A Case Study in Cultural Sensitivity with Bonus Interview

Rivki Chudnoff, MSPT is instructing her new course, Cultural Sensitivity: Treating Conservative Religious Patients, which debuts on May 7, 2023. Save 10% off registration with discount code NEWCOURSE10. We look forward to seeing you in class! This course is designed to provide guidance and skills for engaging patients from religiously conservative backgrounds in a culturally sensitive manner and will gain a foundational understanding of the various traditions, customs, laws, and values associated with Muslim, Jewish, Hindu, and Christian faiths as they pertain to sexuality and pelvic health.

CASE STUDY: Sarah is a 23-year-old woman who presents to your office for an evaluation. Upon scheduling, she did not wish to disclose to your office manager what kind of pelvic health issue she wants to be seen for.

Upon patient interview, Sarah reveals that she has been married for 8 months and all attempts at intercourse have been unbearably painful. She reports a 14/10 on a pain scale and that she has vocally cried out in pain with any attempts at penetration. She is feeling hopeless that this will ever get better, and is concerned that something is wrong with her and that her vagina is “too small” for intercourse. Sarah admits that she has never examined her own vaginal opening or seen it in a mirror because it “grosses her out”.

Sarah is otherwise in good health but has never had a gynecological exam. She and her husband are both from a conservative religious background and were educated in religious schools with limited sex education, and were provided with little information about sex prior to marriage. Neither of them had been sexually active prior to marriage. Sarah currently ascribes to her religious beliefs and practice which prohibits any conversations about sex with anyone other than her partner. She expresses an aversion to sexual activity and to her husband’s genitalia and semen. Sarah confides that she feels guilty that she is not able to have intercourse and “make her husband happy”.

Although she denies any discomfort with sitting or wearing tight-fitted garments and has no other pain in her body, recently she has started to have pain in her vulvar area that starts before attempting intercourse. After attempts at penetration, she has difficulty falling asleep due to her pain.

She has a self-diagnosed “tiny bladder” and frequently has to urinate every hour. Sarah reports a long history of constipation, with bowel movements about once a week with straining (type 1-2 on the Bristol stool scale)

She reports regular periods, but excruciating pain the first 2-3 days that can be debilitating at times. She has never successfully inserted a tampon.  

Sarah’s personal goals for treatment are:

1. To have intercourse without pain
2. To become pregnant as soon as possible, as is expected in her social circles and close-knit community

What other questions would you like to ask this patient?
What is your next move?
What would your treatment plan look like for this patient?
What other healthcare providers might you refer her to?

Cultural Sensitivity: Treating Conservative Religious Patients has the following goals:

1. Demonstrate a foundational understanding of the various traditions, customs, laws, and values associated with Christian, Hindu, Jewish and Muslim faiths.
2. Identify potential challenges and barriers to care unique to pelvic health patients from conservative religious backgrounds.
3. Describe five strategies for increasing comfort and confidence in interfacing with patients from different religious backgrounds.
4. Apply cultural sensitivity to patient interviewing and education techniques.
5. Discuss collaborative approaches to evaluation and treatment that are compliant with the patient’s religious and cultural norms.
6. Evaluate culturally sensitive intervention in a case study format with your peers.

As pelvic health providers, we go into this special field with the desire to provide the best care for our patients in the most sensitive way possible. It can be particularly daunting when we encounter patients from religious backgrounds and cultures that are unfamiliar to us. In our attempts to be sensitive, we may be tempted to shy away from asking patients the questions that really need to be asked. We may avoid providing patient education we may have otherwise provided because we don’t want to offend, or may tiptoe around a treatment session where we may have otherwise taken a more confident approach. My hope is that practitioners will leave my course, Cultural Sensitivity: Treating Conservative Religious Patients, confident in their abilities to provide the highest level of care with confidence, sensitivity, and compassion for all of their patients.

Who are you? Describe your clinical practice.
I’m a mom of a bunch of adolescent kids and a dog. I drive a minivan with the sunroof open blasting Bon Jovi, Janet Jackson, Madonna, and Lizzo down the New Jersey Turnpike with a trunk full of mall returns and reusable shopping bags like a wild woman. Fun fact - I’m married to a gynecologist (no it’s not weird, and no, he’s not my gynecologist, because that would actually be weird).

My secret identity is as a pelvic health physical therapist at my private practice in Bogota, NJ where I hide from said teenagers.

I have been privileged to be involved in the field of pelvic health for the last two decades, both treating patients with a wide variety of pelvic health issues as well as providing community outreach and developing educational initiatives.

I have been joyfully teaching the pelvic floor series at Herman & Wallace for the last several years both in person and in the remote format. This is my maiden voyage teaching my own course for the Institute. I’m working on the accompanying soundtrack for the course and am taking requests.

What made you want to create this course?
At one of the first H&W courses I attended as a participant, I noticed it was a combination of women of different faiths (myself, an Orthodox Jew included) that were all treating each other behind the modesty curtains during lab. I remember thinking, “Cool, it’s like a pelvic health United Nations going on back here”.

I realized I was not alone. Individuals from a myriad of different backgrounds have challenges navigating the intersection of their religious world, its culture of modesty and conservative religious values, and the world of pelvic and sexual health. The very rules, spoken and unspoken that govern religious cultures and are innate to its members, can be mysterious and even surprising to people from more secular backgrounds. My hope is for this course to be the bridge between the two worlds, to be traveled comfortably by all those who wish to partake in the journey. 

What need does your course fill in the field of pelvic rehabilitation?
Having expert clinical, diagnostic, and treatment skills are essential components of providing effective treatment. However, seasoned clinicians know these skills will only get their patients halfway there. My course, Cultural Sensitivity: Treating Conservative Religious Patients, falls under the other half of care: bedside manner, and building a therapeutic alliance. The focus of this course is the way we frame the care we are providing, and the way we interact with the human element within ourselves and within our patients that is more than muscles, nerves, joints, ligaments, and fascia.

Who, what demographic, would benefit from your course?
Anyone who treats patients with pelvic health concerns will leave this course with something they can incorporate into their practice. As pelvic health providers, we go into this special field with the desire to provide the best care for our patients in the most sensitive way possible. The problem is, we don’t always know what that is supposed to look like. It can be particularly daunting when we encounter patients from religious backgrounds and cultures that are unfamiliar to us. Most of us did not learn this in school. In our attempts to be sensitive, we may be tempted to shy away from asking patients the questions that really need to be asked. We may avoid providing patient education we may have otherwise provided because we don’t want to offend, or may tiptoe around a treatment session where we may have otherwise taken a more confident approach. My hope is that practitioners will leave this course confident in their abilities to provide the highest level of care with confidence, sensitivity, and compassion for all of their patients.

Cultural Sensitivity: Treating Conservative Religious Patients

Course Date: May 7th - Save 10% off registration with discount code NEWCOURSE10

Description: This course is designed to provide guidance and skills for engaging patients from religiously conservative backgrounds in a culturally sensitive manner. Participants will gain a foundational understanding of the various traditions, customs, laws, and values associated with Muslim, Jewish, Hindu, and Christian faiths as they pertain to sexuality and pelvic health.