Commentaire/Commentary Commentary Section Break: Intro para  A Case for a Critical Examination of Diagnostic Delays Among Women KELLY GREGORY, CHERYL PRITLOVE, ROSS UPSHUR &amp; PIA KONTOS There are a number of diseases and conditions that have notoriously long diagnostic periods, many of which disproportionately manifest among women (Clarke, 1983; Kempner, 2014). Endometriosis, for instance, takes on average three to ten years to diagnose (Sims et al., 2021), and cardiovascular disease (Johnson, et al., 2021), ADHD (Young, et al., 2020), and pain conditions such as !bromyalgia (Qureshi, et al., 2021) and rheumatoid arthritis (Rosa, et al., 2020) represent other common examples. This phenomenon has also been identi!ed in conditions not typically regarded as   women  s diseases   such as diabetes and cancer (Westergaard et al., 2019). During a diagnostic delay    when the period becomes prolonged between experiencing a health challenge  2025: Vol.17, Numéro 2/Vol.17 Issue 2  until the point at which a diagnosis is made    women continue to suffer from symptoms, lose con!dence in healthcare providers and systems, and experience interruptions to their lives, relationships, and sense of self. While it appears evident that the timing and type of diagnoses are not distributed evenly across genders, what remains unclear is why    what is contributing to the reproduction of diagnostic delays for women? While limited in number, there has been some promising work that has sought to explain this phenomenon. Several investigations have identi!ed reasons for delayed diagnoses among women with endometriosis or cardiovascular disease. These include ineffective diagnostic testing (Ballard, et al., 2006; Almond et al., 2012), deprioritization in hospitals and emergency departments (Almond et al., 2012), pharmacological suppression of symptoms (Ballard, et al., 2006; Davenport, et al., 2022), a lack of physician knowledge or training about disease presentation (Denny &amp; Mann, 2008; Almond et al., 2012; Davenport, et al., 2022), physicians   doubts about the value of a diagnosis (Davenport, et al.,  46  GREGORY, PRITLOVE, UPSHUR &amp; KONTOS DIAGNOSTIC DELAYS AMONG WOMEN: A CRITICAL EXAMINATION  2022), physicians   dismissive attitudes and the normalization of symptoms by both patients and physicians (Ballard, et al., 2006; Denny &amp; Mann, 2008; Almond et al., 2012; Davenport, et al., 2022; Drinkell et al., 2023), poor or imbalanced relationships between patients and providers (Denny &amp; Mann, 2008; Drinkell et al., 2023); a patient  s demographic characteristics (Drinkell et al., 2023), and a lack of patient knowledge, use of selfadvocacy, or self-prioritization (Sjöström-Strand &amp; Fridlund, 2008; Almond et al., 2012; Drinkell et al., 2023). While the identi!cation of these reasons for diagnostic delays are an important step, the majority of investigations fall short of explicating the context in which these factors are located, such as the socio-political structures and power relations that shape and constitute the very circumstances themselves. A notable exception is discussions of stigma surrounding women  s health (Drinkell, et al., 2023) and more speci!cally, stigma surrounding menstruation, in the case of endometriosis (Ballard, et al., 2006; Seear, 2009; Davenport, et al., 2022). However, the only investigation, to our knowledge, which takes its central focus toward such structures is Seear  s (2009) explication of how stigma plays a role in delaying help-seeking behaviour among women. Seear articulates the social sanctioning acts of stigma, such as ostracism, criticism, or the trivialization of pain, as evidence of how menstruating women are regarded as   discreditable individuals   (Goffman, 1963). As a result of this stigma, they are deeply motivated to strategically conceal any discussion of, or materials related to menstruation. This concealment, labeled   menstrual etiquette   (Laws, 1990), effectively inhibits any willingness to disclose menstrual normalcy, let alone menstrual problems, and offers a sociological explanation as to why women may hesitate to enact help-seeking behaviours regarding menstrual dysfunction. Seear concludes that further critical examination of diagnostic delays for women with endometriosis is needed, such as an exploration of why women  s menstrual pain is normalized or who might bene!t from such acts, in order to sharpen our understanding of this phenomenon (Seear, 2009). Another signi!cant gap in research on diagnostic delay is the experiences that women have with this phenomenon (Ashton, 1999; Ballard, et al., 2006; Denny &amp; Mann, 2008; Almond, et al., 2012; Colella et al., 2021). When one considers the extensive research on the experiences of illness among women (see for example Werner &amp; Malterud, 2003; Banks &amp; Malone, 2005; Cho, 2019; Lajoie &amp; Douglas; 2020; Heggen &amp; Berg, 2021; Clerkley, 2022; Hintz, 2022), this gap is all the more apparent, particularly regarding the role of women  s embodied knowledge in the process of diagnosis. The contribution of embodied experience to meaning-making processes is well established (Magrí &amp; McOueen, 2022), and yet the salience of their embodied  Vol.1, Vol.17, 2025: NuméroNuméro 1/Vol.1,2/Vol.17 Issue 1 Issue 2  experience in the context of the diagnostic process has yet to be explored in relation to their help