September 2, 2018September 2, 2018 5min readBy Tayyaba Ahmed
American born confused desi (ABCD) was what I was considered growing up as a first-generation American with immigrant parents. Maybe there is some truth to that but I am inclined to think that our parents were the confused generation. While most of them clung to their roots some chose to embrace the “American way.” What did that mean for us young, South Asian women? Well, most of us grew up with parents that made us focus on education, encouraging us to become professionals, not speaking of fun, love, or menstruation. They also highlighted the importance of staying out of the sun to maintain a light skin tone and eating well to look “healthy,” so that one day their daughters would be married off to men of the same cultural background and religion.
One thing they completely missed out on was the importance of giving their daughters an education on menstruation. I remember my aunt asking me if I knew what a period was—I lied—I said, “you mean like punctuation?” I am not sure why I lied, I just remember feeling embarrassed and ashamed for even knowing. What I knew about periods, I ended up learning during health class in middle school. When I first got my period during sixth-grade gym class I remember not telling anyone and using toilet paper as a faux pad. I went home that day and my mom handed me a bag of pads. As the only daughter with all brothers, it was all I knew about menstrual hygiene until I entered college.
After graduating from a high school class with approximately 95 percent Caucasians, I went to college and quickly became friends with a group of “brown” kids who looked like me – most of whom were born in America and just as “confused” as I was. It was in college where I finally learned about tampons. I specifically remember being taught how to use my first tampon in the bathroom of the college library with step-by-step instructions from a fellow brown girl. She must have had one of those parents that embraced American culture. I never really used tampons once I learned because how would I explain to my mom that I was using tampons? Would she be worried I could lose my virginity to a tampon – I wasn’t exactly sure why they were frowned upon and it didn’t seem worth the drama so I refrained and stuck with pads.
I went on to live the dream of most brown parents: I became a doctor, married to a doctor now with two young daughters of my own. I went on to do my residency in physical medicine and rehabilitation, focusing now primarily on pelvic pain. I spend my days treating males and females with pelvic pain. Yes, you read that right. I examine males and females with pain in their genitals, along with bowel and bladder disturbances like constipation and urinary frequency. Working in this field made me realize what a huge void there is in doctors who treat this incredibly niche field. When I break down the statistics of my own patient population the percentage of South Asians (4 percent) and generally all immigrants is underwhelming. I wondered why and that’s when I started talking to friends and patients about their experiences.
The realization is that there has always been a bit of awkwardness when it comes to anything related to the genitals. I’ve had a desi patient ask if I could do the examination rectally instead of vaginally, as her parents were concerned it will break her hymen despite trying to alleviate her fears that this would not take away her virginity. Due to the stigmas associated with women who are not virgins, women have become ingrained in the need to protect the almighty hymen. In reality, the state of your hymen has nothing to do with your sexual activity. In fact, most women can wear away their hymen by just biking or other physical activities.
Another topic that is finally on the rise is menstruation, often referred to as “Aunt Flo.” American culture has embraced the openness of discussing menstrual cycles and it is even celebrated in many families by throwing “Period Parties” for girls when they get their first period. This is not the case for most brown girls. They are often told not to mention their period to their brother(s) or father as it is considered a very private matter. I have had friends and patients tell me that if their periods were painful it would often be dismissed as “normal” and a part of being a “woman.” Sometimes their mothers would even tell them, “I have painful periods, too,” and so they would assume if my mother or aunts lived with it, I guess I can too. Some parents would accuse their daughter of being lazy and trying to get out of doing work and the unfortunate part of this is that so much endometriosis likely went undiagnosed.
Endometriosis is a condition where the tissue that normally lines the inside of your uterus grows outside your uterus. Endometriosis most commonly involves the ovaries, fallopian tubes, and the tissue that lines the pelvis. Undiagnosed, endometriosis can lead to infertility when it involves the ovaries and Fallopian tubes. The fact is 1 in 10 women has endometriosis and 30 to 40 percent of women with endometriosis are infertile. This makes endometriosis one of the top three causes of female infertility. Many women are unaware of their infertility or endometriosis until they attempt to get pregnant. I wonder if brown parents would encourage the conversation of pelvic pain if they knew that this could affect their daughter’s fertility.
