Mary Lou McDonald (Dublin Central, Sinn Fein)
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I move:

That Dáil Éireann: notes that:

— endometriosis is a serious, chronic inflammatory disease that affects the entire body, and it is characterised by severe pelvic pain, infertility, internal scarring (fibrosis), heavy and painful menstruation, and can cause irreversible damage to multiple organs;

— the disease primarily affects organs within the pelvic cavity, including the uterus, fallopian tubes, cervix, bladder, bowel and kidneys, and has also been found in the diaphragm, gallbladder and lungs;

— at least one in ten women in Ireland are affected, with recent global research suggesting that nearly one in six may have symptoms indicative of endometriosis; and

— it takes an average of nine years for patients to receive a formal diagnosis, resulting in prolonged suffering, permanent organ damage, and increased risk of infertility;

further notes that:

— a number of gynaecologists are striving to deliver better care, but are hindered by a lack of critical resources, including access to theatre time, specialist surgical tools and specialised training programmes in the identification and excision of endometriosis;

— for decades, endometriosis care in Ireland has failed thousands of women;

— the management of suspected cases in primary care settings is fundamentally inappropriate and delays essential intervention; and

— international best practice confirms that expert-led excision surgery remains the gold standard for long-term disease management and improved quality of life;

acknowledges that:

— the most recently published Health Service Executive (HSE) guidelines acknowledge that excision is a superior treatment for managing endometriosis;

— the disease's complexity and varied presentation require specialised expertise and training to diagnose and evaluate;

— excision surgery, involving the complete removal of endometrial lesions with clear margins, offers the most effective means of managing the disease, alongside multidisciplinary care; and

— while there is no known cure, expert surgical treatment allows many patients to regain their quality of life and functional health, with the support of multidisciplinary care teams;

recognises that:

— discussion of excision surgery as a superior treatment option in the most recent HSE treatment guidelines is a step forward;

— the HSE's supra-regional endometriosis clinics have less than 25 out of 50 posts filled across both centres;

— the ongoing neglect of endometriosis care in Ireland is emblematic of broader systemic failures in women's healthcare;

— women living with this disease continue to report being dismissed, ignored and traumatised by a health system, which they state, fails to recognise their suffering;

— the current model of care fails to account for the psychological, emotional and social toll of endometriosis, compounding the physical burden of the disease; and

— use of the outdated staging process in HSE guidelines is causing difficulties for patients and clinicians alike, and has recently been abandoned by specialists in the field; and

calls on the Government to:

— establish a state-of-the-art centre of excellence for endometriosis care staffed by multidisciplinary care teams, including specialists in endometriosis imaging, pelvic floor physiotherapy; dietetics, pain management, occupational therapy, endocrinology, fertility management, psychology and surgical specialties, including colorectal, urology and hepatology;

— immediately establish specialised imaging protocols to assist gynaecologists in identifying and mapping deep infiltrating endometriosis;

— provide upfront financial support for diagnosis and excision treatment in designated specialist centres abroad;

— end the current model which places diagnostic responsibility in primary care, and instead implement a fast-track referral system to specialist services, at home or abroad;

— consider replacing the outdated endometriosis staging system with, the Enzian score combined with the Oxford University Innovation Endometriosis Health Profile 30 questionnaire;

— develop and fund a dedicated training and incentive programme to upskill Irish surgeons in identifying the disease during surgery, and in the specialist excision techniques required to remove it; and

— launch a nationwide public health campaign to raise awareness of the diverse symptoms and severe impact of endometriosis, and to challenge the silence and stigma that still surround the disease.

Meetings full of tears, full of pain, distress and trauma, meeting full of hurt, sorrow and anger, full of women's grief for the lives they could and should be living if it was not for the ordeal of the cruel condition endometriosis. That was the overwhelming atmosphere in each of the nine public meetings we held across the country. These meetings were attended by thousands of women and their families who bravely shared their stories of how suffering from endometriosis, and the absence of proper treatment in Ireland, had ravaged their lives. More than 40 of these courageous women and their family members are here in the Public Gallery this evening and they are most welcome. Despite everything they have gone through, they are ready to fight for the healthcare that all women and girls of Ireland deserve and to say with one voice "enough is enough".

Endometriosis is a crisis in women's healthcare. It affects one in ten women. Endometriosis, therefore, is in our lives, in our families and in our communities. It is our mothers, our sisters, our daughters, our grandmothers, our aunts, our friends and our work colleagues; it is us. A chronic inflammatory and whole-body disease that affects the pelvic region, uterus, fallopian tubes and cervix, it can spread to the bladder, bowels, lungs and even to the brain. It causes persistent, excruciating, debilitating pain. This pain is so intense that it can leave young women confined to wheelchairs or to bed, missing work, missing school, having to give up work and forcing them to drop out of school. It up-ends lives, ruins lives and puts the lives of women and girls at risk. The story of endometriosis in Ireland is the story of women denied proper care and treatment, suffering in silence, forced to travel abroad for treatment if they can. Even though it is a race against time with this disease, women are left waiting an average of nine years for a diagnosis. Women told us of their experiences of not being believed, being told it is all in their heads, being told that this is just how it is and that the unbearable bleeding and pain is just part of being a woman and of a normal menstrual cycle. Women told of being told to woman-up and sent home with a hot water bottle and a couple of Ponstan tablets. Women and girls are ridiculed, sidelined and shamed just for seeking medical help.

I have been in public life for a long time but I have never been at meetings so raw with anguish and anger. Women shared their most intimate stories of trauma hoping to be finally heard. Some were young women whose condition got so bad they lost their wombs. They were left with no option but to have hysterectomies and were robbed of their chance to become mammies. Women stood up and told us that the pain of labour and childbirth without an epidural or any pain relief was a walk in the park when compared to the pain of endometriosis. A mother shared her story of the night when she was again taken to hospital by ambulance because the pain had become so bad. Even though she was in agony, all she could think about was her young son saying, "Mammy, I do not want you to die. You are the best mammy in the world." All she wanted to do was to hug that child and tell him he was the best son in the world for being so brave for her. Women are at the centre of this crisis but endometriosis attacks the whole family. It impacts on children especially. Women told us about the heartache of leaving their children behind as they were forced to travel out of Ireland to seek diagnosis and treatment in London, Athens or Bucharest. It is the incredible love and solidarity of families that has held these women up when they have been so badly failed by the State, as endometriosis gnaws away at their bodies and at their lives. They are held up and supported, too, by such brave advocates as Kathleen King, Cate O'Connor, Vanessa Waldron and others.

It is unacceptable that women's healthcare is still at the bottom rung of the ladder. Tonight, we bring this motion and we are here to say enough is enough. Tonight, we break the silence together. We are standing together to demand that the Government deliver a gold-standard, multidisciplinary centre for the treatment of endometriosis here in Ireland, because no such service currently exists, so that women and girls are diagnosed quickly and early and get the medical interventions they need, including specialist excision surgery when required. It is beyond disappointing - in fact, it is enraging - that the Government, with a shameful amendment, pushes back against the first-hand experiences and real trauma of women. By deleting our motion in its entirety, the Government attempts to delete the women and girls' calls for better. It is a shocking amendment-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is so wrong of the Deputy.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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-----and it is seen by all of us here as exactly what it is. Women who have had access to the correct treatment have told us what it means. They say they feel reborn, that they got their lives back, that they shared the joy of being part of the lives of their children and their families again, that they could work again, that they could breathe easy again. That is what is at stake. That is what real action on endometriosis can give back to so many women and their families. Cuireann inmheatróis isteach ar bhean amháin as gach deichniúr. Tá an Stát ag íoc as mhná a fhágáil ag fulaingt, cráite i gciúnas agus i nganntanas cúraim. Caithfidh sé seo a athrú.

Ordinary women from across the country flocked to public meetings, women from all walks of life brought together by one thing - endometriosis. The meetings were raw with tears, suffering and trauma but also filled with resilience, strength, love and determination to achieve a turning point for the treatment endometriosis in Ireland, to say no longer will we be ignored, sidelined or suffer in silence. The women in the Gallery and tens of thousands at home watching on are strong and united and they are not going away. This is about one in ten women - their health, futures and their very lives. That is what is on the line. The Government must now finally hear their call, respect their experiences and suffering and respond now.

David Cullinane (Waterford, Sinn Fein)
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Sinn Féin held nine public meetings on the issue of endometriosis over the past number of months. I attended some of those meetings. I was shocked when I heard a lot of the stories told by women. I listened carefully and watched as many of them cried in the presence of family members. The collective trauma in the room caught me by surprise. The message from these women of feeling ignored and dismissed and being offered substandard care was truly shocking. Also shocking was the number of women who told me they had to travel abroad, not through choice but through necessity. A 27-year-old woman had three surgeries, one in Ireland, and then had to travel to London for a radical hysterectomy. A lot of her organs, unfortunately, were taken out. It was a really traumatic experience for her.

The same women, 40 of whom are in the Public Gallery, were in the Sinn Féin party room earlier. I got chatting to some of them. They find the Minster's amendment offensive. Nowhere in the amendment does it capture what these women feel. It does not capture the substandard service or the fact that there is no pathway to diagnosis for many women. It is too late in many cases. There can be misdiagnosis, incorrect treatment and substandard care. Really galling for them is the part that says women, as a choice, can travel abroad. We have had far too much of that when it comes to women's healthcare. It is not a choice for these women. They felt heartbroken. The women who travelled were often on their own or in some cases had one or two family members with them. It was not for a day or a week even that these women were away. They can be away for three or four weeks or even longer. No woman should have to go through that. No woman should have to travel abroad.

I have spoken to masters of hospitals and specialists who deliver this service. All of them put their hands up and said they were not providing the care they should and there is an awful lot more that needs to be done. I appeal to the Minister, when this debate is finished, to talk to the women in the Public Gallery and hear their message. If she heard their message and listened to their voices, I guarantee she would do everything possible to provide the centre of excellence needed and make sure there are specialist training programmes in place to train surgeons and specialists to provide gold standard care, the necessary excisions, as opposed to some of the substandard treatments these women are getting.

