{"paper_id":"2120c318-af39-4d43-b185-48f67052280c","body_text":"FULL-LENGTH ARTICLES \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and \nGender Diversity \nMaddalena Giacomozzi1,2\n, Stéphane Guy Aubin3\n, Elisa Castellano4\n, Jasmine Brazelton2,5\n, Max Jahufer6\n, Jip Bouwens2\n,\nDonna Ruumpol7\n, Khushi Jeswani2\n, M Mainetti2\n, Maaike Muntinga8\n, Petra Verdonk8\n, Annemiek W. Nap7 \n1 Obstetrics&Gynaecology , Radboud University Medical Center, 2 Treat it Queer Foundation, 3 Treat it Queer Foundation , 4 Spaghetti Publishing, 5 Donders \nInstitute for Brain, Cognition and Behaviour, 6 Endometriosis Australia, 7 Obstetrics&Gynaecology, Radboud University Medical Center, 8 Department of Ethics, \nLaw & Medical humanities, Amsterdam University Medical Centers \nKeywords: Transgender, endometriosis, graphic medicine, health disparities, participatory action research methods. \nhttps://doi.org/10.35844/001c.137016 \nJournal of Participatory Research Methods \nVol. 6, Issue 2, 2025 \nTransgender and gender diverse (TGD) individuals assigned female at birth \n(AFAB) are greatly impacted by endometriosis, which can severely affect their \nquality of life. This group faces significant barriers to healthcare due to \nstructural discrimination and marginalization. Their experiences are often \nsilenced, and healthcare professionals (HCPs) lack training to adequately \ndiagnose and treat them. A TGD-led group implemented graphic medicine \nmethodology to research endometriosis and gender diversity within a \nparticipatory action research (PAR) approach. Participants had diverse \nbackgrounds and contributed to the project thanks to a combination of their \nreal lived experiences and their professional expertise. In this report, we use a \nparticipatory action research (PAR) approach to implement a graphic medicine \ninitiative on endometriosis and gender diversity. Graphic medicine is a \nmethodology that combines healthcare and visual storytelling to enhance \nunderstanding of medical experiences and is a particularly suitable method for \nrecentering experiences of marginalized communities and empowering them \nthrough the development of a knowledge product. The participants who \ncontributed to the development of the graphic medicine product had diverse \nbackgrounds and contributed both their real lived experiences and professional \nexpertise. A comprehensive graphic medicine product was eventually developed, \nincorporating three key components: (1) a biographical narrative of a \nrepresentative nonbinary transmasculine individual with endometriosis, (2) \nanonymized quotes from focus groups with TGD individuals, capturing diverse \nlived experiences, and (3) educational content aimed at HCPs on combining \nendometriosis treatment with gender-affirming care. Available in English, both \nonline and in hardcopy, the product is currently used for educational, clinical \ntraining, and scientific purposes. Feedback from early users suggests its \neffectiveness in enhancing awareness and understanding among HCPs of \nendometriosis, gender diversities, and the intersections thereof. \nBackground  \nThe current report describes the graphic medicine methodology \nimplemented in It’s a Journey., a project applying a participatory action \nresearch (PAR) approach to research endometriosis among TGD people. \nTransgender and gender diverse (TGD) people are individuals who do not \nGiacomozzi, M., Aubin, S. G., Castellano, E., Brazelton, J., Jahufer, M., Bouwens, J.,\nRuumpol, D., Jeswani, K., Mainetti, M., Muntinga, M., Verdonk, P., & Nap, A. W. (2025).\nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity.\nJournal of Participatory Research Methods, 6(2), 1–15.\nhttps://doi.org/10.35844/001c.137016\n\nidentify with the gender assigned to them at birth (Coleman et al., 2022). \nThey often experience minority stress as a result of historical marginalization \nand are disproportionately affected by social and health disparities compared \nto cisgender individuals (Mezza et al., 2023; Tan et al., 2019). Endometriosis \nis a chronic condition characterized by cyclic pelvic pain that can greatly affect \none’s quality of life (Giacomozzi & Nap, 2022). The dominant discourse \nnarrates endometriosis as a “women’s condition” thus enforcing a binary \ngendered framing it instead of focusing on the relevant sex-related biological \nfactors that interplay in its pathophysiology (Jones, 2021). However, studies \nfind that TGD people assigned-female-at-birth (AFAB) are disproportionately \naffected by endometriosis, and that the healthcare system is inadequate to \nrespond