Culturally competent and inclusive endometriosis care

E766 CMAJ | June 10, 2024 | Volume 196 | Issue 22 © 2024 CMA Impact Inc. or its licensors 1 Racialized patients with endometriosis have higher rates of open-abdominal surgeries than minimally invasive procedures, compared with White patients1 Lower rates of minimally invasive procedures predispose patients to com- plications.1 Providers should ensure that all patients receive high-quality care and are aware of all treatment options. 2 Most Indigenous people who menstruate (65%) have difficulty accessing pain-relieving medicines2 Providers should consider access to medication when discussing endo- metriosis management. Access barriers include affordability, medication supply, and other issues, such as travel distance.2 3 Providers should overcome diagnostic barriers and cultivate an inclusive environment for transmasculine patients3 Providers should avoid dismissing reports of pelvic pain in transmasculine patients who are receiving testosterone therapy, as they can have endo- metriosis. Transmasculine patients can experience self-doubt and fear arising from misgendering, discrimination, and dismissal of symptoms. 4 Patient experience should be validated, and the possibility of endo- metriosis explored. Accurate names and pronouns should always be used in the patient’s presence, absence, and related documentation. 4 Patients who are migrants to or refugees in Canada show low use of sexual and reproductive health services, which may be due to the belief that discussing sex is taboo4 When discussing endometriosis symptoms, which can include intimate topics such as dyspareunia, providers should be transparent about their goals and respect patient autonomy: “I would like to ask some intimate questions to understand your experience better. Is that okay?” A safe space for discussion should be cultivated: “Would you like someone in the room during this discussion or would you like us to be alone?” 5 Cultural practices and beliefs should be respected through shared decision-making and acknowledgement of patient goals and values Culture and beliefs can influence a patient’s perspective on some endo- metriosis treatments such as hormonal therapy. 5 Instead of making assumptions, providers should ask, “How do you feel about this treatment option?” They should spend time with patients, explaining different treat- ment options, allowing them to ask questions, and consulting cultural, spiritual, or religious advisors. Practice | Five ways to support ... CPD Culturally competent and inclusive endometriosis care Marfy Abousifein, Nicholas Leyland MHCM MD n Cite as: CMAJ 2024 June 10;196:E766. doi: 10.1503/cmaj.240278 References 1. Westwood S, Fannin M, Ali F, et al. Disparities in women with endometriosis regarding access to care, diagnosis, treat- ment, and management in the United States: a scoping review. Cureus 2023;15:e38765. doi: 10.7759/cureus.38765. 2. An assessment of menstrual-related needs in northern com- munities. Kitchener (ON): True North Aid; 2022:1-19. Avail - able: https://truenorthaid.ca/wp-content/uploads/2024/03/ an-assessment-of-menstrual-related-needs-in-northern -communities-final.pdf (accessed 2024 Apr. 8). 3. Eder C, Rommaney R. Transgender and non-binary people’s perception of their healthcare in relation to endometriosis. Int J Transgend Health 2023 Nov. 24. doi: 10.1080/26895269 .2023.2286268. 4. Rowland DL. Culture and practice: identifying the issues. In: Rowland D, Jannini E, editors. Cultural differences and the practice of sexual medicine: Trends in andrology and sexual medicine. Cham: Springer; 2020:3-21. 5. Srikanthan A, Reid RL. Religious and cultural influences on contraception. J Obstet Gynaecol Can 2008;30:129-37. Access to health care Competing interests: None declared. This article has been peer reviewed. Affiliation: McMaster University, Hamilton, Ont. Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and repro- duction in any medium, provided that the original publication is properly cited, the use is noncommer- cial (i.e., research or educational use), and no modifications or adaptations are made. See: https:// creativecommons.org/licenses/by-nc-nd/4.0/ Editor’s note: Marfy Abousifein has lived experience as an immigrant, a person with endometriosis, and a women’s health researcher. Dr. Nicholas Leyland is the co-director of the Advanced Gynecology and Minimally Invasive Surgery Fellowship Program at McMaster University and an endometriosis specialist. Correspondence to: Marfy Abousifein, [email protected]