity, men reported less pain and
anxiety from the cold pressor task than women. However,
no differences existed between the sexes in the masculine
or neutral prime conditions. The results indicate that covert
gender cues can alter pain reports. Further, at least in some
situations, feminine role cues may be more influential on
pain reports than masculine role cues.
Keywords

Pain  Priming  Gender  Sex  Cold pressor

S. L. Fowler (&)  H. M. Rasinski  A. L. Geers

Department of Psychology, University of Toledo,
2801W. Bancroft St, Toledo, OH 43606-3390, USA
e-mail: sfowler3@rockets.utoledo.edu
S. G. Helfer
Department of Psychology, Adrian College,
110 S. Madison Street, Adrian, MI 49221, USA
C. R. France
Department of Psychology, Ohio University, 200 Porter Hall,
Athens, OH 45701, USA

Introduction
Research indicates than women and men respond differently to pain stimuli (Fillingim 2000; Fillingim and
Maixner 1995; Riley et al. 1998)with women often
reporting more pain and pain-induced anxiety and experiencing greater cardiovascular reactivity than men (e.g.,
Berkley et al. 2002; Geers et al. 2008). Although numerous
explanations have been proposed (Fillingim 2000; Holdcroft and Berkley 2005; Mogil et al. 2000), gender roles
appear to be a key factor influencing the sex-pain relationship (Bernardes et al. 2008; Myers et al. 2001; Unruh
1996). Sex refers to a biological marker distinguishing
differences between men and women in terms of chromosomes, hormones, external genitalia, and secondary sex
characteristics, whereas gender roles are social beliefs and
behaviors about what it means to be a woman or man
(Deaux 1985; Rosenkrantz et al. 1968; Unger 1979) and
is described in terms of femininity and masculinity
(Bem 1974, 1975; Spence et al. 1974). Femininity reflects
behaviors such as empathy, understanding, and emotionality whereas masculinity reflects behaviors such as
ambition, independence, and dominance. Bem (1974,
1975) has posited that gender role characteristics are represented as stable dispositions found within the individual
as well as a set of characteristics that fluctuate across situations.
Studies indicate that individual differences in gender
roles help account for sex-related differences in experimental pain tasks. For example, participants reporting more
masculine than feminine traits demonstrated greater pain
tolerance than participants reporting more feminine than
masculine traits (Myers et al. 2001, 2006; Otto and
Dougher 1985). Also, when examined separately, femininity was inversely related to pain tolerance and statistically

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accounted for the observed sex-pain relationship (Sanford

et al. 2002; Spence et al. 1974).
Individual differences in gender roles have also helped
to explain sex differences in clinical pain. In one study,
masculinity was associated with less physical disability and
pain, less psychological distress and anxiety, and greater
life satisfaction among male and female patients with
rheumatoid arthritis (Trudeau et al. 2003). In addition, a
prospective study revealed that higher femininity at college
entry was predictive of chronic pain conditions 30 years
later among men, but not women (Applegate et al. 2005).
Importantly, whereas several of the aforementioned
studies demonstrate that gender roles can have main effect
associations with pain, other studies find that gender roles
interact with sex to predict pain. Thus, both main effects of
gender roles as well as interaction effects between sex and
gender roles need to be considered when exploring the link
between gender and pain.
In previous studies gender roles have largely been
conceptualized as a stable, dispositional factor. However,
situational cues may also influence which gender role
characteristics people adopt (Bem 1974, 1975, 1981, 1984).
Specifically, situational cues may elicit gender role
responses which, in turn, affect the way individuals perceive pain (Bendelow 2000; Fagot 1977; Fagot and Hagon
1991; Myers et al. 2003; Unruh 1996). Few pain studies,
however, have actually manipulated situational cues that
prompt the activation of gender roles. In one relevant study
participants were explicitly told that the typical same-sex
individual can withstand the cold pressor task for either
30 s, 90 s, or were given no expectation (Robinson et al.
2003). When no expectation was given, women reported
greater pain sensitivity and lower pain tolerance then men.
When participants were given either a 30 s or 90 s
expectation, however, women and men responded similarly
to the painful task. Interestingly, womens pain became
significantly lower when given this time limit expectation
whereas mens pain did not change. Thus, with these
explicit expectations, the sex-pain difference disappeared
as a result of women changing their perception of the pain,
again indicating that sex can interact with gender roles to
determine pain.
The priming of gender roles
Priming occurs when a particular concept, such as a gender
role, is made salient without individuals conscious
awareness of the primes influence (Bargh and Chartrand
2000). Priming involves presenting individuals with subtle,
covert cues that activate particular mental concepts. An
extensive literature demonstrates the powerful influence
that priming can have on judgment, affect, and behavior
(Bargh and Chartrand 2000). Importantly, researchers have