seeking behaviour. Based on Havi Carel  s (2016) work in the phenomenology of illness, which characterizes illness in one  s lifecourse as an interruption or divergence, it may be of signi!cance to consider how women  s lifeworlds are stretched and altered during periods of diagnostic delay, and how women make meaning of an absence of diagnosis that would have provided an explanatory framework and sense of motion towards a trajectory of care. Such alterity represents another important direction for research on the gendered nature of diagnostic delay. The impetus for this commentary arises from a deep concern about the lack of speci!c and critical discourse on the ways in which gender has shaped the phenomenon of delayed diagnosis for women. Studies which have done so are few and have compartmentalized and decontextualized their !ndings. As a result, how social structures are intertwined with embodied experiences of diagnostic delay, and the ways the relationship between them serves to enable and/or constrain this phenomenon is poorly theorized and understood. Further still, there has yet to be an investigation which takes an intersectional consideration of gender as an interlocking and co-constituting social force that interacts with a range of other social characteristics; this is vital to appreciate the multiplicity of ways in which gender shapes diagnostic delays for a multiplicity of women. The social forces of gender are ever-present, from our social norms and expectations to our relational and embodied ways of being. As such, engaging a theoretical framework that holds the capacity to examine the interrelationship between these micro and macro dimensions, is imperative. In light of such a task, critical phenomenology holds much methodological potential. From its inception, phenomenology has understood that a rendering of the world into facts of objectivity imparts an impoverished sense of meaning (Husserl, 1970). Through the re!nement of many scholars, the tenents of phenomenology articulated the importance of subjectivity in the development of a fulsome understanding of the world, such as that of Alfred Schutz who broadened phenomenology  s reach into the social sciences. Following the work of Simone De Beauvoir and Frantz Fanon who interrogated how uneven distributions of power shaped one  s lived experience and opportunities, critical phenomenology has articulated how such a withholding of lived experience from our descriptions of the world acts to further marginalize those already at its margins (Stanier, Miglio &amp; Dolezal, 2022). While Husserlian phenomenology has been typically concerned with the investigation of lived experience, an explicit inquiry into how social, political, and other structural in#uences shape this experience brings a critical lens  47  GREGORY, PRITLOVE, UPSHUR &amp; KONTOS DIAGNOSTIC DELAYS AMONG WOMEN: A CRITICAL EXAMINATION  and a praxis of social justice to the tradition (Guenther, 2020; Magrí &amp; McOueen, 2022). By engaging with a wide range of critical disciplines, such as philosophies of race and coloniality, disability studies, social and feminist philosophies, and the medical humanities, critical phenomenology has drawn its focus toward the relations between self, social experience, and social norms, and pays close attention to how categories of social identity, such as gender, are involved in self- and otherexperience (Magrí &amp; McOueen, 2022). Both classical and critical phenomenologies fundamentally understand lived experience as embodied; that the body has both material and perspectival qualities (Merleau-Ponty, 1945 [2013]). As a result, the body is understood both as an object that can be understood by medicine, but also as what it means to be human and contend with, or navigate through, human experiences such as health, illness, or death (Welsh, 2022). A method of understanding how the body is lived by women is paramount to understanding the gendered nature of diagnostic delays. Critical phenomenology aims to expose forms of injustice that are hidden in the familiarity of our routine ways of being and thinking, by demonstrating how social norms such as white supremacy, patriarchy, or heteronormativity not only inform our social worlds, but also inform who we are and how we make sense of our experience (Guenther, 2020). It offers a carefully contextualized approach that stresses the active and the acted upon nature of the body, both of which are of paramount importance for feminist struggle and social change. As such it is our contention that critical phenomenology is well-positioned to capture the complexity of the gendered nature of diagnostic delay for women, support continued discussion and advocacy, and help effect change to this enduring and wicked problem.  References Almond, S. C., Salisbury, H., &amp; Ziebland, S. (2012). Women  s experience of coronary heart disease: why is it different? British Journal of Cardiac Nursing, 7(4), 165  170. https://doi. org/10.12968/bjca.2012.7.4.165 Ballard K, Lowton K, Wright J. What  s the delay? A qualitative study of women  s experiences of reaching a diagnosis of endometriosis. Fertil Steril 2006;5:1296  1301. Banks, A. D., &amp; Malone, R. E. (2005). Accustomed to enduring: experiences of African-American women seeking care for cardiac symptoms. Heart &amp; Lung, 34(1), 13-21. Carel, H. (2016). Phenomenology of illness. Oxford University Press.  