– BY ANNA BALMER –
Around 26% of the global population menstruate. Every month. For 2 to 7 days. At any given time, 800 million people worldwide are menstruating (UNICEF, 2020). It’s perfectly healthy and normal. It’s okay to menstruate. As long as you never talk about it and no one knows that you’re doing it.
All around the world girls, women*, transgender, and intersex people suffer from the stigma of menstruation. The word stigma referring to any stain or mark that renders the individual’s body or character defective (Erving, 1963).
Menstruation is a source of social stigma and menstrual blood is a stigmatised substance. Why is a mundane process of nature so shocking given that so many of us experience the menses and manage this every month for decades of our lives? Why does menstruation, a benign process essential to the production of human life evoke fear, disgust, and comparison to toxic waste? (Johnston-Robledo & Chrisler, 2013).
*I’d like to note that whilst I do regularly refer to women throughout this essay, as this is who the vast majority of research and evidence base surrounding periods exists in relation to, I’m aware that periods are far more inclusive than one gender. When possible, I have not been gender specific.
Maybe we’re dirty
Menstrual rituals and hygiene practices imply that like other bodily fluids menstrual blood is considered an abomination (Rozin & Fallon, 1987; Johnston-Robledo & Chrisler, 2013).
In most cultures period blood and anyone who is menstruating is believed to be unclean. Why anyone decided to refer to either as unclean we don’t know. Most religions, except Sikhism, refer to women as ‘ritually unclean’ throughout their periods (Bhartiya, 2013). Religious laws mainly include the prohibition of contact with menstruating women and the need for a ritual bath before they are ritually clean and can resume physical contact with others (Bhartiya, 2013). For a long time, menstruation was seen by many as the body’s natural way of discarding excess blood- too much or too little of which could cause a vast array of ‘women’s diseases’ perhaps reflecting this idea of imbalance, or impurity. Even reminders of menstrual blood can lead to avoidance and social distancing (Roberts, Goldenberg, Power, & Pyszczynski, 2002) suggesting that menstrual stains/blood may serve as a blemish on a person’s character (Johnston-Robledo & Chrisler, 2013)
Lee (1994) found that 75% of young women she interviewed had experienced or were afraid of experiencing leaks during their period and concluded that visible signs of menstruation represent emblems of contamination. Even as late as the 1940s scientists were trying to demonstrate that menstruating women exuded poisonous elements (menotoxins) in their period blood, saliva, urine, and tears. Given the lack of discussion about periods due to their taboo status, the naïve and primitive idea that periods and people who menstruate are unclean and a contaminant perpetuates the narrative surrounding menstruation.
Science can be biased by the cultural conditioning of those who perform it and those who tell it. The people who studied the menotoxin really wanted to believe in it to the point that they would ignore negative results and overstate the power of their anecdotes and case studies (Clancy, 2011). It’s so important to recognise that many ideas which seem intuitive to us derive from cultural conditioning and bias and that these ideas must be questioned. Whilst menstrual blood is different from normal blood due to its composition and its physical properties it is certainly not dirty, never mind toxic. It is blood and tissue that you ended up not using to feed a baby and that’s all (Clancy, 2011).
Maybe we’re not just dirty, but also crazy
Until the early 20th century there was no precise medical explanation for periods. Instead, a long history of taboo and imaginative diagnosis informed medical definitions and rarely aligned with women’s lived experience. They also reflected beliefs about not only the physical but the mental disorder of women. Misconceptions brush-stroked menstruating women as ill, disabled, out of control, unfeminine and even ‘crazy’ (Johnston-Robledo & Chrisler, 2013). These misconceptions have not ceased.
One of the first guides for girls that addressed menstruation was written by Emma E. Walker in 1905; ‘Beauty through Hygiene: common sense ways to health for girls’. This offered us advice to “keep a tighter grip on your self-control during the periodic illness” and that “too much care cannot be taken to keep yourself sweet and dainty”. Whilst the latter sounds ridiculous, it is not altogether dissimilar with expectations today. Popular culture regularly depicts women as out of control and likely, at any moment to become verbally abusive or violent at any given moment. This preconception reinforces the long outdated notion that menstruation is aversive. Besides the threat of discovery there is the more modern threat of the erratic premenstrual women (Chrisler, 1996; Chrisler & Caplan, 2002).