About 40 percent of the female patients in my private practice have endometriosis. Years ago, it was considered a white working woman disease as these were the only women who were taken seriously or had the means to get diagnosed. Today, the number of South Asian women I see with endometriosis is still markedly lower than Caucasian and African Americans and I believe that is due to the lack of education because most preteens learn so little about menstruation and speak even less about it with their family members. I just learned that my aunt has endometriosis after I started treating women with the disease. Women with endometriosis typically have pain during their menstrual cycle, but they may also experience pain that doesn’t correlate to her cycle – this is what makes this condition so unpredictable and frustrating. For many women, the pain of endometriosis is so severe and debilitating that they are unable to go to school, work or even carry on activities of daily living. Many of my patients have told me they used to throw up due to the pain and visit the ER multiple times a year. On average it takes these women 7-10 years before they are diagnosed. The current Meyer’s theory of endometriosis has shown that endometriosis can be present during fetal development and may simply be activated at puberty when the estrogen level increases in the body and menstruation begins. Many women who are placed on birth control that suppresses estrogen may find relief in symptoms; however, some South Asian families believe going on birth control prior to marriage is taboo regardless of the pain relief. Ultimately, the gold standard of treatment is excision surgery by an endometriosis specialist.
Since endometriosis can affect many organ systems, the symptoms often overlap with different conditions. If you or someone you know answers yes to any of the following questions you may want to discuss the possibility of having endometriosis with your physician. Do you have painful periods? Do you have pain in between your periods? Abdominal bloating that makes you feel and look like you are pregnant when you aren’t? Are you constipated more often than not? Do you have painful intercourse? Do you have pain with tampon insertion? Do you have urinary frequency or urgency symptoms? If you are a mother of a daughter, please make sure you learn the difference between normal periods symptoms versus endometriosis. No woman should have to wait years before diagnosis.
Valentine’s Day is here, and my calendar is fully booked on February 14th. It’s not what you think. My calendar is fully booked with therapy clients who will most definitely be reflecting on their singlehood this year. And so will I. Most of them are just like me — single South Asian Americans, between the ages of 22-40 who come from moderately conservative cultures. The adult children of immigrants, who had arranged marriages, wondering when we will ever find “the one,” and why we won’t settle.
I’m a therapist in therapy, and I’ve had a lot of family trauma and baggage to unpack with my therapist. Through my training and personal therapy journey, I learned to question a lot of the things that I’ve been told about marriage and relationships.
At the same time, it’s not easy. No one wants to be lonely. Brené Brown talks about how detrimental loneliness can be for humans in “Braving the Wilderness.” We all want to belong to someone or something bigger. And there is a difference between being lonely, without intimate companionship, and being alone in our experiences. As we get older, everyone we know in our age group is on a different life trajectory, and we start to feel both alone and lonely.
We straddle the line between two cultures — the one that we were born and raised in, and the one our parents and family tried to teach us. Many of us might live double lives. But being single is not an anomaly. In fact, according to the Pew Research Center, about 31% of adults in America are single. About 32% of American women, between ages 18-29, and 29% of women, 50-64, are single. This means that roughly about a third of American women are single, regardless of age or developmental stage.
Results vary by sexual identity and race. 56% of adults who identify as lesbian, gay, or bisexual, between the ages of 18-29, are single, compared to 29% of their straight counterparts. Black adults are more likely to be single than White or Hispanic adults. However, no statistics included Asian Americans. Some studies show we are more likely to get married due to strong values placed on marriage in Asian cultures, and less likely to get divorced. There is also a huge stigma against divorce. For Asian American women, there is a cultural pressure to not only get married, but stay married.
For many South Asian Americans who are first or second-generation, we have no blueprint for the modern world of dating. A lot of us don’t know what a healthy dating experience, let alone a marriage, is supposed to look like if it is even at all possible. In the South Asian diaspora, marriage is taken very seriously, but counter-intuitively; we are not given the opportunity to spend time on making the decision — we are expected to decide very quickly. For most of us, who are children of immigrants, our parents more than likely had an arranged marriage — that was a decision made by our grandparents, aunts and uncles. And the wedding and engagement happened fairly quickly. That is our blueprint
There are many mixed messages about how to approach marriage and dating. Many of us were told to not start dating until after we graduate from college and get a full-time job, which left a lot of us with very little dating experience, and then, Poof! We’re magically just supposed to settle down. There are many desi people who stay single because they know they have issues to work on. A lot of us are aware of how messages about marriage and dating in our communities are sometimes not realistic, if at times rooted in colorism, internalized colonialism, patriarchal and misogynistic values,and racism.
Dating is uncertain because you can’t control whether or not someone wants to date you, let alone if someone wants a relationship with you. And sometimes that has nothing to do with you and everything to do with that person’s preferences or baggage. But is it possible you have some baggage too?
