Abstract
This cultural studies account explores medical management of endometriosis through the lens of patriarchal medical violence. Combining secondary sources and digital ethnography (40 patient stories from the Endozavest website, 2017–2025), it repositions discourses on medical management of endometriosis within the spectrum of patriarchal violence, develops a typology of violence, and highlights the Slovenian situation. The preliminary study uncovers multiple layers of violence, including normalising ignorance and invisibility, inappropriate diagnostics and treatments, discursive violence, and physical violence. By examining care structures as perceived, experienced, and navigated by patients, the paper identifies key challenges and potential avenues for enhancing care.
Introduction
Academic debates on medical violence largely focus on the dimensions of this phenomenon in the past, but often neglect unrecorded perspectives based on different genders, sexualities, ethnicities, and other factors that contribute to power asymmetries in various contexts. Over the past 2,500 years, endometriosis, a chronic gendered disease in which tissue that normally lines the uterus appears to migrate to other parts of the body Jones, 2015, p. 1083, has often been tied to and “treated” through marriage and motherhood (Kosi, 2025). Medical interventions for this disease, which presents with a wide range of more than 300 symptoms (Jones, 2015, p. 1092), predominantly pain and infertility (Agarwal et al., 2019, p. 354), included various attacks on women and their sexual and reproductive organs (Kosi, 2025, p. 48). Such practices ranged from bloodletting, hot showers, carriage or rough horseback rides, and the puncturing of nodules to the application of leeches to the cervix, electric shocks, and the removal of the ovaries or clitoris, among numerous other forms of torture (Hudson, 2022, p. 22; Kosi, 2025, pp. 47–48; Nezhat et al., 2012).
However, gendered medical violence is not merely a thing of the past: we are heirs of a tradition that is kept alive with contemporary updates. A substantial body of scholarship has pointed out that the historical neglect of women in medical research and the persistence of medical paternalism, together with the continuing stigma surrounding female sexuality and reproduction, have produced widespread misunderstandings and misconceptions about women's bodies and health (Davoudi et al., 2025; Fausto-Sterling, 2000; Fee, 1983; Merone et al., 2022; Shai et al., 2021; Short & Zacher, 2022; Stillwell, 2022; Jouanny et al., 2024). The paper traces this harmful legacy and its (dis)continuity as they unfold in the case of endometriosis.
Everyday life, consisting of cultural practices, habits, rituals, rules, and rhythms (Ehn et al., 2016), is heavily disrupted for women with endometriosis. Their bodily symptoms often lead to a loss of control and limited life choices, and some patients begin to hate their bodies (Cole et al., 2021, pp. 170–180). As one Slovenian patient pointedly expressed, “it [endometriosis] takes the right to shape my life” (Tadeja; Endozavest, 2022). “Endo women” 1 often report no longer feeling like themselves. They participate less and less in social life: since they do not want to negatively affect others, as a preventive measure, they isolate themselves (Cole et al., 2021, pp. 179, 182–183).
Infertility, genital pain, as well as other symptoms and consequences of the disease, profoundly affect their romantic and sexual relationships in various ways (Culley et al., 2017, p. 1670; Hudson et al., 2016; Moradi et al., 2014; Young et al., 2015, p. 229). The disease can also impact their work life, often deteriorating their economic situations and contributing to or leading to economic dependency, which strengthens traditional gender roles (Agarwal et al., 2019, p. 453; Hudson et al., 2016, p. 727; Young et al., 2015, p. 229). Therefore, it comes as no surprise that many scholars have noted that women with endometriosis experience a drastically reduced quality of life (Agarwal et al., 2019, p. 453; Guidone, 2020, p. 271; WHO, 2023). In this study, I explore and argue that it is not only the disease and its symptoms that cause harm, but sometimes also the medical management of the disease caught in the net of patriarchal knowledge production and practices that are inherently violent or produce violent effects.
This article builds on a conceptual conjunction of endometriosis and patriarchal medical violence: despite their obvious conceptual correspondences, it is surprising that the existing (feminist) literature offers no detailed analytical interaction between the two terms. The main aim of the article is to situate the medical treatment of endometriosis within the spectrum of patriarchal violence. I reveal, analyse and reflect on various forms and layers of violence and their contextual nuances. Where possible, I introduce local registers or specificities of medical violence related to endometriosis in Slovenia.
Methodology
Methods and Data Analysis
The article combines an analysis of secondary sources with a locally limited digital ethnography. The latter examines 40 stories of women with endometriosis in Slovenia, which were published on the website of Endozavest – Society for raising awareness for endometriosis 2 between January 16, 2017, and April 14, 2025. These voices, both thematically and in terms of discursive articulation, provided the opportunity for a critical cultural studies analysis of the topic.
