Men and Menstruation: A Qualitative Exploration of Beliefs, Attitudes and Experiences

Young Men's Attitudes and Understanding of Menstruation

PURPOSE

To identify sources of information, perceptions, and potential misinformation about menstruation among college-aged men in the United States.

METHODS

This is a mixed-methods cross-sectional survey study of students in the United States. Inclusion criteria included participants aged 17-29 years, male gender identity, enrolled as an undergraduate or graduate student, and no personal history of menstruation.

RESULTS

This study included 70 participants. Almost half of all participants (42.9%) first learned about menstruation from family members. More than two-thirds of respondents felt that menstrual education was essential or very important for all genders. The most common symptoms noted to be associated with periods included cramping (93.6%), mood changes (80.9%), and vague "hormonal" changes (36.2%). When asked how a menstrual period might affect someone's ability to perform daily activities, one-third reported debilitating or very burdensome symptoms, whereas one-fifth felt periods do not have much impact.

DISCUSSION

Comprehensive education and accurate reproductive health knowledge are critical in combating gender bias and stigma. Most males surveyed agree that education on menstruation is important, yet the majority do not have or do not remember formal education on this topic, instead relying on family members and friends as learning tools and resources. Most participants identified negative symptoms associated with menstrual periods, especially mental health concerns including mood changes and irritability. This association with mood changes, as well as vague "hormonal fluctuations," contributes to the societal bias against people who menstruate by marking them as prone to emotional instability, thereby exacerbating gender prejudices. It is therefore critical that accurate menstrual education be widely available for everyone, regardless of gender.

Menstrual Products: Attitudes About Taxation and Safety

Background: This study explored factors associated with the differences between women and men in attitudes, norms, and the support of taxation of menstrual products (MPs) and menstrual-adjacent products. It also investigated the use of these products in women. Methods: Young adults from 18 to 30 years of age were recruited via social media, listserve emails, and flyers placed throughout a university campus. Following cognitive interviewing, a survey investigated attitudes, beliefs, and behaviors associated with MPs. Results: Individuals self-identified as men or women. Women (n = 154) had more positive general attitudes, less positive safety attitudes, and less support for taxation of MPs than men (n = 43). Regression analyses indicated that factors, such as race, age, attitudes, norms, and taxation, were associated with product use. Conclusions: Attitudes about safety and taxation differ for men and women. Tax policies and attitude-shifting interventions need to be tailored to their audience, and our study can inform that effort.

Period shaming behavior among male students in Luang Prabang Province, Lao People's Democratic Republic: A cross-sectional study

Period shaming is defined as any negative and/or disrespectful behavior in relation to the menstrual cycle and menstruating girls. It is suggested that period shaming may limit girls' potential and ability to fully participate in school and community activities. This study aims to examine the prevalence and factors associated with period shaming among male students in Luang Prabang Province, Lao People's Democratic Republic (Lao PDR). This was a cross-sectional study which was conducted during November 19-27, 2020. This study included 1,232 male students from secondary school grade 9 to 12 in Luang Prabang Province, Lao PDR. Informed consent was obtained from the participants, parents/guardians, and teachers prior to data collection. The data was collected by a self-administered questionnaire. Logistic regression was employed to examine factors associated with period shaming behavior among male students. The mean age of the participants was 16.4 years old. Of all the male students, 18.8% admitted that they had shamed girls during their menstruation at least once. Of those who committed period shaming, they shamed girls some of the times (63.2%). Male students who had consumed alcohol during the last month before the data collection day (AOR = 1.83, 95% CI 1.32-2.55, P<0.001), had heard of menstruation (AOR = 1.76, 95% CI 1.27-2.44, P<0.001), and those who had attended activities/classes about sexual reproductive health (AOR = 1.90, 95% CI 1.29-2.78, P<0.01), were significantly associated with period shaming behavior. In conclusion, a single focus on providing biological health education may not be enough to address menstrual stigmatization and taboos. The school curriculum should integrate other life skill education with reproductive health, such as respect and gender equality, to encourage behavioral changes among male students, to address menstrual stigma and to support and empower girls' menstrual health at school and in the community.

A Modified Menstrual Attitudes Scale: Heteronormative Attitudes, Sexism, and Attitudes Toward Menstruation in Male and Female Adults

Social shame and stigma surround menstruation, which may compromise women's health and rights in various contexts. Men's attitudes are particularly important because men often hold positions of power that influence women's experience. This study examined factors associated with menstrual attitudes, including heteronormative attitudes, sexism, and family influences. A cross-sectional Qualtrics panel survey (n = 802; aged 18-44; 50.8% female) was performed. We tested a revised menstrual attitudes scale based on items drawn from previously validated measures. Data were analyzed using a structural equation modeling framework. Factor analysis identified and confirmed a 5-factor model for menstrual attitudes. Men endorsed more negative attitudes toward menstruation than women; however, this difference was largely explained by factors other than gender in the structural equation model. After controlling for family and demographic characteristics, attitudes toward openness and secrecy surrounding menstruation were most strongly associated with gender role expectations and hostile sexism. Benevolent sexism was associated with finding menstruation debilitating, denying menstrual symptoms, and endorsing avoidance of activities during menstruation. Heteronormative and sexist attitudes were associated with more negative menstrual attitudes, while increased menstrual knowledge was associated with more positive menstrual attitudes. The difference in menstrual attitudes between males and females was explained largely by heteronormative attitudes and sexism. This suggests that attitudes toward menstruation are closely linked to social ideals about men and women.

