a living, open-access framework · 2025

endo
violence

[co]defining endometriosis-related injustices

a note before you begin

This is an art and research project, not a medical resource. It was created in crip time — with care, slowness, and the particular logic of a neurodivergent mind working through pain and complexity. Parts of it were made with AI as a collaborative tool. Please bring generosity to any gaps, inconsistencies, or rough edges you encounter. All of it was made with love, rigour, and the belief that this work matters.

This framework names what medicine has refused to see. Nine types of violence — medical, epistemic, reproductive, economic, digital, political, environmental, racial, psychological, and relational — mapped, named, and defined by the Endo Violence Community.

Co-authored by Dr. Alicja Pawluczuk / HYSTERA and co-edited by Allison Rich, Director of the Endo Violence Collective — alongside an international community of survivors, researchers, artists, and advocates. Not a clinical model. A living terrain.

1 in 10with a uterus affected
8–12years avg. delay (UK)
9types named
"Violence is therefore a collective and ontological condition... the harm experienced is not only medical or interpersonal, but rooted in deeper structures that deny full personhood."
explore the framework
click any chapter to expand
01
about this work
co-creation · community

Built with an international community of survivors, researchers, artists, and advocates. Not a study about endometriosis — a framework created from within it. Collective authorship is foundational: the Endo Violence Community are not advisors, they are co-authors.

In practice: a survivor-researcher from Miami and an artist-researcher from Edinburgh co-editing the same framework, each bringing different positionalities, each named.

read more →
02
why violence?
naming · transformative justice

The word is precise, not provocative. Violence names what softer language cannot: the patterned production of harm through structural neglect, institutional silence, and cultural dismissal — including what is withheld as much as what is done.

In practice: waiting 8–12 years for diagnosis is not an unfortunate delay. It is a violent outcome of gendered research priorities and clinical disbelief.

read more →
03
nine types
medical · digital · racial · economic

Nine shifting, overlapping terrains of harm — medical, epistemic, reproductive, economic, digital, political, environmental, racial, psychological, and relational. Not a checklist. A map of how harm moves through systems, bodies, and relationships simultaneously.

In practice: someone with endometriosis may experience medical gaslighting (medical violence), lose income due to pain (economic violence), and have their health content censored on social media (digital violence) — all at once.

explore types →
04
topography
living terrain · healing justice

A living terrain rather than a flat framework — textured, messy, and alive. The topography maps elevations (the nine types), fault lines (tensions like visibility vs. exploitation), and compass points rooted in healing justice: slowness, solidarity, consciousness.

In practice: the "endo warrior" narrative (survival) and the burnout of constant advocacy are a fault line. The topography names this tension rather than erasing it.

use the framework →
05
apply in your context
your work · your community

Endo violence is designed to be applied — in research, advocacy, healthcare, policy, education, and art. This section offers practical tools: a guided reflection form, context mapping, and printable resources for using the framework where you are.

In practice: a clinician might use it to audit their practice. A researcher to interrogate their methodology. A survivor to name what happened. An organiser to frame a campaign.

use the framework →
06
extend the framework
remix · add your voice

This framework is an invitation, not a conclusion. Select any violence type and add what is missing — your experience, your challenge, your context. Not as a framework to commodify, but as a shared language of resistance, reflection, and repair.

In practice: someone in a country with no endometriosis policy might add what political violence looks like there. A Black woman might name what's missing from the racial violence definition.

add your voice →
01 /about this work

built with the community, not about it

Endo violence was never meant to be a book. It began as an exhibition, became a zine, a collective, an academic article — and something larger still.

authored by
Alicja Pawluczuk (PhD)
HYSTERA

Disabled, neurodivergent endo violence survivor and Research Fellow at the University of Leeds (INCLUDE+ Network). Artist, researcher, and co-founder of the Endo Violence Collective. Initiated the framework in 2022 following the first endo violence exhibition in Berlin.

edited by
Allison Rich

Director of the Endo Violence Collective, based in Miami, Florida. Filmmaker, advocate, and co-founder of the collective. Co-edited this book, led the community review process, and co-created the collective's infrastructure of care. Her film Not Normal brought her into collaboration with HYSTERA in 2023.

