Current Research on Endometriosis: An Interview with Nisha Marshall

I hope to contribute to research that ultimately allows individuals across the world to access and receive healthcare that is timely, patient-centered, holistic, and effective.“ 

Teresa Götz: Could you please introduce yourself briefly?

Nisha Marshall: My name is Nisha Marshall, and I am a researcher at the Endometriosis and Pelvic Pain Laboratory at the University of British Columbia (Canada). I recently finished my Master’s degree at this lab and continue to work on endometriosisrelated projects. I hope to pursue a PhD in women’s health research in the near future 

Teresa Götz: Could you summarise your work for our readers in a few words? 

Nisha Marshall: My current work focuses on developing a questionnaire for people who experience sexual pain – the Deep and Superficial Dyspareunia Questionnaire (DSDQ). This questionnaire assesses the characteristics of pain (location, timing, intensity, quality), as well as its impact (how does pain impact behaviour, thoughts, feelings, and sexual well-being).  

The DSDQ was created by patients, clinicians, and researchers. It is intended for use in clinical and research settings, to ensure that the patient’s experience of dyspareunia (sexual pain) is being adequately translated to clinicians and researchers. The DSDQ will be a valid and reliable way to inform diagnoses and treatment plans for patients with dyspareunia, as well as help gauge changes in pain over time.  

About Nisha Marshall

Nisha Marshall is a researcher at the Endometriosis and Pelvic Pain Laboratory at the University of British Columbia (Canada). She recently finished her Master’s degree and continues to work on endometriosisrelated projects. She hopes to pursue a PhD in women’s health research in the near future 

Nisha Marshall

Teresa Götz: How did you come to research endometriosis and work with the DSDQ

Nisha Marshall: I have always had a strong interest in pursuing research in women’s and sexual health. I started to seek out graduate school opportunities in these areas after I finished my undergraduate degree. My mentor, Dr. Paul Yong, received the grant to develop the DSDQ and I took on this project as it aligned with many of my research interests! I’m passionate about working in pain research because it incorporates both my interests in biology and psychology. 

Teresa Götz: What fascinates you most about the topic? What is your main motivation?  

Nisha Marshall: Patient-reported data (outcomes directly reported by patients) are widely used and essential in the field of endometriosis research.  As researchers, it’s so important that we are asking the right questions and gathering the right data from patients.

I see a great need in this field to incorporate the perspectives of patients in the work we do. In my work, we worked directly with patients to ensure the DSDQ consisted of questions that were important to patients – so that research moving forward will look at these outcomes.  

The DSDQ is a questionnaire that assesses sexual pain, which is often a complex and nuanced experience for people. Each person’s unique experience of pain must be translated to clinicians and researchers in a useful way.

My main motivation for wanting to do this work is that I think it’s imperative that the tools that we use to gather data about endometriosis are both patient-friendly and clinically useful. I hope that the methodology used to develop the DSDQ can be used to develop future questionnaires assessing other symptoms related to endometriosis.  

Teresa Götz: In your opinion, what are the biggest challenges in the field of endometriosis?  

Nisha Marshall: In referencing my own knowledge of the Canadian healthcare system and from speaking to colleagues who work outside of Canada, the following three challenges seem to be pervasive internationally: 

  1. Healthcare provider knowledge of endometriosis: Patients that I speak to in my research will often reiterate a similar story; that their journey to diagnosis and treatment was a long and arduous one. This often starts with a dismissal of symptoms right from the primary care setting. I’m starting to hear more in the research world about the creation and implementation of endometriosis assessment tools for primary care physicians – which is very exciting!  
  2. Barriers to providing interdisciplinary care: There is increasing evidence that interdisciplinary care plans can be very efficacious for some people with endometriosis (i.e., care that incorporates the expertise of numerous providers including psychologists, pelvic floor physiotherapy, etc.). However, there are numerous challenges in being able to coordinate care plans amongst these providers due to time constraints, financial constraints, and logistical problems. This issue is exacerbated in rural and underdeveloped locations as well. 
  3. Lack of a cure/not enough treatment options: Hormonal management and surgery tend to be the most common ways that endometriosis is managed. We still have no “cure” for endometriosis, and treatments are focused on managing symptoms instead of treating the underlying cause. Often time these treatments are not well tolerated, not able to target all symptoms, invasive, unavailable… and the list goes on. 

Teresa Götz: How can your work contribute to improving the lives of women with endometriosis in the long run?    

Nisha Marshall: People who experience dyspareunia may not know what type of information to share with their clinician or a researcher about this symptom. Additionally, a clinician or a researcher might not know the right questions to ask a patient about dyspareunia!

I see the DSDQ as a communication tool between the patient and the clinician/researcher, ensuring that the patient’s experience of this symptom is adequately translated to the clinician/researcher. This will allow clinicians to take a more targeted approach to the management of dyspareunia in their patients and will ensure researchers are looking at the right outcomes when doing dyspareunia research.

Teresa Götz: What are your future research goals?    

Nisha Marshall: I have a strong interest in continuing to work in the field of genito-pelvic pain. I hope to contribute to research that ultimately allows individuals across the world to access and receive healthcare that is timely, patientcentered, holistic, and effective. 

Teresa Götz: What do you think about digital self-help?     

Nisha Marshall: Personally, I’m not familiar with any specific digital self-help tools. However, I think it is imperative that we continue to think of innovative ways to increase the accessibility of evidence-based health-related knowledge and management strategies for patients. It seems that digital self-help platforms are optimal for this and I’m excited to learn more about these.

Teresa Götz: Is there anything else you would like to share with those affected?      

Nisha Marshall: It’s unfortunate how research into women’s pain conditions has lagged for far too long. Even now with increasing prioritization of these conditions in research settings, it can be frustrating how translating research to clinical practice is often a lengthy process.  

There are many brilliant individuals (and counting) working around the world to improve endometriosis care. If those affected can participate in endometriosis, I strongly encourage them to do so. I see a brighter future for people with endometriosis moving forward, and we need your continued help to be able to do this! 

Teresa Götz