Teacher Perceptions of and Experiences with Student Menstruation in the School Setting

BACKGROUND

Menstrual hygiene management is an important public health issue for adolescents. The objective of this study was to explore teacher perceptions and experiences addressing adolescent menstruation experiences at school and examine their perception of the impact of menstruation on student learning.

METHODS

Teachers in a Midwest school district participated in an online survey about their perceptions of adolescent school-based menstruation experiences, including: experience and comfort-level with providing menstruation assistance, presence of menstrual products in classroom/office for students, perceptions about adolescent school-based menstruation experiences, and perceptions on the impact of menstruation on student learning.

RESULTS

Two hundred and nine teachers participated in this study. Teachers perceived students' school-based menstruation experiences to be mostly negative, stressful, embarrassing, and focused on concealment. Teachers described school-based menstruation events as a distraction to learning and responded by offering emotional support and menstrual products, typically purchased by teachers.

CONCLUSION

Teachers' negative perception of about menstruation and distractions in the classroom are amplified by social norms associated with overall menstruation-related stigma. Findings emphasize the importance of educating teachers on how to more positively address student menstruation experiences to foster a more supportive environment conducive to learning for these students.

The persistent power of stigma: A critical review of policy initiatives to break the menstrual silence and advance menstrual literacy

Menstruation is shrouded in stigma and shame-that is the common refrain in burgeoning initiatives on menstrual health and hygiene. Public policies alone cannot undo stigma and enact social change, but they do interact with social norms. They can reflect and adopt stigmatizing attitudes and, as a result, institutionalize, formalize, and legitimize stigma; or they can actively challenge and denounce it and mitigate existing discrimination. Against this background, we explored whether and how policies on menstrual health and hygiene address menstrual stigma and advance menstrual literacy based on an analysis of 34 policy documents and 85 in-depth interviews with policy-makers and advocates in four countries: India, Kenya, Senegal, and the United States. We found that policies recognized menstrual stigma and set out to break the silence surrounding menstruation and advance menstrual education, but they did not contribute to dismantling menstrual stigma. Policy-makers seemed constrained by the very stigma they sought to tackle, resulting in hesitancy and missed opportunities. Policies raised awareness of menstruation, often with great noise, but they simultaneously called for hiding and concealing any actual, visible signs of menstruation and its embodied messiness. Educational initiatives mostly promoted bodily management and control, rather than agency and autonomy. As a result, policies might have succeeded in breaking the silence around menstruation, but stigma cannot be broken as easily. We first need to recognize its (invisible) power and its impacts in all spheres of life in order to actively challenge, dismantle, and redefine it.

Period teasing, stigma and knowledge: A survey of adolescent boys and girls in Northern Tanzania

Emerging evidence suggests that menstruation-related teasing is a common experience among adolescent girls with ramifications on their school participation, yet empirical evidence on the prevalence and determinants of period teasing in schools remain scarce. Menstrual hygiene research and policies almost exclusively focus on girls and women, leading to a dearth of knowledge of male attitudes. We conducted the first quantitative survey of period teasing in schools in sub-Saharan Africa, focusing on 432 male and 524 female students in four co-educational secondary schools in northern Tanzania. Period teasing is prevalent; 13% of girls have experienced period teasing, and more than 80% fear being teased, especially by male classmates. Girls’ fears are associated with insufficient menstrual hygiene management resources and practices. Girls cope by reducing school attendance, participation, and concentration in the classroom during periods. Boys engage in period teasing because they perceive periods as embarrassing, especially visible markers of periods (odor or stains). Social norms, such as peer behavior and home restrictions on menstruating women, are associated with more teasing. Boys believe it is strongly inappropriate for girls to reveal period status or to discuss periods with males, including male teachers. In contrast, boys are well informed about basic biological facts of menstruation (scoring 60% on a knowledge quiz, not statistically different from the girls) and have received information from school curricula and health workers. Lack of suitable menstrual hygiene practices and restrictive social norms is correlated with period teasing, which hinders gender equality in educational opportunities. Providing narrowly bio-medical focused education about menstruation may not be enough to reduce period teasing in contexts with period stigma.

Barriers to seeking consultation for abnormal uterine bleeding: systematic review of qualitative research

Background

Although Abnormal Uterine Bleeding (AUB) can have serious medical consequences and significantly impacts daily life, the overall trend is that most women do not seek care for these symptoms. The objective of this review was to synthesise factors impeding women’s access care for AUB.

