Intrauterine insemination (IUI) involves the opening of the vagina using a speculum, then injecting washed sperm directly into the uterus with a  catheter . [ 30 ]  Insemination in this way means that the sperm do not have to swim through the cervix which is coated with a mucus layer. This layer of mucus can slow down the passage of sperm and can result in many sperm perishing before they can enter the uterus. [ 31 ]  Donor sperm is sometimes tested for mucus penetration capabilities if it is to be used for ICI inseminations, for if the sperm's chances of passing through the cervix is low, IUI would provide a more efficient delivery of the sperm than ICI  [ citation needed ] . IUI fertilization takes place naturally in the external part of the fallopian tubes in the same way that occurs following intercourse.


The benefit of double IUI has not been found in patients with undocumented infertility using donor sperm, such as lesbian and single women. [ 32 ]  Typically pregnancy success rates per IUI cycle is approximately 12.4%. [ 33 ]  According to a study from 2021, lesbian women undergoing IUI had a clinical pregnancy rate of 13.2% per cycle and 42.2% success rate given the average number of cycles at 3.6. [ 33 ]   IUI has been reported to be more effective than ICI [ 34 ] [ 35 ]  but this has been contested with some citing no strong evidence to confirm a significant difference between the birth rates of the two procedures. [ 36 ]  It is speculated that IUI is more effective since IUI brings the sperm closer to the oocyte than ICI which might compensate for decreased sperm motility after freezing and thawing. [ 35 ]  IUI includes risk of  endometritis , cramping, bleeding, and  anaphylaxis  (rarely). [ 34 ]  A systematic review and meta-analysis was not able to demonstrate that bed rest after intrauterine insemination effectively increases in pregnancy rate. [ 37 ]


Very similar to IUI, Intracervical insemination (ICI) is the method of artificial insemination which most closely mimics the natural ejaculation of semen by the penis into the vagina during sexual intercourse. ICI is the simplest method of artificial insemination and may also be performed privately in the home instead of at a private practice. ICI is the process of introducing semen into the vagina at the entrance to the  cervix , [ 38 ]  usually by means of a needleless syringe. Sperm used in ICI inseminations does not have to be ' washed ' to remove seminal fluid so raw semen from a private donor may be used. Semen supplied by a sperm bank prepared for ICI or IUI use is also suitable for ICI. A retrospective cohort study showed that total motility and total motile count (TMC) after thawing were associated with ongoing pregnancy rate; with best ICI results at total motility of ≥20% and a total motile count (TMC) of ≥8 × 106 after thawing. [ 39 ]


During ICI, air is expelled from a needleless syringe which is then filled with semen. A specially-designed syringe, wider and with a more rounded end, may be used for this purpose. Any further enclosed air is removed by gently pressing the plunger forward. The recipient lies on their back and the syringe is inserted into the vagina so that the tip is as close to the entrance to the cervix as possible. A vaginal speculum may be used for this purpose and a catheter may be attached to the tip of the syringe to ensure delivery of the semen as close to the entrance to the cervix as possible. The plunger is then slowly pushed forward and the semen in the syringe is gently emptied deep into the vagina. It is important that the syringe is emptied slowly for safety and for the best results, bearing in mind that the purpose of the procedure is the replicate as closely as possible a natural deposit of the semen in the vagina [ citation needed ] . The syringe (and catheter if used) may be left in place for several minutes before removal.  Following insemination, fertile sperm will swim through the cervix into the uterus and from there to the fallopian tubes in a natural way as if the sperm had been deposited in the vagina through intercourse. A  conception cap  instead of a syringe can be used as well.


Some LGBT may opt for using in-vitro fertilization instead of artificial insemination to reproduce. A  zygote  is created in a lab with a donated egg and a donated sperm, both of which can come from different sources like sperm banks, egg banks or one partner. Then, the zygote is implanted in the uterus. The carrying uterus can be a surrogate (gay men or other infertile couples) or one partner (female or  trans man ).