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recently been successful at priming gender roles. One study

examined sex-related differences in spatial skillsan area
where men generally perform better than women (Ortner
and Sieverding 2008). Using a story priming technique,
researchers found that participants primed with a feminine
concept relative to a masculine concept demonstrated
reduced spatial ability on a subsequent spatial-rotation task,
thereby accounting for the sex difference. In another study,
Meier-Pesti and Penz (2008) found that sex-related differences in risk aversion, a behavior more prominently
displayed by women, were diminished by priming gender
role concepts. Interestingly, men exposed to a feminine
prime (i.e., picture of someone coddling a baby) were less
likely to take risks than were men exposed to a masculine
prime (i.e., picture of someone holding a briefcase). No
such effects were found for women. Given that the covert
priming of gender roles can influence spatial ability and
economic decisions, we hypothesized that such priming
would also influence pain in the current study.

Hypotheses
The present study explored the effects of participant sex
and gender role priming on responses to a painful laboratory stimulus: the cold pressor task. Consistent with the
prior pain literature, we predicted that women would report
more pain overall than men. The prior literature on sex and
gender points to two divergent predictions for the effect of
a gender prime manipulation on pain. Specifically, several
studies on gender priming (e.g., Ortner and Sieverding
2008) as well as studies on dispositional gender and pain
(e.g., Myers et al. 2006; Otto and Dougher 1985; Trudeau
et al. 2003) lead to the prediction that gender primes will
have a main effect on pain such that feminine primed
participants will report greater pain relative to the masculine primed and neutral primed participants. Alternatively,
other studies in the gender literature lead to the prediction
that sex and gender role priming will interact to determine
pain (e.g., Applegate et al. 2005; Meier-Pesti and Penz
2008). Consequently, in the current investigation, we
wanted to determine which of these two possibilitiesa
main effect for gender role priming or a sex by gender role
priming interactionwould be supported.
In addition to assessing pain in response to the cold
pressor task, we also assessed participants task-related
anxiety and ratings of task unpleasantness. We included
these two exploratory measures because sex has been found
to relate to emotional and cognitive responses when coping
with pain (e.g., Berkley et al. 2002; Keogh and Eccleston
2006) and we wanted to determine if, like pain, scores on
other measures would be influenced by gender role priming. If this is the case, the result would suggest that, in

J Behav Med (2011) 34:139147

addition to pain reports, situational gender role cues can

alter a broad range of reactions to painful stimuli.
Finally, a number of studies have found that cardiovascular reactivity increases in response to experimental
pain (e.g., Peckerman et al. 1994, 1991) and that this
reactivity can vary by participant sex (e.g., Fillingim et al.
2002; Maixner and Humphrey 1993; Myers et al. 2001). As
such, we measured cardiovascular activity in this experiment to assess whether gender role priming would also
alter this relationship.