Vol.1, Vol.17, 2025: NuméroNuméro 1/Vol.1,2/Vol.17 Issue 1 Issue 2  Cho, H. L. (2019). Can intersectionality help lead to more accurate diagnosis?. The American Journal of Bioethics, 19(2), 37-39. Clarke, J. N. (1983). Sexism, feminism and medicalism: a decade review of literature on gender and illness. Sociology of Health &amp; Illness, 5(1), 62-82. Clerkley, K. (2022). The Underdiagnosis of ADHD in Black Females  . Electronic Theses, Projects, and Dissertations. 1441. https://scholarworks.lib.csusb.edu/etd/1441 Davenport, S., Smith, D., &amp; Green, D. J. (2022). Barriers to a timely diagnosis of endometriosis: a qualitative systematic review. Obstetrics &amp; Gynecology, 10-1097. Denny, E., &amp; Mann, C. H. (2008). Endometriosis and the primary care consultation. European Journal of Obstetrics &amp; Gynecology and Reproductive Biology, 139(1), 111-115. Drinkell, K., Fajzel, H., &amp; Tordon, K. (2023). Patient and practitioner: The impact of social factors on diagnostic delay for endometriosis. Undergraduate Research in Natural and Clinical Science and Technology Journal, 7, 1-11. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Harmondsworth: Penguin. Guenther, L. (2020). Critical Phenomenology. In Weiss, Murphy, &amp; Salamon (Eds.), 50 Concepts for a Critical Phenomenology (pp. 11  16). Northwestern University Press. https://doi. org/10.2307/j.ctvmx3j22.6 Heggen, K. M., &amp; Berg, H. (2021). Epistemic injustice in the age of evidence-based practice: The case of !bromyalgia. Humanities and Social Sciences Communications, 8(1), 1-6. Hintz, E. A. (2022).   It  s All in Your Head  : A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions. Health Communication, 1-15. Husserl, E. (1970). The Crisis of European Sciences and Transcendental Phenomenology. Translated by David Carr. Evanston, IL: Northwestern University Press Johnson, H., Gorre, C. Friedrich-Karnik, A., &amp; Gulati, M. (2021). Addressing the Bias in Cardiovascular Care: Missed &amp; Delayed Diagnosis of Cardiovascular Disease in Women. American Journal of Preventive Cardiology, 8. Kempner, J. (2014). Not tonight. In Not Tonight. University of Chicago Press. Lajoie, C., &amp; Douglas, E. (2020). A Crip Queer Dialogue on Sickness (Editors   Introduction). Puncta, 3(2), 1-14.  48  GREGORY, PRITLOVE, UPSHUR &amp; KONTOS DIAGNOSTIC DELAYS AMONG WOMEN: A CRITICAL EXAMINATION  Laws, S. (1990). Issues of blood: The politics of menstruation. Hampshire: Macmillan.Ashton 1999 Magrì, E., &amp; McQueen, P. (2022). Critical phenomenology: An introduction. John Wiley &amp; Sons. Merleau-Ponty, M. (1945 [2012]). Phenomenology of Perception. Trans. Donald A. Landes. London and New York: Routledge. Qureshi, A. G., Jha, S. K., Iskander, J., Avanthika, C., Jhaveri, S., Patel, V. H., ... &amp; Azam, A. T. (2021). Diagnostic challenges and management of !bromyalgia. Cureus, 13(10). Rosa, J., García, M., Luissi, A., Pierini, F., Sabelli, M., Mollerach, F., &amp; Soriano, E. (2020). Rheumatoid arthritis patient  s journey: delay in diagnosis and treatment. JCR: Journal of Clinical Rheumatology, 26(7S), S148-S152. doi: 10.1097/ RHU.0000000000001196 Seear, K. (2009). The etiquette of endometriosis: stigmatisation, menstrual concealment and the diagnostic delay. Social science &amp; medicine, 69(8), 1220-1227.  About the authors: Kelly B. Gregory, MSc, PhD(c) Dalla Lana School of Public Health University of Toronto Toronto, Ontario, Canada Email: kelly.gregory@mail.utoronto.ca Cheryl Pritlove, PhD Applied Health Research Centre (AHRC) Li Ka Shing Knowledge Institute Unity Health Toronto Toronto, Ontario, Canada Email: cheryl.pritlove@unityhealth.to Ross Upshur, PhD Dalla Lana School of Public Health University of Toronto Toronto, Ontario, Canada Email: ross.upshur@utoronto.ca Pia Kontos, PhD KITE Research Institute Toronto Rehabilitation Institute    University Health Network Dalla Lana School of Public Health University of Toronto Toronto, Ontario, Canada Email: pia.kontos@uhn.ca  Sims, O. T., Gupta, J., Missmer, S. A., &amp; Aninye, I. O. (2021). Stigma and endometriosis: a brief overview and recommendations to improve psychosocial well-being and diagnostic delay. International Journal of Environmental Research and Public Health, 18(15), 8210. Sjöström-Strand, A., &amp; Fridlund, B. (2008). Women  s descriptions of symptoms and delay reasons in seeking medical care at the time of a !rst myocardial infarction: a qualitative study. International journal of nursing studies, 45(7), 1003-1010. Stanier, J, Miglio, N, &amp; Dolezal, L. (2022). Pandemic Politics and Phenomenology: Editors   Introduction. Puncta: Journal of Critical Phenomenology, Vol. 5. Welsh, T. (2022). Feminist existentialism, biopolitics, and critical phenomenology in a time of bad health (p. 200). Taylor &amp; Francis. Werner, A., &amp; Malterud, K. (2003). It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Social science &amp; medicine, 57(8), 14091419. Westergaard, D., Moseley, P., Sørup, F. K. H., Baldi, P., &amp; Brunak, S. (2019). Population-wide analysis of differences in disease progression patterns in men and women. Nature communications, 10(1), 666. Young, I. (1980). Throwing like a girl: A phenomenology of feminine body comportment, motility, and spatiality. Human Studies. 3:137-56.  Vol.1, Vol.17, 2025: NuméroNuméro 1/Vol.1,2/Vol.17 Issue 1 Issue 2  49