to their health needs (Eder & Roomaney, 2024; Giacomozzi et al., \n2024; Kaltsas et al., 2024). This often results in missed diagnoses as well \nas ineffective treatment plans. Little is known about the experiences and \nthe needs of TGD people with endometriosis, who are hardly included in \nknowledge generation and decision-making processes (Ellis et al., 2024). \nProject design   \nGraphic medicine as participatory method within a PAR approach          \nPAR is a research approach that emphasizes the significance of experiential \nknowledge in addressing challenges caused by inequitable social structures \nand in shaping and implementing transformative alternatives (Cornish et al., \n2023). The PAR approach engages the leadership and active participation \nof people directly experiencing inequities, empowering them to drive \nemancipatory social change by conducting research to generate new \nknowledge (Baum et al., 2006; Cornish et al., 2023). As described in its \nmanifesto, graphic medicine is a method that combines “the principles of \nnarrative medicine with an exploration of the visual systems of comic art, \ninterrogating the representation of physical and emotional signs and \nsymptoms within the medium” (Czerwiec et al., 2020). This medium exploits \na unique combination of visual elements (illustrations, speech bubbles, \nonomatopoeia, etc.) and in this unique way not only narrates but also \nliterally makes visible otherwise silenced experiences (Green & Wall, 2020; \nVenkatesan & Peter, 2019). We selected this participatory method as it is \nunderstood to be fourfold: at once a disruptive movement, an education \ntool, a therapy, and a vehicle for community formation (Venkatesan & Peter, \n2019). Graphic medicine was chosen for its capacity to create and disseminate \nknowledge while — or actually because — it is a process of active community \nengagement and empowerment (Green & Myers, 2010; McNicol, 2016). \nFurther, it is proven to be particularly helpful in addressing gendered health \ndisparities through queer and trans scholarship, which suited our project \nobjectives (Councilor & Fink, 2024; Joy et al., 2021). Graphic medicine, \nin fact, allows for more creative and just representations of bodies that fall \noutside of societal norms (Cosma et al., 2020; Green & Wall, 2020; Joy et \nal., 2021). It enables the team to decide not only which bodies matter, but \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 2\n\nalso how, when, and where in the visual and narrative space they should be \nlocated (Councilor & Fink, 2024). Given TGDs’ structural marginalization, \nit is an excellent medium to explore, focus, and linger in the marginal and \nliminal spaces that this community occupies. In this sense, graphic medicine \nis a tool to enlarge margins to full-pages and thereby re-center experiences too \noften relegated to footnotes (Czerwiec et al., 2020; Green & Myers, 2010). \nObjective  \nThis report describes the participatory process that led It’s a Journey. The \nproject aimed to (1) contribute to the broadening of endometriosis narratives \ntoward gender inclusivity, (2) raise awareness of its high prevalence in the \nTGD community, and (3) educate healthcare providers and professionals \non TGD-sensitive diagnostics and treatments. The final graphic medicine \nproduct is meant to serve as a bridge between academic research and the \nlesbian, gay, bisexual and transgender (LGBT+) community, while actively \nengaging and empowering this historically marginalized social group. \nThrough this report, we strive to illustrate the use of graphic medicine \nmethodology with a PAR approach and reflect upon its strengths and \nlimitations for this project. \nCreating a core team     \nPrior to funding acquisition, the project proposal was conceptualized \nand discussed among TGD people with/out endometriosis, endometriosis \nresearchers and HCPs as well as LGBT+ activists. Once the funding was \nassured, a final team was assembled combining members active in academia \nand/or in the LGBT+ community. The two main organizations involved \nwere a Radboud University Medical Center, a University Hospital in the \nNetherlands, and the Treat it Queer Foundation, an international small-\nscale NGO dedicated to health justice for the queer community. The core \nteam involved two junior TGD transmasculine endometriosis researchers \nsupervised by two senior female cisgender scientists, one professional LGBT+ \ncartoonist, and two consulting TGD people with endometriosis (Figure 1). \nIt was crucial to us that the research was TGD-led to counteract hegemonic \nbiomedical knowledge acquisition and cisnormative gendered systemic power \nstructures, thus ensuring more equitable dynamics among project members \nand comprehensive data generation. \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 3\n\nFigure 1. Core team organigram. \nProject implementation   \nIdea generation phase    \nOur first session was an online idea generation during which the core team \ndiscussed characters’ features and relevant themes that should be represented. \nFoundational design choices were made at this meeting, e.g. relating to color \npalettes and illustration style. \nContent development   \nAfter the idea generation, the core team met several times online for short \nmeetings, and for whoever possible sometimes in person for full day work. \nDuring this process, we decided to include three main elements in the final \nproduct. These were: \n1. Fictional storyline : the cartoons illustrate the biography of \nColt, a fictional transmasculine non-binary person with \nendometriosis, from their birth until their late 30s. The story \ndevelops along with the character weaving together different \nthemes, i.e., coming to terms with being gender diverse, \ninternal and external acceptance, living with a chronic illness, \nintimate relationships and family planning as a TGD person \nwith endometriosis, and the role and formation of \n(nontraditional) families. Color is used in a narrative way, \nand each chapter focuses on a single, story-relevant and \nsymbolic, dominant color. For example, the first Chapter — \ntitled “It’s a girl.” — uses a palette consisting exclusively of \npink hues (Figure 2). \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 4\n\nFigure 2. Preview of Chapter 1 cover and page illustrating the narrative use of the colour pink. \n2. Quotes from previous qualitative research    : to \ncomplement the fictional aspect of the cartoon story, we \nhave inserted quotes from focus groups with TGD persons \nwith endometriosis. The research methodology that led to \nthe generation of those data is described elsewhere \n(Giacomozzi et al., 2025). The focus groups were conducted \nonline and included 14 TGD people with endometriosis \nbased in eight different countries to investigate their \nexperiences and needs relating to endometriosis and gender. \nThe quotes are located on designated pages at pertinent \nintersections with the fictional storyline, to showcase the \nreflection and grounding of the fictional themes in real lived \nexperiences. For example, when Colt gets their first period, \nthe featured quotes refer to the experiences of participants \nwith menarche “I didn’t understand what was going on. I \nremember being so scared and I remember going to bed in \npain, then waking up in pain. So, from the first time I \nremember I associated my period with being in pain, not \nbeing able to run around like a kid. I remember [being \nafraid] …because when I told my mom she was like “oh \nyou’re becoming a woman” -the classic things that people \nsay. I remember I was like: I don’t want to become a woman. \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 5\n\nFigure 3. Preview of pages 24 and 26 juxtaposing the fictional storyline of Colt’s first period and the quotes from \nfocus groups about participants’ experiences with menarche. \nI don’t want to do this” -H., non-binary person in his 20s \nfrom Greece (Figure 3). Later in the book, Colt is \nconsidering medical gender transition, and a quote was \nadded to reflect a real lived experience relating to this “I had \nno business being in that body, if that makes any sense at \nall?” -J., non-binary transmasculine person in their 20s from \nthe Netherlands. \n3. Medical information : each chapter features one relevant \ntopic with which HCPs should be familiar, such as \ndiagnostic tools and treatment options for endometriosis for \nTGD people. The themes of these sections were identified by \nthe core team and later weaved into the storyline. Mostly, \nthese matched the development of the character storyline as \nthey represent typical milestones in one’s endometriosis and \ngender journey, such as getting diagnosed and treatment. At \ntimes, the storyline was developed in a certain way to match \nthe medical themes we wanted to touch upon, for example \nwhen there is a timelapse in the storyline so that Colt and \ntheir partner go to a doctor’s appointment to ask about \nfertility preservation options, even if only a few pages were \ndedicated to their love story beforehand and therefore it \nwould have not be logical to see them thinking about family \nplanning already. The content of these informational pages \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 6\n\nCore teams feedback rounds     \nFrequent community checks regarding visual or other minor design or \nnarrative choices were performed through quick communication channels, \nsuch as WhatsApp and phone calls (e.g. to choose Colt’s haircut or the \ncover design). Structural feedback rounds were carried out with scientific \nsupervisors (two supervisors for two rounds) to assess the medical \ninformation, and with the TGD people with endometriosis in the core \nteam (two individuals for two rounds) to outline, (re)think and continue \nColt’s storyline. Feedback rounds were both in written form through emails \nand shared documents, as well as orally in the form of group discussions. \nThe meetings were facilitated by the main junior TGD researcher, and the \ncartoonist was always present. Other members of the core team participated \nbased on the project’s needs and their availabilities. Additional community \nexperts were approached for their specific lived experiences and/or areas \nof expertise — for example, a TGD linguist was consulted to name the \ncharacters appropriately. Feedback from early reception described below was \nalso considered in the development phase. \nDissemination and early reception     \nDuring the implementation phase, the project process and the preliminary \nresults were presented at (1) the monthly meetings of the Treat it Queer \nFoundation (about 8 people each meeting). (2) two events hosted by Share-\nNet, i.e. the funder (approximately 35 participants each event), (3) one \nscientific meeting held at Radboud University Medical Center (about 30 \nparticipants). Early feedback by HCPs and LGBT+ activists was integrated \nin the following project phases. For instance, HCPs suggested to simplify \nmedical information to be accessible to HCPs with different backgrounds, \nand LGBT+ activists gave guidance on how the love story subplot between \nColt and their partner should have developed into a long-term relationship. \nGraphic medicine was particularly praised as an innovative method to convey \ncomplex medical information in an accessible and appealing approach for \nHCPs. Many academics appreciated how this method enabled them to make \nresults from previous research more accessible to a wide audience, while \nactively engaging with an otherwise marginalized community. The main \nthemes addressed in the knowledge product are (1) endometriosis, (2) gender \ndiversity, and (3) their intersection. People who were not familiar with any \nof these topics reported that the product was helpful in learning more about \nthem globally. At the same time, individuals who were familiar with one \nwas developed by the junior researchers and supervised by \nthe senior scientists separately. References to academic \nliterature and additional resources were included to enable \nfurther education of HCPs while validating the given \ninformation by showing how they are supported by the \ncurrent scientific discourse. \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 7\n\ntheme but not with another — e.g., someone who works in endometriosis \ncare but is not familiar with the LGBT+ community — still found the \nproduct appealing and educational, to shore up their information \nshortcomings. Knowledge uptake was said to be facilitated by the fact that \nthe medical information is clearly divided from the storyline and quotes, thus \none can choose to linger more or skip pages based on their prior knowledge \nand/or interests (Figure 4). TGD people with endometriosis who were not \ninvolved in the project implementation also gave early feedback and expressed \ndiscontent about the fact that the main target of the educational tool was \nHCPs and not the community itself. At the same time, they reported feeling \nvalidated and represented by the product which also provided them with \nthe opportunity to read relatable stories and experiences. This feedback was \nparticularly considered during the remaining development of the project, \nand especially for its dissemination. Therefore, we strove to ensure that It’s \na Journey. is actively distributed to the TGD community and becomes as \naccessible as possible. We believe that community members can find not just \nvalidation but also important information in its pages — information they \ncan then wield as a tool to facilitate critical conversations with their HCPs. \nFigure 4. Preview of page 38 that provides information for HCPs on how to diagnose endometriosis. \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 