Menstrual attitudes in adult women: A cross-sectional study on the association with menstruation factors, contraceptive use, genital self-image, and sexual openness

BACKGROUND

Menstruation is a central part of the everyday life of most women, and menstrual attitudes may impact health and well-being.

OBJECTIVES

This article aimed to map menstrual attitudes among adult women and examine factors associated with these attitudes, such as aspects of menarche and current menstruation, and rarely studied factors, such as genital self-image and sexual openness.

STUDY DESIGN

A cross-sectional online survey.

METHOD

A sample of 1470 women, aged 18-50 years, were recruited through social media sites. The Menstrual Self-Evaluation Scale was used to measure three different attitudes: menstruation as natural, shameful, and bothersome. Multiple linear regression analysis was used to investigate the relationship between each attitude and factors related to menarche and current menstruation, contraceptive use, genital self-image (assessed by Female Genital Self-Image Scale), and sexual openness (Personal Comfort with Sexuality Scale). Sociodemographic variables were included into the models as covariates.

RESULTS

Agreeing with the attitude of menstruation as something natural was predicted primarily by positive emotions at menarche, experiencing less menstrual pain, using no or nonhormonal contraception, and having a positive genital self-image. Perceiving menstruation as bothersome was predicted by a lower educational level, experiencing stronger menstrual pain, having more perimenstrual psychological symptoms, and using hormonal contraceptives. Menstruation as something shameful was chiefly predicted by lower sexual openness and a negative genital self-image.

CONCLUSION

Many women held attitudes about menstruation as both something natural and bothersome. Menarche and current menstruation experiences, and contraceptive method, played central roles in shaping attitudes toward menstruation as natural and bothersome. Viewing menstruation as shameful stood out from other attitudes by indicating a triad of self-objectified shame that includes menstruation, sexuality, and genital self-image. Further research into the relationships between menstruation, contraceptive use, sexuality, and body image is needed to enhance our understanding of women's menstrual health.

Understanding how young cisgender heterosexual men navigate sexual health conversations and practices during casual sex: a qualitative study

BACKGROUND

Young cisgender heterosexual men in Australia are the least likely population group to undergo testing for sexually transmissible infections (STI) and ensuring barrier method use during casual sex with cisgender women who have sex with men, with rates of STIs increasing among this group. This research examines how these men navigate sexual health conversations and practices during casual sexual encounters.

METHODS

A total of 30 semi-structured interviews with young cisgender heterosexual men living in Australia during 2021 were conducted. Participants were asked questions about their dating and sexual practices, including sexual health knowledge, how they learned to have sex, and navigating sexual health conversations with partners, such as STI testing, and barrier method and hormonal contraceptive use. Findings were analysed using reflexive thematic analysis techniques.

RESULTS

Findings note that men use various strategies of avoidance including sustaining the erotic moment, and assuming women's responsibility. Participants also noted limited relationality, in which they highlighted individualised concerns for their own sexual health wellbeing but not that of their partners.

CONCLUSIONS

This research highlights that despite increased awareness and promotion of STI prevention and contraceptive responsibility, young cisgender heterosexual men continue to forego their responsibilities regarding their own and other's sexual health during casual sexual encounters. Findings highlight a need to include gender transformative approaches to sexual health promotion and practice to address continuing gender inequities.

Experiences of menstruation in high income countries: A systematic review, qualitative evidence synthesis and comparison to low- and middle-income countries

BACKGROUND

There is growing recognition of the importance of menstruation in achieving health, education, and gender equality for all. New policies in high income countries (HICs) have responded to anecdotal evidence that many struggle to meet their menstrual health needs. Qualitative research has explored lived experiences of menstruating in HICs and can contribute to designing intervention approaches. To inform the growing policy attention to support people who menstruate, here we review and synthesise the existing research.

METHODS AND FINDINGS

Primary, qualitative studies capturing experiences of menstruation in HICs were eligible for inclusion. Systematic database and hand searching identified 11485 records. Following screening and quality appraisal using the EPPI-Centre checklist, 104 studies (120 publications) detailing the menstrual experiences of over 3800 individuals across sixteen countries were included. We used the integrated model of menstrual experiences developed from studies in low- and middle-income countries (LMICs) as a starting framework and deductively and inductively identified antecedents contributing to menstrual experiences; menstrual experiences themselves and impacts of menstrual experiences. Included studies described consistent themes and relationships that fit well with the LMIC integrated model, with modifications to themes and model pathways identified through our analysis. The socio-cultural context heavily shaped menstrual experiences, manifesting in strict behavioural expectations to conceal menstruation and limiting the provision of menstrual materials. Resource limitations contributed to negative experiences, where dissatisfaction with menstrual practices and management environments were expressed along with feelings of disgust if participants felt they failed to manage their menstruation in a discrete, hygienic way. Physical menstrual factors such as pain were commonly associated with negative experiences, with mixed experiences of healthcare reported. Across studies participants described negative impacts of their menstrual experience including increased mental burden and detrimental impacts on participation and personal relationships. Positive experiences were more rarely reported, although relationships between cis-women were sometimes strengthened by shared experiences of menstrual bleeding. Included studies reflected a broad range of disciplines and epistemologies. Many aimed to understand the constructed meanings of menstruation, but few were explicitly designed to inform policy or practice. Few studies focused on socioeconomically disadvantaged groups relevant to new policy efforts.

