English: I'm very pleased to be able to take part in this debate and indeed support all parts of the motion. Can I start by commending Jenny Rathbone in setting the scene and explaining the issue in the full detail that this complex matter merits? As has been mentioned, endometriosis is a condition where the lining of the endometrium - the lining of the womb - parts of it start to grow outside of the womb. We don't quite know why actually, but it starts to grow in other places, like the ovaries, fallopian tubes, bowel, bladder and other parts of the pelvis. And its effects can be devastating - surprisingly common, as we've heard, but the effects in some women can be devastating in terms of chronic, debilitating, severe pain. Now, we all get pain from time to time, and when you're in the middle of a painful episode of whatever, we are usually reassured by the knowledge that it's not going to last that long, be it joint pain, toothache or whatever. It is a totally new level of debilitation to suffer from pain that is so severe that you cannot see a way out of it because it tends to go on for months, weeks, years. There's a relationship to the time of the month, in that it tends to be worse at the time of the period, but not always so. That's why there is a challenge to making the diagnosis in the first place, and it's not always period-related symptoms either. Yes, there's a chronic severe pain, but you can also have symptoms like constipation and diarrhoea when the endometriosis particularly involves the bowel. All of this can produce a huge impact on the woman's life and on the lives of people all around her, as we've heard: on relationships, on the ability to have a baby, on employment prospects. So, there are huge societal costs to not managing endometriosis effectively. We certainly do, as we've heard, need more than one large, multidisciplinary tertiary specialised provision dedicated to endometriosis in Wales. The Cardiff unit is excellent, but it's the only one. And there's the devil's own challenge, from a GP point of view, trying to get women with endometriosis seen in secondary care in the first place - there has to be a level of severity. So, it's very difficult to get people seen early on in the process before they develop any severe symptoms. And sometimes, when women have severe symptoms, it is then also the devil's own challenge to get them seen in secondary care as well. With those women who have a complex type of endometriosis that involves multiple organs, really getting seen in Cardiff is the only way forward because it's not just a problem for gynaecology - it's a problem for those other parts of the anatomy as well. It's a problem for colorectal surgeons, it's a problem for urologists, bladder surgeons as well - it's not just a gynaecological issue, which is why we need those advanced tertiary multidisciplinary centres. All in all, I think there should be a dedicated all-Wales endometriosis pathway, from presentation - from when the woman has the problem - to primary care, through secondary care, through to tertiary care. There should be a dedicated, badged pathway, and our specialised nurses have a prominent role to play in that. But also, from the very start I think it does need to be part of education in the curriculum Bill, as Jenny Rathbone mentioned at the start. It needs to be part of menstrual education, what is normal for girls and women to have, and boys and young men need to know that as well so that there is empathy when these situations come along, because endometriosis needs to be considered whenever a woman has severe period pain, particularly when it's coupled with infertility issues. It should be right up there in diagnosis and it's not at the moment, sometimes not from the woman's point of view and certainly not from primary care's point of view, and occasionally even secondary care. Severe period pains, combined with inability to get pregnant, should be a warning sign. But, all in all, in drawing my remarks to a conclusion, can I commend Jenny Rathbone and others who are supporting this motion? This motion deserves to succeed and we deserve to have an improved specialised service for our women with endometriosis, but also coupled with improved education at the start of menstrual life. Diolch yn fawr.