Standard IVF is the process by which the egg is removed from the ovaries and fertilized outside of the body, and then the pre-embryo is implanted into a uterus. [ 40 ]  There are many steps to ensure that this process works including ovary stimulation, egg collection, fertilization, and embryo transfer. To stimulate the ovaries to produce more eggs than usual, the person must take specific hormones prescribed by a doctor. [ 40 ]  Then, the eggs are collected using an ultrasound-guided aspiration needle. Once the eggs are outside the body, they are mixed with sperm in a culture dish in the hopes of fertilization. The sperm used can come from any sperm donor (either from a sperm bank, or a known donor like a partner). If a pre-embryo forms, it remains in the incubator for two to five days while it continues to grow and divide. At this stage, the pre-embryo is often genetically tested to ensure that it will develop into a healthy baby. If the embryo is deemed healthy, the next step is implantation. [ 40 ]  The embryos are transferred to the uterus which involves an ultrasound being used to guide a catheter through the cervix and into the uterine cavity. [ 40 ]


Partner-assisted reproduction , or co-IVF is a method of  family building  that is used by couples who both possess  female reproductive organs . The method uses  in vitro fertilization  (IVF), a method that means  eggs  are removed from the  ovaries , fertilized in a laboratory, and then one or more of the resulting  embryos  are placed in the  uterus  to hopefully create a  pregnancy . Reciprocal IVF differs from standard IVF in that two women are involved: the eggs are taken from one partner, and the other partner carries the pregnancy. [ 41 ]  In this way, the process is mechanically identical to IVF with  egg donation . [ 42 ] [ 43 ]  Using this process ensures that each partner is a  biological mother  of the child according to advocates, [ 44 ]  but in the strictest sense only one mother is the biological mother from a genetic standpoint and the other is a  surrogate mother . However the practice has a symbolic weight greater than  LGBT adoption , and may create a stronger bond between mother and child than adoption.


In a 2019 study, quality of infant–parent relationships was examined among egg donor families in comparison to in vitro fertilization families. [ 45 ]  Infants were between the ages of 6–18 months. Through use of the Parent Development Interview (PDI) and observational assessment, the study found few differences between family types on the representational level, yet significant differences between family types on the observational level. [ 45 ]  Egg donation mothers were less sensitive and structuring than IVF mothers, and egg donation infants were less emotionally responsive, and involving than IVF infants. [ 45 ]
 [ 46 ]  The eggs are then fertilized with donor sperm to create embryos, one of which can then be transferred to the second person's uterus. In this way, one partner contributes the genetic material and the second partner contributes the maternal environment, allowing both partners to have a profound impact on the development of the fetus and child. [ 46 ]  The laws around parenthood when both partners do not contribute genetic material are complicated and vary by state, so it is imperative to do research before beginning the process. [ 46 ]


The LGBT parent(s) may choose a surrogate or their partner for pregnancy, depending on their  fertility  and personal values. There are many possible ways for an LGBT individual or couple to become pregnant, such as:


Some gay or transsexual couples decide to have a surrogate  pregnancy . A surrogate is a woman carrying an egg fertilized by sperm of one of the men. Some women become surrogates for money, others for humanitarian reasons or both. [ 47 ]  This allows one of the men to be the biological father while the other will be an adopted father.


Gay men who have become fathers using surrogacy have reported similar experiences to those as other couples who have used surrogacy, including their relationships both their child and their surrogate have. [ 48 ]


Barrie and Tony Drewitt-Barlow from the United Kingdom became the first gay men in the country to father twins born through surrogacy in 1999. [ 49 ] [ 50 ]


Surrogacy is a process in which a woman carries and delivers a child for a couple or an individual. This can be an  arrangement  supported by a legal agreement where the surrogate may or may not be compensated. Surrogacy is the most common form of accessing parenthood because it is less complicated due to the biological connection made between parent and child. LGBTQ+ individuals may seek surrogacy when they are in need for someone else to serve as the gestational carrier of their biological child. Recently, traveling for couples outside of the US to seek surrogacy is rising. Usually these commercial services cater only white, wealthy parents-to-be. In some countries it is illegal to pay surrogates, but the debate is that unpaid surrogacy can take place.


Choosing who will be the biological parent can vary from couple to couple because couples get to decide where gametes can come from. Gametes can be purchased through commercial resources, arranged through an agreement from a genetic connection to both parents, or through a friend donation.


