Salud Pélvica, Sin Pena: A Call for Culturally Sensitive Pelvic Health Care
As a Mexican-American woman, broaching the subject of pelvic health was often met with unease. Despite the strength, resilience, and unwavering support of the women in my life, the discussions surrounding sex, menstruation, and other pelvic-related matters were shrouded in secrecy, especially in the presence of male family members. A response that stems from a deep-rooted cultural conditioning that regards certain matters as too intimate for casual discourse. It was as though openly addressing these issues would unravel an unspoken code of silence that had persisted for generations. Yet, each passing generation has seemed to grow increasingly comfortable dismantling these barriers, gradually chipping away at the walls of silence that surrounded discussions about pelvic health. This subtle evolution is a testament to the transformative power of open dialogue, paving the way for a future where conversations about our bodies are met with understanding and acceptance rather than constraint and shame.
Pelvic health concerns impact individuals universally, yet Spanish-speaking communities are confronted with a uniquely dense stigma that obstructs their desire to access proper care. The intersection of cultural nuance and language barriers exacerbates the challenge by perpetuating stigmas and impeding open conversations about pelvic health. Pelvic health is profoundly personal and culturally impacted. Advocating for culturally sensitive information and services is not merely a necessity; it's a crucial path toward inclusivity and expanding access.
Currently, our system is failing to meet the needs of this community. Limited English proficiency among Spanish speakers makes expressing intimate concerns difficult, intensifying the existing stigma. Research has found that Spanish-speaking women experience greater levels of shame by having to discuss their concerns with different doctors or through a translator. Current pelvic health materials in Spanish do not meet the NIH readability guidelines and fail to serve the Spanish-speaking-only or low-English-speaking populations. Additionally, patients report a decrease in confidence when doctors use interpreters, as there's uncertainty about whether their experience is being accurately conveyed. For a community that is already at risk for poorer health outcomes, these barriers lead to fewer pelvic health exams and conversations. Notably, despite being equally likely to experience pelvic organ prolapse as their white counterparts, Spanish-speaking women typically undergo 2-3 more visits to receive a formal diagnosis. This highlights the importance of addressing both linguistic and emotional aspects to improve the overall experience for these women. Aside from the language barrier, providers often lack cultural awareness when suggesting treatment options for pelvic health dysfunction. Hispanic/Latinas are less likely to use tampons compared to their white counterparts and are culturally less comfortable with pelvic dysfunction treatments that require vaginal insertion of devices. Subsequently, when treatments for incontinence or prolapse that require vaginal insertion are suggested to Spanish-speaking patients, their refusal is met with a lack of further education on alternative treatment methods and the unfortunate label of being “noncompliant” or “resistant to recommendations.”
To bridge this gap, it is imperative to offer culturally aware educational materials, online resources, and healthcare services in Spanish, ensuring accessibility and effective communication. Empowering Spanish-speaking communities with information about pelvic health is paramount. Community education programs can dispel myths, provide accurate information, and foster open dialogues about reproductive and sexual health. Breaking the silence on pelvic health within Spanish-speaking communities demands collective action. As a future Spanish-speaking pelvic health physical therapist, I hope to help others discover the power of reclaiming our narratives and steer conversations toward empowerment rather than of discomfort and shame. I look forward to the opportunity to unravel stigmas so that future generations can celebrate their bodies without the weight of unspoken taboos and receive the care they deserve.
About the Author
Ixel Garcia, SPT
Ixel Garcia grew up in Los Angeles County and is currently a second-year student pursuing her doctorate in physical therapy at the University of California, San Francisco and San Francisco State University’s joint program.
Citations/References
Alas, A. N., Dunivan, G. C., Wieslander, C. K., Sevilla, C., Barrera, B., Rashid, R., & Anger, J. T. (2016). Health care disparities among English-speaking and Spanish-speaking women with pelvic organ prolapse at public and private hospitals: what are the barriers?. Female pelvic medicine & reconstructive surgery, 22(6), 460.
Jackson, E., Hernandez, L., Mallett, V. T., & Montoya, T. I. (2017). Knowledge, perceptions, and attitudes toward pelvic organ prolapse and urinary incontinence in Spanish-speaking Latinas. Urogynecology, 23(5), 324-328.
Robb, J., Mackay, A., Rondeau, N., Palomino, J., Mulla, Z. D., Montoya, T. I., & Mallett, V. T. (2019). Spanish language pelvic floor disorders patient information handouts: how readable are they?. Urogynecology, 25(1), 72-75.
Romo, L. F., & Berenson, A. B. (2012). Tampon use in adolescence: differences among European American, African American and Latina women in practices, concerns, and barriers. Journal of Pediatric and Adolescent Gynecology, 25(5), 328-333.
Wieslander, C. K., Alas, A., Dunivan, G. C., Sevilla, C., Cichowski, S., Maliski, S., & Anger, J. T. (2015). Misconceptions and miscommunication among Spanish-speaking and English-speaking women with pelvic organ prolapse. International urogynecology journal, 26, 597-604.
Yeguez, A. C., Yeguez, C. E., & Smith, A. L. (2022). Lost in translation: misconceptions and miscommunications among Spanish-speaking Latinas with pelvic floor disorders. Urology, 163, 34-43.
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