Staying single because of personal baggage is not uncommon for South Asian American millennials. Because of this, many of us believe that something must be “wrong” with us, especially when people ask why we’re still single and unmarried. While we should address underlying issues for why we’re still single, that doesn’t mean anything is necessarily “wrong” with us.
As a licensed therapist, I see many single South Asians Americans who believe that something must be wrong with them because they’ve never been in a relationship before, or because they’re not in a serious relationship yet. If you’re one of these people, I want you to consider:
Who taught you how to date?
Who taught you how to socialize with other genders?
When were you allowed to date?
How often were you allowed to socialize with other genders?
What is your model of a healthy marriage or relationship?
Who taught you free will and how to exercise choice?
How were affection and romance modeled for you?
When we unpack the answers to these questions, we start to realize that there are actually very good reasons for why we’re still single.
If there are that many South Asian Americans who are afraid of dating because they don’t want to repeat toxic relationship patterns, that means that many of us are…meant for each other. So why can’t we find each other?
Our parents had an easier time finding each other because they lived in a homogenous society. My parents came from a community where everyone was of the same or similar Malayalee-Indian background and the same religion. My parents hope that I can find someone from our culture, but they forget that we live in a heterogeneous society, where finding someone who is South Asian, let alone of our specific culture, background, community, and religion, is few and far between. There is pressure on many South Asian Americans to find someone within their specific communities. Not to mention that meeting someone through a mutual connection doesn’t necessarily mean they’re a good fit for you. It makes it feel like our options are limited.
This creates a ‘scarcity mindset.’ Scarcity mindset is the belief that there aren’t enough resources or opportunities out there. When you feel there aren’t enough singles within your community that you can meet, it can cause you to become hyper-fixated on these limited ‘resources’ and even heighten anxiety. And to some extent, there is some truth to that fear — some of my clients are joining dating apps to meet South Asians out-of-state. As the people around you start to settle down, you might start to feel the pressure of settling down quickly to “catch up.” You may have tried to go on a bunch of dates or entertain the idea of certain people in your community, but they eventually fizzle out, fall flat, or end in rejection. You might start to feel discouraged. This kind of pressure can result in:
Avoiding dating in the culture or dating altogether to prevent being hurt or feeling rejected, or having to confront the social anxieties of meeting new people and being open and vulnerable.
Latching on to the idea of someone we meet, working too hard to impress them early on, and attempting to force chemistry to guarantee an outcome (marriage).
When you feel this kind of pressure, you might underestimate or overestimate how to interact with potential partners. This pressure might come from messages you’ve heard in your community that you’ve internalized. For instance, if you’ve heard someone say, “we don’t get divorced in our culture,” you might start to believe that divorce is the worst possible outcome. That might put pressure on you to find the “perfect” partner in order to prevent divorce, but the future of your marriage is not something that you can guarantee. Another example — if you hear your parents tell you to “just compromise,” you might start to believe that your expectations are not realistic; therefore, that’s why you’re not married or in a relationship yet. You might start to lower your expectations and get attached to any potential partner in the hopes that you can guarantee a relationship, but changing who you are does not necessarily mean you’ll attract what you want.
How we approach dating, especially when under this cultural pressure, can have an impact on how we bond emotionally with people. One theory based on psychological research, called Attachment Theory and Styles, describes patterns of how we create and maintain emotional bonds with others and where we fall on the attachment style spectrum or circle. Cultural pressure to settle down and marry someone from your specific culture or community can influence how we date and why, but it prevents us from being mindful and enjoying the process of dating. Your attachment style might be the result of your family dynamics, your parents’ style of emotional connection, and cultural messages you’ve been taught about what a relationship or marriage “should” be like. For example, if you’re under cultural pressure to get married quickly to appease your family, you might develop an anxious attachment style because it triggers thoughts and behaviors that fall under that category. If you question the cultural pressure, you might associate marriage with negative connotations. You might push away dating and marriage and act in the way of an avoidant attachment. Your attachment style is not genetic or something you are born with. It is a pattern of behavior that is about how you relate with others, especially in relationships. It can change over time and vary based on your anxiety or the person you’re seeing. If you want to learn more about attachment style, seeking a therapist is a good resource.
Regardless of what your attachment style is, it can prevent you from being patient, truly vulnerable, and having quality dates or quality relationships. It might keep you in unhealthy dating situations or relationships too long out of fear that you won’t find anyone else “in time.” You might be jumping to conclusions about what should happen next when you date someone. When you really like someone, you might be asking, “What if things go wrong?” But what if things go right?
