Epistemic and affective harms in Endometriosis diagnosis

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.