As a male, I stand with these women. Men and women in this House need to say enough is enough, we have to do more to support women with endometriosis. I encourage the Minister not to move her amendment and to support our motion.

Pearse Doherty (Donegal, Sinn Fein)
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The neglect and failure need to end. Endometriosis affects so many women. Like others, I have attended meetings in different parts of the country. I have heard some harrowing stories. There is also a constant theme that no matter where it is in the country, these women feel they have been abandoned by the State, and they have. They feel they have been ignored, dismissed and talked down to. In those rooms, there were also stories of unimaginable strength and determination as the women told us how they fought for years for what should be basic healthcare. A young woman from County Donegal shared her story with me of her experience of trying to access endometriosis healthcare in Ireland. Having experienced symptoms since she was 15, she attended her local GP and Letterkenny gynaecological department only to be told there was nothing wrong but the pain never went away. She had MRI and ultrasound scans and got a referral to urology where she had a cystoscopy, which was clear. She was told everything was okay and still the pain never went away. After years of living with that pain, in 2021 she was prescribed anti-depressants and told it was all in her head. Still, the pain never went away. Imagine being desperate for help, reaching out to the professionals and being told you were making it all up and it was all in your head.

The woman went privately for an exploratory laparoscopy, at a cost of €4,000, and no endometriosis was found. She was told she needed to change her diet and lifestyle - it was her again. Knowing the pain was still there and there was an underlying issue and not willing to give up, she again went privately to another gynaecologist who agreed the symptoms were consistent with endometriosis but was reluctant to operate. She had to reach out again and again. She spoke to other people with the same challenges and decided to travel to Romania in 2024, where she finally got the answers she deserved. A specialist MRI diagnosed her with endometriosis. That diagnosis took nine years of not being listened to or believed, misdiagnosis and pain. In going to Romania, she faced more difficulties. Her GP would not refer her in order to recoup her costs through the cross-border scheme so, once again, she had to go private for the referral. After she got that diagnosis in Romania and after undergoing counselling due to the lasting effects of this journey on her, she had surgery in Greece where the endometriosis was removed from multiple sites and she was also diagnosed with adenomyosis. For a decade, that young woman suffered with chronic pelvic pain, chronic fatigue, underlying issues, bowel issues, back pain and countless other symptoms, and nobody believed her. That story is not just hers; it is that of far too many women across this State. This needs to be treated like the emergency it is. Too many times, women are being failed and not believed and have to travel abroad. It has to come to an end.

I could recall other stories such as that of another woman failed by the system in this State who had to travel privately outside the State. She got her diagnosis. She was told there were cysts on her ovaries. She cried but not because she needed emergency surgery or because she had cysts on her ovaries. She cried because, for the first time, somebody believed that she had endometriosis and there was a plan in place for her afterwards. This has to come to an end. I said at the start the neglect and failure have to end. We need to start listening and believing our sisters, mothers, aunties, nieces and daughters. The care they deserve has to be put in place.

Mairéad Farrell (Galway West, Sinn Fein)
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I am sure the Minister would agree that for too long women's health was not discussed and was seen as something secretive or embarrassing. As a result, for decades, women's healthcare has been utterly neglected. This is not exclusive to women with endometriosis; it concerns a whole range of things. This needs to end. Especially as the Minister is a woman, I appeal to her to see what this motion says and what these women have told us needs to be done. It comes from the expertise of the women around us today.

I am conscious of time but I want to share the lived experience of a woman who contacted me. She now has stage 4 endometriosis. She was diagnosed in March 2023 at 36 years of age, having suffered terribly with this illness since she first got her period at the age of 11. She was in and out of hospital, suffered loads of misdiagnosis and was even told it was muscle pain or, as she said, some rubbish like that. I ask the Minister to listen to these women.

Joanna Byrne (Louth, Sinn Fein)
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In May, I hosted a public endometriosis meeting in Drogheda. Since then, my office has been inundated with women contacting me by phone, email and in person. Gemma, a 32-year-old nurse from Louth, is one of these women. She asked me to share her story.

Gemma says:

My symptoms of endometriosis were prevalent from the first period I had. The bleeds were heavy, excruciatingly painful, causing me to regularly miss days at schools. I had scans, there would be cysts, I would be sent home and told to take more pain relief. I would vomit, faint from pain and was told that this was normal and part of being a woman, so this is what I believed.

[...]

Working as a qualified nurse in Dublin, my symptoms worsened, and I paid privately to see a gynaecologist. During this appointment, I was told I was too young to have endometriosis and that a D & C would probably fix me. This was a completely unnecessary procedure.

I moved to London for work, saw my GP and was booked in to see the Gynaecology Team at a specialist centre. I received my diagnosis, it all made sense.

I am almost 8 years into my diagnosis. I've had multiple extensive surgeries. I've completely lost the function of my bladder and have been catheter dependent since 2019. My bowel stopped working a year ago and I needed urgent surgery in May of this year to create a stoma. I'm under the care of a specialist pain team and receive infusions every 12 weeks to help manage the pain. I regularly need admissions to hospital where I am treated with dignity and care over here. I'm now on the waiting list for another surgery, which will be more complex and will involve the urology and colorectal team.

In March this year, I had to leave my job as a Clinical Nurse Specialist nurse.

I would love to move home and have more support from my family around me...

This, however, is not an option for Gemma without the adequate healthcare women require in Ireland. Gemma is the voice tonight for the women in Louth and Drogheda who have contacted me. I commend their bravery and thank them for their courage and trust in us to be their voice. The Government needs to listen to these voices tonight and end the suffering and silence. Shame on it if it does not.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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I welcome all the endo-warriors who are with us, and their families. I commend them on their fight and on standing up. I also offer my sympathies to them because I know many of them came here tonight in pain.

The Minister knows she should withdraw the amendment but just in case she is under any illusions, I spoke to these women and these are the words they use to describe her amendment. They call it "sickening", "inaccurate" and "insulting". The Minister can press on with an amendment that is "sickening", "inaccurate" and "insulting" if she will but she should know that if she does so, she does it to the women in the Gallery.

I was diagnosed with endometriosis when I was 24 years of age. I was lucky because I got an answer to what was wrong with me, or I thought I had, why I was always in so much pain every month, and why my husband had to lift me up off the floor when I was crippled with it. I went to a doctor for assistance and I was gaslit. It is a bit like the Minister's amendment. I was gaslit. I was told:

Would you have another baby? Would you chance another baby? That might help. Do you know what? Would you give the Mirena coil a go? Sure that might do something for you. Is it uncomfortable?

No, it was bloody agony and I will never, ever forget the way the doctor made me feel. I shared that experience because it is a collective one.

The Minister knows her amendment is wrong and that it is shameful, sickening and insulting. She knows that because it is what these women are telling her. It is shocking that almost 30 years later, precious little seems to have changed. I ask the Minister to withdraw her amendment, work with the Opposition and deliver the care these women need and deserve.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputies for the work they are doing with and on behalf of women. It is wonderful to see so many different parties and so many different voices, male and female, articulate the female health experience. Every single person knows that it has been overlooked. Every single person knows that experience of telling a story and not being listened to or believed. I completely respect those experiences and I have no interest whatsoever in engaging in politics around something as important and serious as this. What I am interested in is service delivery and the quickest possible way of ameliorating, fixing and making good the sheer lack of service delivery for women's health that has gone on for so long.

There have been important advancements in the last five years. There is an important programme in place now, which is a different way of listening to and respecting women. I cannot make up for previous experience but what I can say is that, as the first female Minister for Health for a long time, I have a very strong commitment to delivering services that are going to make a difference in people's lives. We can deal with the technicalities and politics of an amendment and how that works. Deputies are welcome to make whatever charge they wish against me. I am not here for that. I am here to take steps forward on service delivery, to give some description of what has happened, and to discuss what needs to happen next and how we might deliver that. I have no interest in politics with regard to this. I am only interested in service delivery.

I will, of course, answer the women, whom I thank for coming tonight, on the technical pieces - the motion, the amendment and how they work. However, I am interested, as the first female Minister for Health in a long time, and who, by the way, has also had friends, family and constituents describe to me the pain in their lives and in their bodies that they have lived with for so long as a consequence of endometriosis and, in particular, undiagnosed endometriosis and what that does for their mental health as well. I share all of the stories the women have told. It is so important that they are told on the floor of the Dáil. They are, with every respect to them and they will know this, stories I have also heard already, albeit perhaps from different women but nevertheless on precisely the same experience. I never deliver the speech that is prepared. It is welcome to have it but Deputies know that, as a matter of courtesy, I do not deliver what is prepared.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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It is not a speech. It is bullet points.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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As I said, I am not here to politicise anything. I do not critique the Deputy-----

Mary Lou McDonald (Dublin Central, Sinn Fein)
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The Minister has not explained why she is opposing our motion. Why is she opposing our motion?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Would the Deputy like-----

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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The Minister to respond.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I will address the women in the House.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Please do.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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What is important for us is actually making progress on endometriosis and there is some progress taking place. The first major difference we have, and this does not account for the many years of underinvestment in and under-recognition of women's health, is that we have a dedicated women and infants health programme. That has made some difference to how maternity services are conceived. We have more work to do there. It has made some difference with regard to how menopause services are conceived and we have more work to do there. It has made some difference with regard to endometriosis and we have more work to do there.

We know, of course, that endometriosis is one of the most common gynaecological conditions. How this was under-recognised for so long is beyond me, when there are so many women presenting with such consistent symptoms. We know and recognise it and while our amendment does not go through the physicality of that in the same way the Sinn Féin motion does, I totally understand that. There is a huge range of very difficult symptoms and there is also asymptomatic endometriosis. There is a different spectrum of experience, and with the divergence, it is important that we listen to all of those experiences. It is also important that we respond to that complete spectrum of experience, some aspects of which can be responded to at GP level, while others need specialist intervention services. I have to try to make sure all of that is there.