There is a long history of transnational surrogacy used by gay parents who seek surrogacy in India. They use gametes fertilized by one or both parents to inseminate local women who are employed through an agency. There is global criticism due to transparency around pay and the outcomes for the parties involved. Because of this surrogacy services in India are being recalled by gay parents because there is restricted access to pregnancy updates. Unable to communicate can create emotional distancing for gay parents and the pregnancy can be stressful for gay parents. Going through surrogate services can be a stressful journey because gay parents are caught up in between charts and graphs, instead of being able to have an emotional connection with the baby through the surrogate and the experiences they go through.


Transnational surrogacy can raise legal issues when the child is born. There is conflict about national legal rules on parentage and this complicates citizenship, which can often result in the child not having legal parents or citizenship in any country.


The World Profession Association for Transgender Health ( WPATH ) recommends that all transgender patients make decisions regarding their fertility before starting hormone therapy in their  Standards of Care (2012)  guidebook for medical professionals. [ 10 ]


Pregnancy is possible for transgender men who retain a functioning  vagina ,  ovaries , and a  uterus . [ 51 ] [ 52 ]  Testosterone does not inhibit one's ability to become pregnant and give birth, as it is not a sufficient method of contraception. While trans men can become pregnant while taking testosterone, it is advised to stop before attempting to become pregnant, as taking testosterone during pregnancy can lead to issues with fetal development. [ 53 ] [ 54 ]  Many trans men who have become pregnant were able to do so within six months of stopping testosterone. [ 55 ]  Another study conducted in 2019 found that transgender male patients seeking oocyte retrieval for either oocyte cryopreservation, embryo cryopreservation, or IVF were able to undergo treatment 4 months after stopping testosterone treatment, on average. [ 52 ]  There have been no studies of transgender men attempting pregnancy after testosterone or on the health of offspring conceived from testosterone-exposed oocytes, so exact fertility rates are unknown. [ 11 ] [ 51 ]  However, a 2020 study found that intended pregnancy rates among respondents of a self-administered survey who had ever used testosterone were comparable to those to those who had not - 38% and 45% respectively. [ 56 ]


Masculinizing hormonal therapy in trans men will often lead to  amenorrhea , but this amenorrhea is usually reversible and androgen therapy does not deplete primordial follicles nor affects the developmental capacity of the follicles. [ 57 ] [ 8 ]  However, histologically hyperplasia of the ovarian cortex and stroma has been found. [ 8 ]  It has been debated if this is physiologically comparable to  polycystic ovary syndrome . [ 8 ]   Ovariectomies  lead to irreversible fertility termination (if the eggs are not stored), but doesn't preclude gestational pregnancy with ART. [ 8 ] [ 51 ]  Hysterectomies will eliminate the option to gestate. [ 51 ]


Trans men and transmasculine people who become pregnant are frequently referred to as "seahorse dads." [ 58 ]


Transgender women with a  fertile  partner may choose to have children through natural  sexual activity . Some transgender women have reported a lower sexual desire on hormonal treatment. [ 59 ]  It has been found that transgender patients undergoing feminizing hormonal therapy do have abnormal semen parameters. [ 60 ] [ 61 ]  Sustained hormonal treatment eventually leads to hypo-spermatogenesis and ultimately  azoospermia  which will become irreversible at an unknown point in time. [ 8 ] [ 62 ] [ 63 ]  A 2015 study did demonstrate normal spermatogenesis in long term estrogen therapy patients. [ 10 ]  Surgical removal of testicles also leads to irreversible sterility. [ 8 ] [ 63 ]  It is recommended for those pursuing these options and interested in preserving fertility to cryogenically store their sperm before starting their treatment. [ 8 ]


Fertility treatment and preservation is expensive. The average IVF cycle can cost $12,000 to $17,000 (not including medication), with medication it can up to $25,000-$30,000  [ 64 ] [ 65 ]  and price often comes down to one's insurance which might come with stipulations. The cost of IUI ranges from $500–4,000 per cycle. [ 66 ]  Cryopreservation of genetic material is also costly see table below and can vary greatly from place to place, state to state. [ 67 ]


Another barrier is knowledge. These procedures are not well known and discussion of fertility preservation are uncommon. In a study of 133 transgender women 61% stated that no health care provider discussed sperm banking prior to their hormone therapy or surgery. [ 71 ]  In another study, 70 transgender males cited barriers such as the perceived cost of treatment (36%), need for discontinuation or delay of hormonal therapy (19%), and worsening gender dysphoria with treatment and pregnancy (11%). [ 12 ]