Valentine’s Day has never been something special for me, and while it would be nice to be in a relationship, I’m not going to let the cultural pressure of what I’m “supposed” to do, as a South Asian American single woman, dictate my life. I have my reasons for being single, and it’s no one’s business but mine (and my therapist’s). If someone in my family or my culture doesn’t approve of my singlehood, then I sincerely hope they’re awake at night thinking about why I’m single. What they think of my life is none of my business. At the same time, I’m not going to shut myself off completely from dating and relationships. Dating will be on my terms. While rejection hurts, I have accepted that people will come and go and I wouldn’t want someone to feel forced or obligated to stay with me if they have emotionally left the relationship. Ultimately, I’m looking for someone who will fit the lifestyle I already have, but if I don’t find my life partner, I’m okay being with myself too.
You don’t have to follow your parents’ blueprint to marriage and relationships. You’re allowed to follow your own. If we adopt an abundance mindset, a mindset of knowing that there are enough resources for everyone and accepting what resources are available to us — along with practicing healthy relationship habits — we might develop better, more satisfying relationships. There are enough single South Asian Americans out there who would love to be with you. Stand firm in who you are and what you want, and be open to what comes your way.
Ten to 28% of the world’s population of women experience painful sex. Keep in mind, that this is just what is reported. As embarrassing and as vulnerable as you may feel, you are absolutely not alone. The good news is that in addition to your traditional medical care to treat painful sex (also known as dyspareunia) such as medication, injections and surgery — a conservative approach is effective and long-lasting. Conservative care ranges from pelvic floor physical therapy, chiropractic care and acupuncture which are beneficial in treating the root cause of painful sex, as well as symptoms, for long-term healing.
Some of the signs to look out for if you experience pain are:
Treatment options for painful sex such as pelvic floor physical therapy, chiropractic care and acupuncture provide a long-lasting and profound effect on the pelvic floor and address your entire physical well-being.
The pelvic floor is a layer of muscles that range from the pubic bone to the tailbone. The purpose of these muscles is to assist in bowel and bladder control, support a baby during pregnancy and contribute to sexual sensations. Just like any other muscle in your body, these pelvic floor muscles can become tight or weak which can be a contributing factor to pain.
Pelvic Floor Physical Therapy
Pelvic floor therapy can assist by strengthening and relaxing the muscles which is necessary to relieve pain during sex.
Chiropractors can be extremely beneficial with assisting in helping relieve pain. Associated pain and discomfort can originate from the lower back and buttock muscles. Chiropractors are trained in taking a history and performing a neurological, orthopedic and soft tissue examination to identify treatment options. Deep tissue massage, skin rolling, Active Release Technique, muscle energy technique, ice, heat and electrical stimulation are just to name a few.
Acupuncture
Acupuncture can activate the human dopamine system which helps regulate hormone levels and can assist in psychological factors. Acupuncture can improve mood, decrease pain and can be vastly beneficial in managing pain and mental health symptoms.
Ask for help
“Everyone is having pelvic pain and no one is talking about it”
Start with seeing your gynecologist who you trust for a history and examination of current symptoms to rule out any other medical conditions that could be a contributing factor to symptoms.
How to talk to your partner about this in a safe/healthy way
Being open with your partner about your symptoms and painful sex may seem like a difficult conversation. Intercourse should never be painful and learning when to stay ‘stop’ is important in communication. Talking about pain before, during and after sex is important also in your own health diagnosis to see if pain symptoms are improving or becoming worse. Having open communication does not only benefit your relationship but most importantly, your own health.
To experience these symptoms may seem taboo or unheard of but quite frankly, they are common in many women. Women deserve to be directed to proper healthcare.
Disclaimer: These are based on recommendations from a board-certified chiropractic physician and licensed acupuncturist. If symptoms become new or worse, consult with a primary care physician and or OBGYN to co-manage symptoms.
Reference: Tayyeb M, Gupta V. Dyspareunia. [Updated 2022 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562159/
Photo by anushkaniroshan stock photo ID: 2071991336
Mental health is quite the subject these days, its troubles affect everyone; it knows no gender, orientation, race — it strikes upon one’s inner journey. But specifically, what have not been put in the same sentence are men, mental health and vulnerability. Too often it is seen that men are not allowed to show their emotions. But the aftermath shows that this repression of emotions bleeds into relationships, substance abuse, domestic violence, and more. It is seen time and time again in films, books, art — it’s all too familiar.
And it is beyond the point of “let’s talk about it.”
