Sex and gender considerations in orthopaedic research remain underdeveloped, and this episode highlights the need for systematic change. The discussion traces how leaders in the field convened a major symposium to address persistent gaps—particularly the failure to analyze outcomes by sex despite routinely reporting participant counts. Pain research emerges as a critical area, with clear biological and gender-driven differences that influence acute and chronic responses, yet remain largely unstudied in orthopaedics. The speakers emphasize coordinated responsibility across researchers, journals, funders, and IRBs to require thoughtful study design, adequate representation, and transparent reporting. Their ideal future is one where sex and gender analysis becomes a default expectation, shaping more accurate evidence, improving clinical guidelines, and informing training for the next generation of clinicians.