8\n\nThe product is currently available in digital format and as hardcopies \n(Figure 5). It is disseminated through several online channels not only of \nthe participants’ affiliations and the funding organization, but also through \nmany patients’ associations and LGBT+ groups. Hardcopies are distributed \nat scientific events for HCPs about endometriosis such as the World \nEndometriosis Conference, and at community events like Beyond the Binary \nDay in Nijmegen, Netherlands. The product is further incorporated in the \nTreat it Queer Foundation workshops that are offered to medical students \nand HCPs in many medical faculties and hospitals across Europe and \nCanada. The team is working at expanding press coverage of the project \nto include, among others, Medisch Contact, the medical journal of the \nNetherlands, and TRANSmagazine. \nFigure 5. Picture of the hardcopy of the final research output. \nStrengths and limitations    \nGraphic medicine was an effective methodology to meet project objectives, \noperating along each of the four pathways highlighted by Venkatesan and \nPeter (2019): as a form of disruptive movement, an education tool, a form of \ntherapy, and as community formation. Using illustrations in health research \nenabled us to convey complex medical information relating to both \nendometriosis and gender in an accessible format (“graphic medicine as \nan education tool”). Moreover, the creative aspect of making a cartoon \ncontributed to a stimulating, inspiring, and fun team process that fostered \nboth individual and community empowerment cross-bridging between \nacademia and LGBT+ activism communities (“graphic medicine as \ncommunity formation”). Another advantage of using an illustrated medium \ninstead of a photovoice or video documentary was that it allowed us to \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 9\n\ndepict consciously reflexive and arbitrary representations of how especially \nTGD bodies look — or don’t (“graphic medicine as a disruptive movement”). \nThis disrupted the otherwise hideous task of “looking for people who look a \ncertain way” to have a representative final product. For example, we wanted \nto show fat bodies to counteract the overrepresentation of slim, androgynous, \nand white nonbinary bodies over other TGD body types. Therefore, we \nsimply asked the cartoonist to illustrate more fat bodies, instead of having to \nselect participants with certain body types. In this way, illustration allowed us \nto sidestep common pitfalls in representations of marginalized groups, such \nas tokenism and stereotyping. Specifically relevant to the TGD community, \nanother great advantage of this graphic medium presented in the ability — \nwithin the same product — to represent Colt, a TGD character, at different \npoints in their gender transition without risking triggering gender dysphoria. \nUsing illustration, it was possible to show an individual’s transition without \nrequiring a person to dig into old personal records or problematic “before/\nafter” pictures. \nSimilarly, the storyline was malleable, able to adapt to the group’s input \nand did not rely on a single testimony. This permitted us to combine and \nincorporate various real lived experiences and to choose for each chapter/\nscene what the group found most relevant to tell. In this fashion, for example, \nit became clear during the idea generation phase that the team wanted \nto prioritize an encouraging “happy ending” over a (unfortunately) more \nrealistic one to uplift and provide inspiration and strength to TGD people \nwith endometriosis who may read the book (Figure 6). This conscious choice \nfor the ending contrasts with the dominant discourse in both endometriosis \nand TGD-related media which favors hopeless, helpless, and sensationally \ncatastrophic endings (“graphic medicine as therapy”). \nFigure 6. Preview of pages 69 and 71 depicting the happy ending of the fictional storyline. \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 10\n\nHowever, graphic medicine also presented limitations, which were often \nthe flipside of the strengths outlined above. In fact, a limitation intrinsic \nto graphic medicine was the necessary restriction of representation given by \nthis method. Illustrating someone’s story implied deliberately choosing not \nonly a storyline, but also how the characters looked like and spoke, their \nmannerisms, their flaws, their personalities. Inevitably, this meant every time \nwe made a choice, we opted to represent someone’s experience and not \nsomeone else’s. In this we