Culturally Informed Pelvic Floor Physical Therapy for the Asian American Pacific Islander (AAPI) Community

Sonali-Patel
Dr. Dr. Vivian Zhang PT, DPT, MS
The Asian American and Pacific Islander (AAPI) community faces unique challenges when it comes to receiving effective pelvic floor physical therapy. Culturally informed physical therapists are crucial in understanding and addressing the challenges that AAPI individuals encounter surrounding the model minority myth, bicultural tensions, hypersexualization, language barriers, and a lack of representation in research. Adopting a patient-centered care approach that prioritizes cultural competence is essential to meeting the unique needs of individuals with diverse values, beliefs, and behaviors. By raising awareness, we can work towards creating a more equitable and inclusive healthcare system that provides quality pelvic floor physical therapy for all individuals.

What is the Model Minority Myth?

For decades, the AAPI community has grappled with the pervasive and damaging “model minority” stereotype. This harmful myth characterizes AAPIs as successful, diligent, and law-abiding citizens. While it may seem like a compliment, it is, in fact, a racist and harmful generalization that diminishes individual diversity. Not all Asians are good at math, better at adjusting to a different culture, or financially well off, and it’s important as clinicians to refrain from putting patients in harmful boxes that may impact their care.

The model minority myth emerged during the Civil Rights Movement in a New York Times Magazine article written in 1966 by sociologist William Petersen titled “Success Story, Japanese American Style,” where he praised Japanese Americans for their apparent success in America despite facing decades of discrimination and racial injustices. The article attributed the
achievements of Japanese Americans to their cultural values, work ethic, and respect for authority, while undermining the struggles of Black Americans seeking equal rights by suggesting that they didn’t share the same positive traits. The article dismissed the impact of systemic oppression faced by other marginalized groups, and is one of many examples of how
the media used this myth to pit minority groups against each other and wrongly shift the responsibility of oppression onto Black people.

How does the Model Minority Myth Impact Asian American Pacific Islanders Today?

Although the model minority myth was invented for political reasons, its effects continue to be felt today. For instance, it has led to the belief that the worth of the AAPI individuals as Americans is tied to their capacity to sustain a continuous level of productivity, which reinforces the harmful and draining “hustle culture.” Generations of Asians living in America, in order to survive, emphasized the importance of obtaining a good education and job. As a result, many AAPIs continue to be pushed by their family members to become doctors, lawyers, and engineers, and made to feel ashamed if they do not pursue these careers. Choosing career or studies over pleasure, and experiencing failure as a personal affront, results in burnout, low self-worth, and unhappiness. The pressure to constantly perform and meet high expectations, as perpetuated by the model minority stereotype, can have serious consequences on mental and physical health, which can lead to pelvic floor dysfunction. This mentality can also lead to a lack of prioritization of self-care and thus a decreased likelihood to seek help for pelvic floor issues, as AAPIs may feel like they should be able to handle everything on their own. It is therefore important that as clinicians we make a concerted effort to educate the AAPI community on pelvic floor symptoms, what is normal and not normal, and encourage those suffering from pelvic floor dysfunction to seek care.

We can’t talk about the impacts of the model minority myth without discussing its effectson mental health. As an Asian American myself, I learned early on to suppress my emotions, work hard, and keep my head down. Now as an adult, I understand that these were simply coping mechanisms passed down to me by a generation of Asian immigrants who faced severe  , and had to prove their worth in a country that did not see them as equal. In myexperience, speaking up and taking space was often discouraged and seen as being “too much” or“too aggres sive.” Expressing emotions both positive or negative was never modeled in my household. To this day even saying “I love you” to my parents feels extremely awkward, and that alone can create a harmful internal conflict within an AAPI person. While many AAPI persons share similar experiences, it’s important to recognize that they can be diverse as well. This is whyit’s mportant to make the time to listen  each person’s own unique story. Unfortunately, in many Asian communities, there is also still a stigma attached to seeking treatment for mental health that is only exacerbated by the model minority myth that suggests that seeking mental
health services goes against the idea of being the “model minority”. As a result, many AAPI individuals refrain from seeking mental health support, as they fear it will not only bring shame both upon themselves and their family, but also that they aren’t “allowed” or “supposed to” based on what society expects. Suppressing emotions and internalizing negative feelings can have serious impacts on mental and physical health. If not addressed, it can manifest as pelvic floor dysfunction, resulting in physical pain and discomfort.

Furthermore, the model minority myth is also a damaging stereotype that disregards the healthcare inequalities and disparities faced by individuals in the AAPI community. This misconception wrongly assumes that all AAPIs are financially well off and successful, which is far from the truth. It’s essential to understand that socioeconomic factors and financial hardship can impact access to healthcare services, including pelvic floor physical therapy, which may not always be readily accessible to all individuals in the AAPI community.

Understanding Bicultural Tension as a Mental Health Stressor

Many AAPI individuals who grow up in two different cultures find themselves balancing conflicting expectations and values from their heritage culture and mainstream society. As a result, they may feel confused, disconnected, and struggle to find a sense of belonging. This everyday stress, known as bicultural stress, can stem from the pressure to adopt the majority culture’s values while also preserving one’s cultural identity. Examples of common bicultural stress AAPI individuals experience throughout their lifetime include struggling with being bullied as children for bringing “smelly” or “weird” Asian food for lunch, language barriers that limit connection with family, conflicting dating/marriage rules, feeling frustrated with their parents’ limited English proficiency, and feeling pressure to assimilate more into American culture in order to fit in with their peers. It’s important for AAPIs to recognize the impact that cultural factors can have on their mental and physical health, and to prioritize self-care and seeking help when needed. This may include pelvic floor physical therapy to address any symptoms of dysfunction, as well as therapy or other mental health services to manage stress and anxiety. By acknowledging and addressing bicultural tension and its effects on mental and physical health, AAPIs can take steps towards achieving holistic wellbeing.

