1
|
Casola AR, Medley L, Kunes BC, McGlone N, Silverio A. "It shouldn't be just hush-hush": A qualitative community-based study of menstrual health communication among women in Philadelphia. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024. [PMID: 39073267 DOI: 10.1111/psrh.12277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community. METHODOLOGY In partnership with No More Secrets (NMS), a Philadelphia menstrual health non-profit, we conducted a community-based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18-45 recruited from NMS' catchment in Philadelphia participated in semi-structured interviews about their menstrual experiences and communication (N = 20). A deductive, theory-driven approached based on the social-ecological model was used to analyze the data. RESULTS Varying emotional responses arose across social-ecological levels: communication was awkward and simplistic with family; positive and supportive with friends and community members; and uncomfortable and frustrating with healthcare providers. Participants echoed the importance of menstrual communication as a means of sharing information, feeling less alone, and decreasing menstrual stigma. DISCUSSION Findings can inform future CBPR workshops that address stigma in familial, healthcare, and community-based discussions to improve menstrual health and experiences for cisgender girls and women, transgender men, and gender non-binary individuals who menstruate.
Collapse
Affiliation(s)
- Allison R Casola
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lynette Medley
- No More Secrets Mind Body Spirit Inc., Philadelphia, Pennsylvania, USA
| | - Brianna C Kunes
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nya McGlone
- No More Secrets Mind Body Spirit Inc., Philadelphia, Pennsylvania, USA
| | - Alexis Silverio
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
2
|
Orellana M, DSouza KN, Yap JQ, Sriganeshan A, Jones ME, Johnson C, Allyse M, Venable S, Stewart EA, Enders F, Balls-Berry JE. "In our community, we normalize pain": discussions around menstruation and uterine fibroids with Black women and Latinas. BMC Womens Health 2024; 24:233. [PMID: 38610011 PMCID: PMC11010402 DOI: 10.1186/s12905-024-03008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Uterine fibroids are non-cancerous neoplasms that arise from the uterus affecting over 75% of women. However, there is a disparity with Black women having an increased prevalence of nearly 80%. Black women also experience increased symptom burden, including younger age at the time of diagnosis and increased number and volume of fibroids. Less is known about other ethnoracially diverse women such as Latinas and the potential cultural impacts on fibroid burden and treatment. METHODS Community engagement studios were conducted to facilitate discussions with stakeholders on their uterine fibroid and menstruation experience. We recruited Black women (n = 6) diagnosed with uterine fibroids and Latinas (n = 7) without uterine fibroids. We held two virtual community engagement studios split by uterine fibroid diagnosis. The studios were not audio recorded and notes were taken by four notetakers. The notes were thematically analyzed in Atlas.ti using content analysis. RESULTS Participants felt there was a lack of discussion around menstruation overall, whether in the home or school settings. This lack of menstruation education was pronounced when participants had their first menstruation experience, with many unaware of what to expect. This silence around menstruation led to a normalization of painful menstruation symptoms. When it came to different treatment options for uterine fibroids, some women wanted to explore alternative treatments but were dismissed by their healthcare providers. Many participants advocated for having discussions with their healthcare provider about life goals to discuss different treatment options for their uterine fibroids. CONCLUSION Despite uterine fibroid diagnosis, there is silence around menstruation. Menstruation is a normal biological occurrence and needs to be discussed to help prevent delayed diagnosis of uterine fibroids and possibly other gynecological disorders. Along with increased discussions around menstruation, further discussion is needed between healthcare providers and uterine fibroid patients to explore appropriate treatment options.
Collapse
Affiliation(s)
- Minerva Orellana
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Karen N DSouza
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Jane Q Yap
- Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - M Elena Jones
- Department of Neurology, Washington University School of Medicine, 4488 Forest Park, St. Louis, MO, 63108, USA
| | - Charis Johnson
- Department of Neurology, Washington University School of Medicine, 4488 Forest Park, St. Louis, MO, 63108, USA
| | - Megan Allyse
- Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Program in Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | | | - Elizabeth A Stewart
- Division of Reproductive Endocrinology, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Felicity Enders
- Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic College of Medicine & Science, Rochester, MN, USA
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Joyce E Balls-Berry
- Department of Neurology, Washington University School of Medicine, 4488 Forest Park, St. Louis, MO, 63108, USA.