Only 3% of transgender people take efforts to preserve their fertility in transition [ 72 ]  51% of trans women express regrets for not preserving their fertility, [ 73 ]  and 97% of transgender adults believe it should be discussed before transition. [ 74 ]


Testosterone therapy affects fertility, but many trans men who have become pregnant were able to do so within six months of stopping testosterone. [ 75 ]  Another study conducted in 2019 found that transgender male patients seeking oocyte retrieval for either oocyte cryopreservation, embryo cryopreservation, or IVF were able to undergo treatment 4 months after stopping testosterone treatment, on average. [ 76 ]  All patients experienced menses and normal AMH, FSH, and E 2  levels and antral follicle counts after coming off testosterone which allowed for successful oocyte retrieval. [ 76 ]  Although the long-term effects of androgen treatment on fertility is still widely unknown, oocyte retrieval does not appear to be affected. Future pregnancies can be achieved by  oophyte banking , but the process may increase gender dysphoria or may not be accessible due to lack of insurance coverage. [ 75 ]  Testosterone therapy is not a sufficient method of  contraception , and trans men may experience unintended pregnancy, [ 75 ] [ 77 ]  especially if they miss doses. [ 75 ]


Some studies report a higher incidence of  polycystic ovary syndrome  (PCOS) among transgender men prior to taking  testosterone , [ 78 ] [ 79 ] [ 80 ]  the disease causes infertility and can make it harder for trans men to freeze eggs, [ 81 ]  though not all have not found the same association of trans men and PCOS. [ 82 ]  People with PCOS in general are also reportedly more likely to see themselves as "sexually undifferentiated" or "androgynous" and "less likely to identify with a female gender scheme." [ 83 ] [ 82 ]


There is theoretical work being done on creating a  zygote  from two men which would enable both men to be biological fathers, but it is yet to be practically implemented. [ 84 ]


There is theoretical potential for same sex reproduction using  stem cells  to derive  gametes  to produce biologically related children, [ 85 ]  but this has been contentious [ 86 ]  and has been considered to be "impossible". [ 85 ]  However, scientists have successfully created eggs from male mice to produce offspring with 2 biologically male genetic donors and have been optimistic that human application could come within the next 10 years. [ 87 ] [ 88 ]


For prepubertal transgender girls, testicular tissue cryopreservation (TTC) is currently the only fertility preservation option. [ 11 ]  An experimental surgical procedure to remove and cryopreserve testicular tissue for a later date when the spermatogonial stem cells can be matured into sperm. To date no spermatogenic recovery has been reported and TTC technologies enabling this are currently only being studied in animal models [ 11 ]


There is theoretical work being done on creating a  zygote  from two women which would enable both women to be biological mothers, but it is yet to be practically implemented. [ 84 ]  Creating a sperm from an egg and using it to fertilize another egg may offer a solution to this issue, [ 5 ]  as could a process analogous to  somatic cell nuclear transfer  involving two eggs being fused together. [ 89 ]


In 2004 and 2018 scientists were able to create mice with two mothers via egg fusion. [ 2 ] [ 3 ] [ 4 ]  Modification of  genomic imprinting  was necessary to create healthy bimaternal mice, while live bipaternal mice were created but were unhealthy likely due to genomic imprinting. [ 4 ]


If created, a "female sperm" cell could fertilize an egg cell, a procedure that, among other potential applications, might enable female  same-sex couples  to produce a child who would be the biological offspring of their two mothers. It is also claimed that production of female sperm may stimulate a woman to be both the mother and father (similar to asexual reproduction) of an offspring produced by her own sperm. Many queries, both ethical and moral, arise over these arguments. [ 90 ] [ 91 ] [ 92 ] [ 93 ]


Some trans women want to carry their own children through  transgender pregnancy , which has its own set of issues to be overcome, because transgender women do not naturally have the anatomy needed for embryonic and fetal development. As of 2008, there were no successful cases of  uterus transplantation  concerning a transgender woman. [ 94 ]


