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，在英国每10名妇女中就有1人被发现(Rogers等人，2009年)。在这种情况下，类似于子宫衬里的组织在子宫外被发现(英国所有党派议会小组和子宫内膜异位症，2020)。这些组织出血并引起炎症，导致慢性疼痛(DeDespite非常常见，一直以来都缺乏对子宫内膜异位症的研究。这反映在一种未知的原因和缺乏可以治愈子宫内膜异位症的护理上(Facchin等人，2015年)。它还平均需要7.5年才能确诊(英国子宫内膜异位症，2011年)，并且经常被误诊(Jones等人，2004年)。这会增加患有这种疾病的人的痛苦和痛苦(Evans等人，2019年)。Young等人(2015)强调了子宫内膜异位症的主题，包括疼痛管理、医疗保健专业知识、工作生活和社交生活。因此，对与这种疾病相关的生物学、心理和社会方面的知识越多，就越能根据个人的生活方式进行量身定制和互补的治疗。以前的子宫内膜异位症研究是通过异型透镜进行的。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。这项研究的参与者是399名男性伴侣(法钦等人，2020)。考虑到女性对子宫内膜异位症的直接经验认识有限，研究男性伴侣如何受这种情况影响的紧迫性似乎还为时过早。此外，尽管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，还有关于女性经历的更普遍的假设。性行为研究倾向于只关注穿透性行为导致的痛苦的性交。此外，“性功能”等术语的定义也受到限制，并不适用于所有人(Vercellini等人，2012年)。Rea等人(2020)发现只有一项研究提到了子宫内膜异位症妇女使用的关于非穿透性行为或替代性活动的应对策略(Denny&Mann，2007)。同样，医生给出的减少症状的建议也可能是麻木不仁的，比如“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。与医疗保健提供者展示的LGBTQ+社区相比，文献中对同性关系的这种驳回反映了现实生活中对异性恋者的偏好。无论是有意还是无意，这可能会影响LGBTQ+社区接受的护理质量(Sabin等人，2015年)。人们已经注意到，以前女性在收到这种建议时会感到不安(Young等人，2015)，因此这项研究对于消除健康专业人员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。以前的文献明确指出了关于少数群体的子宫内膜异位症研究的空白，例如来自低社会经济背景的妇女、不认为自己是高加索人的妇女和非异性恋妇女(Young等人，2015年)。对于那些认为自己是LGBTQ+社区一部分的子宫内膜异位症妇女的描述，几乎没有什么探索(McKay等人，2022)。因此，这个项目的总体目标将是研究LGBTQ+妇女的子宫内膜异位症经历，重点是性行为和关系。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以及随后对他们福祉的影响来产生实际影响。

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.