The Negative Impacts of the Hypersexualizaiton of AAPI Individuals

The hypersexualization of Asians is a deeply ingrained and harmful stereotype that has roots in colonialism and racism. The fetishization of Asian women as exotic and submissive and Asian men as emasculated and sexually inept has led to a culture of objectification and dehumanization. This has serious consequences for the mental and physical health of AAPIs, including making them more vulnerable to sexual harassment and assault which studies support is correlated with pelvic floor dysfunction and chronic pelvic pain. One particular aspect of the sexual objectification of Asians is the stereotype that Asian women have tighter vaginas than women of other races. The pressure to conform to this stereotype can lead to pelvic floor tension and dysfunction, including pain during sex and difficulty with urination. The misinformation around this stereotype can also prevent Asian women from seeking treatment, thinking that these issues are normal. Additionally, the stigma around discussing sexual health and dysfunction in Asian cultures can further exacerbate the problem. The taboo around talking about sexual topics in Asian cultures can prevent individuals from recognizing that their pelvic floor symptoms are abnormal or feel comfortable discussing their symptoms fully with providers. It is therefore crucial for clinicians to create supportive safe spaces for AAPIs to discuss pelvic health and seek treatment without fear of stigma or shame.

How Language Barriers Limit Access to Treatment of the Pelvic Floor

Language barriers between patient and provider can be a significant obstacle for AAPI individuals seeking treatment for pelvic floor dysfunction. Many healthcare providers may not speak the patient’s native language, making it difficult for patient’s to communicate their symptoms and concerns effectively. Miscommunications due to the presence of a language
barrier can lead to misunderstandings, misdiagnoses, a lack of compliance with treatment plans,and a delay in seeking followup care. The issue is particularly prevalent for immigrants and firstgeneration AAPI individuals who may have limited English proficiency and may not be familiar with the healthcare system in the United States. Additionally, AAPI individuals may feel uncomfortble or embarrassed discussing pelvic floor issues with a provider who does not share their cultural background or language. As a result, some may avoid seeking treatment altogether, which can worsen their condition and lead to longterm complications. Pelvic floor physical therapists can take proactive steps towards meeting the needs of AAPI individuals by acknowledging cultural differences and being sensitive to their needs by utilizing language translation services, providing translated materials, and ensuring that patients feel comfortable communicating their concerns.

The Problem with a Lack of Representation in Research

It’s important to acknowledge that the AAPI community is not a monolith, but a diverse group of people with different cultural backgrounds, experiences, and health needs. Unfortunately, these groups are often grouped together under the umbrella term “Asian American Pacific Islander”. As a result, AAPI individuals may be underrepresented or misrepresented in health research, which can have significant implications for their care. Studies on stress urinary incontinence management guidelines provide an example of this issue. Most of these studies did not report race and ethnicity data, and those that did showed that Asian, Black, and Hispanic women were included at lower rates than non-Hispanic white women. Research informs clinical care, the exclusion of non-white racial and ethnic groups from clinical trials may lead to the neglect of crucial factors, such as psychosocial and environmental influences on a patient’s symptoms. As a consequence, AAPI women with urinary incontinence might not receive the same level of care as non-Hispanic white women. The lack of representation of AAPI individuals in research studies could have serious consequences when it comes to accurate diagnoses, effective treatments, and culturally competent care. More inclusive and representative research can help to meet the specific needs of AAPI individuals with pelvic floor dysfunction and ultimately lead to better outcomes and quality of life.

Suggestions on How to Deliver Culturally Competent Care as a Pelvic Floor Physical Therapist

Below are some ways pelvic floor PTs can better provide culturally competent care to their AAPI patients:

  1. Challenge your own biases: Reflect on your own judgments about AAPI patients who walk into your clinic. Do you downplay their symptoms? Take less time to counsel them? Assume they can afford certain services? Talk over them? Once you identify your own biases, actively work to challenge them and approach each patient with an open mind.
  2. Educate yourself: With up to 43 distinct ethnic groups, each with their unique language, dialect, culture, religion, and immigration history, it is important to appreciate the diverse backgrounds within the AAPI community. Educating yourself on Asian customs, values, and beliefs can be beneficial to providing culturally competent care. Remember that not all Asians are the same, and understanding these differences can make a significant difference in providing culturally competent care.
  3. Work with a diverse group of people: It is crucial to consider hiring a diverse staff or, at the very least, having a referral list of Asian healthcare providers available. Some patients may feel more comfortable working with someone who speaks their language ounderstands their cultural background. By offering a diverse staff or resources to access AAPI providers, you can provide a welcoming and inclusive environment for all patients, ultimately leading to better health outcomes.
  4. Stay open and curious: You don’t have to be a part of the AAPI community to provide exceptional care to your patients. Culturally competent doesn’t mean that you need to be an expert about every Asian culture and experience, it just means that you need to be open to talking and learning more about what you don’t know. Recognize that you will never fully understand the lived experiences of AAPIs, but that you can listen and provide support. If you aren’t familiar with someone’s culture, don’t be afraid to ask questions.

Overall, physical therapists who are sensitive to these cultural nuances are better equipped to
address the unique needs of the AAPI community necessary for optimal pelvic floor care. Aculturally competent patient-centered approach to care can help to ensure that all individuals receive the care they need to maintain and improve their health and well-being.

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