Cristina Ganz

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.

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.

This article examines the pathologisation and over-medicalisation of pregnancy, arguing that pregnancy should not be classified as a disease. While medical interventions are essential in managing pregnancy-related complications, excessive medicalisation can undermine maternal autonomy and contribute to unnecessary interventions. We trace the historical shift from midwifery-led childbirth to obstetric control, highlighting how pregnancy came to be viewed as a clinical condition requiring constant medical oversight. Drawing on philosophical theories of disease, we analyse the debate surrounding pregnancy’s classification, considering naturalistic, normative, and pragmatic perspectives. Using focus group data from midwives, we provide concrete examples of over-medicalisation, including the routine overuse of procedures such as induction and episiotomy. We argue that a balanced approach is needed – one that acknowledges pregnancy’s physiological nature while ensuring access to medical care when appropriate. Avoiding both excessive medicalisation and rigid naturalisation can better support pregnant individuals’ well-being and decision-making autonomy.

Effective communication is widely recognized as a cornerstone of successful medical treatment, as extensively documented in prior research. The doctor-patient relationship relies on clear, accurate information exchange to ensure precise diagnoses, treatment adherence, and patient satisfaction. Yet misunderstandings can seriously undermine this process, creating barriers to optimal care and weakening the therapeutic alliance—a critical element of effective healthcare. Consequently, identifying, understanding, and addressing these misunderstandings is essential. This paper introduces a novel approach to detecting and analyzing such misunderstandings in clinical interactions by drawing on concepts from the philosophy of language. Specifically, we present the ToUCAN Codebook, a structured framework designed to systematically classify and examine instances of textual miscommunication in doctor-patient dialogues. By offering a clear methodology for identifying and preventing potential communication breakdowns, the ToUCAN Codebook contributes to improved healthcare outcomes and a deeper understanding of the dynamics that shape medical discourse.

In this paper, I will argue, following Adrianne Rich (1976), that there is a lack of narrative about the experiences of pregnancy and childbirth constructed from women’s perspectives that can reflect the embodied and lived aspects of pregnancy and childbirth. The dominant narrative portrays these experiences as passive and mechanical, perpetuating the image of pregnant, parturient, and postpartum women as passive, weak, fragile, and unreliable subjects. By looking at the historical development of women’s role in the reproductive process since the 5th century – both in the medical-scientific (Filippini 2017) and symbolic levels (Muraro 2022; Cavarero 2023; Prezzo 2023) – I aim to unravel the roots of this dominant narrative. By emphasising the importance of narratives, particularly in healthcare (Frank 1995), I will explore the epistemological, phenomenological, and practical consequences arising from the absence of an embodied narrative of pregnancy and childbirth, as well as women’s internalisation of the dominant narrative (Sbisà 1996; MacLellan 2022). I will focus in particular on the practical consequences, arguing that it is possible to interpret this absence – and the resulting internalisation of the dominant narrative – as a form of “hermeneutical injustice” (Fricker 2007), which in turn has determined a form of “testimonial quieting” and “testimonial smothering” (Dotson 2011). Finally, I will argue that women need to develop their own narratives about pregnancy and childbirth. However, I will also emphasise that this development would be insufficient to overcome all epistemological, phenomenological, and practical consequences.