Another possibility for transgender women would come from a successful  uterus transplant  that can carry a pregnancy to term in a transgender women. [ 95 ]  There have been successful births with uterus transplantation in cis-women, but currently none in trans women [ 95 ]  as currently there have been no successful uterus transplants in transgender women. [ 96 ]  Theoretical problems arise in the  sexual dimorphism  of the human pelvis, drug regime risk (post-transplant immunosuppression and hormone therapy to sustain implantation and pregnancy), and risk of neovaginal anastomosis. [ 95 ] [ 96 ] [ 97 ]  The same studies that identified these risks also came to the conclusion that despite the considerations uterine transplant shouldn't be confined to cis-women, [ 95 ] [ 96 ] [ 97 ]  with one journal article unable to find any increase in theoretical procedural risk compared to cis-women. [ 97 ]  There is no expectation that trans women would give birth through the neo-vaginal canal. [ 98 ]


As of 2019, in cisgender women, more than 42 uterine transplant procedures had been performed, with 12 live births resulting from the transplanted uteruses as of publication. [ 99 ]  The International Society of Uterine Transplantation (ISUTx) was established internationally in 2016, with 70 clinical doctors and scientists, and currently has 140 intercontinental delegates. [ 100 ]  Its goal is to, "through scientific innovations, advance medical care in the field of uterus transplantation." [ 101 ]


In 2012,  McGill University  published the "Montreal Criteria for the Ethical Feasibility of Uterine Transplantation", a proposed set of criteria for carrying out uterine transplants, in  Transplant International . [ 102 ]  Under these criteria, only a  cisgender  woman could ethically be considered a transplant recipient. The exclusion of trans women from candidacy may lack justification. [ 103 ]


In addition, if trans women wish to conceive with a cisgender male partner, they face the same issues that cisgender gay couples have in creating a zygote.


Marthe Voegeli  was a Swiss  physician  and pioneer in the field of male  contraceptive  research.


Between 1930 and 1950, Voegeli practiced medicine in India at her own private hospital.  During this time, with the assistance of 9 volunteers, she experimented with a process of  heat-based contraception . [ 1 ]


The process was simple and effective.  A man would bathe his  testes  in a hot bath for 45 minutes a day for 3 weeks.  On the completion of the 3 weeks, a period of infertility was recorded by the volunteers.


Different bath temperatures produced varying lengths of infertility.  A bath of 116 °F (46.7 °C) would provide  contraceptive  protection for 6 months.  A bath of 110° (43.3 °C) would provide contraception for at least 4 months.


After fertility returned in the males, the conception of healthy offspring with normal childhood development was recorded. [ 2 ]


Voegeli retired from medicine in 1950 and spent the next 20 years involved in efforts to publicise the contraceptive method, which were largely ignored. [ 3 ]


Feminine hygiene  products are  personal care products  used for  women 's  hygiene  during  menstruation ,  vaginal discharge , or other bodily functions related to the  vulva  and  vagina . Products that are used during menstruation may also be called  menstrual hygiene products , including  menstrual pads ,  tampons ,  pantyliners ,  menstrual cups ,  menstrual sponges  and  period panties . Feminine hygiene products also include products meant to cleanse the vulva or vagina, such as  douches ,  feminine wipes , and  soap .


Feminine hygiene products are either  disposable  or  reusable . Sanitary napkins, tampons, and pantyliners are disposable feminine hygiene products. Menstrual cups, cloth menstrual pads, period panties, and sponges are reusable feminine hygiene products. [ 1 ]


Disposable:


Reusable:


The environmental impact of each product varies enormously:
In a lifetime, a menstruating person in developed countries can use between 5,000 and 15,000 pads and tampons creating about 400 pounds of packaging.