CONCLUSIONS

We developed an integrated model of menstrual experience in HICs which can be used to inform research, policy and practice decisions by emphasising the pathways through which positive and negative menstrual experiences manifest.

REVIEW PROTOCOL REGISTRATION

The review protocol registration is PROSPERO: CRD42019157618.

"The night comes early for a woman": Menopause and sexual activities among urban older Yoruba men and women in Ibadan, Nigeria

This article explores older peoples' perceptions of menopause and sexuality in old age. The research was exploratory, consisting of 12 vignette-based focus group discussions and 18 face-to-face semistructured interviews among older Yoruba men and women (60+). Findings revealed menopause as a biopsychosocial marker of aging that provides gendered spaces for women to abstain from or suppress their sexual desires and avoid a folk pregnancy- oyun iju(folk fibroid). Older men construe menopause and sexual refusals from their wives as opportunities for extramarital relations. Thus, both older men and women have differentiated perceptions and dispositions toward menopause, which have implications for their sexual health and well-being.

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.

Presidential Address: Embracing the Repulsive: The Case for Disgust as a Functionally Central Emotional State in the Theory, Practice, and Dissemination of Cognitive-Behavior Therapy

Disgust is a primary emotion, but it is also understudied in general, and in psychopathology in particular. Disgust plays a potential role in the reluctance of many non-scientifically minded practitioners from adopting evidence-based methods of treatment. This article summarizes findings from psychopathology research and treatment, and highlights basic science that potentially accounts for the hesitancy for some therapists to adopt evidence-based methods. Several recommendations are provided for future research in disgust related to both psychopathology and dissemination research.

Experiences and Constructions of Menarche and Menstruation Among Migrant and Refugee Women

Experiences and constructions of menarche and menstruation are shaped by the sociocultural environment in which women are embedded. We explored experiences and constructions of menarche and menstruation among migrant and refugee women resettled in Sydney, Australia, and Vancouver, Canada. Seventy-eight semistructured individual interviews and 15 focus groups comprised of 82 participants were undertaken with women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, Sri Lanka, and varying South American countries. We analyzed the data using thematic decomposition, identifying the overall theme "cycles of shame" and two core themes. In "becoming a woman," participants constructed menarche as a marker of womanhood, closely linked to marriage and childbearing. In "the unspeakable," women conveyed negative constructions of menstruation, positioning it as shameful, something to be concealed, and polluting. Identifying migrant and refugee women's experiences and constructions of menarche and menstruation is essential for culturally safe medical practice, health promotion, and health education.

When Sex and Power Collide: An Argument for Critical Sexuality Studies

Attentive to the collision of sex and power, we add momentum to the ongoing development of the subfield of critical sexuality studies. We argue that this body of work is defined by its critical orientation toward the study of sexuality, along with a clear allegiance to critical modalities of thought, particularly feminist thought. Critical sexuality studies takes its cues from several other critical moments in related fields, including critical psychology, critical race theory, critical public health, and critical youth studies. Across these varied critical stances is a shared investment in examining how power and privilege operate, understanding the role of historical and epistemological violence in research, and generating new models and paradigms to guide empirical and theoretical research. With this guiding framework, we propose three central characteristics of critical sexuality studies: (a) conceptual analysis, with particular attention to how we define key terms and conceptually organize our research (e.g., attraction, sexually active, consent, agency, embodiment, sexual subjectivity); (b) attention to the material qualities of abject bodies, particularly bodies that are ignored, overlooked, or pushed out of bounds (e.g., viscous bodies, fat bodies, bodies in pain); and (c) heteronormativity and heterosexual privilege, particularly how assumptions about heterosexuality and heteronormativity circulate in sexuality research. Through these three critical practices, we argue that critical sexuality studies showcases how sex and power collide and recognizes (and tries to subvert) the various power imbalances that are deployed and replicated in sex research.

