“It makes me feel like less of a woman” : a reflexive thematic analysis of endo belly and the gendered illness experience of endometriosis : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Psychology (Health Psychology) at Massey University, Albany, Aotearoa New Zealand

Abstract

Endometriosis is characterised as an incurable gynaecological condition causing inflammatory reactions across multiple bodily systems. Endometriosis affects one in 10 women of reproductive age in Aotearoa New Zealand. Endometriosis has historically been framed through a biomedical lens within Western contexts, with limited attention paid to how wider sociocultural meanings shape sufferers’ experiences, especially in relation to gender identity. While there is a developing interest in the broader impact of endometriosis on body image, “endo belly”—the visible abdominal bloating that alters the body’s appearance and can prompt significant distress— remains under-researched. This research examines how individuals who experience endo belly construct and negotiate their feminine identity in Western sociocultural discourses that often define womanhood through bodily appearance and normative gender ideals. A feminist, social constructionist approach was adopted to prioritise the embodied lived experience of 59 participants, positioning them as experts in their social realities. The participation criteria included an endometriosis diagnosis by laparoscopy situated within the context of Aotearoa New Zealand. An online qualitative survey, advertised through social media platforms, was utilised as the method of data collection, and the data were analysed using reflexive thematic analysis (Braun & Clarke, 2019). Four key themes were identified: (1) “It Makes Me Feel Like Less of a Woman”: Endo Belly as a Disruption of Normative Femininity; (2) Striving to Perform Ideal Womanhood: “We Have to Put On a Brave Face”; (3) The Enemy Within: Battling and Making Peace with the Unruly Body; and (4) Rewriting the Rules: Redefining Femininity and Resistance. The findings suggest that many of the women’s experiences of endo belly are associated with psychological and social challenges, as its pervasive appearance-based symptoms disrupt sociocultural expectations of femininity, identity, and illness experiences in Western cultural contexts. Ultimately, this thesis calls for a re-evaluation of healthcare encounters in Aotearoa New Zealand to support empirically guided interventions that better address the appearance-based symptoms of endo belly.