Since 2021, we have invested over €5 million to expand specialist endometriosis services to provide treatment for women with moderate and complex endometriosis. There is an additional €2 million this year to continue to do that. So far, that investment has allowed us to recruit 24.6 whole-time equivalent staff, or 24 people and one part-time person. We have the funding. Specialist services are expanding further with the HSE recruitment process to recruit another 18.6 people, or 18 people and a part-time person, with the funding provided this year. We are more than halfway through that recruitment programme and there is no question about that. That is for some of the specialist services.

For most endometriosis cases, particularly at the less severe end - and I appreciate many of the people here are perhaps at the more severe end - most of the care can be provided by GP care. That requires GPs who understand endometriosis and listen to women who are presenting with these symptoms. It also requires having this dialogue in public. That is why it is so welcome that Deputies are telling this story as broadly as possible, as many women have been doing for many years.

The moderate and severe cases of endometriosis, however, may require - they do require it, in my view but it is a clinician's decision - referral to the specialist model of care. At the moment, as Deputies are aware, there are two services, one in Dublin and a more recent one in Cork. I visited the Cork service where I spoke with the nurses and doctors and some of the patients. I understand the care pathways and where that has yet to go. There are also five regional endometriosis hubs that many people will be aware of. For those who are not aware of them, they are in the Rotunda, the Coombe, the National Maternity Hospital in Limerick, in Galway and in Lee Road clinic. They are all operating and taking referrals. Women are receiving care through Galway and the National Maternity Hospital.

There is more work to do on the structuring of those clinics.

We now have clinical guidelines in relation to this. GPs are encouraged to initiate treatment for suspected endometriosis. They can and are encouraged to refer suspected cases through those different pathways. That all sounds very clinically-led, and it is, but it is about the visibility of this condition in GP services and GP surgeries, so that they know there are pathways where more complex cases can be progressed.

I understand more than 1,100 new patients were seen in 2024 and that, on average, 72% of those women were seen within six months, between August and December. More than 300 specialist surgeries were provided between August and December last year and another 200 in the first three months of this year. I know more needs to be done on that. However, it is important for me to put those facts on the record of the House.

Women with endometriosis may be on other gynaecology waiting lists. That is also important. There was an increase of 108% in general gynaecology referrals over the past number of years. I hope in part that this is some recognition of women presenting with their conditions and being listened to about their conditions and being referred onwards. There has been significant investment since 2021. It has enabled twice as many women to be referred to our gynaecology services with more than 80% of women waiting less than six months. As a woman, I would say that is still not enough. I have been Minister for a number of months and I have visited Cork and met with women who are really suffering from this condition. A lot more work needs to be done.

We have see-and-treat gynaecology clinics that you can walk into and be treated immediately. Those are having a real impact. I hear from women that they are making an impact on waiting lists and on women's lives. They are being seen and treated at the same time. There is work on related issues.

Let me address the national framework. For the first time in Ireland, we have this defined clinical pathway for women with endometriosis at the highest level expressed in the national framework for endometriosis. We are not finished with it yet. There is a body of work to be done to agree with GPs how they will fit in and how they will be part of that. That is not yet complete. There is more work to be done. Discussions are ongoing between the HSE and the Irish Medical Organisation, which represents GPs. I would love to be in a position to update the House on that in the next while.

There are important diagnostic criteria for endometriosis that are determined by clinical specialists but I do not have time to get into them. I want to address the particular question around motions and how they are dealt with. I appreciate the members of Sinn Féin will disagree with me as is their right. In any event, we take the opportunity to set out the different things that have been done. I do not reject any of the points articulated by the women here. We take a slightly different policy direction in one respect, which is that instead of one centre of excellence, we have decided to do it more regionally-----

Mary Lou McDonald (Dublin Central, Sinn Fein)
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It is failing.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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-----to reduce the amount of travel and make sure there is an opportunity to get more regional care. In the countermotion we try to set out what has happened, what has yet to happen and to recognise that there are different choices. The point was raised about private treatment and choices. Women are entitled to choose. I want them to be treated within the public system.

Pearse Doherty (Donegal, Sinn Fein)
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That is not a choice.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I want women to be treated within the public system. I want to make sure that women have every option to be treated in the public system.

Verona Murphy (Wexford, Independent)
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Minister, the time is up.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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However, where a woman has gone abroad, she must be supported when she comes back to Ireland. We have set that out in the countermotion.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Doctors send them away.

Verona Murphy (Wexford, Independent)
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It is not Deputy McDonald's time. There is a sequence and a format.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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The Minister is gaslighting us.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is an outrageous statement to make in the House. That is a term used in domestic abuse situations.

Verona Murphy (Wexford, Independent)
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Deputy Newsome Drennan is on her feet. I ask the Minister please to resume her seat.

Natasha Newsome Drennan (Carlow-Kilkenny, Sinn Fein)
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I commend my colleagues in Sinn Féin, especially Senator Maria McCormack on her outstanding work in raising awareness about endometriosis. If we ever needed a clear-cut example of how women are treated as second class citizens-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It is by a woman.

Verona Murphy (Wexford, Independent)
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Minister, please stop interrupting.

Natasha Newsome Drennan (Carlow-Kilkenny, Sinn Fein)
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-----we need look no further than the treatment of those suffering from endometriosis. Despite one in ten women having this condition, there is currently a nine-year delay in diagnosis. This allows the disease free rein to spread, causing irreversible damage to organs.

Three weeks ago Senator McCormack, Deputy Cullinane and I hosted a public meeting on endometriosis in Kilkenny city. Dozens of women attended and shared their personal battles with the disease. That meeting gave a glimpse into the immense suffering endured by so many. Far too many women across Carlow-Kilkenny and throughout the State are suffering in silence. Repeatedly, we heard about the delay in diagnosis, misdiagnosis, inadequate care and denial of access to proper treatments. These women spoke of Ireland's utter lack of treatment options and the devastating impact on their personal lives.

I heard from one mother whose teenage daughter has been forced to drop out of all sports due to the crippling impact of the disease. There are countless teenage girls throughout Ireland whose parents are being told by doctors that it is all in their head, they are blowing it out of all proportion and that it is just something teenage girls go through. These outdated methods from doctors are an insult to the women of Ireland. They are devastating the lives of these young girls and resulting in high rates of absence from school. Not only do we need adequate treatment, but we also need awareness in schools throughout Ireland to ensure teenage girls are not suffering in silence, that they know they are not alone, and that there is support.

One thing that is echoed in the voices of the women in the Public Gallery is that they do not want to travel abroad for their operations or treatment. They want to have them here in Ireland-----

Verona Murphy (Wexford, Independent)
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Deputy, time is up.

Natasha Newsome Drennan (Carlow-Kilkenny, Sinn Fein)
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-----with support from their families. Now that we finally have a female Minister for Health, I implore her, woman-to-woman, to implement modern, fit-for-purpose treatment for women throughout Ireland because for far too long women's health has been treated as an afterthought by her side of the House.

Thomas Gould (Cork North-Central, Sinn Fein)
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There were women in the Public Gallery tonight. I spoke with some of them earlier and listened to their stories. A few weeks ago, I attended a meeting in Cork where people told their horrific stories. Here I am a 6 ft 5 in. man talking about women's health and women's period pains. I have no idea. I believe the Minister is a decent person so I ask her not to let the bureaucracy, the Department or the men in this Government tell her to put down an amendment. She should be backing this motion wholeheartedly. She should be leading the way.

Rose Conway-Walsh (Mayo, Sinn Fein)
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Hear, hear.

Thomas Gould (Cork North-Central, Sinn Fein)
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These people want her to lead the way. As a woman and as Minister for Health, she has the ability to do that. I implore her to do it. There are girls who have given up sport and who cannot go to school. Education is needed here. There are girls and women who every month cannot go to work or are out of work for long periods. They have lost their jobs and lost their friends, because they have not been able to go to things. They have not been able to socialise. They have been trapped in their rooms in pain. For all these girls and young women, what we are proposing tonight does not come from Sinn Féin but from all these people up in the Public Gallery and their families who live this every day. I ask the Minister to withdraw her amendment and to run with this motion.

Rose Conway-Walsh (Mayo, Sinn Fein)
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Hear, hear.

Thomas Gould (Cork North-Central, Sinn Fein)
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In politics, we politically disagree on many issues. Can we not come together on this issue? Can we not park the politics and for once let the women of Ireland be listened to? For far too long, they were sent home to suffer in silence, but no longer.

Pearse Doherty (Donegal, Sinn Fein)
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Hear, hear.

Donnchadh Ó Laoghaire (Cork South-Central, Sinn Fein)
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I, too, was at the same meeting as Deputy Gould. I have been going to political meetings since I was 17 or 18 years of age and I have never left a meeting more shook than I was by that meeting. Some of the stories would make your blood boil and some would break your heart, to hear the accounts of the pain and on top of the pain and suffering, the grief in some instances that some of the women were suffering.

The attitude of medical professionals towards them was in some instances dismissive, in others careless and in some others frankly heartless and completely lacking in compassion. They totally dismissed what these women were going through.

The Minister and I disagree on a great deal. It seems we disagree on the policy approach. Surely she must accept that something is fundamentally wrong. I apologise. I am sure the Minister is dealing with something important-----

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am trying to deal with this issue. Forgive me.

Donnchadh Ó Laoghaire (Cork South-Central, Sinn Fein)
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-----but I am a bit distracted, to be totally honest. I want to address the Minister because I am appealing to her. The attitudes that are being encountered are so dismissive. It is not as if members of the medical profession, or a large section of the profession, were unaware or that this is a new disease or condition. It was not as if there was no knowledge of the best kind of treatment. The Minister has spoken forcefully in the past about us exporting issues relating to women's health. That is what is happening here. I know of instances where women have struggled to get the money they have expended back. That has been a difficulty.

The attitude that is there needs to be addressed but there is also a systemic issue. What these women are facing is simply not good enough. There are differences of opinion in terms of approach, but I urge the Minister to take this on as a key priority because what is happening is absolutely shocking.