| |
Collapse
|
3
|
Casola AR, Renaud A, Mulki AK. Discussing menstrual health in family medicine. Fam Med Community Health 2024; 12:e002149. [PMID: 38599789 PMCID: PMC11015204 DOI: 10.1136/fmch-2023-002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024] Open
Affiliation(s)
- Allison R Casola
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Alice Renaud
- Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Ashwini Kamath Mulki
- Lehigh Valley Health Network, Allentown, Pennsylvania, USA
- Valley Health Partners Family Health Center, Allentown, Pennsylvania, USA
| |
Collapse
|
4
|
Casola AR, Pando O, Medley L, Kunes B, McGlone N, Rea O. Examining menstrual health experiences in Philadelphia, PA: A qualitative investigation. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241251975. [PMID: 38738597 PMCID: PMC11092546 DOI: 10.1177/17455057241251975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND While menstruation is a physiologic process, it remains highly stigmatized. Despite the sheer number of menstruators, menstruation is a highly individualized experience, with wide variation in duration, symptoms, and management. This wide variability lends itself to large disparities in access to menstruation management products and subsequently the lived experience of menstruators. OBJECTIVES The research team sought to understand lived menstrual experiences, symptoms, management tactics, and commonly used and desired resources among 20 cisgendered women aged 18-45 years in Philadelphia. DESIGN This project was a qualitative research study. METHODS We used a collaborative, community-based participatory research approach with No More Secrets, a Philadelphia-based grassroots sexuality awareness and menstrual health hub. Semi-structured telephone interviews were used to gain insight into general menstruation-related experiences, communication, worries, and concerns, with subsequent thematic analysis via Key Words in Context approach. RESULTS Four themes emerged following analysis: cycle characteristics, menstruation management, coping resources, and future resources. Participants largely spoke about their menses as a negative experience, asked for more comprehensive, verified sources of information and needed greater access to menstrual management supplies. CONCLUSION Menstruation is a highly individualized experience with a large variety in knowledge, menstrual product use, and individual needs. Despite the individuality of menstruation, our community-based research shows that there is a dire need for interventions that promotes knowledge and access to menstrual care.
Collapse
Affiliation(s)
- Allison R Casola
- Department of Family & Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Oriana Pando
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lynette Medley
- No More Secrets Mind Body Spirit Inc., Philadelphia, PA, USA
| | - Brianna Kunes
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nya McGlone
- No More Secrets Mind Body Spirit Inc., Philadelphia, PA, USA
| | - Olivia Rea
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
5
|
Miller TA, Farley M, Reji J, Obeidi Y, Kelley V, Herbert M. Understanding period poverty and stigma: Highlighting the need for improved public health initiatives and provider awareness. J Am Pharm Assoc (2003) 2024; 64:218-221. [PMID: 37863396 DOI: 10.1016/j.japh.2023.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023]
Abstract
Period poverty affects millions of people who menstruate, but there is limited research to fully understand the scope and impact. Societal stigmas and cultural taboos negatively affect menstruation, a natural, biologic process. When unable to afford or find appropriate menstrual products, individuals may resort to alternative, poorer quality items, which increase their risk of infections. In addition, lack of products may cause individuals to miss events and have negative emotions. Implicit sexism and gender inequality are notable through the high cost of essential period products. Uncomfortable environments prevent patients from openly discussing menstruation with health care providers, who may lack training to competently assess needs and address barriers. Period poverty is a public health issue that not only needs to be addressed by our health care providers but also through increased education in schools and changes in local and federal legislation. In this paper, we discuss the financial, physical, and mental health impacts of period poverty and describe our experience creating a period pantry at a free medical clinic.
Collapse
|
6
|
Casola AR, Rea O, Ho T. Family physicians and menstrual care: An analysis of CERA 2023. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241247799. [PMID: 38676375 PMCID: PMC11055483 DOI: 10.1177/17455057241247799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/15/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Menstrual health is an important indicator of overall health and has large impacts on quality of life. Despite number and impact, discussion of menstruation remains largely taboo within health care. Patients and physicians are not engaging in regular, meaningful discussions on menstruation. Family physicians, as primary care providers, can facilitate these important conversations. OBJECTIVES We sought to understand the profile of menstrual care providing family physicians and assessed physician comfort, knowledge, training, and perceived importance regarding menstrual care. DESIGN/METHODS This is a cross-sectional analysis of the 2022 Council of Academic Family Medicine Educational Research Alliance survey. The survey included actively practicing US physicians who are members of the Council of Academic Family Medicine organizations. Descriptive demographic statistics were calculated; chi-square tests were generated for menstrual care-specific items; logistic regression models were fit to determine the association between receiving formal menstrual care training, importance of physician training in menstrual care, and demographic factors. RESULTS Eighty-five percent of respondents report frequently providing menstrual care. Participants of younger age, or who had earned their degree more recently, were significantly more likely to provide frequent menstrual care. Respondents who earned their medical degree at an earlier year were significantly more likely to believe that physician training in menstrual care was of limited importance (OR = 1.02, 95% CI = 1.00, 1.03). CONCLUSIONS Our findings show that family physicians are providing menstrual care, despite non-uniform training, and recognize its importance to patients. By understanding physician profile and the care they provide, we can work toward comprehensive physician education in menstrual care and providing appropriate menstrual care to patients.
