The etiquette of endometriosis: Stigmatisation, menstrual concealment and the diagnostic delay
The etiquette of endometriosis: Stigmatisation, menstrual concealment and the diagnostic delay
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DOI：
10.1016/j.socscimed.2009.07.023
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发表时间：
2009-10-01
影响因子：
5.4
通讯作者：
Seear, Kate
中科院分区：
文献类型：
--
作者：
Seear, Kate
子宫内膜异位症是一种病因不明的慢性妇科疾病，其特征是月经不规律。此前有几项研究发现，患者从首次出现症状到最终诊断之间经历了漫长的延迟。对于诊断延迟，人们提出了各种解释，医生和妇女都受到牵连。这些解释包括医生将女性的经痛视为正常现象，以及女性可能会因为难以区分“正常”和“异常”月经而推迟寻求医疗建议。有人建议，如果女性接受过如何区分“正常”和“异常”月经周期的培训，则可以减少诊断延迟。在本文中，我认为虽然这些可能是导致诊断延迟的因素，但女性不愿透露与月经周期相关的问题可能是一个更重要且迄今为止被忽视的因素。我认为女性不愿意披露月经不规律是因为月经是一种“不名誉的属性”（Goffman，1963），而披露会让女性容易受到污名化。妇女通过“月经礼仪”（Laws，1990）的实践来积极掩盖她们的月经不规律，这涉及策略性地掩盖月经问题。对 20 名被诊断患有子宫内膜异位症的澳大利亚女性的经历进行的分析支持了这一论点。考虑了该分析对更广泛的慢性疼痛状况以及旨在解决子宫内膜异位症诊断延迟的实际策略的影响。 (c) 2009 Elsevier Ltd. 保留所有权利。
Endometriosis is a chronic gynaecological condition of uncertain aetiology characterised by menstrual irregularities. Several studies have previously identified a lengthy delay experienced by patients between the first onset of symptoms and eventual diagnosis. Various explanations have been advanced for the diagnostic delay, with both doctors and women being implicated. Such explanations include that doctors normalise women's menstrual pain and that women might delay in seeking medical advice because they have difficulty distinguishing between 'normal' and 'abnormal' menstruation. It has been suggested that the diagnostic delay could be reduced if women were trained in how to distinguish between 'normal' and 'abnormal' menstrual cycles. In this paper I argue that whilst these may be factors in the diagnostic delay, women's reluctance to disclose problems associated with their menstrual cycle may be a more significant and hitherto neglected factor. I argue women are reluctant to disclose menstrual irregularities because menstruation is a 'discrediting attribute' (Goffman, 1963) and disclosure renders women vulnerable to stigmatisation. Women actively conceal their menstrual irregularities through practices of the 'menstrual etiquette' (Laws, 1990) which involves the strategic concealment of menstrual problems. This argument is supported through an analysis of the experiences of 20 Australian women diagnosed with endometriosis. The ramifications of this analysis for chronic pain conditions more generally and for practical strategies designed to address the endometriosis diagnostic delay are considered. (c) 2009 Elsevier Ltd. All rights reserved.