Methods
Participants and design
Eighty-nine non-smoking adults (44 female and 45 male)
attending the University of Toledo participated individually in return for course credit. Participants ranged in age
from 18 to 45 (M = 19.52). Sixty-two were White (70%),
fourteen were Black (15%), nine were Asian (10%), and
four categorized themselves as some other unspecified
ethnicity (5%). Participants were randomly assigned to one
of three gender prime conditions. Sex of participant was
also recorded, making this a 3 (gender prime: feminine vs.
masculine vs. control) by 2 (sex: female vs. male) betweensubjects factorial design.
Procedure
All procedures were approved in advance by the Institutional Review Board of the University of Toledo. Upon
arrival, participants were greeted by a female experimenter
wearing a white lab coat. After participants were told that
the study involved responses to a laboratory pain task, they
read and signed an informed consent document. Next,
participants completed a health history questionnaire
including two items assessing the extent to which participants were already experiencing pain and soreness.
Answers were drawn on a 100 mm line with endpoints
labeled no pain/no soreness (0) to extreme pain/extreme
soreness (100). During data analysis two participants were
found to have arrived to the study with unusually high levels
of pre-existing pain. These individuals had scores above
50 mm on both the pain and soreness scales which put them
at more than three standard deviations above the mean on
the scales. Because of this high level of pre-existing pain,
we removed these two individuals from data analyses.
Analyses including these two individuals produced very
similar, albeit slightly weaker, results to those presented.
A blood pressure cuff was then attached to participants
non-dominant arm. Participants rested for 10 min while
their blood pressure and heart rate were measured every

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2 min. Blood pressure (in mmHg) and heart rate (in bpm)
were recorded using a GE Medical Systems Dinamap Pro
Series 100 Vital Signs Monitor. The Dinamap Pro Series
100 yields similar, although sometimes slightly lower,
blood pressure readings to those obtained using a mercury
sphygmomanometer (Ni et al. 2006).
Gender prime manipulation
Following a procedure used in prior studies (e.g., Geers
et al. 2005, 2008), participants were told that the experimenter was going to record a second set of physiological
readings in which the participant was cognitively active. In
fact, this time was used to administer the priming manipulation. Specifically, participants completed one of three
versions of a behavior recall task (Bargh and Chartrand
2000). For this priming task, participants were prompted to
recall and write down three instances in which they
behaved consistently with either masculine or feminine
stereotypes, or behaved in gender neutral ways. The exact
behaviors that participants recalled and wrote down during
this task were based on items from two prominent gender
role scales: the Bem Sex-Role Inventory (Bem 1974) and
the Personal Attributes Questionnaire (Spence et al. 1974).
In the masculine prime condition, participants recalled
times when they behaved stereotypically masculine (i.e.,
not backing down from ideas, taking on a leadership role,
and striving to be the best). In the feminine prime condition, participants recalled times when they behaved stereotypically feminine (i.e., relying on others for help,
demonstrating selflessness, and empathizing with others
feelings). In the control condition, participants recalled past
behaviors they enacted that were unrelated to gender (i.e.,
route taken to get to campus, meals eaten the week before,
and how they chose what to wear that day). Participants
wrote their responses in a blank area (1.500 by 600 ) provided
just below each of the behavioral prompts. Participants
were explicitly instructed to only write about each behavior
within the blank area provided and were not given a time
limit for finishing this task. It should be noted that the
underlying concept of masculinity or femininity was never
explicitly mentioned to participants.
There are many possible techniques by which to prime
constructs such as gender and these techniques vary in their
level of explicitness. Prior research has found that primes
delivered below conscious awareness, subliminal primes,
tend to be weaker than those in which participants are aware
of the priming material but are not aware of the influence of
the primes, called supraliminal primes (Bargh and Chartrand
2000). For this reason, we used a supraliminal priming task in
this study. It should be emphasized that, although our participants were conscious of the behaviors they recalled
while performing the task, they remained unaware that the

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underlying concept was being activated and that the priming

material could have lingering effects on pain reports. In fact,
during the debriefing, no participant mentioned gender roles
as the purpose of this study.
Cold pressor task
Following the prime manipulation, participants placed their
non-dominant hand in a container of non-circulating ice and
water at 4C. Water temperature was measured just prior to
the cold-pressor task. Participants were instructed to keep
their hand in the ice water for 2 min but were told they could
remove their hand early if the pain became unbearable.
The experimenter then left the room and instructed
participants over an intercom system to place their hand in
the container of ice water. Blood pressure and heart rate
were recorded every 30 s during the cold pressor task. Due
to a malfunction with the blood pressure cuff, the physiological data for three of the participants was lost.