## Références

S. C., Salisbury, H., & Ziebland, S. (2012). Women’s experience of coronary heart disease: why is it different? British Journal of Cardiac Nursing, 7(4), 165–170. https://doi.org/10.12968/bjca.2012.7.4.165

K, Lowton K, Wright J. What’s the delay? A qualitative study of women’s experiences of reaching a diagnosis of endometriosis. Fertil Steril 2006;5:1296–1301.

A. D., & Malone, R. E. (2005). Accustomed to enduring: experiences of African-American women seeking care for cardiac symptoms. Heart & Lung, 34(1), 13-21.

H. (2016). Phenomenology of illness. Oxford University Press.

H. L. (2019). Can intersectionality help lead to more accurate diagnosis?. The American Journal of Bioethics, 19(2), 37-39.

J. N. (1983). Sexism, feminism and medicalism: a decade review of literature on gender and illness. Sociology of Health & Illness, 5(1), 62-82.

Clerkley, Kiana, "The Underdiagnosis of ADHD in Black Females" (2022). Electronic Theses, Projects, and Dissertations. 1441. https://scholarworks.lib.csusb.edu/etd/1441

Davenport, S., Smith, D., & Green, D. J. (2022). Barriers to a timely diagnosis of endometriosis: a qualitative systematic review. Obstetrics & Gynecology, 10-1097.

