![]() The importance of investigating the psychology of TMD patients was well-understood. Psychodynamic (e.g., inability to express emotional conflicts, fear, guilt), cognitive (e.g., feeling helpless, lack of control), behavioral (reduced job performance due to stress and low earnings) and biological (pain control and stress mechanisms) models are included in the explanation of the relationship between the physical and psychological dimensions of pain. The role of psychosocial factors (anxiety, depression, stress) in the onset of temporomandibular disorders is well-known, in accordance with the multifactorial theory. In addition, TMDs share many traits of chronic conditions, so they are treated with the same biopsychosocial models as chronic conditions. ![]() Although pain is the main reason that drives patients to the specialists’ observation, it should be considered that many of these patients report a marked stress degree due to pain and its interference in activities of daily living, and all this often leads to a certain degree of depression. As stated earlier, it is constantly clinically found that patients with temporomandibular disorders requiring treatment are 80% female. However, it is important to consider that extreme hormonal conditions, such as those that accompany pregnancy or the menstrual cycle, can give important changes on nociceptive responses. ![]() Apparently, hormones play an important role in nociceptive processes as they influence both the central and peripheral nervous systems (involved in pain transmission), although it is still necessary to determine the degree of their influence in the pathophysiological process of pain. Finally, it should be considered that women have additional stress loads compared to men, such as domestic duties and childcare, in addition to work, and this predisposes them to be more sensitive to pain. This behavior, in association with pain, interferes with their routine activities, such as work, and their tendency to take part in social activities. In so doing, women also have a more apprehensive attitude toward pain and its symptoms than men, and a stronger awareness and willingness to freely admit to health problems. This approach does work to the advantage of men who are better able, in this way, to accept even more severe pain in contrast, women only increase their sufferance, since the emotions associated with pain are all negative. Women experience pain mainly from an emotional point of view, while men focus on the strictly physical aspects. What does this imply? Next: why are some pathologies mostly female, and others mostly of men? In most clinical trials (especially on new drugs), women of childbearing age are not enrolled. Reflection began in the scientific world on what it means to be a woman in the treatment of various diseases, but not only that. National Institute of Public Health, in a famous editorial in the NEJM, spoke of Yentl syndrome, in reference to cardiologists’ discriminatory behavior against women. It was in 1991 when Bernardine Healy, then head of the U.S. ![]() Therefore, in agreement with Rubin and other contemporary authors, belonging to one category rather than another is not an innate characteristic, but is a social invention that is influenced by different cultures and historical periods. In 1975, anthropologist Gayle Rubin, in her “The Traffic in Women”, began to speak of a sex–gender system in which the biological datum is transformed into an asymmetrical binary system, where the masculine occupies a privileged position over the feminine, to which it is linked by close connections from which both derive mutual definition. This diversity is a social construct, varying over the years and from society to society. Since the 70s, the difference between “males” and “females” has been analyzed, not only from the biological (sex) point of view, but also from viewpoints that culture and society attribute to such biological differences (gender) as the totality of personality traits, attitudes, feelings, values, behaviors and activities.
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