J Behav Med (2011) 34:139147

administered a funnel debriefing. During the debriefing,

participants responded to a series of probing questions
about the priming task. Debriefing questions began very
broadly, first asking participants if they understood all of
the directions, and then funneled down to more specific
questions asking participants to guess which concept was
primed by the behavioral recall task. After several more
questions, participants were asked if the behavior-recall
task affected their responses later in the study. In the debriefings, none of the participants reported that they wrote
about gender-related themes. Further, none of the participants reported believing that the behavioral recall task
altered their subsequent responses. Consequently, the
gender manipulation met the criteria laid out by Bargh and
Chartrand (2000) for supraliminal priming.

Results
Process check

Pain
Participants reported their pain immediately after removing
their hand from the water using the Short-Form of the
McGill Pain Questionnaire (SF-MPQ; Melzack 1987). The
total pain index of the SF-MPQ was our primary pain
outcome measure. For this index, participants indicated the
degree to which they experienced 15 affective and sensory
pain descriptors (e.g., stabbing, punishing-cruel) using a
four-point scale labeled 1 (none) to 4 (severe). The affective and sensory items can be analyzed separately or
combined. As the affective and sensory items produced
similar results in the present study, we analyzed overall
pain scores by summing the ratings of the 15 descriptors
(a = .873, scores ranged from 17 to 53).
Exploratory items
After completing the SF-MPQ, participants answered
exploratory questions regarding their experience with the
cold pressor task. Specifically, two subsidiary items asked
participants, How anxious did you feel when your hand
was in the ice water? and How unpleasant did it feel to
have your hand in the ice water? Participants responded
to these items using a seven-point scale with end-points
labeled 1 (not at all anxious/unpleasant) and 7 (extremely
anxious/pleasant).
Debriefing
After the questionnaires were completed, participants were
thanked for their participation and then the experimenter

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Before analyzing the pain data, we examined participants

responses to the behavioral recall task to determine if the
prime manipulation elicited thoughts consistent with the
gender concepts, as intended. To achieve this goal, participants written responses to the behavioral recall task
were submitted to a content analysis using the Linguistic
Inquiry and Word Count program (LIWC; Pennebaker and
Francis 1999). The LIWC program codes written text by
placing individual words into a set of specified categories
(e.g., positive emotion words, achievement words, communication words). LIWC then analyzes the amount of
words used within each category compared to the total
number of words within the text. Thus, a percentage score
is created for each category. A feminine word usage score
was computed by averaging across percentage scores for
three categories representative of stereotypic feminine
behaviors (i.e., emotion, feelings/sensations, and communication). A masculine word usage score was similarly
computed by averaging across percentage scores for three
categories representative of stereotypic masculine behaviors (i.e., energy, achievement, and sports). And finally, a
control score was computed by averaging across percentage scores for three categories representative of the
behaviors that control participants recalled (i.e., motion,
eating, and sleeping).
A series of 3 (gender prime: feminine prime vs. masculine prime vs. control) 9 2 (sex: male vs. female) betweensubjects analysis of variance (ANOVA) was conducted on
word usage scores to compare the extent to which each prime
condition evoked the associated gender concepts. As can be
seen in Table 1, significant main effects were observed for

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Table 1 Means and standard deviations on the linguistic inquiry and word count composite scores as a function of gender prime condition
Prime

Feminine word usage

Masculine word usage

Neutral word usage

Feminine (n = 33)

M = 2.51a (SD = 1.77)

M = 1.35b (SD = 1.14)

M = .53b (SD = .64)

Masculine (n = 25)