tried to be as faithful as possible to our own \nexperiences and previous research data. For example, the main character is \nwhite because we did not have sufficient background among us or our data \nto tell the story of a Black, Indigenous, and people of color (BIPOC) person \n(Giacomozzi et al., 2025). We are aware that BIPOC experiences are more \noften silenced than white ones and recognize that this conscious choice — \nthough motivated by data and our desire to avoid misrepresentation as it \nmay be — contributed to this continued disparity in representation (Figure \n7) (Bougie et al., 2022; Katon et al., 2023; Westwood et al., 2023). Further \nstudies are necessary to assess the impact and reception of the final product, \ne.g., through a questionnaire dispended to the readers. This project was \nfurther limited by logistic restraints such as the total project timeline being \nconstrained to a mere eight months. This placed not-insignificant strain on \nthe team members, who worked under great time-sensitive deadlines, and \nsignificantly reduced the possibility of large-scale idea generation sessions \nand extensive community checks. We recommend carefully considering the \nworkload of such a project beforehand and keeping reassessing it periodically \nover the project lifespan, especially when working with marginalized \ncommunities that already operate under resource-restricted circumstances. \nWe were fortunate to have received funding which allowed us to compensate \npeople financially for their time and input, partially mitigating this issue. \nEnsuring sufficient funding to compensate research participants for their \nwork and expenses should be pivotal for any research with a PAR approach. \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 11\n\nFigure 7. Character sketches for the main character through their transition. \nConclusion  \nTaking a PAR approach to graphic medicine is useful to collect and tell the \nstories of otherwise marginalized people, maximizing the impact of enriching \ncommunity engagement. It allows for the active involvement of individuals \nand groups with diverse backgrounds, facilitating the creation of mixed teams \nwith both academics and activists. It’s a Journey. was in itself a journey, a \nprocess as well as a product that we believe will help shift the narrative around \nendometriosis and gender diversity, thus contributing to social and health \njustice through meaningful community engagement. \nAcknowledgements  \nThank you to all the people who took part in the focus group whose \noutcomes have been integrated into the final product. We would also like \nto offer special recognition and gratitude to: Anna Mai (they/them), PhD, \npostdoctoral researcher at the Max Planck Institute for Psycholinguistics, \nfor coming up with original and well-suited names for the characters and \nNicol Moran (she/her), coordinator at Share-Net, for the unwavering support \nthroughout all phases of this project. \nFunding  \nThis project was sponsored by Share-Net International through an \nactivation fund granted to the Treat it Queer Foundation under project \nnumber 10201-2404.03.1. \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 12\n\nSubmitted: December 08, 2024 EDT. Accepted: February 03, 2025 EDT. Published: July 03, 2025 EDT. \nThis is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 \nInternational License (CCBY-4.0). View this license’s legal deed at http://creativecommons.org/licenses/\nby/4.0 and legal code at http://creativecommons.org/licenses/by/4.0/legalcode for more information. \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 13\n\nReferences  \nBaum, F., MacDougall, C., & Smith, D. (2006). Participatory action research. Journal of \nEpidemiology & Community Health, 60(10), 854–857. https://doi.org/10.1136/jech.2004.028662 \nBougie, O., Nwosu, I., & Warshafsky, C. (2022). Revisiting the impact of race/ethnicity in \nendometriosis. Reproduction and Fertility, 3(2), R34–R41. https://doi.org/10.1530/raf-21-0106 \nColeman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L. C., Deutsch, M. B., \nEttner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., \nKnudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F. L., Monstrey, S. J., Motmans, J., \nNahata, L., … Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender \nDiverse People, Version 8. International Journal of Transgender Health, 23(sup1), S1–S259. \nhttps://doi.org/10.1080/26895269.2022.2100644 \nCornish, F., Breton, N., Moreno-Tabarez, U., Delgado, J., Rua, M., Aikins, A. D., & Hodgetts, D. \n(2023). Participatory action