Collapse
Affiliation(s)
- Allison R Casola
- Department of Family & Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Olivia Rea
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tiffany Ho
- Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
7
|
Ramaiyer M, Lulseged B, Michel R, Ali F, Liang J, Borahay MA. Menstruation in the USA. CURR EPIDEMIOL REP 2023; 10:186-195. [PMID: 38275000 PMCID: PMC10810236 DOI: 10.1007/s40471-023-00333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 01/27/2024]
Abstract
Purpose of review Menstruation touches all spheres of human society, including psychology, education, business, policy, race, and religion. This narrative review aims to describe the relationship menstruation holds with these spaces. Recent findings First, menstruation plays many roles in psychology - premenstrual syndrome affects psychological wellbeing and in turn, psychological stress impacts menstruation. Functional hypothalamic amenorrhea can result when stress hormones inhibit the Hypothalamus-Pituitary-Ovarian axis. Furthermore, menstruation has many implications for all aged individuals, especially adolescents and those who are menopausal. These implications underscore the importance of proper education surrounding menstruation, which can be achieved via social media, school systems, family, and clinicians. However, menstrual health education is highly variable depending on the state and family that someone is raised in. Additionally, menstruation can pose a financial burden as menstrual products can be expensive and access to these products is limited for those who are homeless, incarcerated, and low-income. Recent public policy measures in various states have aimed to achieve "menstrual equity," by requiring public schools to supply free menstrual products in bathrooms. Furthermore, racial disparities exist with menstrual disorders. Uterine fibroids occur more frequently in Black menstruators compared to White menstruators, and Black women experience worse outcomes overall with fibroids and endometriosis management. Finally, analysis of religion and its relationship to menstruation underscores the immense stigma and "impurity" associated with menstruation. Summary Overall, this review highlights the universality of menstruation in society. As a "fifth vital sign", there is significant room for improvement in terms of education, research, and cultural acceptance of menstruation. Future research should explore interventions to reduce these gaps.
Collapse
Affiliation(s)
| | | | | | - Fiza Ali
- Johns Hopkins University, Krieger School of Arts and Sciences, Baltimore, MD
| | - Jinxiao Liang
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore MD
| | - Mostafa A. Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| |
Collapse
|
8
|
Casola AR, Luber K, Riley AH. Period Poverty: an Epidemiologic and Biopsychosocial Analysis. Health Promot Pract 2023:15248399231192998. [PMID: 37605547 DOI: 10.1177/15248399231192998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
In the United States, approximately one in five persons experience period poverty, defined as the inability to obtain resources needed for healthy, safe, and dignified menstrual management. Limited access to an inadequate number of menstrual supplies may lead to longer-than-recommended use, which can increase skin chafing, disruption of vaginal flora, and intravaginal toxin overgrowth. However, period poverty goes beyond simply having enough menstrual products and can encompass the embarrassment, stigma, shame, and barriers in conversation surrounding menstruation. Discussion and critical examination of the multilayered attributes surrounding period poverty have been intermittent in academic literature, particularly from a domestic lens. Thus, this narrative review and theoretical analysis aimed to describe the epidemiology of period poverty and analyze its biological, socio-emotional, and societal implications. We applied a descriptive epidemiology approach of person, place, and time, and employed a social-ecological lens to examine risk factors. Our findings describe the incidence, distribution, and possible ways to alleviate period poverty. Practitioners, medical providers, and public health professionals may have limited knowledge of period poverty, what it entails, and who it impacts, but they have great potential to address it and associated menstrual inequities in their work. With its widespread implications for psychosocial and community-level health, this phenomenon needs urgent attention to promote menstrual equity as an issue of human rights and social justice. We conclude with research and policy recommendations for alleviating period poverty.
Collapse
Affiliation(s)
| | - Kierstin Luber
- Thomas Jefferson University, Philadelphia, PA, USA
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | | |
Collapse
|
9
|
Casola AR, Luber K, Riley AH, Medley L. Menstrual Health: Taking Action Against Period Poverty. Am J Public Health 2022; 112:374-377. [PMID: 35196038 PMCID: PMC8887146 DOI: 10.2105/ajph.2021.306622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Allison R Casola
- Allison R. Casola is with the Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Kierstin Luber is with the Jefferson College of Population Health, Thomas Jefferson University, and the Philadelphia College of Osteopathic Medicine, Philadelphia. Amy Henderson Riley is with the Jefferson College of Population Health, Thomas Jefferson University. Lynette Medley is with No More Secrets: Mind Body Spirit Inc, Philadelphia
| | - Kierstin Luber
- Allison R. Casola is with the Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Kierstin Luber is with the Jefferson College of Population Health, Thomas Jefferson University, and the Philadelphia College of Osteopathic Medicine, Philadelphia. Amy Henderson Riley is with the Jefferson College of Population Health, Thomas Jefferson University. Lynette Medley is with No More Secrets: Mind Body Spirit Inc, Philadelphia
| | - Amy Henderson Riley
- Allison R. Casola is with the Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Kierstin Luber is with the Jefferson College of Population Health, Thomas Jefferson University, and the Philadelphia College of Osteopathic Medicine, Philadelphia. Amy Henderson Riley is with the Jefferson College of Population Health, Thomas Jefferson University. Lynette Medley is with No More Secrets: Mind Body Spirit Inc, Philadelphia
| | - Lynette Medley
- Allison R. Casola is with the Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA. Kierstin Luber is with the Jefferson College of Population Health, Thomas Jefferson University, and the Philadelphia College of Osteopathic Medicine, Philadelphia. Amy Henderson Riley is with the Jefferson College of Population Health, Thomas Jefferson University. Lynette Medley is with No More Secrets: Mind Body Spirit Inc, Philadelphia
| |
Collapse
|