M = .90 (SD = 1.59)

Control (n = 31)

M = .26b (SD = .36)

M = 2.82 (SD = 2.02)

M = .93 (SD = .76)

M = 1.44a (SD = .85)

M = .39 (SD = .42)

Word usage represents the percentage of feminine, masculine, and neutral words written within the behavioral recall task. Means with different
superscripts in the same row are significantly different from one another

the feminine prime, F (2, 83) = 6.403, P = .003, g2p =

.134, masculine prime, F (2, 83) = 25.621, P \ .001,
g2p = .382, and control condition, F (2, 83) = 15.507,
P \ .001, g2p = .272, with follow-up analyses indicating
that word usage was consistent with the prime manipulation.
That is, more feminine word usage was observed for the
feminine prime, more masculine word usage was observed
for the masculine prime, and more gender neutral words were
observed for the control condition (all Ps \ .05). Importantly, there was no significant main effect for sex nor was the
prime by sex interaction significant for word usage scores.
Thus, the behavioral recall task successfully evoked
thoughts consistent with the masculine and feminine
concepts regardless of participants sex. As such, the priming manipulation worked as intended for both men and
women.
MPQ-SF pain ratings
Scores from the SF-MPQ overall pain index were subjected
to a 3 (feminine prime vs. masculine prime vs. control) 9 2 (male vs. female) between-subjects analysis of
variance (ANOVA). There was a significant main effect for
sex such that women (M = 32.27, SD = 8.69) reported
more overall pain than men (M = 27.81, SD = 7.90), F (1,
81) = 7.708, P \ .01, g2p = .087 whereas no main effect

was found for gender prime (P = .738, g2p = .007). The

sex main effect was qualified by a significant interaction
between gender prime and sex, F (2, 81) = 3.560,
P = .033, g2p = .081 (see Table 2).
To clarify this overall interaction, tests of simple effects
were conducted. The first set of simple effects examined if
pain scores differed between women and men within each
of the priming conditions. These tests revealed a significant
difference in pain scores between women and men within
the feminine prime condition, t (27) = 3.422, P = .002,
d = .57 (95% CI, .281.14), with men reporting less pain
than women in this condition. No sex differences were
found within the masculine prime condition or the control
condition (Ps [ .20, d \ .18). For the second set of simple
effects, we tested for differences in pain scores for men
across the three priming conditions. These analyses produced no significant effects between men in the three
conditions (P \ .12, d \ .14). Finally, we tested for differences in pain scores for women across the conditions.
No significant differences emerged in these tests (P [ .18,
d \ .17).
In addition to the overall pain index, the SF-MPQ
contains two single item pain scales that assess pain
intensity and pain severity. We also subjected these single
SF-MPQ items to the same 3 9 2 ANOVA. Women reported significantly more pain than men on both of these

Table 2 Means, standard deviations, and cell sizes for self-reported pain ratings and anxiety as a function of gender prime condition and
participant sex
Prime

Feminine

Masculine

Control

Pain rating index

Anxiety scores

Task unpleasantness

Female

Male

Female

Male

Female

Male

M = 34.56a

M = 24.15b

M = 5.37a

M = 3.23b

M = 3.94

M = 3.08

SD = 9.98

SD = 5.93

SD = 1.89

SD = 1.59

SD = 2.24

SD = 1.12

n = 16

n = 13

n = 16

n = 13

n = 16

n = 13

M = 33.23

M = 28.93

M = 4.84

M = 4.78

M = 3.08

M = 3.36

SD = 8.60

SD = 8.69

SD = 1.81

SD = 1.12

SD = 2.10

SD = 1.65

n = 13

n = 14

n = 13

n = 14

n = 13

n = 14

M = 29.00

M = 29.81

M = 4.33

M = 4.31

M = 3.33

M = 3.13

SD = 6.61

SD = 8.00

SD = 1.63

SD = 1.35

SD = 1.45

SD = 1.45

n = 15

n = 16

n = 15

n = 16

n = 15

n = 16

Higher scores indicate greater pain and anxiety. Means with different superscripts are significantly different from one another

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individual items (Ps \ .001), whereas the main effect of

gender and the Gender Prime x Sex interaction were not
significant on either item (Ps [ .60).