The observation of accessible digital sources as the main preliminary method for a locally specific analysis seems appropriate, as research shows individuals with endometriosis (both adolescents and adults) are often stigmatised because of their chronic disease (Tragantzopoulou, 2024). In his classical theory on stigma, Goffman (1963) describes it as a “discrediting” and socially shameful trait that sticks to those who fail or do not follow up on societal expectations and identity norms. Patients’ lives greatly depend on the health system, so they may find it harder to divulge information on it. Such digital records allow them to be more open and relaxed since they are free to disclose only what they want and to a degree of anonymity they choose. 3
However, online spaces remain unevenly accessible, and not every person affected by endometriosis becomes a part of this particular community. In line with this methodological consideration, I have expanded and cross-checked the research material by integrating several methods: locally limited ethnography in the form of formal and informal conversations (both short and extended) with friends and acquaintances (some with endometriosis and others without), an informal conversation with one of the founders of Endozavest – Society for raising awareness about endometriosis in Slovenia, participatory observation, and the analysis of secondary sources such as academic literature, self-help books, autobiographies, novels, films, social media posts, and visual arts projects about endometriosis. Recognising the specificities and differences across these modes of knowledge production, I began compiling a personal archive of the topic from 2020 to 2025, which is still gradually growing and being enriched.
In order to bring forth both global patterns and local particularities and situate them within the frame of patriarchal medical violence, this preliminary study will approach it qualitatively, using close reading of a small portion of the cultural archive (local testimonies) in dialogue with secondary sources, especially academic books and articles. 4 My approach aligns with three types of validity suggested by Saukko (2003, p. 34) – dialogic, deconstructive, and contextual. Admittedly, and perhaps self-evident, my work of documentation and examination is by no means representative, nor was it designed as such. It brings certain stories into focus while allowing others to fade from attention.
As noted by de Souza São Bento and Nunes Moreira (2017, p. 3024), research on endometriosis tends to fall into two theoretical camps. One reduces the disease to a clinical entity by focusing on symptoms, treatments, and prevalence, while the other explores its psychosocial dimensions. Both approaches often overlook women's lived experiences and the knowledge derived from them 5 (de Souza São Bento & Nunes Moreira, 2017, p. 3024). For precisely this reason, in what follows, women's stories form the backbone of this paper – whether cited directly in the text or carefully stored in the author's cultural archive – as they are crucial to understanding the contemporary cultural positioning of endometriosis and the lived realities of those it affects. Highlighting evidence of violations of bodily autonomy aligns with the (reproductive) justice framework, while this methodological decision sets aside the voices of medical professionals.
Patriarchal Medical Violence
Patterns emerging from the research material invited me to deploy a concept of violence in order to describe, organise, analyse, reflect and interpret experiences along their affective, discursive, and material dimensions. Since there is no unified, widely accepted terminology for violence within the medical system and various, sometimes overlapping terms are used instead (such as “medical violence”, “obstetric violence”, “abuse in health care”, “patient abuse or neglect”, “poor patient care”, “medical torture”, etc.), I offer the notion of patriarchal medical violence. It functions as an umbrella term that could loosely be defined as a form of “structural violence in the medical system that arises as a consequence of omnipresent patriarchal forces” (Kosi, 2025, p. 45). Rather than defining it in narrow terms, I approach it as a nuanced, complex, and fluid concept that must nevertheless always be used with ethical sensitivity, contextual framing, and critical precision.
Galtung's (1969) popularised and widely adopted notion of structural violence offers a basic framework for understanding how inequalities are reflected in and adapted within social systems and structures. In a similar vein, patriarchal medical violence also resonates with what Nixon (2011) called slow violence – “a violence that occurs gradually and out of sight, a violence of delayed destruction that is dispersed across time and space” (Nixon, 2011, p. 2). One of the main characteristics of these types of violence is that they are “typically not viewed as violence at all” (Nixon, 2011, p. 2), or, as Galtung put it, they “may be seen as about as natural as the air around us” (Galtung, 1969, p. 173).
Not just patriarchal medical violence, but any term that directly connects medicine and violence provokes tangible discomfort and remains contested, 6 which reflects the importance of language and discourse in struggles to create meanings. Accordingly, in what follows, the term patriarchal medical violence is deliberately used – not only because it precisely and accurately captures the phenomena in question but also because it signals the seriousness of such experiences that are often dismissed as exaggerated, trivial, or merely “natural”. To date, patriarchal medical violence has been insufficiently examined in the scholarly literature, even though it is common knowledge that patriarchal violence is very flexible, easily adaptable, and is certainly also a part of contemporary medical practice.
Analysis
The preliminary data and theoretical roadmap presented below are part of a wider personal project that aims to shed light on, empirically map, explain and theorise different forms of patriarchal medical violence and its place in patriarchal structures of everydayness that, for various reasons, make certain bodies “missable, redundant and not matter” (Mencin Čeplak, 2017). The proposed typology is roughly divided into four interrelated and overlapping categories, progressing from structural, seemingly softer and subtle forms of violence to physical violence. In what follows, I present and critically discuss: (1) creating and normalising ignorance and invisibility, (2) inappropriate diagnostics and treatments, (3) discursive violence, and (4) physical violence. As a preliminary classification, this simple typology remains tentative with the hope of inviting other scholars to critically engage with, refine, and expand upon it in the future.
