Female pelvic floor dysfunction in the Middle East: a tale of three factors—culture, religion and socialization of health role stereotypes

Abstract

Female pelvic floor dysfunction in the Middle East: a tale of three factors-culture, religion and socialization of health role stereotypes

Muslim Women's Physician Preference: Beyond Obstetrics and Gynecology

“…2002) or in Islamic countries (Lafta, 2006; Downloaded by [New York University] at 00:55 06 October 2014 Rizk et al 2005;Rizk & El-Safty, 2006;Rizk, Nasser, Thomas, & Ezimokhai, 2001;Rizk, Shaheen, Thomas, Dunn, & Hassan, 1999;Uskul & Ahmad, 2003;Winslow & Honein, 2007). Thus, in contexts and communities where culture and religion are deep rooted, a same-gender practitioner is likely to be important for women, particularly for intimate examinations such as breast, obstetric, gynecological, and urogenital examinations (Aldeen, 2007;Matin & LeBaron, 2004;Rajaram & Rashidi, 1999Rizk & El-Safty, 2006;Rizk et al, 2001Rizk et al, , 2005Underwood et al, 1999;Zuckerman et al, 2002).…”

Ethnic differences in women’s knowledge level and other barriers to care seeking and the true incidence and/or prevalence rate of female pelvic floor disorders

“…The knowledge barrier found in non-white women of their study was similarly responsible for low care seeking in urinary incontinent women from the Middle East [2]. Likewise, incontinence status minimally affected individual knowledge level since pelvic floor disorders were perceived by Middle Eastern women, both continent and incontinent equally, as a neurological or senile disorder rather than an obstetric/gynecologic condition related to childbirth or menopause [3].The influence of this ethnic variation in women's background knowledge of pelvic floor disorders and subsequent care seeking is, however, frequently overlooked in incidence and/or prevalence studies of multi-ethnic and/ or multi-national patient populations. This highlights the inherent "selection" bias in estimates based on hospital data [4].…”

“…Furthermore, care seeking for female pelvic floor disorders is not only dependent on patient "internal" knowledge level but also on other "external" ethnicitybased factors [5]. These include convenience of consultation, provider gender preference, access to health care facilities, expectations from health care, language proficiency, incurred service cost, and perceptions of medical encounter [3,5]. Heit et al recently described a 14-item modified Melnyck's barrier scale as an objective and psychometrically validated measurement tool of external barriers to care seeking in an ethnically heterogeneous group of incontinent women [5].…”

“…The knowledge barrier found in non-white women of their study was similarly responsible for low care seeking in urinary incontinent women from the Middle East [2]. Likewise, incontinence status minimally affected individual knowledge level since pelvic floor disorders were perceived by Middle Eastern women, both continent and incontinent equally, as a neurological or senile disorder rather than an obstetric/gynecologic condition related to childbirth or menopause [3].…”

“…The study sample should include only communitydwelling women as opposed to clinic or hospital population in order to determine the true or ''un-selected'' incidence and/or prevalence rate of these disorders in multi-ethnic women. Similar epidemiologic studies are expected to identify underprivileged ethnic groups who are not adequately or properly informed about pelvic floor disorders with a potential for formulating ethnic-responsive and clientelecentered educational programs that will ultimately improve knowledge, correct misconceptions, and increase care seeking worldwide [1][2][3][4][5]. More importantly, international qualitative research is urgently needed in women from various ethnic origins to investigate the role of other anthropologic and societal factors particularly cultural authenticity, religion, spirituality, geopolitical orientation, indigenous psychology, personality, and gender identity on women's realization of health role, experience of health and illness, medical care seeking, and utilization of health services [3,4].…”