"The international standards for endometriosis care are a failure. May this book be a companion to our collective work against gendered medical violence."
watch: Not Normal (film) ↗

The framework emerged from lived experience, research, artivism, and years of navigating what happens when medicine refuses to believe you. It was co-created with an international community of researchers, artists, activists, and survivors.

This work follows collective authorship principles — the community is not an advisor, but a co-author. As Alicja writes: "I see Allison as the person who actually created the collective and the online endo violence community. Allison's care, dedication, patience, and the ability to hold space for others."

"Endo violence as a concept is both a theoretical framework and a community-led practice of resistance and advocacy, grounded in intersectional and feminist analyses."

This interactive space combines an explorable terrain of the nine violence types, a living topography map, and a remix space where your voice extends the framework. It is open access, freely available, and designed to be remixed.

publication info

  • Published 2025 · Endo Violence Collective Self-Publishing
  • Open access · freely remixable for non-commercial use
  • www.endoviolence.com
  • @endo.violence.collective
02 /on naming

why we use the word violence

The word is not chosen lightly. It is chosen because it is precise.

Before writing about endometriosis as a political issue, there was a foundational question to sit with: what do we mean by violence? Not as an abstract question — as an urgent one. If we want to name something as endo violence, we must be clear about what kind of harm we are speaking about, and why that naming matters.

Violence, in this framework, is defined as the patterned production of harm through structural neglect, institutional silence, and cultural dismissal. It includes what is done — coercion, stereotyping, epistemic erasure — but also what is withheld: care, rest, diagnosis, dignity. It is not limited to visible or interpersonal acts. It is a structure, a system, a way of organising who matters and who is left out.

"To [co]imagine nonviolent endo futures — or to build solidarities that refuse harm — we must first understand the mechanisms through which violence operates."

This matters because harm sustained through indifference, ignorance, and ideological positioning is still harm. Medical neglect is violence. Being disbelieved is violence. Waiting eight years for a diagnosis because of gender bias is violence. The word holds the weight that softer language cannot.

Endo violence is not meant to become a static framework for scoring degrees of injustice. It is a lens — one that names patterns, makes them legible, and opens space for collective resistance.

grounded in transformative justice

Transformative justice does not seek punishment — it seeks to understand and dismantle the conditions that produce harm. Applied here, it means asking not only what happened to individuals with endometriosis, but what systems, structures, and silences made that harm possible and persistent.

Endo violence as a concept resists the individualisation of suffering. It refuses the idea that harm is a personal failure or medical misfortune. Instead, it locates injustice structurally — in funding decisions, research priorities, clinical training, workplace policy, and the political economy of care.

grounded in non-violence

Naming violence is the first step toward imagining its absence. Drawing on Judith Butler's work, nonviolence here is not passive — it is a form of resistance, a mode of world-building. It asks how we relate to one another, how care circulates (or fails to), and how systems uphold certain lives while abandoning others.

"Nonviolence is not simply a passive practice or a moral ideal. It is an ethical obligation arising from the understanding that we are fundamentally dependent on one another." — Butler (2021)

By dissecting what violence means, we make space to imagine what nonviolence could look like — not as an abstract ideal, but as a relational, collective, feminist practice.

an interactive map of harm

click any node to expand — key statistics and sources from the book

03 /terrain explorer

the nine types

These are not clinical categories — they are shifting, overlapping terrains of harm. Select any type to explore its definition and mechanisms.

05 /apply in your context

how to use the endo violence framework

Not a framework to diagnose others or a concept to commodify — a shared language of resistance, reflection, and repair. Here is how to apply it where you are.

people with endometriosis

Use endo violence to affirm your truth. When you feel gaslit, unseen, or dismissed, return to this language as a form of self-defence and solidarity. Let it be the balm for the guilt of not doing enough, the grief of lost years, the fury of being dismissed.

example question to ask "Which type of endo violence do I recognise most in my own experience — and has it been named before?"

researchers & academics

Resist the urge to tidy this up. Use it to disrupt what counts as knowledge. To centre the lived, the emotional, the contradictory. Healing justice in research means co-creating with, not studying from. Be transparent about power, credit community labour.