Rose Conway-Walsh (Mayo, Sinn Fein)
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The Minister's response is not good enough. It is as plain and simple as that. She should hear the stories of all the women in the Gallery. I am proud of my party colleagues, particularly Senator McCormack and my party president, Deputy McDonald, for bringing this motion before the House. It would never be brought to the House by the Government.

Since the beginning of the Sinn Féin campaign to achieve adequate endometriosis services, I have spoken to many people from Mayo who are suffering with this debilitating condition. The Minister paints a particular picture, but women tell me they cannot live with the pain. They are sent to mental health services. If the picture the Minister is painting is correct, why are they being sent to mental health services?

I particularly welcome Ms Sinéad Conlon and her father Dermot, who have come all the way from Mayo this evening. I want to tell the Minister about Ms Conlon's experience in her words. I want the Minister to look her in the face when she is giving her response to this debate. She said she was never listened to as a teenager and it took until the age of 23 to be referred to a specialist, who advised her to have a child because it would help the problem. After having surgery for endometriosis in Ireland and taking the advice, she was still left in horrific pain every day. She got no help or advice and was left completely hopeless. As a self-employed person, she had no income. She asked how she was supposed to live and provide for her child.

Ms Conlon reported that the pain she experienced every day was all over her body and described it as unbearable. She said daily tasks were impossible. She said that mentally and physically, it was unbelievably difficult. She said it has been a long battle and going abroad should not be the answer but is something she must do. She feels she is being exported. She thinks those suffering from endometriosis should get help in Ireland and should not be ignored. Only that she has the support and help from her family financially, she would not have the option to get help aboard to end her torture.

Michelle, also from Mayo, wrote to me today. She stated that she was meant to be going for surgery to check for endometriosis. Instead, she was booked for a scan last week and the surgery was cancelled. She said the medical professionals admitted she probably has endometriosis but offered no other support. She went on state that she has an autoimmune condition and that her endometriosis is causing health problems. She stated she is now more nervous than she has been previously. She stated it is spreading to her organs, especially her bladder and kidneys, as she has had problems previously.

This is what is happening to women. This is what is happening to the women in the Gallery tonight. The Minister's response is not good enough.

Pearse Doherty (Donegal, Sinn Fein)
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Hear, hear.

Marie Sherlock (Dublin Central, Labour)
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I sincerely thank Sinn Féin for this detailed motion. When you look at the detail and the very specific calls that are in this motion, it behoves us all to look at how women, and particularly teenage girls and young women, are being absolutely failed in this country.

As I speak this evening, I think of the conversations I have had over the past four years with women who have had to muster the courage to ask me on their doorsteps to speak up for them. They have told me what they are going through. They have told me that their lives have been upended. Their work, education, friendships, families and involvement in sport have been upended because of a condition that few within the health service take seriously in this country.

When I read an article by the playwright Lisa Tierney-Keogh last weekend, I wondered if I should put any of my thoughts on the record because that gripping and devastating account of her life told it all about how women suffering from endometriosis have been failed in this country. She, and, of course, so many hundreds of others, have been continually gaslit. They have been told they are hypochondriacs. They have been dismissed. That goes on to this day.

There is a perspective in this country that the days of dismissing women are in the Ireland of the past. They are not. For so many women in the Gallery today, their daily lived experience in terms of their interaction with the health service is as has been described, and that needs to change.

To be fair, a lot has been said about endometriosis over recent years and some actions have been taken. However, those actions have been far too patchy and inconsistent to provide a comprehensive and proper service for all those suspected of suffering from endometriosis in this country.

I want to raise a number of issues this evening. The first regards the so-called distinction between mild and severe cases of endometriosis, and who determines that. We know that a diagnosis of endometriosis only happens when there is a surgical intervention to diagnose what exactly is going on within a woman's body. I have a real concern with the current model of care and current pathways to care. We know the GP will always be the first point of contact but I am concerned that women suspected of having endometriosis would remain within GP care. The reality is that for some people endometriosis is being contained by a form of contraception. A woman told me today that she was put on the pill at the age of 13 and told, "Away you go; you will be fine now." A mother told me that her daughter was put on the coil at the age of 16. Doing that contains the symptoms but masks the need for the comprehensive and fundamental treatment that is required. We know that it is not just about helping with the incredible and debilitating pain but is also about the long-term injury and damage to a woman's body with the ongoing effects of endometriosis as they get older. There is a reality here. We must ensure that if women are suspected of having endometriosis, they are directed into the specialist hubs that have been established.

It is welcome that we now have five specialist hubs, but the reality is that of the 50.2 whole-time equivalent positions, only 24.6 have been filled. Not only that, but for the Munster region alone, only one third of the staff are in place. I know that efforts are made to try to recruit accordingly but even those staff members in place on those multidisciplinary teams are not working full time in those hubs. They are also having to work in gynaecology, urology and the other areas in which they specialise. We need a full-time and dedicated set of teams across this country working on these services. To be frank, we do not have the required specialist level of care even in those hubs.

The other key issue I want to raise relates to the treatment abroad scheme. It is reckoned that approximately 100 to 150 women travel to Romania each year for specialist endometriosis surgery.

We know that there are women who go to other countries as well. Of course, it is all down to money as to who can afford to travel because of the transposition of the healthcare directive in this country. Effectively, you get the money back afterwards as opposed to upfront. There is another key issue here, and that is that the State does not even have a proper handle on who is travelling abroad for specialist endometriosis treatment. When we asked how many women are travelling for such care under the cross-border directive, we could get no answer because women are categorised under general gynaecology, pain management, urology, etc., meaning that the State has no true understanding of the number of women who are forced to travel every year. That has to change. We need a handle on how many women are forced to travel and how we can expect to try to look after them in this country.

The final point I will make is that this is not just about the health system; it is about the education system, the workplace and society in general in understanding what endometriosis involves. I want to recall one mother who contacted me. She talked about how this is obviously hugely debilitating, particularly for teenage girls. Her daughter had missed well over 20 days of school in her leaving cert year. This girl was very bright but had lost key days in her education. The decision was made by the family, with the specific encouragement of the school, to apply for the disability access route to education programme. After going through many hoops with a consultant, there was eventually a letter, a form, signed by the consultant confirming that this child, this teenager, had missed precious schooldays because of her condition. However, there was no definitive diagnosis for the condition because she was undergoing investigations, because they were waiting until she got a little older and because there would need to be a surgical intervention. They submitted the form signed by the consultant, but when it went to the Department of education, it was refused because there was no formal diagnosis. I find that absolutely appalling, that a civil servant could make a determination as to the health and well-being of a teenage girl who had just done her leaving cert against the very clear advice of the consultant. That is what is happening not only in the Department of education but right across workplaces in this country. Employers are not understanding because we have not spoken often enough about what is happening to women suffering with endometriosis, and that has to change. It has to change, not only through the conversations we are having here but also in the community. In the context of that specific example involving the Department of education, we have to ask what it will do to make sure that teenage girls going through this are properly looked after within the education system.

Duncan Smith (Dublin Fingal East, Labour)
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I thank Sinn Féin for this really detailed, strong motion that has been presented tonight, and I thank our party's spokesperson, Marie Sherlock, for sharing time. As a former party spokesperson on health, nothing has struck me more than the cases of women who have come to me to explain to me the pain, the silencing, the suffering and the exclusion they have felt as women in this country suffering from endometriosis. This motion from Sinn Féin says everything that needs to be said because it focuses on diagnosis. The calls in the motion are clear, they make sense and they are step by step. They include imaging, protocols, resourcing, awareness training and training for healthcare professionals. It is about cutting the time of diagnosis, those years of being silenced and all the pain.

Then we get the countermotion. It is about waiting lists being cut and women not being long on waiting lists. It is taking them, on average, seven years - if they can get on a waiting list - because of the delays in diagnosis. The countermotion the Government has put forward does not answer the very good motion that has been put forward by Sinn Féin. It is angering. There are women in the Gallery who have been crying almost non-stop since this debate started. The issue is finally having a proper airing on the floor of the house, but the answers they are looking for from the Government they are not getting.

This is not a usual motion. This is not a usual Tuesday evening. When we describe any healthcare issue in this country and within that description is the line "women are travelling abroad for healthcare", we know we are getting it wrong. We are getting it wrong and we are not doing enough. I ask the Minister to withdraw her amendment and support the motion that has been put forward. It is a really good motion, it makes sense and it is achievable.

Pádraig Rice (Cork South-Central, Social Democrats)
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I, too, thank Sinn Féin for this motion and for putting a spotlight on this important issue. I also commend the campaigners in the Gallery. They should not have to be here, they should not have to share their stories and they should not have to email their TDs and lay out their pain, but I commend them on their work and their advocacy in respect of this matter. I urge the Minister to take action and ensure we are not back here again.

It is estimated, as we know, that one in ten women and girls may suffer from endometriosis. It affects women and girls from eight to 80. Yet, in the words of the Endometriosis Association of Ireland, "endometriosis is a misunderstood, misdiagnosed and mistreated condition". It is no coincidence that it is women who are being misunderstood, misdiagnosed and mistreated. There is a widespread culture of women's concerns being dismissed, minimised and invalidated within the Irish medical system. This is a cultural problem and an attitude problem, and it needs to change. Women's healthcare for far too long has not been a priority for the State. In recent years, two women's health action plans have been published but they consisted largely of repackaged initiatives that had already been announced or were already in train, and there is no implementation plan alongside the 2024-25 action plan. Publishing glossy plans is all well and good, but delivery is key.

The Minister talked about the national endo framework. It is now two years since the development of the framework was announced. It was due to be published within a year, by April 2024. However, 14 months later, we are still being told the framework is nearing completion. This is the line the Department of Health has rolled out time and again. Obviously, the framework is no panacea, but it is an important step in improving the model of care for endo. Even at the most basic level, it would provide us with proper data on disease prevalence because what gets measured gets managed.

