{"paper_id":"0f6e9bf9-c32c-485d-938f-6d86ec14a834","body_text":"E766 CMAJ  |  June 10, 2024  |  Volume 196  |  Issue 22 © 2024 CMA Impact Inc. or its licensors\n1\n Racialized patients with endometriosis have higher rates of \nopen-abdominal surgeries than minimally invasive procedures, \ncompared with White patients1\nLower rates of minimally invasive procedures predispose patients to com-\nplications.1 Providers should ensure that all patients receive high-quality \ncare and are aware of all treatment options.\n2\n Most Indigenous people who menstruate (65%) have difficulty \naccessing pain-relieving medicines2\nProviders should consider access to medication when discussing endo-\nmetriosis management. Access barriers include affordability, medication \nsupply, and other issues, such as travel distance.2\n3\n  Providers should overcome diagnostic barriers and cultivate \nan inclusive environment for transmasculine patients3\nProviders should avoid dismissing reports of pelvic pain in transmasculine \npatients who are receiving testosterone therapy, as they can have endo-\nmetriosis. Transmasculine patients can experience self-doubt and fear \narising from misgendering, discrimination, and dismissal of symptoms. 4 \nPatient experience should be validated, and the possibility of endo-\nmetriosis explored. Accurate names and pronouns should always be used \nin the patient’s presence, absence, and related documentation.\n4\n Patients who are migrants to or refugees in Canada show low \nuse of sexual and reproductive health services, which may be \ndue to the belief that discussing sex is taboo4\nWhen discussing endometriosis symptoms, which can include intimate \ntopics such as dyspareunia, providers should be transparent about their \ngoals and respect patient autonomy: “I would like to ask some intimate \nquestions to understand your experience better. Is that okay?” A safe space \nfor discussion should be cultivated: “Would you like someone in the room \nduring this discussion or would you like us to be alone?”\n5\n Cultural practices and beliefs should be respected through \nshared decision-making and acknowledgement of patient \ngoals and values\nCulture and beliefs can influence a patient’s perspective on some endo-\nmetriosis treatments such as hormonal therapy. 5 Instead of making \nassumptions, providers should ask, “How do you feel about this treatment \noption?” They should spend time with patients, explaining different treat-\nment options, allowing them to ask questions, and consulting cultural, \nspiritual, or religious advisors.\nPractice  |  Five ways to support ...    CPD  \nCulturally competent and inclusive \nendometriosis care\nMarfy Abousifein, Nicholas Leyland MHCM MD \nn Cite as: CMAJ 2024 June 10;196:E766. doi: 10.1503/cmaj.240278\nReferences\n1. Westwood S, Fannin M, Ali F, et al. Disparities in women with \nendometriosis regarding access to care, diagnosis, treat-\nment, and management in the United States: a scoping \nreview. Cureus 2023;15:e38765. doi: 10.7759/cureus.38765.\n2. An assessment of menstrual-related needs in northern com-\nmunities. Kitchener (ON): True North Aid; 2022:1-19. Avail -\nable: https://truenorthaid.ca/wp-content/uploads/2024/03/\nan-assessment-of-menstrual-related-needs-in-northern  \n-communities-final.pdf (accessed 2024 Apr. 8).  \n3. Eder C, Rommaney R. Transgender and non-binary people’s \nperception of their healthcare in relation to endometriosis. \nInt J Transgend Health 2023 Nov. 24. doi: 10.1080/26895269  \n.2023.2286268.\n4. Rowland DL. Culture and practice: identifying the issues. In: \nRowland D, Jannini E, editors. Cultural differences and the \npractice of sexual medicine: Trends in andrology and sexual \nmedicine. Cham: Springer; 2020:3-21.  \n5. Srikanthan A, Reid RL. Religious and cultural influences on \ncontraception. J Obstet Gynaecol Can 2008;30:129-37.\nAccess to health care\nCompeting interests: None declared.\nThis article has been peer reviewed.\nAffiliation: McMaster University, Hamilton, Ont.\nContent licence: This is an Open Access article \ndistributed in accordance with the terms of the \nCreative Commons Attribution (CC BY-NC-ND 4.0) \nlicence, which permits use, distribution and repro-\nduction in any medium, provided that the original \npublication is properly cited, the use is noncommer-\ncial (i.e., research or educational use), and no \nmodifications or adaptations are made. See: https://\ncreativecommons.org/licenses/by-nc-nd/4.0/\nEditor’s note: Marfy Abousifein has lived experience \nas an immigrant, a person with endometriosis, and a \nwomen’s health researcher. Dr. Nicholas Leyland is \nthe co-director of the Advanced Gynecology and \nMinimally Invasive Surgery Fellowship Program at \nMcMaster University and an endometriosis specialist.\nCorrespondence to: Marfy Abousifein,  \nabousifm@mcmaster.ca","source_license":"CC0","license_restricted":false}