Genital panics: constructing the vagina in women's qualitative narratives about pubic hair, menstrual sex, and vaginal self-image

An emerging body of research targets women's relationship to their genitals, particularly as pubic hair removal and the promotion of female genital surgeries increase in popularity and visibility. This study asked women to discuss their subjective feelings about three related but distinct genital attitudes: pubic hair grooming, sex during menstruation, and genital/vaginal self-image. Specifically, this study applied thematic analysis to qualitative interviews with a community sample of 20 women (mean age=34, SD=13.35) from diverse ages, races, and sexual identity backgrounds to illuminate seven themes in women's narratives about their vaginas: (1) "dirty" or "gross"; (2) needing maintenance; (3) unknown or frustrating; (4) unnatural; (5) comparative; (6) ambivalent; (7) affirmative. Overwhelmingly, women used strong emotional language when discussing their genitals, often evoking descriptions of anxiety, excess, and need for control. Fusions between sexuality and body image, and connections between "genital panics" and internalized racism, sexism, and homophobia, also appeared.

Menstruation during a lifespan: A qualitative study of women's experiences

Menstruation is a natural phenomenon for women during their reproductive years. Our aim was to describe women's experiences of menstruation across the lifespan. Qualitative interviews with a narrative approach were conducted with 12 women between 18 and 48 years of age in Sweden. Using thematic analysis, we found menstruation to be a complex phenomenon that binds women together. It is perceived as an intimate and private matter, which makes women want to conceal the occurrence of menstrual bleeding. Over time, menstruation becomes a natural part of women's lives and gender identity. Health professionals play a central role supporting women to deal with menstruation.

Notes from the back room: gender, power, and (In)visibility in women's experiences of masturbation

While popular culture has more frequently depicted women's masturbation in recent years, scholarly attention to women's own meaning making about masturbation remains largely absent. Existing research that emphasizes women's masturbation frequency, health correlates, masturbation as a factor in couples therapy, and masturbation as a substitute for partnered sexual behaviors have dominated the research, largely neglecting social identity correlates and women's subjectivities about masturbation. This study drew upon qualitative interviews with 20 women (mean age = 34, SD = 13.35) from diverse backgrounds to illuminate five themes in women's experiences with masturbation: (a) assumptions that most women self-penetrate during masturbation even when primarily using clitoral stimulation; (b) masturbation as sexual labor; (c) masturbation as a threat to male dominance; (d) masturbation as routine tension release; and (e) masturbation as a source of joy, fun, and pleasure. Because women revealed such a diverse set of experiences, we explored the advantages and disadvantages of the invisibility of women's masturbation. As a result of the internalization of stereotypically masculine scripts about sexuality-including an imagined penetrative focus, goal-oriented drive toward orgasm, sex as labor, and masturbation as nonemotional-women's masturbation experiences, regardless of sexual orientation, revealed the power imbalances often present in partnered (hetero)sexual dynamics.

Women wearing white: Discourses of menstruation and the experience of menarche

This study examines how dominant societal discourses of menstruation are appropriated, rejected, or interpreted as adolescent girls make meaning of their menarche. Thirteen women ages 18–21 participated in flexible in-depth interviews to retrospectively recount their menarcheal experience. A variation of the Reading Guide was used for primary data analysis, which identified four themes highlighting girls’ ambivalence regarding menarche. Participants were conflicted at menarche about their putative status as ‘women’; used imprecise, distancing language when discussing menstruation; engaged in material and discursive practices of concealing menstruation; and referenced a community of menstrual suffering. Further, discourse analysis of participants’ talk suggests their continued discomfort. We argue that girls experience menarche ambivalently in relation to menstrual taboos, body shame and emergent womanhood. Negative discourses of menstruation and women’s bodies converge to set girls on a problematic gendered trajectory at menarche that can be expected to inform meaning making and experiences across the lifespan.

It’s not all bad: Women’s construction and lived experience of positive premenstrual change

Although premenstrual change is invariably pathologized and described as PMS or PMDD, there is evidence that many women experience premenstrual changes positively. This suggests that premenstrual change is both a lived experience and social construction, which is not inevitably positioned as debilitating or distressing. However, previous research has provided little insight into how and why women construct premenstrual change as positive. Accordingly, the present study used a critical realist epistemology and a material-discursive-intrapsychic model to explore women’s construction and lived experience of positive premenstrual change. Drawing on focus groups with 47 women, explanations for positive premenstrual experiences included: ‘positive emotional outcomes’, ‘releasing tension’, ‘increased attractiveness’, ‘legitimacy of self-care’ and ‘indication of menstruation’. Findings not only reinforce reports from previous research that many women experience positive premenstrual changes, but also challenge bio-medical conceptualizations of premenstrual change as inherently negative, with accounts of relational negotiation emphasizing the context-dependent nature of premenstrual change.