Creating and Normalising Ignorance and Invisibility
One of the central cultural dynamics surrounding endometriosis is the production and normalisation of ignorance, which contributes to both the invisibility of the disease as well as those who suffer from it.
Given the persistent lack of research on endometriosis (As-Sanie et al., 2019; Bruggmann et al., 2016; Hudson, 2022, p. 21), the first thing that stands out is passivity or non-action, which has heavy consequences: despite decades of medical advancement, the aetiology of endometriosis remains inconclusive, with only competing theories proposed thus far (Bruggmann et al., 2016); although biomarker research has advanced, no reliable non-invasive tests are in use 7 ; the relationship between endometriosis and infertility also remains poorly understood (Bonavina & Taylor, 2022; Macer & Taylor, 2012); and most notably, there is a broad scientific consensus that there is no consensus on how to classify the disease (Lee et al., 2021). Crucially, over time, knowledge gaps have been accepted and normalised (Hudson, 2022, pp. 22–23).
Furthermore, some researchers have argued that while the key characteristics of endometriosis are still considered “a riddle” or “an enigma”, even the features of the disease that are viewed as objective “medical facts” remain deeply problematic under the surface of the commonsensical acceptance. 8 The most dangerous part of such beliefs and processes is that they strongly influence treatment approaches (Jones, 2015, p. 1092).
Notably, there have been a few exceptions within the medical and political spheres where guidelines for the treatment of women with endometriosis were developed (e.g., ESHRE, 2022; Kalaitzopoulos et al., 2021). However, given the limited evidence base, the absence of scientific consensus, and the long-standing misrecognition and under-recognition of the disease itself, these efforts to standardise care rest on a fragile foundation (Hudson, 2022, pp. 22, 24). Such attempts at standardisation can be understood as a form of “uncertainty work”: by recognising specific uncertainties and ignoring others, politicians, scientists, and health professionals reconcile existing ambiguities and the lack of reliability with their own authority. Here, the failure to properly investigate endometriosis is attributed to its “enigmatic nature” or even to the enigmatic nature of the female body, rather than as a failure of science (Hudson, 2022, pp. 22, 24).
“Undone science” (Hudson, 2022, p. 25) has contributed to the normalisation of “the fact” that ignorance is a constitutive part of endometriosis (Hudson, 2022, p. 23), which, together with the lack of education and awareness of the disease, results in endometriosis not being neither diagnosed nor adequately treated (Kosi, 2025; Guidone, 2020, p. 273). There is a good reason why existing studies on endometriosis devote most of their attention to the period before women are diagnosed – namely, because there is a “diagnostic delay” of several years (Seear, 2014, p. 8). On average, it takes 3.8 years from the onset of symptoms to seeking medical help (Culley et al., 2013, p. 632), and the delay at the medical level – measured from the time consultation to receiving an accurate diagnosis – is horrifically even much longer, averaging 7.5 years (Hogg & Vyas, 2015, p. 134), with some research indicating even longer delays of up to 10 years or more (Grogan et al., 2018; Moradi et al., 2014; Sesar, 2014, p. 8), with substantial national differences ( Ballard et al., 2006, p. 1296) that deserve further exploration.
Due to the marginalisation of endometriosis in public discourse, many women remain poorly informed about it (Moradi et al. 2014), and some only hear of it upon diagnosis. As one patient recalled, “I will never forget when my gynaecologist said, ʻI thought this would be a quick visit, but I noticed a growth on your ovary.' This was the first time I heard about endometriosis …” (Marta; Endozavest, 2021). If and when endo women in Slovenia ask healthcare professionals about the disease, they often report receiving vague, unhelpful, or dismissive responses. One patient stated, “During a check at my gyno, I was SHOCKED. I only got a brochure on endometriosis” (Anja; Endozavest, 2022). Another described a similarly dismissive experience:
I wished to know the details of this disease, its symptoms, and life with it, so I went to my long-time gynaecologist who, after all these years, only noticed I had endometriosis then. His attitude towards the diagnosis was as if we were talking about cars. He said that this is just something one every ten women in Slovenia has and that it's nothing to be alarmed about. (Jana; Endozavest, 2021)
Given the numerous systemic barriers and shortcomings described above, it is not surprising that many women often become their own advocates within the medical system, frequently acting as “their own doctor”. Many report that, after recognising their symptoms – based on the information they find in medical journals, on the internet, in support groups, and through friends and family members – armed with knowledge, they require verification of the diagnosis from their doctors (Young et al., 2020, pp. 31–32). Despite this, some report that doctors refuse to diagnose them, and they brush them off with all kinds of humiliating arguments. Patients also frequently and repeatedly receive a wrong diagnosis, a pattern exemplified in the following account (Andreja; Endozavest, 2022): I had severe pain during menstruation since I was 15 years old. One day during class, my pain got so bad that I ended up in the emergency room. I was 18 years old at the time. I was diagnosed with appendicitis. After a few years, I learned that this is a common diagnosis mistake patients with endometriosis face. I have just been diagnosed with endometriosis at the age of 31, when my partner and I were directed to an infertility clinic due to repeated unsuccessful attempts to conceive.