Welsh: Rwy'n falch iawn o allu cymryd rhan yn y ddadl hon ac yn wir, rwy'n cefnogi pob rhan o'r cynnig. A gaf fi ddechrau drwy ganmol Jenny Rathbone am osod y cefndir ac egluro'r broblem gyda'r manylder llawn y mae'r mater cymhleth hwn yn ei haeddu? Fel y soniwyd, mae endometriosis yn gyflwr lle mae leinin yr endometriwm - leinin y groth - mae rhannau ohono'n dechrau tyfu y tu allan i'r groth. Nid ydym yn gwybod pam mewn gwirionedd, ond mae'n dechrau tyfu mewn mannau eraill, fel yr ofarïau, tiwbiau ffalopaidd, y coluddyn, y bledren a rhannau eraill o'r pelfis. A gall ei effeithiau fod yn ddinistriol - yn syndod o gyffredin, fel y clywsom, ond gall yr effeithiau mewn rhai menywod fod yn ddinistriol o ran poen cronig, gwanychol, difrifol. Nawr, rydym i gyd yn cael poen o bryd i'w gilydd, a phan fyddwn yng nghanol pwl poenus o beth bynnag, cawn ein calonogi fel arfer wrth wybod nad yw'n mynd i bara mor hir â hynny, boed yn boen yn y cymalau, y ddannoedd neu beth bynnag. Mae'n lefel gwbl newydd o boen sydd mor ddifrifol fel na allwch weld ffordd allan am ei fod yn tueddu i bara am fisoedd, wythnosau, blynyddoedd. Mae cysylltiad ag adeg o'r mis, gan ei fod yn tueddu i fod yn waeth adeg y mislif, ond nid felly bob amser. Dyna pam y mae'n her i wneud y diagnosis yn y lle cyntaf, ac nid yw'r symptomau'n gysylltiedig â'r mislif bob amser ychwaith. Oes, mae poen difrifol cronig, ond gallwch hefyd gael symptomau fel rhwymedd a dolur rhydd pan fydd yr endometriosis yn gysylltiedig â'r coluddyn yn arbennig. Gall hyn i gyd gael effaith enfawr ar fywyd y fenyw ac ar fywydau pobl o'i chwmpas, fel y clywsom: ar berthnasoedd, ar y gallu i gael babi, ar ragolygon cyflogaeth. Felly, mae costau cymdeithasol enfawr i beidio â rheoli endometriosis yn effeithiol. Yn sicr, fel y clywsom, mae angen mwy nag un ddarpariaeth drydyddol amlddisgyblaethol arbenigol fawr benodol ar gyfer endometriosis yng Nghymru. Mae uned Caerdydd yn ardderchog, ond dyna'r unig un. Ac o safbwynt meddyg teulu, mae ceisio cael menywod ag endometriosis wedi'u gweld mewn gofal eilaidd yn y lle cyntaf yn her anferthol - rhaid wrth lefel o ddifrifoldeb. Felly, mae'n anodd iawn cael pobl wedi'u gweld yn gynnar yn y broses cyn iddynt ddatblygu unrhyw symptomau difrifol. A weithiau, pan fydd gan fenywod symptomau difrifol, yr her anferthol wedyn yw eu gweld mewn gofal eilaidd hefyd. Gyda'r menywod sydd â math cymhleth o endometriosis sy'n gysylltiedig ag organau lluosog, cael eu gweld yng Nghaerdydd yw'r unig ffordd ymlaen mewn gwirionedd gan nad problem gynaecolegol yn unig ydyw - mae'n broblem i'r rhannau eraill hynny o'r anatomi hefyd. Mae'n broblem i lawfeddygon y colon a'r rhefr, mae'n broblem i wrolegwyr, llawfeddygon y bledren hefyd - nid mater gynaecolegol yn unig ydyw, a dyna pam y mae angen y canolfannau amlddisgyblaethol trydyddol arbenigol hynny. At ei gilydd, credaf y dylid cael llwybr endometriosis penodol i Gymru gyfan, o'r ymweliad cyntaf â gofal sylfaenol - o'r adeg y mae'r fenyw'n dechrau cael y broblem - drwy ofal eilaidd, drwodd i ofal trydyddol. Dylid cael llwybr bathodynnau digidol pwrpasol, ac mae gan ein nyrsys arbenigol rôl amlwg i'w chwarae yn hynny. Ond hefyd, o'r cychwyn cyntaf, rwy'n credu bod angen iddo fod yn rhan o addysg yn y Bil cwricwlwm, fel y soniodd Jenny Rathbone ar y dechrau. Mae angen iddo fod yn rhan o addysg mislif, yr hyn sy'n normal i ferched a menywod ei gael, ac mae angen i fechgyn a dynion ifanc wybod hynny hefyd fel bod empathi pan fyddant yn wynebu'r sefyllfaoedd hyn, oherwydd mae angen ystyried endometriosis pryd bynnag y bydd gan fenyw boen mislif difrifol, yn enwedig pan fydd wedi'i gyplysu â materion yn ymwneud ag anffrwythlondeb. Dylai fod ar frig y rhestr mewn diagnosis ac nid yw yno ar hyn o bryd, weithiau nid yw yno o safbwynt y fenyw ac yn sicr nid o safbwynt gofal sylfaenol, na gofal eilaidd weithiau hyd yn oed. Dylai poenau mislif difrifol, ynghyd ag anallu i feichiogi, fod yn arwydd rhybudd. Ond at ei gilydd, wrth ddod â fy sylwadau i ben, a gaf fi ganmol Jenny Rathbone ac eraill sy'n cefnogi'r cynnig hwn? Mae'r cynnig yn haeddu llwyddo ac rydym yn haeddu cael gwell gwasanaeth arbenigol i'n menywod sydd ag endometriosis, ynghyd â gwell addysg ar ddechrau bywyd gyda mislif. Diolch yn fawr.