The gender of the examiner affects pain perception and reporting: a systematic review and meta-analysis

Abstract

The gender of examiner/experimenter can influence patients' pain experiences because of social and interpersonal dynamics. However, the magnitude and direction of this influence is unclear. This systematic review and meta-analysis investigated whether the gender of the examiner affects pain perception and reporting. After registration in PROSPERO (CRD42023473445), electronic searches were conducted in PubMed, Web of Science, PsycINFO, and CINAHL to identify clinical and experimental studies published up to March 18, 2025 that evaluated the impact of examiner gender on pain-related outcomes, eg, pain threshold, tolerance, and intensity. Two independent reviewers conducted abstract screening, full-text assessment, quality appraisal with the Newcastle–Ottawa Scale, and data extraction. Examiner gender was operationalized in the studies as a female/male classification corresponding to biological sex. A random-effect meta-analysis was conducted to estimate pooled effects for each pain variable. Of 3919 identified records, 27 studies (19 experimental and 8 clinical) that included 2494 participants met the inclusion criteria. Meta-analytic results showed that pain tolerance was significantly higher when assessed by male examiners (Hedges g = −0.25, 95% CI [−0.45, 0.05], I ² = 9%). A small but significant effect was found for higher pressure pain thresholds with female examiners (Hedges g = 0.20, 95% CI [0.04, 0.36], I ² = 0%), whereas no significant effects were observed for cold or heat pain thresholds. Pain intensity did not differ between female and male examiners. In conclusion, the results present meta-analytic evidence that examiner gender can influence how pain is perceived and reported. Incorporating such examiner–participant dynamics into experimental designs and clinical assessments is important for advancing pain research.