Such “active inactivity”, the absence of (meaningful) action, can be seen as a form of structural violence, perpetuated through institutional passivity. Analysed testimonies indicate that silence and silencing play an important role in this, reinforced in part by self-silencing and menstrual stigma.
Although menstruation is culturally framed as a natural process, it is simultaneously constructed as abnormal, as a failure within the female cycle, which deep within the cultural subconscious – in the automated, normalised, repressed, or otherwise not readily visible dimensions of culture – it might still be seen as a productive enterprise. This contradiction contributes to a widespread social imperative to remove menstruation from the field of visibility (Delaney et al., 1976; Shohat, 1992, p. 61). The anxiety, discomfort and taboos surrounding menstruation (Delaney et al., 1976), rooted in patriarchal cultural framework (and also echoed in medical writings), are intensified in the case of women with endometriosis, whose menstrual blood is considered “thicker” and to flow “excessively” (Shohat, 1992, p. 62). The enduring menstrual shame reflects “generational taboos and lack of body literacy”, which, in the case of endometriosis, together with “poor information systems, and practices”, contributes to a lack of education, delayed diagnosis, and poor quality treatment (Guidone, 2020, p. 277).
Among the many direct and indirect forms of silencing experienced by endo women, self-silencing stands out. The process reflects the internalisation of patriarchal norms and the effects of ideological interpellation (Althusser, 2000). Within the dominant construction of femininity, women are often expected to be supportive partners, nurturing mothers, and obedient daughters – roles that implicitly demand emotional restraint and silence about personal suffering. As a result, endo women may avoid discussing their symptoms, even with those closest to them (Cole et al., 2021, p. 174), or speak only minimally. Ethnography shows that self-silencing is often tied to a loss of self and self-sacrificing practices, especially in the context of caring for others. These dynamics are underpinned by an ongoing concern with how others perceive endo women, as noted by one participant (Tadeja; Endozavest 2022): “I often feel that women with endometriosis are not understood, we are judged, some people think we’re just sensitive. This is why we probably don’t want to talk about it, we fight our own battle because we feel that others don’t understand us anyway.”
Gender stereotypes within the medical system also contribute to the self-silencing of women with endometriosis (Cole et al., 2021, p. 175). For example, qualitative studies show that physicians often form an image of a “good patient” with endometriosis who agrees with the clinical assessment without question, particularly when told that nothing more can be done (Young et al., 2018, p. 347). This makes patients cautious when speaking to medical staff, fearing that if they are perceived as “problematic”, it may negatively affect their care (Young et al., 2020). Of course, self-silencing is not an effective strategy, as it is associated with emotional suppression and heightened depression (Cole et al., 2021, pp. 175, 185).
Inappropriate Diagnostics and Treatments
The structural violence that normalises ignorance and passivity in relation to endometriosis is further perpetuated through problematic diagnostics, treatment approaches and procedures. These “mistakes” are too numerous to cover exhaustively here, but several representative examples highlight how patriarchal ideology operates within institutional medical settings.
At the outset of their diagnostic journeys, many endo women report poor history-taking, inadequate diagnostic testing, and prescriptions of temporary painkillers or hormone suppressants that only mask symptoms and postpone diagnosis (Guidone, 2020, p. 273). As discussed in my previous work (Kosi, 2025, pp. 50–58), these practices are often shaped by cultural narratives that frame female pain as exaggerated, psychologised, or caused by deviations from gendered norms. The following testimony captures how these dynamics manifest in practice (Sofija; Endozavest, 2025a): I am 25 years old and I have been dealing with severe menstrual pain for the last 10 years. Over the years, the pain gradually worsened, so painkillers no longer helped. I have been to gynaecologists many times, and they said that the sooner I will accept the pain, the better it will be for me. And that I obviously have a low pain threshold. But it never seemed normal to me that I couldńt do anything for the first two days of my period, that I was writhing on the bed in pain, crying and waiting for the pain to pass.
Already in 1992, Shohat (p. 66) observes that even when a diagnosis is made, treatment options are often highly mythologised and polarised between two extremes: sterilisation and childbirth. Between these lie other interventions also rooted in maternal ideology, such as “conservative surgery” and hormone therapy – both aimed primarily at preserving fertility (Shohat, 1992, p. 66). International research indicates that endo women are rarely allowed to choose their treatment plans; rather, they are typically presented with a predetermined plan and told what will be done (Young et al., 2020, p. 27). However, this hypothesis has yet to be properly tested in the Slovenian context.
