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Although multiple sclerosis (MS) affects both women and men, women are more susceptible to MS than men with increasing incidence and prevalence. Accumulating evidence indicatesthat gender appears to play a critical role in the development, efficacy and prognosis of MS, and therefore should be considered as an independent influencing factor. In this review, factors that can potentially explain the gender-biased observations in MS are discussed, which include incidence and prevalence, mechanism, course and prognosis, imaging, treatment principles. <br />