example question to ask "Does my methodology centre lived experience as primary evidence — or as anecdote?"

clinicians & healthcare professionals

If reading this makes you uncomfortable — stay with that. Let it move you into action. Ask better questions: who benefits from the current system? Who gets heard, and who doesn't? Use endo violence to shift from treating symptoms to addressing structural neglect.

example question to ask "In the last month, how many patients did I disbelieve — and what made me do so?"

activists & organisers

Let endo violence expand your frame. Chronic illness is a justice issue. It touches housing, labour, migration, environmental justice, and more. Make your movements accessible — not just theoretically, but practically. We're not always loud, but we're here.

example question to ask "Is our campaign accessible to people operating on crip time — slow, non-linear, rest-requiring?"

policymakers & funders

Healing justice calls for structural accountability, not saviourism. Let endo violence humanise the data. Which nine types are already embedded in current policy failures? Where are the funding gaps that sustain epistemic and economic violence?

example question to ask "Does our funding model require applicants to be in good enough health to apply — and what does that exclude?"

allies & loved ones

To support someone with endometriosis, start by unlearning what you think care should look like. Healing justice means listening without fixing, holding space without judgement. You don't need the right words — you need to keep showing up.

example question to ask "Have I asked what support looks like — or have I assumed?"

Endo violence looks different depending on where you are. Healthcare systems vary. Legal protections vary. Cultural norms around menstruation and pain vary. Here are prompts to help you locate the framework in your own context.

your healthcare system
How long is the average diagnostic delay in your country or region?
Is endometriosis covered under public health provisions?
Do GP/primary care providers receive endometriosis training?
Which communities face the greatest diagnostic barriers locally?
your legal & policy context
Is endometriosis recognised as a disability in your jurisdiction?
Are there workplace protections for chronic illness?
Has endometriosis appeared in any national health strategy?
What reproductive rights framework operates in your country?
your community
Which endo violence types are most visible locally — and which are invisible?
Are there community groups or support networks? Are they accessible?
What language or cultural barriers shape endometriosis experience here?
Who in your community carries the most endo-related harm unrecognised?
your role
What part of the endo violence framework most directly touches your work?
What one change in your practice could reduce endo violence?
Who should you be co-creating with — and aren't yet?
How do you acknowledge community labour in your work?

Select the types of endo violence most present in your context. This creates a visual map you can use in presentations, workshops, or advocacy. Click to toggle.

Your selection is personal and contextual — it does not rank or score endo violence types.

05 /reflect & respond

your voice matters

This framework is an invitation, not a conclusion. Select a type and use it as a starting point — to reflect on your own experience, research, or practice. What does this name for you? What does it miss?

← select a violence type to begin

06 /talk to the book

the book as conversation

Ask anything about the framework, the theory, or the community behind it. Grounded in the book's own language and ethics.

ask, explore,
find language

This companion draws on the full text of the book to help you explore what endo violence means for your context, understand the theory, or find words for experiences that have gone unnamed.

It will not diagnose, prescribe, or pathologise. It speaks in the language of the framework.

try typing something like…
"I keep being told my pain is normal. What does the framework say about this?"
"I'm a nurse and want to understand how I might be contributing to epistemic violence without realising."
"How can I use endo violence in a funding bid or grant application?"
"What does environmental violence mean for communities in the global south?"
"I'm writing a paper on menstrual health policy — how does this framework apply?"
"Can you explain transformative justice in simple terms and how it connects here?"
or pick a starting point
what is endo violence?
epistemic violence
digital violence
apply in my work
crip time
collective authorship
fault lines
race & endometriosis
toward nonviolence
for policymakers
endo violence companion · powered by the book
companion
This companion is grounded in the endo violence framework and book by Dr. Alicja Pawluczuk / HYSTERA and the Endo Violence Community (2025). Ask anything about the framework, theory, or community. You can also use the suggested prompts to get started.

When you send your first message, you will be asked for your Anthropic API key (sk-ant-…). It is stored only in your browser.

endo violence: living framework · interactive edition · 2025

University of Leeds · INCLUDE+ Network