Exploratory items
To examine participants anxiety toward the cold pressor
task, anxiety scores were subjected to the same 3 9 2
ANOVA as described above. This analysis revealed a
significant main effect for sex such that women (M = 4.86,
SD = .1.80) reported greater anxiety than men (M = 4.13,
SD = 1.47), F (1, 81) = 4.969, P = .032, g2p = .055. The
main effect for gender prime was not significant (P = .399,
g2p = .022). This analysis also produced a Gender Prime 9 Sex interaction, F (2, 81) = 4.203, P = .018, g2p =
.094 (see Table 2). To clarify this overall interaction, tests
of simple effects were conducted. First, we compared
anxiety scores for women and men within each of the three
prime conditions. These tests revealed a significant sex
difference in task-related anxiety only within the feminine
prime condition, t (27) = 3.255, P = .003, d = .45 (95%
CI, .281.13), such that men reported less anxiety than
women in this condition. There were no sex differences in
anxiety in the masculine prime condition or the control
condition (Ps [ .90, d \ .03). Next, we tested for differences in anxiety scores for women and then for men across
the three priming conditions. These simple effect tests
yielded no significant results (P [ .13, d \ .15).
Participants self-reported ratings of task unpleasantness
were also submitted to the same 3 9 2 between-subjects
ANOVA as previously mentioned above. Neither the sex
nor prime main effects, nor the Gender Prime by Sex
interaction were significant on this item (Ps [ .48, see
Table 2).

Blood pressure and heart rate

Changes in systolic blood pressure, diastolic blood pressure, and heart rate were then submitted to the same 3 9 2
between-subjects ANOVA. Change scores for each variable were created by subtracting baseline composite scores
(the average of the last 2 baseline readings) from coldpressor composite scores (the average reading during the
cold-pressor task). For participants who removed their
hand early from the ice water, we computed composite
cold-pressor scores by averaging the readings that were
obtained prior to removal. Thus, all participants were included in the cardiovascular reactivity analyses regardless
of how long they kept their hand in the water. Analyses of
the cardiovascular reactivity scores yielded no significant
main effects or interactions, (Ps [ .11, g2p \ .016, see
Table 3).
We conducted several other analyses with the blood
pressure and heart rate data. For example, we ran correlations to examine if these cardiovascular responses were
related to pain and anxiety reports. These correlations were
not significant overall or when broken down by condition
(Ps [ .22). However, it should be noted that MPQ-SF total
pain index scores and anxiety scores were significantly
correlated r = .623, P \ .01. Further, we also analyzed
pain and anxiety scores while controlling for blood pressure and heart rate. The pattern of results and level of
significance reported previously remained the same with
these control variables in the ANOVAs.
Cold-pressor exposure time
Finally, the number of participants who withdrew their
hand early from the cold-pressor task was examined. Of the
87 participants, 23 participants withdrew their hand early

Table 3 Means, standard deviations, and cell sizes for blood pressure and heart rate change scores as a function of gender prime condition and
participant sex
Prime

