The purpose of this study was to examine the relationship between sexual orientation, self-described gender expression and preferred levels of gender expression in romantic partners with ischemic pain performance in healthy young women. It was hypothesized that lesbian and bisexual women would be less sensitive to pain than heterosexual women. It was also hypothesized that regardless of sexual orientation, women who endorse a preference for more feminine romantic partners and who describe themselves as more masculine would report higher pain thresholds, higher pain tolerance, and lower pain intensity levels than women who report attraction to more masculine romantic partners and rate themselves as possessing more feminine dispositions. A total of 172 women completed multiple assessments of identity and gender expression followed by an ischemic pain task. The study demonstrated that ischemic pain performance is associated with sexual orientation, dispositional gender expression, and preferred gender expression in romantic partners in healthy young women. Compared to heterosexual women, lesbian and bisexual women reported lower pain intensity ratings. Among heterosexual women, attraction to more feminine romantic partners was associated with lower pain intensity ratings early into the ischemic discomfort task, and there was a slight association between self-described masculinity and lower pain intensity ratings for heterosexual women. Similar associations emerged between attraction to more feminine romantic partners and higher pain tolerance in the heterosexual group and for dispositional masculinity and higher pain threshold and tolerance levels in the combined lesbian and bisexual group. These findings provide preliminary support for the hypothesis that, irrespective of biological sex, various other aspects of sexual identity are associated with ischemic pain performance.