Like others, I want to share some of the stories of those who have come to my office in recent times. Last week, I heard from Dr. Rachel Marie O'Connor, a physician who recently underwent lifesaving surgery for endometriosis. Like so many women, she had to go abroad for treatment. For a decade, Rachel endured excruciating pain because of her undiagnosed endometriosis. She was repeatedly prescribed antibiotics for UTIs. However, Rachel never had a UTI; she had bladder endometriosis. When she eventually got an appointment with a consultant gynaecologist in Ireland, she was told her endometriosis was "too advanced for the Irish medical system". The waiting list was one to three years. As a result, Rachel was forced to travel to Poland for treatment. Once she was there, she discovered the true severity of her condition. Due to a decade of misdiagnosis and mistreatment in Ireland, Rachel's endometriosis had spread beyond her reproductive organs. It turned out that she had been living with multi-organ damage for almost a year and that her organs were failing. In Poland, away from family and friends, Rachel had to have major surgery to save her life. Had her endo been diagnosed and treated earlier, this would not have been necessary. As Rachel herself has said, "No woman should have to leave Ireland—or empty her life-savings—to receive the care her own health service should provide." Like so many women before her, the State turned its back on Rachel, exporting the problem. Rachel is now fighting to ensure that no woman has to suffer the same fate. She has sent the Minister a concise proposal outlining the ways in which early diagnosis, early recognition and referral pathways for endo can improve if the political will exists. I ask the Minister to consider the proposals carefully, and it would be great if the Minister could meet her.

I also received another correspondence from a constituent which I would like to briefly share with the Minister. This is a woman who is just 18. She had been suffering from endo since she was 15. Her pain was often chronic, leaving her bedridden and unable to move. She described it as feeling like her insides were being stabbed. She has attended her GP repeatedly over many years. As she herself said, what she got was an eyeroll and some paracetamol. It was not until April of this year that she finally got a referral to a gynaecologist. This is after four years of debilitating pain as a result of which she missed out on countless days of school and college. When she went to the gynaecologist, one of the solutions proposed was to get pregnant to ease her symptoms. This is unacceptable but it is the reality of care in this country.

Ultimately, we need the framework and we need better care. That starts with better understanding and, crucially, better services.

Jennifer Whitmore (Wicklow, Social Democrats)
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I thank Sinn Féin for bringing this motion forward and I welcome everyone in the Gallery.

Here we go again. At what stage will we provide women with the support, healthcare, care and attention that they deserve? We are in a situation where we are failing a generation of women all over again. One in ten women suffer from endo. We are sending them overseas. We are ignoring their symptoms, their pain and their trauma. We are telling them it is in their heads, to suck it up, to take some aspirin and to go home and continue with their lives but that is just not possible. Probably the worst part is that women are not being believed and are being ignored when they go to their GPs in crippling pain. I cannot believe we have not learned yet and as a society or country we have not taken on board all the previous times when we have failed women. Here we are doing it again.

A constituent sent me an email and I think it would far outweigh any speech I could give tonight:

To date, endometriosis has cost me [where I could see] having a family of my own, I may never be a mother despite best efforts and emotional, financial and physical stress through self funded IVF for many years now.

Endometriosis has cost me days and days off from my job. Luckily I have a good employer and I can work from home.... I really feel for those that have jobs that will not allow for this crippling disease.

I have been ignored and pushed aside for so many years. I pleaded with consultants to believe that I was in crippling pain for 10 days [every] 21 days cycle. I had 11 days respite if I was lucky to feel normal. I advocated for myself, I self diagnosed myself, I urged a consultant to listen to me and get a treatment plan in place.

I have lost an ovary, the disease destroyed my ovary. The disease also nearly took away my Bowel. I now live in fear this disease will take this in the near future.

Endometriosis has taken away, and cost me too much. I can’t attend classes I’ve signed up to, I can’t attend birthday parties, weddings and family gatherings a lot of the time.

I had to tell “I told you so” when the consultant debriefed me after my surgery to tell me, how scary the surgery was for me and how badly ravaged my insides were.

I look normal and healthy from the outside. I vomit with the severe pain before I join work calls and spend time presenting to my colleagues. I have chronic fatigue, migraines and these are my day to day.

Imagine not being able to go to the Dáil tomorrow because you have a flare up, you're bleeding so heavily, you can't stand straight due to pain and nausea? Imagine not doing a school run, having a child’s birthday party. Imagine a consultant not believing you when the equivalent pain of a ravaged ovary is being stabbed. Imagine being in so much pain, you can’t stand and you won’t go to A&E because they won’t believe you or just say, it’s [just your] period. I’m in this position now because for years and years, we’ve been told , there is nothing wrong with us and our disease has festered.

[...]

Fertility and endometriosis, have taken away joy, hope, love and much more. Ireland has also not had my back with zero support.

Please be a government who finally take action and believe us, get behind us, empower us and investment in to centre and expertise.

Please don’t let us down ...

Jen Cummins (Dublin South Central, Social Democrats)
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I am thankful to Sinn Féin for tabling this motion and I welcome all the people in the Gallery. Yet again, here we are in Ireland where women have to talk about the most private things in public. I was in here earlier talking about child sexual abuse in Ireland, another secret that was kept for so long. In the time I have been here, I have spoken many times in the Dáil on issues that affect women and children in this country. I do not understand how we keep repeating the same thing over and over.

We need to see the effects this has on people. It is very hard to follow my colleague Deputy Whitmore and the email from her constituent. The lived experience of people is why it is so important but having to talk about these things is painful and very traumatising for people again and again. I remember reading the brilliant book Invisible Women: Exposing Data Bias in a World Designed for Men by Caroline Criado-Perez, which said endometriosis affected one in ten women yet took years to diagnose because women’s pain was not and never had been a priority for medical research. In Ireland, the average time to receive a diagnosis is nine years. That is nine years of pain and turmoil, both physical and emotional. It is not just the agony, but the fact no one believes women that they are in this agony that makes it so difficult for many women. That our whole health service seems to ignore women time and again is compounded by the fact it takes nine years for a diagnosis.

Listening to people’s stories, what I hear is how it affects every aspect of life. For people’s social lives, someone in agony cannot go out and enjoy themselves. Someone cannot continue schooling, education or work. It is not good enough that an employer might be very reasonable. The fact is people should be supported and healthcare should be available in this country instead of having to travel abroad. We have seen that echoed throughout healthcare for women.

I was shocked to learn from the motion that we would have to call for proper healthcare, surgeries and training. It is 2025. Maybe I am naïve as a new TD thinking that surely this has happened but I am just shocked, and I am heartbroken for the women to whom this happens. This is one example and I will probably be here again after the summer recess talking about another issue. I am just a little flabbergasted, as people can probably hear. I will focus again.

We are neglecting women all the time and this is another example. It needs to stop. Women need to stop having to travel abroad and we need a start to the medical system totally supporting these women so they can live full lives

As someone wrote to me earlier, endometriosis is not a bad period; it is a full-body disease. When I hear people say it is only a bad period and take some aspirin, I wonder how many people have had to hear that and the devastation it causes. People probably start to think they are imagining it and they start to doubt themselves. That is not good enough. Bloody hell. I nearly cursed there. We really have to get this together. Everything that needs to be done must be done.

I thank Sinn Féin for tabling this motion. I really appreciate it.

Brian Stanley (Laois, Independent)
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I welcome our guests in the Public Gallery. I have heard similar stories to the testimonies from the last two Deputies, and particularly the testimony Deputy Whitmore read out from a woman who wrote to her. It might not have been as long, but snippets. As a man, constituents have told me similar stories about this problem over the years and particularly in recent years. We have to stop exporting our health issues and people for treatment, particularly women in the case of this chronic condition. Not nearly enough attention has been given to it. Proper resources have not been given for the proper treatment of it. People have said this disease is pain like one could not describe in words that affects women’s bodies. It causes severe pelvic pain, affects fertility and can cause scarring. It is very stressful and it has been explained to me very clearly how it exacerbates the monthly cycles. It is unbearable, several women have told me. They have described their own situations and that of their daughters to me. It also causes damage to other parts of the body. It is well documented that it does not just affect the womb and pelvic areas, but other parts of the body as well, including the bowel and the kidneys.

This is a disease that affects 10% of women in Ireland. Surely if something is affecting 10% of women we have to stand up and take notice. It is unbelievable that the average waiting time is eight to nine years and how this has been let run for so many years. Think of all the women of previous generations who have suffered this silently. As the previous Deputy said, this is 2025. This has to stop. We have to try to bring forward proper, expert treatment for this debilitating condition.

Endometriosis can cause infertility. For women and couples trying to have a child, this presents a terrible problem and the woman, unfortunately and wrongly, will often feel under pressure and blame herself because of the condition. Many gynaecologists strive to improve services but there are issues around resourcing.

There is also an issue around theatre time for surgery and specialised treatments. Expert-led surgery is a necessity. We must deal with this area and improve the quality of that service for women. HSE guidelines acknowledge that this is a superior treatment for managing the condition and providing an improved quality of life. While there is no known cure, many women who get proper treatment go on to live a good life when the condition is managed properly and they get the proper care.

Women with this condition have been failed for years in Ireland. I know the Minister mentioned the five hubs but the level of expertise, staffing and timely access are issues. Nine, eight or five years is not good enough. This needs to be done in a matter of months so that women can have treatment once it is properly diagnosed. We have to shorten the time from diagnosis to treatment because nine years is appalling. We need more surgeons in the area. Only 25 out of 50 posts have been filled. Recruitment and retention of surgeons and clinical nurses in the field has to be stepped up and has to be stepped up at pace.

Women often feel they are dismissed when they suffer this disease due to not being able to go to work or social events or just participate in normal family life. This is very distressing for them and some of them have described that to me. The situation regarding fertility creates a problem. We have fertility clinics but waiting times for these clinics and costs are factors. While very welcome changes were brought in in September 2023, not all couples are able to access IVF due to age, weight issues or other circumstances and this needs to be re-examined.