Hormonal therapy aimed at suppressing ovarian oestrogen production is typically considered a primary treatment option for endometriosis (Vannuccini et al., 2022). Despite prevailing narratives of medical advancement, this method carries significant drawbacks, most notably the induction of a pseudomenopausal state (Shohat, 1992, p. 70). Culturally, such treatment reflects and reinforces the perception that menstruation is inherently pathological and requires medical interventions (Guidone, 2020, p. 271). Hormone therapy is linked to the widely held but unproven belief that pregnancy and menopause eradicate endometriosis (Jones, 2015, p. 1106). The normalisation of female pain persists in clinical practice, and as ethnographic material shows, doctors often ignore it (Kosi, 2025). Instead, they sometimes express concerns about patients’ weight gain resulting from hormone treatment (Young et al., 2020, p. 27).
Furthermore, Shohat (1992, p. 66) also makes an important argument about how surgical treatment for endometriosis is dictated by a woman's reproductive age. If she is of childbearing age and presumed to desire children, ovarian preservation is prioritised. If the pregnancy is complicated or unwanted, treatment is typically directed towards the surgical removal of the endometrial tissue. The “standard recipe” for women who are not interested in bearing a child or have already performed their “reproductive duty” is a hysterectomy (Shohat, 1992, p. 66).
Hysterectomy, often accompanied by the removal of the ovaries and fallopian tubes and leading to early menopause, is usually considered a last-resort intervention when other treatment options fail (Jones, 2015, p. 1106). The literature warns that ovaries are frequently removed along with the uterus to halt oestrogen production, as oestrogen is believed to “feed” the disease. However, oestrogen is then prescribed post-hysterectomy to prevent osteoporosis. Since other organs also produce oestrogen, the medical rationale for uterus removal is questionable. Women who continue to suffer from endometriosis following the removal of their ovaries are often told that “the doctors are doing everything they can”. This type of treatment can also be seen as a “solution” to a dysfunctional female reproductive system that becomes redundant (Jones, 2015, pp. 1106–1107). The problem with the described types of treatment is that the symptoms mainly persist (Jones, 2015, p. 1106). When symptoms persist or worsen, physicians typically repeat standard tests and examinations, showing little willingness to explore alternative or innovative treatment approaches (Young et al., 2020, pp. 27, 30).
The third – and by far the most common “ideological cure” underpinning both hormonal and surgical treatment – is motherhood. Just as it is in Slovenia proverbially said that “all will be well after marriage”, the same is said about childbirth in the context of endometriosis. This notion is frequently communicated to patients: “My doctor told me that everything will go away after I give birth. But this didn’t happen. … After I gave birth, my problems got worse …” (Patricija; Endozavest, 2022). Various health professionals continue to promote the belief that pregnancy cures endometriosis. Kristina, for instance, was first told this by her physician, who “nicely added that getting pregnant will make all the symptoms disappear” (Endozavest, 2017). Later, before her third operation, her anaesthetist told her the same: “The kind lady interviewed me on a multitude of things and also concluded that all my troubles will disappear when I give birth” (Endozavest, 2017). Such persistent advice reflects not only medical misconceptions but also entrenched ideological narratives linking female health to reproductive function.
The “prescription” of motherhood, reported both by patients and healthcare professionals themselves (Young et al., 2020, p. 23), often provokes anger and distress. It is especially ironic when pregnancy is suggested even after a patient has been declared infertile (Young et al., 2015, p. 231). In some countries, clinics may even refuse to provide treatment to women with endometriosis who do not express a desire to conceive. Moreover, doctors sometimes refuse to believe women who say they do not want to have children – a pattern also confirmed through local fieldwork.
In Slovenia, women without children or a desire for motherhood are frequently blamed and subjected to pressure. As one woman recounted, “A specialist told me that these [ovaries] are not functional anyway and that I should have children sooner” (Jana; Endozavest, 2021). Anja's experience of a gynaecological diagnosis further illustrates how the imperative of motherhood can induce guilt and anxiety (Endozavest, 2022): Her [the gynaecologist's] comments: that I got the cyst because I stopped taking the pills, that only this can treat hormonal imbalance, that I have to start taking the pills again. She answered some of my questions by saying that I’m not taking the situation seriously at all, that I should already have children, etc. She began listing how many months, how many years I’ll lose in waiting lists and infertility processes, artificial insemination… And finally, that I should already decide whether to give me a prescription or not, because I’m making them skip lunch. In short, inhumane and unprofessional.
In some cases, healthcare providers persist in recommending pregnancy as a treatment even when patients have clearly expressed that they do not want children or cannot feasibly have them given their current life circumstances. I started taking pills every day in the morning and at night, after six months the situation was not good, I was still in pain, every time I saw them, they answered: you are not well, it would be best for you to get pregnant… At the age of 24, with an irregular job, on a contract, living in a one-room flat, a partner who was not serious or mature enough to have a child… He didn’t even support me or stand by me in this pain … (Urška; Endozavest, 2017)
Discursive Violence
While I have so far outlined several instances of discursive violence in the context of endometriosis – from the systematic dismissal of women's symptoms to mechanisms of silencing – this section aims to summarise and expand on these themes through three discursive pathways within the medical system. First, I examine how endometriosis is framed as a mystical narrative in medicine; second, I consider how medicine suppresses women's voices; and third, I explore how medical discourse constructs a prototype of the endo women. Together, these dimensions serve as critical nodes, discursive hotspots, through which medical violence is enacted and extended into broader socio-cultural and institutional landscapes.
