Health surveys have found higher female morbidity rates, as reflected by indices such as general health status, number of acute conditions or physical symptoms and medical care utilization. Such findings can lead to the conclusion that women are the "sicker sex" in terms of objective health status. However, the size of the sex difference varies with the different indices used to operationalize the morbidity concept. Apart from sex specific conditions, the female morbidity excess seems most substantial with regard to general health status, acute and mild chronic conditions and physical symptoms. Findings from a large health survey in the Netherlands, presented in this article, confirm this picture. Some major methodological sources of bias, that have been held responsible for part of the sex differences found in health surveys, such as the poor definition of the morbidity concept and aspects of the data collection process, are discussed. One explanation for the higher morbidity of women, i.e., the differential perception of physical symptoms by men and women, is elaborated in more detail. The authors suggest that part of the sex differences found in health surveys can be explained by a higher female symptom sensitivity, defined as a readiness to perceive physical sensations as symptoms of illness. Research supporting this symptom sensitivity hypothesis is reviewed and explanations are given. It is suggested that further research on sex differences in morbidity should control for methodological sources of sex bias and should focus explicitly on differences in the perception of physical symptoms by men and women.

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The effects of BGAT were smaller than expected. Possible reasons for this negative outcome may be the adapted version of BGAT (shorter in duration), a lack of statistical power, or a difference between American and European samples in their reaction to BGAT.

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Medically unexplained (gynecological) symptoms can be viewed as an indication of the somatization of negative emotions. Most studies regarding psychological correlates of medically unexplained gynecological symptoms have paid attention only to certain personality characteristics of women with these symptoms. In this study the reporting of physical symptoms and the resulting illness behavior is explained in terms of information processing or a perception process, i.e. the process by which people detect and interpret physical sensations as symptoms of illness (symptom perception). Symptom perception is in part determined by environmental characteristics and cognitive and emotional processes, such as variation in daily life, (coping with) emotional threat and the use of cognitive illness schemes. Differences in symptom perception and illness behavior of women with medically unexplained and explained gynecological symptoms, compared to women with medically explained gynecological symptoms and a control group, were established with the help of a questionnaire, containing a number of scales. As expected, women with medically unexplained gynecological symptoms had higher reports of common symptoms and sensations and showed also more other illness behavior than the other two groups. They reported less variation and more threat in daily life than the other two groups. These variables together with the use of illness schemes contributed most to symptom reporting of women with medically unexplained symptoms. It is concluded that defence against threat is probably an important determinant. Suggestions for further research and some practical implications are discussed.

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