Worst in terms of environmental impact are tampons as they usually contain plastic or a blend of cotton and rayon and synthetic fibers, packaged in paper and plastic, may have plastic strings and plastic applicators, which cannot be recycled. the most environmentally friendly option is considered to be the menstrual cup. [ 12 ]


The different products may carry different health risks, some of which might be proven, others speculative. [ 13 ] [ 14 ] [ 15 ]


The vulva acts as the initial defense line, shielding the genital tract from infections. Often, contaminants accumulate in the folds of the vulva, and factors like increased moisture, sweating, menstruation, and hormonal fluctuations can impact the growth and balance of microbial species, potentially leading to odor and vulvovaginal infections. [ 11 ]


Distinct from other skin areas, vulvar skin exhibits variations in hydration, friction, permeability, and visible irritation. It is more susceptible to topical agents compared to forearm skin due to increased hydration, occlusion, and friction. The non-keratinized vulvar vestibule is likely more permeable than keratinized skin. Notably, genital skin is unique with a thin stratum corneum and large hair follicles, making it easier for microbes and substances to permeate. [ 11 ]


The vagina, a fibromuscular canal extending from its external opening in the vulva to the cervix, is primarily composed of smooth muscle covered by a non-keratinized epithelial lining. This lining, until menopause, remains thick, kept moist by fluid from the vaginal wall and mucus from cervical and vestibular glands. [ 11 ]


Before reaching puberty until after menopause, women typically experience a natural and healthy occurrence of vaginal discharge. [ 23 ]  This discharge comprises bacteria, desquamated epithelial cells shedding from the vaginal walls, along with mucus and fluid (plasma) produced by the cervix and vagina. [ 24 ]  Throughout the menstrual cycle, the quantity and consistency of the discharge undergo variations. At the start and end of the cycle when estrogen levels are low, the discharge is dense, adhesive, and unwelcoming to sperm. As estrogen levels increase before ovulation, the discharge gradually becomes clearer, more liquid, and stretchier. [ 11 ]


Feminine hygiene presents discrepancies in various ethnic groups. Differences in feminine hygiene practices are often associated with varying cultural beliefs and religious customs. Research indicates that Afro-Caribbean immigrants, in contrast to Caucasian women, are more inclined to cleanse the vulva with bubble bath or antiseptic. [ 11 ]  This practice aligns with the belief in the necessity of thorough body cleansing for health and well-being. Among Orthodox Jewish women, a ritual bath known as mikveh is performed after menstrual periods or childbirth to achieve ritual purity. In the Muslim faith, both men and women partake in a bathing ritual called full ablution (ghusl) after sexual intercourse or menstruation as a purification practice. In regions like Mozambique and South Africa, certain women opt for internal cleansing of their vaginas using substances such as lemon juice, saltwater, or vinegar with the intention of eliminating vaginal discharge and "treating" sexually transmitted diseases. [ 11 ]


A research study involving 500 women in Iran revealed a notable association between bacterial vaginosis and inadequate menstrual and vaginal hygiene practices. Additionally, findings from a household survey conducted by Anand et al. indicated that women employing unhygienic methods during menstruation—excluding sanitary pads or locally prepared napkins—were 1.04 times more likely to report symptoms of reproductive tract infections. Furthermore, these women were 1.3 times more likely to experience abnormal vaginal discharge, encompassing symptoms like itching, vulvar irritation, lower abdomen pain, pain during urination or defecation, and low back pain. In another investigation, findings revealed that women engaging in the use of bubble bath on the vulva exhibited a twofold increase in the likelihood of experiencing bacterial vaginosis, in contrast to those who refrained from using this product. [ 11 ]  Furthermore, the occurrence of bacterial vaginosis was three times greater among women who applied antiseptic solutions to the vulva or within the vagina. Additionally, the frequency of bacterial vaginosis was six times higher in women utilizing a douching agent. When it comes to bacterial vaginosis, African American women are 2.9 times more likely to be diagnosed with bacterial vaginosis compared to women of European ancestry, possibly due to variations in their "normal" vaginal flora. [ 11 ]


To observe the menstrual hygiene in adolescent girls, a cross-sectional study conducted in a secondary school in Singur  West Bengal  involved 160 girls. the findings were published in 2008 and revealed that a significant portion of respondents became aware of menstruation before menarche, with mothers being the primary source of information. While the majority recognized menstruation as a physiological process, knowledge and usage of sanitary pads were limited. Most girls employed soap and water for cleaning purposes, and a considerable percentage observed various restrictions during menstruation. [ 25 ]  Among the 160 respondents, 108 (67%) girls were aware of menstruation before experiencing menarche. Mothers were the primary source of information for 60 (37.5%) girls. A majority, 138 (86%), considered menstruation a physiological process. Only 78 (48%) girls were familiar with the use of sanitary pads during menstruation. In terms of practices, merely 18 (11.25%) girls used sanitary pads during menstruation. For cleaning purposes, 156 (97%) girls utilized both soap and water. Regarding restrictions, 136 (85%) girls adhered to various restrictions during menstruation. [ 25 ]


