Epistemic and affective harms in Endometriosis diagnosis

Mara Floris, Cristina Ganz, Annamaria Grisorio
In: Philosophical Psychology · 2026 · pp. 1–24 · doi:10.1080/09515089.2026.2632370 · W7130581611
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This paper explores the epistemic and affective harms experienced by individuals during the diagnostic process for endometriosis.

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ABSTRACT Endometriosis is a chronic and often debilitating condition affecting around 10–15% of individuals assigned female at birth, yet diagnosis is delayed by five to eleven years. Beyond biomedical limits, socio-epistemic factors crucially shape how pain is perceived, communicated, and legitimized. This study analyses how epistemic and affective injustices intersect in clinical encounters, showing how power asymmetries sustain diagnostic delay. Testimonial injustice arises when patients’ credibility is deflated through gendered stereotypes of emotionality, leading to psychologization or trivialization of pain reports. Hermeneutical injustice emerges when menstrual and pelvic pain remain conceptually unintelligible within dominant medical frameworks, limiting patients’ interpretive resources. We also identify a form of affective injustice – pathologising affect – in which emotions and bodily experiences are reframed as psychiatric disturbances, disqualifying affect as a legitimate epistemic source. Drawing on source-based epistemic injustice, we argue that downgrading affective experience undermines epistemic agency and diagnostic accuracy. Together, these mechanisms form a self-reinforcing loop that perpetuates epistemic and affective harms. Disclosure statement No potential conflict of interest was reported by the author(s). Ethical statement This study was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments. Informed consent was obtained from all participants included in the study. I hereby confirm that the manuscript has not been published elsewhere and is not under consideration for publication by any other journal. I further attest that the paper is solely the work of the listed author(s), and that neither ChatGPT nor any other artificial intelligence program was used to write or assist in writing any part of the manuscript. Notes 1. Four out of eleven participants identified a specific age at which their symptomatology became severely disabling. They reported a preceding period − in some cases lasting years or even decades − during which their pain had been underestimated or normalized, often due to its misattribution to typical menstrual experiences. Therefore, it is important to highlight that the age indicated in these cases does not reflect the actual clinical onset. 2. As mentioned previously, the interviews were conducted as part of a broader study aimed at exploring the experiences of women affected by endometriosis. For that reason, the structure of the interviews covered different topics. In this paper, we focus solely on the incidence of affective and epistemic injustice, as we aim to understand the impact of these injustices on diagnostic delay.

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endometriosis

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