The motion is calling on the Government to establish a state-of-the-art centre of excellence for endometriosis care, to establish specialised imaging protocols to assist gynaecologists in identifying, mapping and getting the information on endometriosis; to develop and fund a dedicated training and incentive programme; and to launch a nationwide public health campaign to raise awareness. Doctors and specialists need to start believing women when they present with this condition because of its chronic nature and the sheer number of women who endure it throughout their lives.

We are talking about women's health and we cannot forget about those women who suffer due to the menopause, which can be an extreme condition for some women. This is often overlooked, particularly for those women who are working and who for many reasons have to take time off or who struggle with mental health during that period. It can be a very emotional time for them and we need to do better for them. I acknowledge and welcome the roll-out of free HRT. I raised the issue with the Minister and her predecessors on a number of occasions. I acknowledge that the Government has introduced it. It is very welcome, particularly for low- and middle-income families and women who might not be able to access it otherwise.

We need a step change and improvements with regard to endometriosis. There is a clear action plan and I urge the Minister and Government to get behind this, so women do not have to go to Romania or anywhere else for treatment.

Paul Lawless (Mayo, Aontú)
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I welcome the motion brought forward by Sinn Féin. I also welcome the visitors in the Public Gallery. Aontú has done quite a lot of work on this issue. It is really important that the lived experiences of so many women across Ireland are brought to the floor of the Dáil and put in front of the Minister. The fact is endometriosis is not a minority condition. It affects one in ten women. There are more women with endometriosis in this country than there are people with diabetes and yet many of these women suffer in silence. Many women have endometriosis for several years and it goes undiagnosed.

I will raise the story of Holly Barr. Holly Barr is a young woman from Kildare whose harrowing journey and endometriosis experience are worth raising here today. For Holly, the delay nearly cost her life. Misdiagnosed for over a year, she was told she had anxiety and depression despite having all of the symptoms, pain, vomiting and digestive issues. At 26 years of age, her bowel perforated due to undiagnosed bowel endometriosis and she needed surgery as a result. Had she not had that surgery, she would have died. This is how significant this is. The idea that Holly and hundreds of other women across this country were told "it's in your head" is deeply wrong. This is the lived experience of so many women across the country. They suffer in silence, they go to their GP, they go to accident and emergency and they go to the consultant in many cases and in some cases, they are told "it's in your head".

That is why we have actively worked on this issue and have raised the national framework with the Minister on so many occasions. The national framework is a key piece - guidelines that will provide a pathway for women and a referral pathway for GPs that is critically important. I would like the Minister to make a statement on this in her reply. My understanding is that there is great difficulty with regard to the HSE and GPs regarding bringing that framework to the next level. My understanding is that the GPs have yet to engage with the HSE on this. It is critical that this is introduced and I would like the Minister to make a statement on where that framework is now and what the next steps to bring that to fruition are.

I also commend the work of my colleague in Aontú, Melissa Byrne, from Kildare South who has done tremendous work on this. We hosted the Endometriosis Association of Ireland recently in the audiovisual room in Leinster House. When we met the association, I was struck by the number of constituents who contacted me with really harrowing experiences. Many mothers contacted me as well. What is very concerning is that so many women present with difficulties and pain and in some cases the pill is prescribed. That obviously has a benefit in terms of the pain but it also has a masking effect and, as a result, there is a significant delay in diagnosis and, therefore, treatment. This needs to be looked at seriously by the framework. It is totally unfair that women have to wait ten years in many cases to get the diagnosis they deserve and it is only at that point that they can get the treatment they need. I appreciate that this is a very difficult condition to diagnose but simply putting girls and young women on the pill cannot be the answer.

In some cases, women only realise they have this disease when they are in their 30s and are trying to have children. In many cases, this is a significant problem.

A significant number of women who undergo IVF realise they have endometriosis. There is obviously a very significant impact on day-to-day life, including the work experience, for many women. Since I raised this in Leinster House, I have had hundreds of women contact me who stated it was incredibly difficult to go about their lives during particular times of the month.

We very much welcome and support this motion, but it is really important that the Government does not just table an amendment. I hope the Minister gets a chance to meet the women who are here and listen to their experience. It is too important an issue to simply move an amendment on and forget about. I want to see the Minister address this issue with urgency. I want to see her tell the women who are here, before the Dáil, what is happening with the national framework, whether the GPs are engaging in that forum and if not, then why not. I want to see her say what she has done as Minister to bring the GPs to the forum to make sure the national framework moves to the next stage. This is what the women who are here with us want to know. This is what the future women and girls want to know. It is critical that we progress this national framework and get to a situation where women are no longer suffering in silence.

Women should not have to wait ten to 15 years for a diagnosis. I urge the Minister to engage proactively with the Endometriosis Association of Ireland to bring the framework to the next stage. The women of Ireland deserve it. This is not a minority condition. It affects one in ten women, which is more than the number of people in Ireland who suffer from diabetes, yet there is so little information. There is a vacuum of information. When one speaks to women across the country, there is significant variation in what their treatment pathways look like. I am keen for us to progress the national framework so that we have a standardised system and get to the bottom of this for women across Ireland.

Carol Nolan (Offaly, Independent)
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I welcome this motion. It is timely and is there to address the frustration and chronic pain too many women have to endure unnecessarily. I welcome the visitors to the Gallery. It is great to have them all here. They should not need to be here because this is an issue that should have been addressed long before now. I certainly will be supporting the motion.

We urgently need to rapidly increase the level of support and the diagnostic pathways for women experiencing endometriosis. I know from the vast amount of correspondence and calls I have received from women in my constituency that this issue is having major consequences for women’s physical, mental and emotional health and that it is also creating real pain through fertility issues for many women. There is a lot of frustration, upset and anger. This motion should be the start of a change of direction. We need to send out a message of support and we need to change the way we do things. We need to ensure there are centres of excellence for women and that this condition is diagnosed in a timely manner, first of all, and that women are supported.

I would specifically like to see a strengthening of the multidisciplinary care framework with clear implementation timelines. Perhaps we could consider mandating the establishment of at least two fully staffed endometriosis centres of excellence within 24 months, each with a multidisciplinary team, including gynaecologists, radiologists, pain specialists, psychologists and fertility experts. While I note the motion did not specify annual funding allocations, we need to do that to ensure sustainability into the future. Additionally, embedding patient advocates in the planning process would ensure centres address real-world patient needs such as psychological support and post-surgical care. It is important that every approach we take to these matters, and to this condition especially, be patient-centred and informed by women.

I agree that we urgently need to expand and fast-track a referrals system with primary care training. While the motion’s proposal to end primary care’s diagnostic responsibility is critical, it requires a robust and timely replacement system. Perhaps we should look at mandating a nationwide fast-track referral pathway within 12 months to ensure women with suspected endometriosis are referred to specialists within four weeks of presenting with symptoms. The stories I am hearing indicate women are enduring this for years and years and it has greatly impacted their lives, and that is unacceptable. It is reasonable that the referral to specialists be a timely process. It has to be. That is something that needs to be improved on and can be improved on fairly quickly. This system should be supported by mandatory training for general practitioners on recognising endometriosis symptoms using tools like Endometriosis UK’s symptoms diary to standardise assessments. I am aware Australia’s National Action Plan for Endometriosis has cut diagnostic times by 30% through similar reforms, so that is a model that could be used here.

There is no doubt but that we need to introduce an enhanced public awareness campaign with target metrics, community engagement and direct engagement from the women who are affected. A fully budgeted three-year campaign launching within six months that targets schools, workplaces and community groups to educate on endometriosis symptoms and the challenges would be a start, and obviously would challenge the whole stigma. That would send out a message of support to many women who are not being given a diagnosis or support with their symptoms or who are being misdiagnosed in some cases. It would show we support them and we would send that message through a campaign.

Danny Healy-Rae (Kerry, Independent)
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I am glad to get the opportunity to talk on this very important motion. I thank Sinn Féin for bringing it before us. I welcome all the people who had to come here to the Gallery, all the girls and women. We are sorry they had to come to highlight their condition and their problem, but why not, because they are very welcome here. It is sad to hear and see what they have had to suffer. We see a figure like 10% of women, but if it was only 2% of women, it would still be too many. Pain or anyone suffering pain is absolutely a no-no and we should do everything possible to ensure any women who present with endometriosis are looked after as a priority.

I was appalled when I heard the Deputies here saying people were often frowned upon as if it was in their heads or they were only imagining it. That is not right. When there are so many people presenting with it, one would think the GPs would be more informed and understand the different symptoms that suggest endometriosis.

I am appealing to the Minister, who is a woman, and to the Minister of State, Deputy Troy, who is beside her, as well as to the Government more widely to do whatever is necessary to look after these people. It galls me to hear that women in times gone by had to suffer pain. When families depend on the mother so much, and the woman in the home - and we all do - we have to appreciate them and look after them. This is a very serious thing. The Minister has to prioritise it and ensure whatever is lacking or wherever we are falling down, be that with our GPs, our consultants, our hospitals or whatever, is prioritised.

This has been going on for long enough. It is terrible to hear that the women who came before us suffered pain and agony and did so silently. I feel for anyone who has pain. I know people who have passed on who suffered fierce pain. The last thing we want to hear is of anyone suffering in pain. With all the things we have today and our affluent society, this matter will have to be looked at and taken care of.

The Minister is a woman in the Cabinet. We are looking to her to sort out all the problems with the health service. I ask her to prioritise the problems women with endometriosis have and to sort them out as soon as she can. I appeal to her not to oppose the motion or put forward any amendments. We must work together to ensure this issue is sorted out and that the women here today, and any other women who are suffering and need to be treated, get treatment. We need to move on from the time when people were suffering in silence.

Verona Murphy (Wexford, Independent)
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I call the Minister of State, Deputy Troy.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Am I entitled to speak for one minute, a Cheann Comhairle?