According to the World Health Organization, as of 2018 there are about 1.9 billion women who are of reproductive age. [ 26 ]  In low-income countries, women's choices of menstrual hygiene materials are often limited by the costs, availability and social norms. Not only are women's choices limited but, according to the WHO and UNICEF, 780 million people do not have access to improved water sources and about 2.5 billion people lack access to improved sanitation. The lack of proper hygiene leads to a harder time for women to manage feminine hygiene. [ 27 ] [ 28 ] [ 26 ] [ 29 ]


Tampon tax is a shorthand for sales tax charged on tampons, pads, and menstrual cups. The cost of these commercial products for menstrual management is considered to be unacceptably high for many low-income women. At least half a million women across the world do not have enough money to adequately afford these products. This can result in missing days of school or even dropping out entirely in the worst cases. In some jurisdictions, similar necessities like medical devices and toilet paper are not taxed. Several initiatives worldwide advocate to eliminate the tax all together. In some countries, such petitions have already been successful (for example parts of the UK and the United States). The UK abolished the 5% minimum VAT imposed on sanitary products on 1 January 2021, as previously whilst a member of the European Union; EU law prohibited the UK or any EU member state from removing the 5% VAT imposed on sanitary products. [ 30 ] [ 31 ] [ 32 ]


The Federal Bureau of Prisons in the  United States  announced that women in its facilities would be guaranteed free menstrual pads and tampons. In section 411 of the First Step Act which was passed on May 22, 2018, states, "The Director of the Bureau of Prisons shall make the healthcare products described in subsection (c) available to prisoners for free, in a quantity that is appropriate to the healthcare needs of each prisoner". [ 33 ]


Some girls and women may view tampons and menstrual cups as affecting their  virginity  even though they have not engaged in  sexual intercourse . [ 4 ]


For those with  autism , using pads before menstruation begins may help reduce sensory issues associated with menstrual hygiene products. Prior education and practice may help familiarize an individual with body changes and the process of using products associated with menstruation. [ 34 ]


Menstruation may occur despite paralyzation; product use depends on the individual's personal preference. [ 35 ]


In ancient Egypt, the Roman Empire and Indonesia, various natural materials – wool, grass,  papyrus  – were used as tampons. In ancient Japan, the tampon was made of paper and held in place by a special binder called  kama , and was changed up to 12 times a day. [ 36 ]


In 18th-century Sweden, women in common society were not known to use feminine hygiene products and visible period stains on clothing did not attract much attention. A common expression for menstruation during this period was to "wear the clothes" or "wear the  särk ", a  chemise -like undergarment. [ 37 ]


It is likely that pieces of cloth or special rags were used to collect the menstrual fluid. However, there are few records of menstrual pads from the pre-industrial era. [ 38 ]  As artifacts, the various types of menstrual pads have not been preserved or survived in any particular sense, as the cloths used were discarded when they became worn out or the need for them ceased with menopause. However, as technology evolved, commercial hygiene products were introduced in the form of the menstrual pad, also known as the sanitary napkin. In Sweden, this happened at the end of the 19th century and has been linked to an increased focus on cleanliness, personal hygiene and health that occurred in the early part of the 20th century in the wake of urbanization. [ 39 ]  By the end of the 19th century, the first commercial sanitary napkin had also been introduced on the American market by  Johnson & Johnson . It was a variant of the menstrual pad made of flannel. [ 40 ]


Advertisements and product information for sanitary pads are the primary source of knowledge about the history of sanitary pads. [ 41 ]


Sanitary napkins could be made of woven cotton, knitted or crocheted and filled with rags. [ 42 ]  They could be homemade for personal use or mass-produced and sold, such as in towns that had a textile industry. [ 43 ]


The menstrual receptacle was the very earliest hygiene product to be launched as menstrual protection in Sweden, as early as 1879. It was made of rubber, like many of the hygiene articles of the time, and resembled a bowl-shaped casing that would sit on the outside of the abdomen. The menstrual receptacle is not considered to have gained much popularity. [ 44 ]


