You’re Making Me Sick: A Systematic Review of How Virtual Reality Research Considers Gender & Cybersickness

Research has shown that female-identified participants are more prone to cybersickness in virtual reality (VR).
A systematic review of 71 publications (59 studies, 12 surveys) examining gender and cybersickness highlighted several confounding factors in study designs, such as:
- Varied technical specifications
- Diverse tasks and content
- Underreported demographic data
- Recruitment biases
The review calls for improved representation and reporting of women's experiences in VR to understand the gendered nature of cybersickness better.
Recommendations for future VR research include incorporating gender considerations into study designs, irrespective of whether gender is the primary focus.
Keywords: gender, cybersickness, simulator sickness, virtual reality, systematic review

Historical evidence indicates women may experience cybersickness symptoms more severely, including:
- Discomfort
- Emesis (potential for vomiting)
Cybersickness is differentiated from simulator sickness, with cybersickness typically having greater severity and a distinct symptom profile.
Despite the underlying gender susceptibility suggestions, the scientific community lacks extensive validation and systematic study on this subject.
Access to VR technologies through consumer head-mounted displays (HMDs) has been increasing, raising safety concerns for the experience of diverse groups.
There is a pressing need for study designs in VR that account for gender effects to combat potential exclusion in VR experiences.

Previous studies fall into three categories:
1. Comparative examinations of gender impacts on sickness susceptibility.
2. Investigations of gender variances affecting discomfort in VR, detailing aspects such as path integration and visual dependencies.
3. Interventional work aimed at addressing discomfort causes.
Misalignments exist between these categories in assessments and prescribed solutions.
The inconsistency in exploring gender differences highlights the need for enhancements in systematic review approaches within VR research.

Knowledge derived from human factors research highlights distinct symptom experiences for genders:
- Stanney et al. found females experienced a total sickness symptom severity 15% higher than males and different symptom hierarchies.
- Typical symptom hierarchy for women:
- Disorientation > Oculomotor Disturbances > Nausea (D > O > N)
- Typical symptom hierarchy for men:
- Disorientation > Nausea > Oculomotor Disturbances (D > N > O)
This essentialized view of sickness may obscure the multifaceted nature of experiences.

Research has attempted to clarify whether women might simply report discomfort more often due to social factors rather than experiencing it inherently more.
- Jokerst et al. captured higher symptom scores for women but approached self-report validity skeptically.
- Cheung and Hofer's study lacked clarity in detecting gender differences on physiological measures, speculating on reporting biases instead.
Understanding cybersickness as a multifaceted experience, specifically in its various dimensions, is vital.
- Nausea's complexity encompasses variations in somatic, gastrointestinal, and emotional distress.

Interventions aimed at reducing cybersickness lack a gender-specific focus, making generalizability difficult.
Field of view (FOV) considerations may impact gendered experiences and symptoms, with past studies suggesting poignant effects of FOV on navigation and sickness.
Recent studies point to the relationship between physical attributes of VR devices, such as interpupillary distance, and gender differences in comfort and experience.

HCI studies focused on usability seldom account for gender differences, underscoring the necessity for demographic reporting in findings.
Despite the underrepresentation of female authors and participants, the implications of demographic disparities continue to impact Virtual Reality.

An exploratory review of CHI 2019 papers pointed to inconsistent treatment of gender and cybersickness.
Only 20 of 96 papers discussed participant experiences of cybersickness, with significant variability in methodology and reporting expectations.

96 relevant papers were selected based on predefined keywords, with procedures ensuring proper evaluation of abstracts and titles while excluding various unrelated fields.

The inspection focused on:
- Gender reporting inconsistencies
- Measurement and documentation practices for cybersickness

The PRISMA protocol was utilized to ensure systematic review methodology integrity.
71 eligible articles (59 studies and 12 surveys) were identified through a robust multi-database search to inform broad-based recommendations.

Findings summarize current literature encompassing gender nuances in 71 reviewed papers and their implications on cybersickness due to methodological variability and incomplete data reporting.

Analysis covered reviews mentioning gender and cybersickness, concluding that many correlations remained unsupported or inconclusive.
Specific hypotheses relevant to FOV outcomes reflected gender representation inequities in the studies.

The primary focus of analysis addressed observed relationships between gender and cybersickness through summarized standardized factors such as sample size, demographics, and usability feedback of VR technologies utilized across the studied pool.

The consistency in how gender is reported across 59 studies poses challenges for gaining deeper insights into cybersickness implications, calling for an enhanced perspective.

Discrepancies arise in how researchers treat gender within findings, with limited focus on addressing non-binary identities or aspects beyond the binary perspective.

Outlying concerns about relying solely on SSQ as a measure to quantify cybersickness suggest a need for more diversified methodological approaches.

Clear demographic reporting, broader gender considerations, and comprehensive documentation of dropout rates should be prioritized in future VR research to optimize methodological integrity and inclusivity.

The systematic review highlighted historical identification of gendered susceptibility to cybersickness and delineated gaps impacting current understanding and research rigor, advocating for gender considerations in every step of VR research processes.