Believe it or not someone having PMS is a modern threat with an interesting backstory. In 1981 two women in England on trial for murder received lesser convictions because Dr. Katharina Dolton testified that they had ‘premenstrual syndrome’ (PMS) (Chrisler, 2011). Prior to that PMS was a little known phenomenon. Most people coped with premenstrual signs and symptoms and considered them, if they considered them at all, to be part of the ups and downs of life (Chrisler, 2011). Most of us still do exactly this today. Unfortunately the trials resulted in an explosion of media interest in PMS which led to the current belief that most of us are ill several days prior to our menses. PMS was referred to in popular culture like a ‘menstrual monster’ turning people into Jekyll and Hyde (Chrisler & Caplan, 2002; Chrisler & Levy, 1990).
The thing about PMS
First things first; premenstrual symptoms are not technically part of the menses. They are defined as resolving when menstruation begins. However it seems that the threat of the menstruating and premenstrual person has merged into one stereotype of someone who is moody and possibly dangerous. Recent studies of attitudes toward women indicate that premenstrual women are now described in similar ways, e.g. angry, tense, irritable and changeable (Chrisler, Gorman, Marván, & Johnston-Robledo, 2010; Forbes, Adams-Curtis, White, & Holmgren, 2003; Marván, Islas, Vela, Chrisler, & Warren, 2008).
Another important thing to know is that not all women have PMS. The myth that all women have PMS comes from the popular mistake to attribute any symptoms occurring before the period directly to PMS. In truth dealing with premenstrual symptoms does not necessarily equate to PMS. Symptoms do not equal syndrome.
Premenstrual syndrome is a diagnosis of multiple premenstrual symptoms that have a significant negative effect on a person’s life. Premenstrual symptoms of low to moderate intensity that do not have a significant negative effect on a person’s life are not considered PMS from a medical perspective. Scientific reports can be confusing and inconclusive in reporting the percentage of women actually affected by PMS and often referring vaguely to ‘some sort of PMS’ (Kennelly, 2015). Many individuals who report having ‘some sort of PMS’ are actually experiencing premenstrual symptoms.
A headache happening a few days before a person’s period every cycle may not have a significant negative impact on their day to day functioning and therefore may just constitute a mild premenstrual symptom. However a recurrent experience of depression, insomnia and extreme fatigue may significantly impact someone’s wellbeing and therefore meet the criteria for PMS. PMS is not mental illness, nor contrary to what pop culture would have you believe does it affect all or even most women (Kennelly, 2015).
It is important for us to learn that menstrual cramps and premenstrual changes in affect (feelings and emotions), water retention, acne, and are experiences are normal- unless they are severe. Most people are so used to the term ‘PMS’ that they don’t even realise the ‘s’ stands for syndrome and that it is a medical disorder. It is not good for anyone’s psychology or social status to refer to themselves as ill or disordered due to their hormonal cycle, when they are actually normal and healthy. To explain behaviour by hormones is a gross and damaging oversimplification that says we have no control over our own actions. Perhaps they are hormonal, but all humans male or female or other, have hormonal cycles. We are all hormonal.
Hormones are a crucial reason we’ve survived and thrived. For most people who have periods, our biology and hormones have been politicised to suggest that they make us different, out of control, erratic, incapable and irresponsible and so it becomes very difficult to untangle this myth from reality. The reality is that we are all hormonal and hormones influence all of our behaviour as we are at once biological, psychological and social beings. But we are not a victim of our hormones (Haselton, 2018).
‘It is easy to see that adults we know – from CEO’s to brain surgeons – rarely lay down, slow down or otherwise change their usual activities or behaviours during the premenstrual or menstrual phases of their cycles’
In fact to think that periods make us physically or mentally incapacitated defies logic. It is easy to see that adults we know – from CEO’s to brain surgeons – rarely lay down, slow down or otherwise change their usual activities or behaviours during the premenstrual or menstrual phases of their cycles. Whether someone is premenstrual or menstruating usually isn’t apparent at all. Think of just how many people per day we come into contact with, at work, and in public spaces; can you tell what stage of their reproductive cycle they’re in? Of course not. We see people give award winning performances, train for and win Olympic medals, go to space, perform organ transplants, make scientific breakthroughs and we do not wonder or notice whether they were on their period.
