Centring LGBTQ+ women's experiences of endometriosis: A critical mixed-methods analysis

子宫内膜异位症是一种妇科疾病，在英国十分之一的女性中发现（Rogers et al, 2009）。在这种情况下，在子宫外发现类似子宫内膜的组织（英国全党议会小组和子宫内膜异位症，2020年）。这种组织会出血并引起炎症，导致慢性疼痛(尽管很常见，但对子宫内膜异位症的研究却非常缺乏。这反映在病因不明和缺乏治疗子宫内膜异位症的护理（Facchin et al, 2015）。平均需要7.5年才能确诊（子宫内膜异位症UK， 2011），而且经常误诊（Jones et al, 2004）。这可能会增加患者的痛苦和痛苦（Evans等人，2019）。Young等人（2015）强调了子宫内膜异位症的主题，包括疼痛管理、医疗专业知识、工作生活和社交生活。因此，对与疾病相关的生物、心理和社会方面的了解越多，就越能根据个人的生活方式量身定制和补充治疗。以前的子宫内膜异位症研究是通过异位标准晶状体进行的。例如，最近的一项系统综述调查了“伴侣”对子宫内膜异位症的看法。本研究的参与者为399名男性伴侣（Facchin et al, 2020）。考虑到女性对子宫内膜异位症的直接经验认识有限，调查男性伴侣如何受到这种情况的影响似乎为时过早。此外，虽然这篇论文承认它不包括同性伴侣，但它没有解释为什么他们被排除在外。除了将LGBTQ+群体排除在子宫内膜异位症研究之外，人们还对女性的经历做出了更普遍的假设。性学研究往往只关注插入性行为带来的痛苦性交。此外，像“性功能”这样的短语的定义也很有限，并不是适用于所有人的术语（Vercellini et al, 2012）。Rea等人（2020）发现只有一项研究提到了子宫内膜异位症女性在非插入性行为或替代性行为中使用的应对策略（Denny & Mann, 2007）。同样，医生提出的减轻症状的建议可能不敏感，例如“怀孕”（Jones等人，2004年）。对于许多女性来说，这可能不是一个可行的选择，包括那些处于同性关系中的女性。文献中对同性关系的忽视可以反映现实生活中对异性恋者的偏好，而不是医疗服务提供者所展示的LGBTQ+社区。无论是有意还是无意，这都可能影响LGBTQ+社区接受的护理质量（Sabin et al, 2015）。人们注意到，女性在收到这类建议时会感到不安（Young等人，2015），因此，这项研究对于消除健康专业人士对子宫内膜异位症的无知和偏见，并考虑个人的个人情况至关重要。女性对子宫内膜异位症的描述正在得到重视，但并非所有女性都是如此。之前的文献明确指出了子宫内膜异位症研究中涉及少数群体的差距，如社会经济背景较低的女性、不认为自己是白人的女性和非异性恋女性（Young et al ., 2015）。对于那些被认为是LGBTQ+群体成员的子宫内膜异位症女性的研究很少（McKay et al ., 2022）。因此，该项目的总体目标将是研究LGBTQ+女性子宫内膜异位症的经历，重点关注性和关系。这项研究旨在通过减少LGBTQ+社区在接受医疗保健时可能遇到的不平等现象以及随后对他们福祉的影响，产生实际影响。

Endometriosis is a gynaecological condition found in 1 in 10 women in the UK (Rogers et al, 2009). In this condition, tissue similar to the uterus lining is found outside of the uterus (All Party Parliamentary Group & Endometriosis UK, 2020). This tissue bleeds and causes inflammation that results in chronic pain (DeDespite being very common, there has been a monumental lack of endometriosis research. This is reflected in an unknown cause and lack of care that can cure endometriosis (Facchin et al, 2015). It also takes on average 7.5 years to be diagnosed (Endometriosis UK, 2011) and is frequently misdiagnosed (Jones et al, 2004). This can increase both pain and distress for people with the condition (Evans et al, 2019). Young et al (2015) highlighted themes of endometriosis that included pain management, healthcare professional knowledge, work life and social life. Therefore, the more knowledge concerning the biological, psychological and social aspects that are relevant to the condition, the more treatment can be tailored and complimentary to individuals' lifestyle.Previous endometriosis research has been conducted through a heteronormative lens. For example, a recent systematic review investigated 'partners' perspectives of endometriosis. The participants in this study were 399 male partners (Facchin et al, 2020). The urgency to investigate how male partners are affected by this condition seems too soon considering the limited awareness of the direct experience women have of endometriosis. Furthermore, although this paper does acknowledge that it does not include same-sex couples, it does not provide an explanation as to why they are excluded. As well as the exclusion of the LGBTQ+ community in endometriosis research, there are more general assumptions about women's experiences that are made. Sexuality research tends to only be concerned with painful sexual intercourse as a result of penetrative sex. In addition, phrases such as 'sexual functioning' are also limited in their definition and are not applicable terms for everyone (Vercellini et al, 2012). Rea et al (2020) found only one study that mentioned coping strategies used by women with endometriosis concerning non-penetrative sex or alternative sexual activity (Denny & Mann, 2007). Similarly, advise given by doctors to reduce symptoms can be insensitive, such as 'getting pregnant' (Jones et al, 2004). This may not be a feasible option for many women, including those in same-sex relationships. This dismissal of same-sex relationships in the literature can reflect real-life preferences towards heterosexual people compared to the LGBTQ+ community displayed by healthcare providers. Whether intentional or not, this may affect the quality of care received by the LGBTQ+ community (Sabin et al, 2015). It has been noted that women have been previously upset when receiving this kind of advice (Young et al, 2015), therefore this research is pivotal to remove health professional ignorance and prejudice concerning endometriosis and consider the individual's personal circumstances.Women's accounts of endometriosis are being highlighted, however not equally for all women. Previous literature had explicitly identified gaps in endometriosis research concerning minority groups such as women from low socioeconomic backgrounds, women who do not identify as Caucasian, and non-heterosexual women (Young et al, 2015). There has been little exploration into the accounts of women with endometriosis who identify as part of the LGBTQ+ community (McKay et al, 2022). Therefore, the overall aim of this project will be to examine LGBTQ+ women's experience of endometriosis with a focus on sexuality and relationships. This research aims to have a practical impact by reducing inequalities that the LGBTQ+ community can encounter when receiving healthcare and the subsequent impact on their wellbeing.