Verona Murphy (Wexford, Independent)
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It is not usual but it is at my discretion if the Minister wishes to share time with the Minister of State. There will be no extra time. I note, for the attention of the women in the Gallery, that I am allowing this because, as they appreciate, this is a very important topic. The guests are indicating they have no objection. I call the Minister.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I move amendment No. 1:

To delete all words after "Dáil Eireann" and substitute the following:

"recognises that: — endometriosis is one of the most common gynaecological conditions in Ireland and approximately one in ten women may have endometriosis;

— there is a wide range of symptoms associated with this condition and the burden of disease varies from person to person;

— some women may have endometriosis that goes undetected, while for others endometriosis can have a significant impact on their quality of life; and

— endometriosis is a chronic condition for which there is no definitive cure, many women with endometriosis require long-term care and treatment provided within a multidisciplinary care team; notes that: — the Health Service Executive established the National Women and Infants Health Programme (NWIHP) to lead the management, organisation and delivery of gynaecology services in Ireland;

— just over €5 million has been invested in developing endometriosis care and management in Ireland since 2021, and the Programme for Government commits to continue to support specialist endometriosis services;

— new development funding of €543,822 provided in Budget 2024, with full year costs of €2.175 million in 2025 is further expanding and improving these services;

— investment since 2021 has provided for 24.6 whole-time equivalent (WTE) staff;

— services are expanding as recruitment continues for a further 18.6 WTEs with the additional funding provided for this year;

— the recruitment process of these specialised posts will take time to complete;

— Ireland's first National Framework for the Management of Endometriosis, alongside the implementation of structured care pathways is in final development;

— in March 2025, the publication of the National Clinical Practice Guideline: Assessment and Management of Endometriosis, will support the delivery of evidence-based standardised care;

— investment in endometriosis services has provided for the establishment of two supra-regional centres in Tallaght and Cork and five regional hubs, providing specialist services in each maternity network across the country;

— regional endometriosis hubs operate from the Rotunda Hospital Dublin, the Coombe Hospital, the National Maternity Hospital (NMH), University Maternity Hospital Limerick and University Hospital Galway;

— the NWIHP has advised that all regional hub sites are taking referrals and providing treatment pathways for women affected by endometriosis, a specialist endometriosis clinic structure has been formalised in the Coombe Hospital, the Rotunda Hospital, and University Maternity Hospital Limerick;

— women are receiving care through the University Hospital Galway and the NMH regional hubs, while the formal structuring of these defined clinics is in ongoing development;

— endometriosis care is provided through multidisciplinary teams, these include consultant roles in colorectal, urology and radiology, along with women's health physiotherapists, dieticians, psychologists, specialist nurses and healthcare assistants, recruitment for these funded posts is actively ongoing to further expand specialist capacity;

— surgical treatment abroad, under the Treatment abroad scheme, is available when the necessary treatment is not available in Ireland or within the time normally necessary to get this treatment in Ireland;

— women may choose to avail of private treatment abroad; and

— women who opt for treatment abroad will be provided with ongoing care to manage their condition across the public network after they return; and acknowledges that: — psychologists play a key role in endometriosis care by helping patients manage chronic pain, emotional distress and the psychological impact of the condition, a psychologist has been appointed to support the supra-regional service at Cork University Maternity Hospital with further expansion of the service under consideration;

— the diagnostic criteria for endometriosis are determined by clinical experts in the field, the clinical guidelines and the framework emphasise individualised woman centred care rather than rigid staging;

— in line with clinical guidelines, general practitioners are encouraged to initiate treatment for suspected endometriosis, where symptoms persist or if symptoms are severe, timely referral to secondary care for laparoscopy is recommended;

— the NWIHP has advised that on average 72 per cent of women waiting on specialist services were seen within six months of referral;

— women affected by endometriosis may also be waiting on general gynaecology waiting lists, as of 26th June, 2025, 79 per cent of women waiting on gynaecology waiting lists are seen within six months and 97 per cent of women are seen within 12 months; and

— improvements in endometriosis care are an integral part of the overall transformation of women's healthcare included in the Programme for Government, 18 ambulatory gynaecology 'see and treat' clinics are currently operational with more in development as part of the Model of Care for Ambulatory Gynaecology, six specialist menopause clinics are currently operational for women who require complex specialist care, six regional fertility hubs will provide support to the estimated 47 per cent of women with endometriosis who will also experience related fertility issues.".

I greatly appreciate being facilitated, a Cheann Comhairle. It is most unusual for a Member to be allowed to speak a second time in these circumstances.

I move the amendment very reluctantly. I do not wish to criticise the motion, which has been put forward in the best of faith by Sinn Féin, but there are a number of references in it that we cannot allow to stand on the Dáil record. I refer specifically to clinical decisions, which are very important and may be relevant in some, but not all, cases, and absolutely are for the discretion of clinicians in the fields. In addition, there are some contradictory elements around not wanting women to have to travel abroad but also providing funding for women to travel abroad.

Acknowledging Deputy Danny Healy-Rae's point, I do not wish to be at odds or in disagreement with the House on this issue.

Pearse Doherty (Donegal, Sinn Fein)
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Is that why the Minister got to her feet a second time?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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However, I cannot allow clinical decisions to be on the record of the Dáil.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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To which clinical decisions specifically is the Minister referring?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I do not wish to speak across the Minister of State, Deputy Troy, whose voice is just as important as anybody else's in the House. I appreciate the Ceann Comhairle's discretion.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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To what clinical decisions is the Minister referring? The Ceann Comhairle gave her extra speaking time.

Pearse Doherty (Donegal, Sinn Fein)
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On a point of order, the Minister was given discretion to speak twice, which is unique. Can she explain the clinical decision with which she has an issue?

Verona Murphy (Wexford, Independent)
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Thank you, Deputy Doherty.

Pearse Doherty (Donegal, Sinn Fein)
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I thought the Minister was going to be a bit humble, believe the women and be a bit respectful. Instead, she stands up with this nonsense.

Verona Murphy (Wexford, Independent)
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Perhaps the Minister of State, Deputy Troy, will address the issue.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Tell us which clinical decision the Minister is talking about, Robert, please. I am all ears.

Robert Troy (Longford-Westmeath, Fianna Fail)
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I thank the Ceann Comhairle for facilitating me to speak. I welcome the visitors in the Gallery. I thank the speakers who contributed so passionately to the debate.

I recognise the profound and adverse impact endometriosis can have on the life and health of women affected by this chronic disease, which is one of the most common gynaecological conditions in Ireland. It is difficult to determine exactly how many women are impacted. There is a long pathway to diagnosis for many women and long-term follow-up care, including specialist pain management and psychological support, may be required.

Recognising the wide-ranging impact of the condition, multidisciplinary teams have been established to deliver holistic, woman-centred care.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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No, they have not.

Robert Troy (Longford-Westmeath, Fianna Fail)
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They include specialist consultant roles-----

Mary Lou McDonald (Dublin Central, Sinn Fein)
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The Minister of State cannot do that. He should not do that.

Verona Murphy (Wexford, Independent)
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I ask that the clock be stopped. I remind Deputy McDonald that this is a debate. There is a structure and format.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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This is outrageous.

Verona Murphy (Wexford, Independent)
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Out of respect for the visitors in the Gallery-----

Mary Lou McDonald (Dublin Central, Sinn Fein)
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I am the only person respecting the visitors.

Verona Murphy (Wexford, Independent)
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Excuse me, Deputy, I am speaking. Your party will have ten minutes later. Let the Minister of State speak uninterrupted for the benefit, or not, as the case may be, of the visitors. Please allow them to hear the debate.

Mary Lou McDonald (Dublin Central, Sinn Fein)
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Is the Minister of State watching the reaction in the Gallery? The visitors know, as I do, that what he said is wrong.

Verona Murphy (Wexford, Independent)
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You know what you are doing now is wrong, Deputy. I ask that you please stop interrupting the Minister of State. The clock will be restarted.

Robert Troy (Longford-Westmeath, Fianna Fail)
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The multidisciplinary teams will include specialist consultant roles in colorectal care, urology and radiology, along with women's health physiotherapists, dieticians, psychologists, specialist nurses and healthcare assistants. Recruitment for these funded posts is actively ongoing to further expand specialist capacity.

The Minister for Health and the Government are committed to promoting and improving women's health outcomes, including the expansion of specialist services in endometriosis. Our commitment is spelled out very clearly in the programme for Government. I accept some people wish for the five-year programme to be implemented in five or six months but that is not possible.

The HSE's national women and infants health programme has led on the development of the national endometriosis framework and on the expansion of existing endometriosis services. The HSE has advised that it shared an agreed framework with the Irish Medical Organisation, IMO, on 7 July. Alongside the development of specialist treatment centres, work is continuing in education and training, in reducing the threshold for investigations for suspected endometriosis and in raising the index of suspicion, all of which will go towards reducing the time for diagnosis and treatment.

The diagnostic criteria for endometriosis are determined by clinical experts in the field. The clinical guidelines and the framework emphasise individualised woman-centred care rather than a rigid staging approach to determine the extent of disease. GPs are encouraged to initiate treatment for suspected endometriosis and then to refer to secondary care for laparoscopy if symptoms are severe. This referral pathway is the same for all specialist health services in Ireland.

While the national framework for endometriosis is still being finalised before publication, it is important to note that specialist services in the regional hubs and supra-regional sites are operational and taking referrals. The defined clinics in Galway and at the National Maternity Hospital, while accepting referrals, are not yet fully developed to the same level as other hubs. Services are expanding as recruitment progresses for the outstanding posts.

I am advised that most women referred to specialist endometriosis services and gynaecology services are seen within six months. I accept what previous speakers said about this not being the case. The Minister has taken on board the views that were expressed this evening and will look into them further. The services are being continuously expanded as recruitment continues with the funding provided this year. I acknowledge that many of the posts that have been funded are not yet filled. Most of these unfilled posts relate to new funding allocations in 2024 and 2025 to expand our existing endometriosis services. The HSE recruitment process is in progress for those 18.6 recently funded whole-time equivalent posts.