Time for action.
Mental health hits close to home for me. As a filmmaker, I will always share my journey with others. – Jacquile Singh Kambo
Men, mental health and vulnerability often aren’t talked about enough. “Embrace” is a short film that seeks to change that. It is a short animated film about Arty, a well-dressed man who has no face, gets ready for his date until he meets a younger version of himself. Arty and this younger version of himself delve into a surreal world where he learns to embrace himself. It’s him versus himself.
The façade self; the feeling of wanting to be somebody — are all things people are dealing with especially in adult life. From the dating world to the social media world — it feels like different masks are worn only to make us feel faceless, feel numb or a nobody. Too many masks could make people feel like a lost identity amidst everything that is going on in this crazy world. Out of touch, and out of life — with others and with themselves. The masks are metaphorical, the story is internally about men and mental health. Arty learns to ’embrace’ himself and to overcome his internal struggles.
Not often is it discussed that men should have a safe environment to be vulnerable, amongst others or even other men. Perhaps this is because men are wired to put on a façade when things go wrong, when things get difficult, or when true emotions are not expressed. If these are not dealt with, it can lead to other relationships, including romantic relationships. Further it becomes a cycle: suppression could lead to aggression, substance abuse or self-sabotaging behaviors and could create a toxic environment. Many of these arise from childhood trauma. Quite often childhood is repressed or ignored, and one may take their troubles along with them into adulthood. Perhaps revisiting the roots of the past can help one become successful in a better tomorrow. “Embrace” is an example of how important it is for men to embrace their past.
“Embrace” was meant to be a live-action film — until animation was considered. Seven years of re-writing, re-working, and digging down deep with the characters for the story to better fit the message at its core. Animation is an underrated avenue for a universal story that became the key pillar for “Embrace”. What many do not know about animation is that you can create a serious subject matter in a light-hearted way that is universally acceptable. Men and mental health are heavy subjects for some, but animation allows the exploration to become innovative, creative and fun. Animation allows the experimentation of entering surreal worlds.
For example, in “Embrace” Arty enters a surreal world where he has to go up against a younger version of himself — to unmask the root cause of his internal struggles and give himself the “big hug” he needs. This heart-throbbing metaphor is captured in animation that a live-action film couldn’t have captured. The freedom of animation helps tackle tough subject matters about self-love, and how we must embrace the soul, the child, the person within.
The Story Behind The Story
There are many inspirations behind “Embrace”. Film noir, the silent film era, surrealism and the works of Christopher Nolan and David Lynch — the film is able to articulate something far more special. This is more than just a mental health piece for educational purposes. This is a classical narrative from beginning to end; a story of important themes and beloved characters that needed to be shared with the world.
It is not often the words mental health and men and vulnerability are discussed under the same umbrella — especially with growing hypermasculinity, and the likes of social media where facades are put up and the vulnerable parts of ourselves aren’t as expressed. It is here where the film encourages men to look within themselves, and allows them to be vulnerable to themselves. Perhaps this is an important step to better themselves on the journey to have successes (whatever success means to them), and to enlighten and lift those around them. The first step should always begin with “you.”
It’s tough to find places where men have access in ways of improving their mental health without feeling like a patient or a victim in the institutionalized realm. It’s tough to find places where men can talk to other men about their struggles among peer groups, educational groups, and more.
The “Let’s Talk” phase and awareness is long overdue; it is indeed time for action. Perhaps creating seminars or group-related events and activities to help create vulnerable environments. Art or art therapy can be a great way of producing something stemming from the inner journey. Or maybe it is time to look at “sick days” as “mental health days” as well. Perhaps more can be done to simply just talk about it. It’s time to give ‘doing’ a chance to start in our close-knit communities.
Maybe if one learns to ’embrace’ themselves, only then, perhaps one can fully understand others and their pain — and have the vision of empathy for others. “Embrace” took seven years to write and a year of animation for a four-and-a-half-minute short film. The film is about self-love, embracing one’s self before one can see empathy for others. It is produced by Raman K Fenty and Jayesh Kodwani and his team, directed and written by Jacquile Singh Kambo, co- written by Sidartha Murjani and stars Jenna Berman. “Embrace” has received numerous international accolades including Best Audience choice at the Emerging Lens Cultural Film Festival of Halifax, Nova Scotia, as well as acceptances in hometown Vancouver, Canada; Goa, India and Chicago, United States.
If you are struggling with your mental health, please call your regional crisis hotline. These are a few non-crisis mental health resources for men’s mental health.