Methods

Systematic literature review of qualitative studies (interview and focus group) regarding the lived in experiences of women with abnormal menstrual symptoms, followed by a thematic analysis of these studies. We screened CINAHL, SCOPUS, ProQuest, OVID and Pubmed for qualitative studies. Studies were assessed using the Clinical Appraisal Skills Programme checklist and thematic synthesis was used to develop themes from the findings of the studies.

Results

The review yielded 12 studies that satisfied the inclusion criteria. Three themes were developed that described barriers for women seeking care for AUB: health literacy (understanding of normal periods, role of cervical Pap smears and lack of access to appropriate information), taboo/normalisation (fear and embarrassment of symptoms, prioritising others) and health care provider (lack of accessible and trusted female GPs and poor experiences with GPs).

Conclusions

For 20 years women have consistently reported poor experiences in accessing care for AUB. The findings from our review indicate that drivers to impeding access are multiple; therefore any approaches to improve access will need to be multi-level – from comprising local sociocultural considerations to improved GP training.

Understanding menstruation: Influence of gender and ideological factors. A study of young people's social representations

This research investigates social representations of menstruation. It analyses firstly how young Spanish people understand menstruation in their everyday lives. And secondly, it explores how gender and ideological factors (liberal vs. conservative; feminist vs. non-feminist) impact on the meaning of menstruation and its implications for acceptance of this process. A free association exercise elicited by the word “menstruation” was answered by 250 people and the content was examined by lexical analysis. The results divided social representations of menstruation into two levels: firstly, a traditionalist level that is clearly linked to a negative stigmatized discourse about menstruation; and, secondly, a progressive level where two different discourses emerge, one representing liberal men and the other representing feminist women. The results show that only the feminist conception of menstruation provides an empowered and emotionally positive representation. The concept of menstruation is concluded to emerge from various sources of information, values and social conventions that are somewhat removed from its scientific meaning. The representation of menstruation is therefore understood to be situated within a social, ideological and emotional context. Accordingly, health education campaigns should frame their discourse about menstruation within a feminist perspective as their point of departure, thereby increasing their effectiveness.

Assessing the Role of Caste/Ethnicity in Predicting Menstrual Knowledge, Attitudes, and Practices in Nepal

Menstruation is a natural, physiological process, but it can be a challenging experience for millions of women around the world. In Nepal, a geographically small yet diverse country of 125 caste/ethnic groups, understanding how caste/ethnicity impacts menstrual health is critical for developing context-specific interventions to improve women's health. A community-based, cross-sectional survey was conducted with 679 women and girls between the ages of 13-51 from the country's most populous castes/ethnic groups. Forty eight percent had high menstrual knowledge, 60% had positive menstrual attitudes, and 59% had positive menstrual practices. Caste/ethnicity was a significant predictor of menstrual knowledge and practices. The caste/ethnic groups Tarai/Madhesi/Other, Newar, Janajati, and Muslim all had statistically significant fewer odds of positive menstrual practices compared to Brahman/Chhetri (high caste groups), with Janajati (indigenous ethnic groups) having the poorest outcomes. Despite Nepal making impressive advances in health, certain caste/ethnic groups have fallen behind in terms of menstrual health outcomes. Consequently, blanket menstrual health programs may not be sufficient for improving menstrual knowledge and practices for all. Future programming should consider the use of local languages and context-specific content that incorporates indigenous beliefs, as well as cultivate partnerships with indigenous health organizations, and develop outcome indicators disaggregated by caste/ethnicity to ensure improved menstrual health for all.

Male perception about the inconveniences associated with monthly bleeding for their partner - an international survey

OBJECTIVE

To assess men's perceptions about monthly bleeding and associated inconveniences for their partner, as well as men's attitudes regarding the desired menstruation frequency for their partner and knowledge about hormonal contraceptives.

METHODS

A 15 min quantitative online survey was conducted among 5044 men aged 18-45 years, who had been in a relationship for more than 6 months, across 13 European countries (Austria, Belgium, Czech Republic, France, Germany, Hungary, Italy, Latvia, The Netherlands, Poland, Portugal, Spain and Switzerland). Responses were compared to those obtained in a similar study among European women.

RESULTS

Most men perceived that their partner considered her menstrual flow as moderate, lasting an average of 5.2 d, slightly longer than previously reported by women. Almost all men reported that their partners experience menstruation-related symptoms. However, prevalence of mood-related symptoms was perceived to be more frequent and physical symptoms less frequent, relative to women's self-reported symptoms. Given the option, 71% of men would choose longer intervals between their partner's periods. Maintaining the couple's sex life, social life and relationship quality were key factors cited in their preference. Overall, 42% of respondents stated that women taking hormonal contraceptives needed to have monthly periods.

CONCLUSIONS

Men's perception regarding their partner's periods was generally consistent with that previously reported by women. Most men would prefer less frequent bleeding episodes for their partners. Although, the present data suggest that couples are discussing periods, knowledge about contraception could be improved. Health care professionals should intensify counselling to better inform both partners about their contraceptive options.