To understand how endometriosis continues to be constructed and maintained as a mythical narrative within medical discourse, it is useful to briefly revisit its historical underpinnings. The ancient belief, dating back over 2,500 years, that the uterus is like an animal, hungry for motherhood, which begins to wander around the body, causing various distressing symptoms and diseases if its main purpose (motherhood) is not fulfilled, has proven remarkably persistent (Laqueur, 1990, p. 110; Nezhat et al., 2012, p. 2). Although now couched in scientific language, this myth endures. Endometrial cells are still commonly described as “wandering” into unexplored areas of a woman's body (Jones, 2015, p. 1092).
As previously noted, medical discourse very clearly contextualises endometriosis “in terms of disorderly female biology, behavior, and personality” (Shohat, 1992, p. 60). Referring to the condition as “a mystery” or “an enigma” echoes the historical discourse of hysteria,
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once used to pathologise women, which continues to have clinical implications for those with endometriosis today (Jones, 2015, p. 1098). When “this authoritative discourse wraps the condition in an aura of mystery, creating a compelling mythological narrative”, it implies that solutions lie “beyond the powers of mere mortals to solve, limiting effective medical treatment” (Jones 2015, p. 1098). In her article Wandering Wombs and ‘Female Troubles’, Jones (2015, pp. 1098–1099) splendidly describes: Using language that mythologizes endometriosis, doctors become heroes trying valiantly to decode the mysteries of the disease, rogue endometrial cells act as the villains who cause the trauma, while the uterus plays the part of the suspect, and women its pitiful victims. Treating endometriosis as a mythical narrative directs attention away from problems with the medical construction of the disease and the social implications of the disease, instead blaming the condition itself for being difficult and, by extension, women who have it.
Furthermore, the voices of endo women have been persistently marginalised within medicine. Scientific (and other) texts frequently undermine the legitimacy of the disease (Shohat, 1992, p. 71). As noted by one patient, “It's hard; nobody actually takes me seriously about the symptoms of the disease, such as painful periods and intercourse, excessive bleeding I just want this hell to end” (Danijela; Endozavest, 2023). This is one of many testimonies that reflect how endo patients are routinely dismissed. This trivialisation occurs at multiple levels: from being turned away by nurses (Karmen; Endozavest, 2022) to not being referred to specialists (Patricija; Endozavest, 2022). Aligned with this, medical discourse often portrays endo women as hysterical or overly emotional (Kosi, 2025, pp. 51–58), while male scientists are positioned as rational problem-solvers employing advanced technologies to address so-called “female complaints” (Shohat, 1992, p. 71).
The suppression of women's voices operates through a complex interplay of structural, cultural, and discursive mechanisms. As this article has shown, endo women are systematically marginalised within a medical system that normalises their invisibility. This marginalisation is reinforced by inadequate information infrastructures, routine disbelief of symptoms, pervasive stereotyping, and persistent myths such as the notion that motherhood can cure the disease. To add to that, with the help of Shohat (1992, p. 71), the medical discourse on hormone therapy focuses on their supposedly disordered, chaotic bodies, while newer technologies emphasise minimally invasive techniques that preserve the aestheticised female body. Medical literature often omits the fact that endometriosis is prone to recurrence, erasing failure and doubt in the medical field (Shohat, 1992, p. 79).
What, then, is the prototype of the endo woman within medical discourse and its accompanying mythologies? An analysis of medical texts from the 1920s to the 1980s made by Jones (2015, p. 1104) reveals that, despite all their similarities and differences, women with endometriosis are consistently framed through the lens of “abnormality”. Their personalities are pathologised, and they are described as having “an intense desire to excel” or labelled as “tense perfectionists with demanding and specific goals” (Jones, 2015, p. 1104). They are portrayed as well-groomed, middle- or upper-class women in their early to mid-thirties who do not conform to traditional gender expectations – delaying childbirth, pursuing careers, and exhibiting traits perceived as aggressive, masculine, or privileged (Jones, 2015, p. 1104).
As Jones (2015) continues, in the twenty-first century, endo women are labelled as either too feminine or not feminine enough: too feminine due to excessive oestrogen and menstruation, yet not feminine enough because of their assertiveness, career orientation, and possible childlessness. They are linked to psychoticism, introversion, anxiety, and neuroticism and described in research as less socially adaptive, with higher incidences of social dysfunction and mood and personality disorders (Jones, 2015, pp. 1104–1105).