Feminine

Masculine

Control

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Systolic blood pressure

Diabolic blood pressure

Heart rate

Female

Female

Female

Male

Male

Male

M = 13.00

M = 10.45

M = 7.18

M = 10.16

M = 6.56

M = 2.34

SD = 8.27

SD = 5.08

SD = 7.00

SD = 8.92

SD = 11.59

SD = 9.08

n = 15

n = 13

n = 15

n = 13

n = 15

n = 13

M = 15.79

M = 12.57

M = 7.57

M = 11.70

M = 5.68

M = 4.03

SD = 6.60

SD = 8.07

SD = 9.71

SD = 8.63

SD = 5.51

SD = 6.85

n = 13

n = 13

n = 13

n = 13

n = 13

n = 13

M = 11.89

M = 15.44

M = 8.62

M = 11.08

M = 2.76

M = 6.34

SD = 5.86

SD = 7.75

SD = 5.38

SD = 7.23

SD = 6.70

SD = 10.43

n = 14

n = 16

n = 14

n = 16

n = 14

n = 16

J Behav Med (2011) 34:139147

with 10 of those participants in the feminine prime

condition, 6 in the masculine prime condition, and 7 in
the neutral condition. A 3 (feminine prime vs. masculine
prime vs. control) 9 2 (male vs. female) between-subjects
ANOVA was conducted to determine if participant sex or
gender prime was influencing the length of time participants kept their hand in the water. This analysis only
yielded a main effect for sex such that women (M = 98.23,
SD = 32.62) kept their hand in the water for less time than
did men (M = 114.79, SD = 16.85), F (1, 81) = 8.287,
P \ .01, g2p = .093. There was no significant main effect
of gender prime nor was there a significant interaction
between sex and gender prime on how much time participants kept their hand in the water (Ps [ .57, g2p \ .014).
Additionally, self-report and cardiovascular reactivity
measures were again submitted to separate 3 (prime condition) 9 2 (sex) ANOVAs, this time controlling for the
amount of time participants held their hand in the ice water.
Importantly, these analyses yielded the same findings as
reported above, without changes to the statistical significance of the effects. These subsidiary analyses indicate that
the variations in the amount of time participants held their
hand in the water were not responsible for our Gender
Prime 9 Sex interactions observed on the pain and anxiety
scales.
Finally, t-tests confirmed that there were no differences
in self-report or cardiovascular reactivity measures between participants who kept their hand in the water versus
participants who removed their hand early (Ps [ .11,
d \ .02).

Discussion
The aim of the present research was to explore the possibility that priming covert gender role cues can influence
how women and men respond to a laboratory pain task.
Consistent with results from the pain literature, we found
that women reported greater pain, greater anxiety, and were
not able to endure the pain task as long in comparison to
men. Extending beyond the current literature, we also
found that sex and gender role cues interacted such that
men reported less sensitivity to pain and less anxiety during
the cold pressor task relative to women, but only when
primed with a feminine gender role. There were no sex or
gender role priming differences in blood pressure and heart
rate or on a measure of task unpleasantness.
The present research suggests that in addition to individual differences in gender roles, sex-related pain differences may also be affected by contextual factors associated
with gender. This possibility is consistent with the theorizing of Bem (1974, 1975, 1981, 1984) in that gender roles
vary as a function of the individual and of the situation. It is

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also consistent with studies in other domains in which

traditional sex differences were altered by gender role
priming. In terms of clinical practice, the present results
suggest that situations can prompt gender role activation
which, in turn, can alter pain and anxiety. As such, contextual cues associated with femininity can moderate pain
reports.
It is interesting that only in the feminine prime condition
did sex differences in pain and anxiety emerge. Several
explanations for this finding may be offered. One important
line of research to consider in respect to this finding is the
work on gender role expectations and pain. Research
indicates that men are reared and socialized so that they
expect to act masculine when confronting a painful situation (Bendelow 2000; Fagot 1977; Fagot and Hagon 1991;
Myers et al. 2003; Unruh 1996). As a result of these gender
role expectations, men have learned to display masculine
characteristics when encountering a pain stimulus such as
reporting less fear of pain or less attention to pain than
women (Mechanic 1964). Importantly, these masculine
expectations of withstanding pain may be amplified by the
presence of a feminine cue. This possibility would be
consistent with the results of Fillingim et al. (2002). These
researchers found that men showed greater tolerance to a
laboratory pain stimulus relative to women after being told
that women have higher pain tolerance than men (Fillingim
et al. 2002). Thus, when expected to withstand pain in
conjunction with feminine cues, men may feel highly
motivated to display and report less pain. Clearly,
researchers should directly test for an increase in masculinity and toughness when men are presented with social
cues relating to femininity.
Dovetailing with research on gender role expectations,
cognitive dissonance theory (Festinger 1957) may too shed
light on our pattern of results. Because men in the feminine
prime condition were asked to write about behaving in an
anti-masculine manner, this could have aroused cognitive
dissonancea feeling of psychological discomfort. This
arousal would be manifested if men in the feminine prime
condition were reflecting on a time when they behaved
inconsistently with their self-view or gender role expectation. According to this theory, one way to eliminate this
unpleasant feeling state would be to engage in a masculine
behaviorsuch as minimizing their painso as to reaffirm
their masculine self-conception. Thus, men who wrote
about past feminine behaviors may have reported lowered
pain and anxiety levels relative to women due to a desire to
reduce this dissonance or inconsistency. Clearly, this
is only one of many possible explanations and further
research is needed to clarify this finding.
A different type of explanation for our pattern of results
is that the findings are due to the type of gender prime
manipulation implemented in this study. For example,