E., & Mann, C. H. (2008). Endometriosis and the primary care consultation. European Journal of Obstetrics & Gynecology and Reproductive Biology, 139(1), 111-115.

K., Fajzel, H., & Tordon, K. (2023). Patient and practitioner: The impact of social factors on diagnostic delay for endometriosis. Undergraduate Research in Natural and Clinical Science and Technology Journal, 7, 1-11.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Harmondsworth: Penguin.

L. (2020). Critical Phenomenology. In Weiss, Murphy, & Salamon (Eds.), 50 Concepts for a Critical Phenomenology (pp. 11–16). Northwestern University Press. https://doi.org/10.2307/j.ctvmx3j22.6

K. M., & Berg, H. (2021). Epistemic injustice in the age of evidence-based practice: The case of fibromyalgia. Humanities and Social Sciences Communications, 8(1), 1-6.

Hintz, E. A. (2022). “It’s All in Your Head”: A Meta-Synthesis of Qualitative Research About Disenfranchising Talk Experienced by Female Patients with Chronic Overlapping Pain Conditions. Health Communication, 1-15.

Husserl, Edmund. 1970. The Crisis of European Sciences and Transcendental Phenomenology. Translated by David Carr. Evanston, IL: Northwestern University Press

H., Gorre, C. Friedrich-Karnik, A., & Gulati, M. (2021). Addressing the Bias in Cardiovascular Care: Missed & Delayed Diagnosis of Cardiovascular Disease in Women. American Journal of Preventive Cardiology, 8.

J. (2014). Not tonight. In Not Tonight. University of Chicago Press.

C., & Douglas, E. (2020). A Crip Queer Dialogue on Sickness (Editors' Introduction). Puncta, 3(2), 1-14.

Laws, S. (1990). Issues of blood: The politics of menstruation. Hampshire: Macmillan.Ashton 1999

Magrì, E., & McQueen, P. (2022). Critical phenomenology: An introduction. John Wiley & Sons.

Merleau-Ponty, M. (1945 [2012]). Phenomenology of Perception. Trans. Donald A. Landes. London and New York: Routledge.

A. G., Jha, S. K., Iskander, J., Avanthika, C., Jhaveri, S., Patel, V. H., ... & Azam, A. T. (2021). Diagnostic challenges and management of fibromyalgia. Cureus, 13(10).

J., García, M., Luissi, A., Pierini, F., Sabelli, M., Mollerach, F., & Soriano, E. (2020). Rheumatoid arthritis patient's journey: delay in diagnosis and treatment. JCR: Journal of Clinical Rheumatology, 26(7S), S148-S152. doi: 10.1097/RHU.0000000000001196

K. (2009). The etiquette of endometriosis: stigmatisation, menstrual concealment and the diagnostic delay. Social science & medicine, 69(8), 1220-1227.

O. T., Gupta, J., Missmer, S. A., & Aninye, I. O. (2021). Stigma and endometriosis: a brief overview and recommendations to improve psychosocial well-being and diagnostic delay. International Journal of Environmental Research and Public Health, 18(15), 8210.

A., & Fridlund, B. (2008). Women's descriptions of symptoms and delay reasons in seeking medical care at the time of a first myocardial infarction: a qualitative study. International journal of nursing studies, 45(7), 1003-1010.

Stanier, J, Miglio, N, & Dolezal, L. (2022). Pandemic Politics and Phenomenology: Editors’ Introduction. Puncta: Journal of Critical Phenomenology, Vol. 5.

Welsh, T. (2022). Feminist existentialism, biopolitics, and critical phenomenology in a time of bad health (p. 200). Taylor & Francis.

A., & Malterud, K. (2003). It is hard work behaving as a credible patient: encounters between women with chronic pain and their doctors. Social science & medicine, 57(8), 1409-1419.

D., Moseley, P., Sørup, F. K. H., Baldi, P., & Brunak, S. (2019). Population-wide analysis of differences in disease progression patterns in men and women. Nature communications, 10(1), 666.

Young, I. (1980). Throwing like a girl: A phenomenology of feminine body comportment, motility, and spatiality. Human Studies. 3:137-56.