The typical perception is that if you have PMS you become a bloated emotional mess for a few days a month. This may be accurate for some, and this is okay, but there is much more to PMS that this stereotype. PMS is now a cultural catch all for everything from eating a whole tub of ice-cream to discrediting women in places of power (Kennelly, 2015). PMS is given unfounded weight to validate certain behaviours and make people victims of their biology. In reality the premenstrual experience ranges from person to person dramatically and can range from mild complaints to near debilitating symptoms (Kennelly, 2015). PMS is one of the biggest misconstructions about the menstrual cycle. It is important to be clear about what we mean when we say PMS.
Hide it, hide it at all costs
The self-monitoring and self-policing that goes on surrounding periods to hide their existence from the world is frankly a waste of time and energy that could be spent on more interesting pursuits. However, if this is what people are lead to think about periods it’s not surprising that we try to conceal it at all costs rather than openly acknowledging them and talking about them.
Most people have probably never been told that periods are stigmatised but their reactions suggest that they ‘know it’ (Johnston-Robledo & Chrisler, 2013). The stigma surrounding menstruation is conveyed to us every day via various sociocultural routes. Negative attitudes toward menstruation and cultural beliefs about periods and everyone who has them are transmitted through products and media, such as adverts, magazine articles, books, television- and we see these every day.
Adverts play an important role in the social construction of meaning, with period product ads contributing to the communication taboo by emphasizing secrecy, avoidance of embarrassment and freshness. This is clear in the allegorical images of flowers and hearts, the blue liquid to illustrate its functionality rather than realistic red or brown, and zero evidence of these products in use of having been used. Adverts emphasise fear of being discovered because discovery means stigma (Coutts and Berg, 1993; Merskin, 1999; Chrisler, 2011).
‘When it’s indicated that a women is premenstrual or menstruating she is rated as less likable and less competent’
Ruptures in concealment of menstrual status leads to social distancing and negative perceptions. Forbes, Adams-Curtis, White, & Holmgren (2003) found that both male and female college students rated a menstruating women as less sexy, more impure, and more irritable than women in general. When it’s indicated that a women is premenstrual or menstruating she is rated as less likable and less competent (Ussher, 2004; Roberts et al. 2002; Marván, 2008).
Kowalski and Chapple (2000) investigated the consequences of the social stigma of menstruation on women’s impression management behaviour. They assigned women to be “interviewed” by a male confederate. 50% of these women were on their period at the time, 50% were not. The male “interviewer” was made aware of the menstrual status of 50% of the women in each group. Those on their period, interviewed by the man aware of this believed that they had made a more negative impression on him than the other women thought they had. They were also less concerned about making a positive impression on him than the women in the other groups.
Roberts et al. (2002) primed menstrual status by instructing a research assistant to drop a tampon or hairclip where study participants could see her. Both male and female participants in the tampon condition rated the assistant as less competent and likable than those in the hairclip condition. Those who saw her drop the tampon also exhibited a tendency to sit farther away from her during data collection compared to those who saw her drop the hairclip.
‘Just search ‘Hilary Clinton and PMS’ and see what comes up’
Chrisler (2011) suggests that to bring this stigma out of the lab and into the real world just search ‘Hilary Clinton and PMS’ and see what comes up, or perhaps consider Gordon Liddy’s radio comment about then Supreme Court Nominee Sonia Sotomayor: “Let’s hope that the key conferences aren’t when she’s menstruating or something, or just before she’s going to menstruate. That would really be bad. Lord knows what we would get then!” (“Liddy Worried About Sotomayor,” 2009; Chrisler, 2011). It is worth noting that neither of these women still have periods, but the threat of a women in a position of power can cause mind-blowing emotional reactions.