A total of 47% of women impacted by endometriosis will have fertility issues related to the condition. Fertility care has really benefited from targeted investment by the Government. There are now six regional public fertility hubs across Ireland accepting referrals from GPs directly and from consultants. The system ensures early access for women with suspected or confirmed endometriosis, who are exempt from the standard referral criteria. This integrated model allows for streamlined cross-referrals between fertility and endometriosis services, thereby ensuring women receive timely and appropriate care based on individual needs.

The HSE has identified a holistic care package for women suffering from endometriosis. Multidisciplinary teams, including clinical nurse specialists, dietitians, physiotherapists and psychologists, are being funded to provide a holistic service. Other developments in the provision in gynaecology service will support healthcare provisions. Eighteen gynaecology see-and-treat clinics are already operational, with more in development.

Six specialist menopause clinics are currently operational for those women who require complex specialist care in menopause. A total of six regional fertility hubs will provide support to the estimated 47% of women with endometriosis who will also experience related fertility issues.

To support the implementation of the national framework, the HSE has established an endometriosis professional network to help drive a standardised approach to endometriosis service delivery and care. The HSE national clinical guideline for management of endometriosis was also published in March 2025. Training of medical specialists in the management and diagnosis of endometriosis forms an integral part of the specialist medical training programme provided by the Institute of Obstetricians and Gynaecologists.

The Irish College of General Practitioners also provides education regarding endometriosis to its members, including delivering a blended modular course in community gynaecology in which endometriosis is included as a mandatory topic. Endometriosis is also listed as a core component of the women’s health portion of the postgraduate GP training curriculum.

The HSE is planning an awareness campaign following the publication of the framework. This campaign will focus on highlighting the wide range of signs and symptoms of disease and promote the services available and the associated care pathways. The HSE is also developing a comprehensive patient information resource that will be made publicly available online.

As the Minister for Health, Deputy Carroll MacNeill, advised, the programme for Government is committed to continue to expand specialist service in this area. There has been investment of more than €5 million in the provision of these specialised services to build up a national framework and model of care for endometriosis. This is very much the beginning but it is clear from listening to the contributions tonight that more work needs to be done to continue to broaden the support for women suffering from the impact of this life-changing condition.

The Government is committed to promoting and improving women's health outcomes. In recent years, there has been significant investment to improve, reform and stratify our gynaecology services. This process is ongoing and includes the development of gynaecology clinics, specialist menopause clinics, regional fertility hubs and endometriosis clinics. Through the continued implementation and establishment of these services, our model of gynaecological care and the focus on women’s health is being changed for the better to meet the needs of women accessing these services.

Shónagh Ní Raghallaigh (Kildare South, Sinn Fein)
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I thank the courageous women in the Gallery who have bravely shared their stories with us today and over recent months. Women have been forced to travel abroad due to the neglectful health system in this State. It is a system that has told young girls to get pregnant to stop their periods, allowed their mothers to go into debt seeking treatment abroad and referred our women to mental health services instead of gynaecological ones because it is "all in their head". It is a system that allows women to go into septic shock on the floor of a hospital waiting room, all while there are start-of-the-art facilities available across Europe.

A constituent in south Kildare wrote to me recently. Like so many other women, when Sheena first made contact with our health system because of excruciating pain, she was told it was normal. Her experience was dismissed outright. After seeing four specialists and paying €3,000 out of pocket, she finally got a diagnosis. In that time, she had to leave work and on numerous occasions, her partner and children looked on helpless and sick with worry. She was left in the dark by doctors about a string of other related symptoms. The only insight and guidance she received was from women like herself in online forums. She counts herself as one of the lucky ones.

Another constituent endured nine IVF procedures and two miscarriages before receiving treatment abroad. Yet another constituent emailed me just today to tell me she waited 20 years for her diagnosis. This is absolutely shameful. We need to take a long hard look at ourselves and the system of care we provide women in this State. Women are told to put up and shut up by a system indifferent to their suffering. It is high time we started taking women’s pain and women’s health seriously. We have a horrifying track record in this respect, stretching back to the foundation of the State. It is a living history, with the recent collective trauma of the cervical check scandal hanging over mná na hÉireann, along with a litany of other injustices, including HRT shortages, lack of proper menopause care and ADHD misdiagnoses. There is a moral question that must be deeply considered. For just how long is this Government willing to let women suffer? Women with endometriosis are simply in too much pain to fight this fight alone. Tá sé in am infheistíocht cheart a dhéanamh i gcúram sláinte na mban in Éirinn. Ní féidir linn neamhaird a dhéanamh ar a bhfulaingt a thuilleadh.

Fionntán Ó Súilleabháin (Wicklow-Wexford, Sinn Fein)
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Cuirim fáilte roimh mhná na hÉireann atá thuas san Áiléar Poiblí anocht. Tá céad míle fáilte rompu. Like most men, I knew very little about the silent problem of endometriosis until we held a meeting in Arklow recently for the Wicklow-Wexford constituency. It certainly was an eye-opener for me. I am sure it would be for most men, and for many women as well. We heard so many heartbreaking stories one after the other of women not only having to battle with chronic excruciating pain, but also having to endure the trauma of having to fight for a diagnosis in the first place, to be listened to and to get adequate treatment. That is simply not good enough in 2025. No one should be forced to fight to be believed, to be diagnosed or to receive proper care.

The Arklow meeting was full of harrowing accounts from women who had been suffering in silence. We heard stories from three generations in one family, a mother, daughter and granddaughter. One such story came from the political assistant in my office, Nicola, who is from County Wicklow. She spoke about her symptoms from her early teens and her first surgery at the age of 16. After five surgeries to laser off the endometriosis, she was told to have a child at the age of 22 because that might help. However, she ended up losing her ovary to endometriosis in her early thirties. Nicola’s mother, Phil, suffered constant pain as a young women. Like many other women, she was told that it was only women’s problems and to get on with it. At 34 years of age, she had a full hysterectomy after being diagnosed with endometriosis. It was that bad that when they opened her up, they could not find her womb. The endometriosis covered her bowels as well. She is now aged 69 and still suffering because of endometriosis, which is this unspoken disease that we are supposed to believe is non-existent.

Sadly, little or nothing has changed in 40 years. My personal assistant's daughter, Sarah, also suffers severe pain, bleeding three weeks every month, yet “the experts” did not listen to her or her mother despite knowing their history. At the age of 18, she got off the DART, went to the accident and emergency department and sat there until she was listened to. She was diagnosed with endometriosis, had a tilted womb and also a sister condition, adenomyosis. When she went back at the age of 25 because she was still having problems, she was told recently that she does not have that either.

At the meeting, we heard many similar stories from County Wexford about maltreatment and young women who had been rendered infertile from it. It is time to end the suffering and silence, to stop exporting this problem and instead to build our own centre of excellence because endometriosis is affecting one in ten women. This is the least they deserve.

Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I welcome all the ladies in the Gallery who have suffered long enough. I thank Senator Maria McCormack who has travelled the length and breadth of the country to be informed of endometriosis. I have said in the House before that this State has a sad history of failing women. The Government continues to fail women today when it comes to the diagnosis and care for those with endometriosis. It is accepted by clinical specialists that the true prevalence of this condition goes beyond the official figure of one in ten women. The failures to diagnose and believe women when they say they are in pain, and the failure of a Minister to act, have led to nine-year delays in women being able to access adequate treatment.

Sinn Féin has hosted nine meetings across the State. The stories told by women were harrowing. Women have been dismissed, not believed and told to go to invisible endometriosis hubs. Women who have been told to do this have travelled to England. Why would they do that if the treatment were here in this country? What has been apparent at Sinn Féin’s public meetings is that endometriosis does not simply impact on women. It impacts on families, quality of life, intimacy and planning for and having children. It impacts on people’s ability to get an education and to work, with 95% of respondents to a Sinn Féin survey indicating they had missed such commitments.

Sinn Féin recognises these impacts on women, families and our society. That is why our motion calls for a dedicated, multidisciplinary endometriosis treatment centre to be staffed and resourced to provide diagnostic and holistic management and specialised excision surgery. We want to see gold standard surgical management for this agonising condition. Unfortunately, the Government's amendment tonight represents anything but that. I am disgusted by it.

With regard to women who choose to avail of private treatment abroad, women travel abroad for healthcare for chronic conditions but they do not travel abroad to enjoy it as a trip. They do it literally for the good of their health because they have been failed by the Minister's health service. I call on all Deputies to support the Sinn Féin motion. The Minister should withdraw the callous and uncaring amendment and listen to the stories of many women who are suffering immediately.

David Cullinane (Waterford, Sinn Fein)
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Never have I seen a debate where the Ministers' speeches were so far removed from the reality of women and their experiences. I watched as women in the Public Gallery got very angry when they listened to the Ministers' speeches. Many of them were in tears, and rightly so. For so long, these women have felt ignored and dismissed. I wager that they feel ignored and dismissed by the Minister's responses this evening. The Minister said in her opening statement that women are cared for at the most appropriate level of intervention, beginning at primary care by GPs and then in local hospital care and on to specialist hospital care. The reality is that, for the vast majority of women, primary care and local GPs are not the best option. In fact, that is where many of them were failed. The Minister did not say anywhere in her speech that local hospitals have also failed. I do not blame the staff in those hospitals because they simply have not been trained. Women have had bad experiences where they have gone to hospitals.

The Minister talked about specialist hospital care. For the women we talked to, specialist hospital care does not exist. The Minister said that some women may choose to avail of private treatment abroad.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I did not say that.

David Cullinane (Waterford, Sinn Fein)
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I do not know any woman who would choose to go abroad for invasive treatment by choice. The reason they go abroad is that the specialist treatment the Minister spoke about simply does not exist. What we are calling for in our motion is a centre of excellence supported by regional centres where women can get gold standard treatment. Women travel because the gold standard is not available. The Minister was accused earlier of gaslighting women. I have to say I stand over that because that is how those women will feel.

Verona Murphy (Wexford, Independent)
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In accordance with Standing Order 85(2), the division is postponed until the weekly division time on Wednesday, 16 July 2025.