These portrayals, sometimes supported by detailed medical research, can be interpreted through various critical lenses. Patients who attempt to manage their pain are labelled as egocentric; those who seek answers or advocate for themselves are seen as aggressive. Yet such actions may in fact be rational and legitimate responses to chronic pain, gendered expectations, systemic medical sexism, and the objectification of female bodies. Nonetheless, women are often reductively diagnosed as “mentally and socially ill and maladjusted” (Jones, 2015, p. 1105). Because endometriosis is constructed as an unfortunate consequence of women living deviant lives, research into the condition is often deemed illegitimate or unnecessary (Shohat 1992, p. 63).
In examining language and discursive forms of violence, it is crucial to underscore how social expectations can mark a woman as violent simply for speaking up (about violence). As Ahmed (2010, p. 61) argues, when individuals are expected to remain silent or invisible, the act of voicing dissent is often framed as defiance. A “hierarchical turn” may occur in which blame for the oppressor's discomfort is shifted to the oppressed, the structurally weaker party (Zaviršek, 2018, p. 29). And since society sometimes still insists that the oppressor must not feel uncomfortable, the oppressed are often expected to present themselves as comfortable within their own oppression (Firestone, 2019, p. 115).
If society perceives words spoken or written by women as violent, they might provoke violence in response (Dworkin 2007, p. xxxi). This perception and its consequences influence women's behaviour and their social positioning. Due to the violence that may follow their speech, female voices are “lower”, they “whisper …apologize … shut up … trivialize… shrink … pull back. Most women have experienced enough dominance from men – control, violence, insult, contempt – that no threat seems empty” (Dworkin, 2007, p. xxxi).
Precisely in the case of a threat, we can observe how the absence of physical contact can nonetheless produce consequences as severe or even more severe than direct physical violence (Komel, 2008, p. 86), revealing how material outcomes are tangled with the affective and discursive dimensions of culture.
Physical Violence
The various forms and layers of violence described and discussed so far are ultimately also inscribed upon the woman's body at a physical level. I argue that the medical management of this disease, not only can, but must also be seen as a form of physical violence, enacted in insidious ways that require recognition, exposure, scrutiny, and articulation.
Here we encounter another intersection between discourse and violence. Ule (2003, p. 135) describes a “collective state of mute pain” – a condition that arises alongside increasing brutalisation of society and remains largely unspoken due to the lack of a shared language through which it can be understood or communicated. A similar silence surrounds the violence associated with endometriosis, which comprises a patchwork of various violent acts, omissions and enduring states. This underscores the urgent need for the development of new conceptual frameworks, terminologies, and methodological approaches. While a comprehensive elaboration of such tools lies beyond the scope of this paper, I propose several pathways that link the previously discussed forms of violence to physical violence.
One analytical approach to physical violence is to consider its consequences. In the case of endometriosis, medical violence relates to the female body, with effects that manifest in chronic and often escalating pain. Ethnographic accounts in Slovenia reveal that as symptoms intensify, increasingly invasive medical interventions are administered, sometimes resulting in long-lasting physical and emotional consequences. Simona's story (Endozavest, 2022) exemplifies this: My difficulties got worse and worse each year. I was in more and more pain, my period longer and longer. At first, I was bleeding for ten days in a row, then for two weeks. Only after a long time, after I went to the ER several times, and after I bled for two months, did I receive a proper examination. It was followed by an operation, but they were too late. If they acted sooner and if they started treating me seriously earlier, I wouldn’t have lost one ovary.
The effects of such violence extend beyond the body, affecting wider cultural and emotional realms.
I was being diagnosed for 10 long years. During this time, it spread around and attached to many of my organs, causing debilitating chronic pain and symptoms that forced me to quit my job as a nurse. I lost a lot of confidence, I was very lonely, and I felt like I was starting to lose myself. It shouldn’t take so long to get a diagnosis, we need more support in dealing with this cruel disease. (Eva; Endozavest, 2022)
As the case of endometriosis makes clear, structural violence can take shape through slow, diffuse intensities that, in their complexity and force, may exceed those arising from direct physical aggression, conventionally exemplified by slaps and punches.
An important dimension in the analysis of violence involves examining its legal definitions. In Slovenia, Article 3 of the Family Violence Act (Zakon o preprečevanju nasilja v družini, ZPND) defines physical violence as “any use of physical force or threat of physical force that coerces the victim to do or to refrain from doing something or to suffer, or restricts the victim's movement or communication and causes pain, fear or humiliation, whether or not physical injury is caused” (ZPND 2008, Article 3). It is evident that women with endometriosis may experience psychological and ideological violence in the form of coercion, fear, humiliation, suffering, and restriction of movement and communication, and pain as a result of medical “touch”, which can use no direct physical force. This aligns with the minimum threshold in the legal definition of physical violence. It is worth mentioning that coercion is often hidden behind the mask of free choice, embodying the paradox of forced choice described by (Žižek 1997, p. 44): “Every belonging to a society involves a paradoxical point at which the subject is commanded to accept freely, as a result of their own choice, what is imposed on them anyway”.