research. Nature Reviews Methods Primers, 3(1). https://doi.org/\n10.1038/s43586-023-00214-1 \nCosma, A., Goodliffe, S., Hiltner, S., Joy, P., Magnée, T., & Plug, I. (2020). A Journey of Gender in \nHealth: A Comic Book. \nCouncilor, K. B., & Fink, A. E. (2024). Gendered bodies: A graphic medicine commentary. Social \nScience & Medicine, 351, 116436. https://doi.org/10.1016/j.socscimed.2023.116436 \nCzerwiec, M., Williams, I., Squier, S. M., Green, M. J., Myers, K. R., & Smith, S. T. (2020). \nGraphic Medicine Manifesto. https://doi.org/10.5325/j.ctv14gpf04 \nEder, C., & Roomaney, R. (2024). Transgender and non-binary people’s experience of \nendometriosis. Journal of Health Psychology. https://doi.org/10.1177/13591053241266249 \nEllis, K., Armour, W., & Wood, R. (2024). ‘I never see anyone like myself represented in discussions \nabout endometriosis’: Priorities of LGBTQIA + endometriosis patients in New Zealand. Culture, \nHealth & Sexuality, 0(0), 1–21. https://doi.org/10.1080/13691058.2024.2394650 \nGiacomozzi, M., Bouwens, B., Aubin, S., Pastoor, H., Verdonk, P., & Nap, A. (2024). Transgender \nand gender diverse people embodying endometriosis: A developmental intersectional analysis. \nFrontiers in Medicine, 11. https://doi.org/10.3389/fmed.2024.1430154 \nGiacomozzi, M., Brazelton, J., Jeswani, K., Ruumpol, D., Verdonk, P., & Nap, A. W. (2025). \nInsights from focus groups with trans and gender diverse people with endometriosis: stories you \ntell, stories you don’t. Sexual and Reproductive Health Matters. Under review. \nGiacomozzi, M., & Nap, A. (2022). Surgical Management of Endometriosis-associated Pain. In A. \nHorne & L. Whitaker (Eds.), The Continuous Textbook of Women’s Medicine (Vol. 3). https://\ndoi.org/10.3843/GLOWM.417673 \nGreen, M. J., & Myers, K. R. (2010). Graphic medicine: use of comics in medical education and \npatient care. BMJ, 340(mar03 2), c863. https://doi.org/10.1136/bmj.c863 \nGreen, M. J., & Wall, S. (2020). Graphic Medicine—The Best of 2020. JAMA, 324(24), 2469. \nhttps://doi.org/10.1001/jama.2020.19479 \nJones, C. E. (2021). Queering gendered disabilities. Journal of Lesbian Studies, 25(3), 195–211. \nhttps://doi.org/10.1080/10894160.2020.1778852 \nJoy, P., Cosma, A., Goodliffe, S., Hiltner, S., Magnée, T., & Plug, I. (2021). A journey of gender in \nhealth: Transforming health by promoting gender considerations through comic art. Journal of \nApplied Arts and Health, 12(2), 145–162. https://doi.org/10.1386/jaah_00066_1 \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 14\n\nKaltsas, A., Stavropoulos, M., Symeonidis, E. N., Kratiras, Z., Zachariou, A., Zikopoulos, A., \nChrisofos, E. E., Dimitriadis, F., Sofikitis, N., & Chrisofos, M. (2024). Endometriosis in \nTransgender Men: Bridging Gaps in Research and Care—A Narrative Review. Biomedicines, \n12(7), 1481. https://doi.org/10.3390/biomedicines12071481 \nKaton, J. G., Plowden, T. C., & Marsh, E. E. (2023). Racial disparities in uterine fibroids and \nendometriosis: a systematic review and application of social, structural, and political context. \nFertility and Sterility, 119(3), 355–363. https://doi.org/10.1016/j.fertnstert.2023.01.022 \nMcNicol, S. (2016). The potential of educational comics as a health information medium. Health \nInformation & Libraries Journal, 34(1), 20–31. https://doi.org/10.1111/hir.12145 \nMezza, F., Mezzalira, S., Pizzo, R., Maldonato, N. M., Bochicchio, V., & Scandurra, C. (2023). \nMinority stress and mental health in European transgender and gender diverse people: A \nsystematic review of quantitative studies. Clinical Psychology Review, 107, 102358. https://\ndoi.org/10.1016/j.cpr.2023.102358 \nTan, K. K. H., Treharne, G. J., Ellis, S. J., Schmidt, J. M., & Veale, J. F. (2019). Gender Minority \nStress: A Critical Review. Journal of Homosexuality, 67(10), 1471–1489. https://doi.org/\n10.1080/00918369.2019.1591789 \nVenkatesan, S., & Peter, A. M. (2019). Towards a theory of graphic medicine. Rupkatha Journal on \nInterdisciplinary Studies in Humanities, 11(2). https://doi.org/10.21659/rupkatha.v11n2.08 \nWestwood, S., Fannin, M., Ali, F., Thigpen, J., Tatro, R., Hernandez, A., Peltzer, C., Hildebrand, \nM., Fernandez-Pacheco, A., Raymond-Lezman, J. R., & Jacobs, R. J. (2023). Disparities in \nwomen with endometriosis regarding access to care, diagnosis, treatment, and management in the \nUnited States: A scoping review. Cureus. https://doi.org/10.7759/cureus.38765 \nIt’s a Journey: A Graphic Medicine Exploration of Endometriosis and Gender Diversity\nJournal of Participatory Research Methods 15","source_license":"CC0","license_restricted":false}