Finally, menstrual stigma is perpetuated indirectly through silence and it is typically avoided in conversation except under certain circumstances, e.g. with close friends and relatives, in health education or biology lesson, the doctors. When the classic first talk about puberty happens in school and girls and boys are separated to watch videos or when facts of life talks are one-to-one and private- this conveys not only facts but guidelines for communication about periods as being a secretive topic and not one for ordinary conversation (Johnston-Robledo & Chrisler, 2013). Exclusive talks held in private convey the notion that menstruation is an embarrassing event that must be concealed from others and never discussed openly (Johnston-Robledo & Chrisler, 2013). This communication taboo is only supported further by the existence of so many menstruation euphemisms, I’m sure we could all name a few.
So what? And what now?
The menstrual cycle is a perfect example of a biopsychosocial process; it is a normal aspect of physiology that both affects and is affected by behaviour. Our periods occur, our beliefs about them are learned and our attitudes towards them are formed within a cultural context. So, although around 26% of the global population share this same process of having their period, we experience it differently and these differences are caused for the most part by sociocultural effects on our beliefs, attitudes and behaviour (Chrisler, 2008).
Teaching basic facts about the menstrual cycle is a chance to fill in the blanks in what we know about our bodies, correct myths and misinformation we have learned, and show the power of culture and social cognition on something as basic as a physiological process (Johnston-Robledo & Chrisler, 2013). If we’re not progressive about how we view periods we leave ourselves and others behind. How can we be truly comfortable in and accepting of our own body and be accepted in our own society and culture if we have to keep something our body does almost every single month for decades a secret? If we keep being told that something perfectly natural our body does is dirty, incapacitating, and unmentionable?
I’m not suggesting that periods must be romanticized, or that they’re central to anyone’s identity but the stigma around them does limit our behaviour and compromise our self-esteem, self-perception, and our wellbeing. We can all alleviate these negative consequences. Simply talking about periods can create more positive attitudes (Culpepper, 2002), and if discussed openly it is far easier to challenge others when they make incorrect or stigmatising assumptions. Analyse menstruation in popular culture and question things that reinforce and perpetuate stigmatizing and inaccurate messages.
Start the conversation early and make it open. From a young age boys and girls can be prevented from thinking of periods as a taboo subject. Yes, boys too; we can’t eradicate the stigma without men and boys taking part in the conversation. It’s something they can, and should, know about too. Education should be clear and not held back by the stigma surrounding the subject and educators and healthcare providers can help by changing the language to use to talk about periods- they are perfectly natural and normal and should no longer be treated as a bloody secret. Being told to stay silent about periods is a healthcare issue too; periods can be a vital sign of overall health and an open dialogue must be encouraged between healthcare providers and patients.
More research is needed on how menstrual status may impact people across all genders and sexualities; it’s quite obvious that most research I’ve cited was carried out on biological females, all of whom identified as women. But there’s lots of other people out there who have periods too, what’s their experience like?
‘How can we best help women dying in period huts in Nepal, if we are avoidant of even the word ‘period’ ourselves?’
Finally, by tackling our own detrimental ideas about periods we can better help those suffering enormously due to period stigma around the world; how can we best help women dying in period huts in Nepal, if we are avoidant of even the word ‘period’ ourselves?
To conclude: periods are not dirty, they do not make us cognitively or emotionally incapacitated and it is damaging to think this is the case. Secrecy and silence doesn’t help anyone who menstruates. Talk about them, teach about them, think about them and be open and honest about them. Often the only way to change how we feel about something is to stop and reflect about why we even have these feelings about it at all and what underlying beliefs these feelings come from. Stigmas, although they can be very prevalent and damaging often come from the most absurd incorrect or outdated assumptions. After even the tiniest unpicking it’s clear that period stigma was, and always has been, null and void, if not also ill-intended.
The societies we live in have lots of suggestions about how we should think and feel about periods and ourselves but they do not have the final say in this. We do. We can question and choose wisely our own beliefs and by doing so leverage necessary change. This can be challenging, as it is challenging to face any stigma and consciously challenge ourselves and others; in this sense the stigma surrounding periods seems almost too great to change. However that is not to say that change won’t happen or that it is too late, too far, or too much and that this cannot be done. Only we can decide that.
About the author Anna Balmer is an assistant psychologist and research assistant in Liverpool. You can follow her via Twitter.
We finally need to talk about periods at work, by Katharina Eggert
The case for menstrual leave, by Rathi R
Pure or impure? Contesting the menstrual taboo, by Yasmin Soni
If Men Could Menstruate
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