These forms of violence and coercion occur within a society that venerates freedom and where physical violence against anyone is generally prohibited (Komel, 2008, p. 13). Within such a framework, medical violence remains largely unacknowledged, partly because medicine is institutionally and culturally associated with healing, care, and benevolence. Harmful practices within medicine are seldom recognised as violent; instead, they are perceived as standard or necessary. This perception is further reinforced by the prevailing image of medicine as an ideologically neutral, scientifically grounded discipline endowed with high social prestige. It is seen as a field that produces life-extending knowledge and seeks to improve the quality of life. However, as Komel (2008, p. 187) reminds us, knowledge is never neutral or independent of ideology; in fact, claims to neutrality often mask the strongest ideological investments.
Patriarchal medical violence with physical effects may be understood as a state apparatus of care, control, regulation, punishment, correction, and prevention – a collaboration of ideology and repression (Althusser, 2000). Whereas in the past, the body was primarily a site of punishment, today correction has been largely replaced by prevention, which does not necessarily occur through the use of direct physical force (Komel, 2008, p. 129). Endometriosis, often constructed as a disease of transgressive or non-conforming women, may thus function as a tool of correction. Alongside its correction role, medical management serves as a deterrent, ensuring other women are discouraged from resisting social norms and expectations.
Medical violence in this context can also be understood as a form of “anticipated” or “predictable” violence: we know that systemic production of ignorance, inappropriate and harmful procedures, together with other systemic, symbolic, structural, and discursive forms of violence described above, also lead to physical violence.
Unlike in some other violent contexts, patriarchal medical violence offers no real point of exit since women's pain and other symptoms necessitate engagement with the healthcare system. It is not only their quality of life that is at stake but also their very survival. Paradoxically, the institution that perpetuates their suffering is also their only potential relief, leaving them with no viable alternatives.
Conclusion
This cultural studies account investigates medical management of endometriosis through the lens of patriarchal medical violence. By framing medical interventions not only as help but also as potential harm, the analysis complicates the conventional boundaries between helping and harming, offering a more complex, ambiguous and critical consideration.
The preliminary study weaves together digital ethnography (patient testimonies shared on the Endozavest website) with a range of secondary sources. By zooming in on patients’ narratives from Slovenia, it traces how ignorance is produced and normalised, how gendered stereotypes shape diagnostic and treatment pathways, as well as how women's voices and agency are routinely muted or reshaped within medical settings. Patriarchal medical violence operates through structural, discursive, symbolic, and physical channels – each deserving a more detailed exploration in the future.
Furthermore, I argue that violence in this context is not accidental or exceptional but rather anticipated, emerging from entrenched ideological, institutional, and epistemological conditions. Local testimonies in a study reveal ethical violations, breaching bodily integrity (autonomy) and provide important insights into how broader social dynamics enable medical violence to appear and persist. What is visible so far is that the situation in Slovenia is similar to the rest of the developed world. Specificities worth mentioning are the vestiges of the socialist public health system, which is currently disintegrating, 10 and a long-standing feminist (partly socialist) tradition, neither of which significantly mitigates the established repertoire of patriarchal violence. Still, a lot of work needs to be done for an integral, nationally specific archive and for stronger claims about the local situation. To achieve that, this preliminary study will be complemented and further validated through future interviews, encompassing both patients and medical professionals.
Despite the critical focus and the largely negative tones of this article, it is important not to overlook some positive developments in Slovenia, such as the establishment of the Endometriosis Day Centre in 2013 within the Gynaecology Clinic of the University Medical Centre Ljubljana and the founding of the Endozavest – Society for Raising Awareness for Endometriosis in 2016. They have significantly contributed to public awareness and have created supportive physical and digital spaces where patients can share experiences and build a community.
This feminist investigation contributes to rethinking structures of care for people with endometriosis in Slovenia, while also opening a modest possibility for the presented typology of patriarchal medical violence to circulate, transform, and be reimagined across diverse national and institutional settings, attuning to their particularities. It is also a gentle reminder for how crucial it is – especially in todaýs climate, where toxic political environments threaten basic human rights in various parts of the world and where a renewed tendency to reduce women to their reproductive role is increasingly visible and felt – to reveal, interrogate, and critically engage with the political dimensions of everyday life; to question what is taken for granted; and to recognise the essential role of academic inquiery in developing more nuanced narratives and forms of knowledge that can serve as a foundation for more just and meaningful social transformations (Grossberg, 2010). The necessity and value of such work is perhaps best captured by those who are most affected by it, as one of the voices in this study concludes: “Perhaps I should be more informed, more proactive, more assertive. Perhaps. But I also know that I should never be ignored or dismissed with a ‘that's just the way it is’” (Sabina; Endozavest, 2025b).
Footnotes
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
This work was supported by the Slovenian Research and Innovation Agency (ARIS) within the “Young Researchers” programme and by the ARIS research and infrastructure programme “The Production of Meaning and Knowledge in a Time of Crisis: Cultural, Religious and Scientific-Developmental Aspects of Societies in Slovenia, the Balkans, and Europe”.