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some aspect of our gender prime manipulation may have

allowed the feminine prime to be more influential than the
masculine prime. Although our manipulation check did
support the effectiveness of the masculine prime manipulation, it may be that priming masculinity will alter pain
reports with different priming stimuli such as pictures
(Meier-Pesti and Penz 2008) or subliminal messages
(Bargh and Chartrand 2000). However, it should be noted
that sex differences emerged only in the feminine prime
condition within the Meier-Pesti and Penz (2008) study as
well, despite having used a different type of gender priming stimuli. Similar to the present results, men were most
affected by the feminine prime in that studyalthough
men in that study came to display more feminine behaviors. Future research should examine the effects of different
types of gender role primes on women and men response to
pain.
These results also highlight the need for theories concerning sex and pain to account for both dispositional
and situationally determined gender roles. Interestingly,
manipulating ones gender roles versus measuring ones
gender roles may guide men to perceive pain in different
ways. Researchers measuring individual differences in
gender roles have found high dispositional femininity to be
associated with greater pain in men (Applegate et al. 2005;
Trudeau et al. 2003). In the current study, however, men
primed with a feminine cue tended to display lower pain.
Perhaps there are fundamental differences between situationally prompted gender roles and dispositional gender
roles that lead to different effects on mens pain ratings.
Men who are prompted by a feminine situational cue are
confronted with a situation that may potentially make them
look anti-masculine in front of other people. Therefore, in
order to reassert their masculinity, they may underreport
pain. However, men who are dispositionally high in feminine qualities may acknowledge these characteristics as
part of who they are and therefore do not feel the need to
reassert their masculinity by underreporting pain.
It is important to comment on the limitations of the
current study. One limitation is that our sample consisted
of young, healthy, undergraduate students. Because this
type of sample differs from clinical samples in a variety of
ways, we must be cautious about generalizing these findings to patient samples and clinical situations. A second
limitation is that the findings did not emerge on all
dependent measures available, with several single item
scales and the physiological measures not yielding the
interaction effect. Third, there was a relatively small
number of men and women in each experimental condition.
Although we did find differences due to both sex and our
prime manipulation, it will be important for future studies
to replicate these findings with larger samples. A fourth
limitation is that our sample consisted only of American

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J Behav Med (2011) 34:139147

participants. As researchers have shown that men and

women from other cultures hold different expectations
about sex-related pain and experience pain differently than
do American participants (Defrin et al. 2009), it is important for future research to examine gender expectations
cross-culturally. Finally, we used only one laboratory pain
stimulus and our cold pressor procedure differed from the
procedure adopted in some other studies in which the ice
water circulates. With these limitations in mind, we believe
future research is needed to focus on the interactive influence of gender role cues and pain with a wide range of
samples and painful experiences.
Acknowledgments This research was supported by National Institutes of Health grant R03 NS051687. We thank Jillian Auxter and
Kimberly Kross for their assistance with data collection.

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