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In my early 20s, I recall sitting in a gynecologist’s office being told without any further tests that I had PCOS, endometriosis, and possibly ovarian cancer. Hours later, I sat in the car with a close friend, a calculator open on her phone, desperately trying to decode ovarian volumes from my ultrasound. The fear and confusion I felt then were overwhelming and have stayed with me since.
Sexual and reproductive health and rights (SRHR) are central to women’s health, wellbeing, and quality of life. Yet, across much of our region, they remain defined by silence, conservatism, and systemic neglect.
Maternal health and fertility dominate public health discourse, while chronic gynecological illnesses such as polycystic ovary syndrome (PCOS) and endometriosis are left in the shadows. These conditions affect millions of women and shape their everyday lives, long-term health, and reproductive trajectories.
My own experiences, and those of women I have spoken to, show how deeply entrenched this silencing runs. From fears instilled in girlhood about virginity being “threatened” by something as ordinary as a faucet or a bicycle, to clinical encounters where diagnoses are handed out casually or delayed for years, the patterns are painfully similar.
Epidemiological evidence shows the significant scale of PCOS. According to the Global Burden of Disease (GBD) the number of prevalent PCOS cases nearly doubled between 1990 and 2021, rising by 89 percent from 34.81 million to 65.77 million. During the same period, the overall disease burden, measured in DALYs (Disability-Adjusted Life Years, a metric used to measure the burden of disease in a population) , grew by 87 percent.
Although the numbers of endometriosis cases are not well-documented, it is astonishingly widespread: One in every 10 women, meaning 10 percent (190 million) of women and girls globally are affected. In the MENA region, roughly 13 percent of women undergoing laparoscopy are diagnosed with endometriosis, with prevalence rising to nearly 50 percent among those with infertility or chronic pelvic pain.
Statistics capture only part of the picture. The reporting and management of endometriosis and similar gynecological conditions is severely lacking, with an invasive and expensive laparoscopy being the golden standard for diagnosis, pain being the main pressing symptom. The number of women living with endometriosis is significantly underestimated as it also takes an average of 6.6 years to get a diagnosis.
Across the region, women’s health is overwhelmingly framed through fertility. PCOS is usually addressed only when infertility emerges, despite its long-term metabolic risks, and endometriosis is treated primarily when it blocks conception, despite the chronic and debilitating pain and fatigue that define the condition.
For unmarried women, virginity remains a powerful social marker, and these young women are refused the consultations and examinations that are needed for early diagnostic care, even when symptoms are severe.
One woman I met described her first gynecological appointment as a moment of terror, not of diagnosis, but of discovering whether “a baby might magically appear on the screen,” despite never having been sexually active.
Such fears are not irrational, they are embedded in a system where sexuality is policed and worth is tied to purity and fertility. By the time you become a woman, this fear is already stitched into you and so deeply embedded that no amount of comprehensive sexuality education can wash it away.
Infertility itself is overwhelmingly framed as a woman’s fault, even though male factor infertility accounts for nearly half of all cases. I recall one doctor’s casual reminder: “Men’s sperm is only tested after six months of trying,” a protocol that placed the burden squarely on me, while delaying acknowledgment of male infertility. Such policies and protocols reproduce the assumption that reproductive struggles are women’s responsibility alone.
Reducing complex, chronic conditions to quick fixes that silence women’s pain instead of addressing it is counterintuitive, as gynecological conditions often result in fertility complications and hormonal treatment comes with severe side effects.
I was prescribed hormonal treatment. I bled for seven weeks straight, yet this was normalized and left unexplained by my healthcare providers. We don’t realise the profound consequences of handing out hormonal pills with no guidance.
Women repeatedly dismissed by physicians often avoid seeking care altogether. Many turn to self-research, restrictive diets, or alternative therapies in desperation. Chronic illness then becomes not only a medical condition but also a social sentence, one of invisibility in societies that undervalue suffering it does not understand.
When I was first diagnosed with PCOS, I tried to find comfort in my nutritionist’s words: “Every woman who walks into my clinic has PCOS. I think I myself have PCOS.”
At first, I thought it was solidarity. Later, I realized it was a dismissal. It was proof of how little women’s suffering is taken seriously. It was like being told that if every woman has it, then no woman’s suffering matters.
The invisibility of PCOS and endometriosis in the MENA region is not accidental, it is produced through conservatism, systemic neglect and inequality, and gendered narratives of reproduction.
Addressing this requires a significant shift towards rights-based care. Healthcare providers must be trained to validate women’s accounts of pain and move away from a fertility-centered model towards person-centered care.
At the community level, harmful misconceptions around virginity, contraception, and infertility must be challenged through advocacy and education initiatives. Overall, recognizing gynecological conditions as SRHR priorities is not only a medical necessity but a matter of justice. It affirms that women’s suffering deserves acknowledgment and validation not only when it threatens fertility, but when it threatens dignity, wellbeing, and life itself.
Despite these structures, women are speaking, and in speaking we find each other. My own story is not unique; in conversations across Egypt and the region, I am struck by how often our stories echo one another. The shock of delayed diagnoses, the sting of dismissal, the grief of chronic pain, the fear of infertility, and the resilience of bodies negotiating illness – these experiences connect us.
Illustration credit: Zein Gaia
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