The first half of the 20th century also saw the development of early intravaginal menstrual products similar to the menstrual cup, with an early patent dating from 1903. [ 45 ]


Menstrual belts were another form that menstrual protection took and began to appear in the late 19th century. They were made so that the pad itself was contained in a special holder that was fastened around the waist with a belt. The pads in these designs are referred to as "suction pads" in Swedish patent documents, such as the "Suction pad for menstruation" patent from 1889. [ 46 ]  The price for a menstrual belt could be between 2.75 – 3.50  SEK  and pads had to be purchased for about 4–5 SEK each, depending on the size of the pack. From the price information available, menstrual protection was likely a costly purchase that was not available to everyone. [ 39 ]


The sanitary belt can be seen as a modern version of the menstrual belt, but more like a  girdle . The function of the belt is to hold the pad in place while giving the user greater freedom of motion. [ 47 ]  In Sweden, the product was introduced in the 1940s and was in use until the 1960s. [ 48 ]  In the 1970s, the adhesive strip on the underside of the pad was introduced, allowing it to be attached to the underwear and held in place without the use of a girdle, safety pin or belt. [ 49 ]


Cloth menstrual pads  are cloth pads worn in the  underwear  to collect  menstrual fluid  (blood from  uterine lining ). They are a type of reusable  menstrual hygiene  product, and are an alternative to  sanitary napkins  or to  menstrual cups . Because they can be reused, they are generally less expensive than disposable pads over time, and reduce the amount of  waste  produced. [ 1 ] [ 2 ] [ 3 ]


Generally they are made from layers of  absorbent  fabrics (such as  cotton  or  hemp ) which are worn during  menstruation ,  post-birth bleeding  or any other situation where it is necessary to absorb the flow of blood from the  vagina , or to protect underwear from regular discharge of vaginal fluids.  After use, they are washed, dried and then reused. [ 4 ]


The majority of commercially available pads are manufactured by  work-at-home moms  or  small businesses  and can be purchased through some  health food stores , specialty stores, and via Internet stores and marketplaces. They are available in a range of lengths and thicknesses, similar to  disposable pads , with longer pads for night use and thinner and shorter pads for light use.  Some manufacturers will allow the buyer to select the fabrics, shape and size of the pad so that they can be custom made to fit an individual and be as efficient as possible.


Some people make their own cloth menstrual pads. These pads range from folded wash cloths to pads similar to the cloth menstrual pads available commercially. [ 5 ] [ 6 ]


Cloth menstrual pads may be hand or  machine washed , and then dried on a  clothes line  or in a  clothes dryer , depending on the instructions from the manufacturer. (Different fabrics require different care methods.) Some people choose to rinse out their pads in cold water before putting them in the wash with their other clothing. Others do not rinse, but put the soiled pads straight into the wash. After washing it is recommended that the pads are dried in a hygienic area under direct  sunlight . Sunlight acts as a disinfectant and prevents microbial growth, which may happen if the pads are not completely dry. [ 7 ]


When changing cloth menstrual pads away from home, some people place the soiled pads into a waterproof or  Ziploc  bag to keep them from drying out and to contain or prevent  odor  and then wash the pads when convenient. [ 8 ] [ failed verification ]


The fabrics used range from 100% natural fibres to 100% synthetics.  Some commonly used fabrics include  terrycloth ,  cotton ,  silk ,  hemp , and  Gore-Tex . Specialty fabrics such as  hemp ,  bamboo  terry, bamboo velour, soy French terry, wool interlock and  polyurethane laminate  (PUL) may be used. PUL may be purchased from online  nappy/diaper  supply stores. [ 8 ]


Some styles of cloth menstrual pad have a  waterproof  layer to help prevent the pad leaking through while other styles of cloth pad may rely on more layers of absorbency and not include waterproofing.  Wool  can also be used as a natural, breathable backing that provides leak protection. [ 8 ]


In  developing countries , reusable or makeshift pads are still used to collect menstrual blood. [ 9 ]  People in these countries most often resort to either staying in their rooms during menstruation or using pieces of old cloth/ rags, old mattress foam and even infection-causing items such as leaves, husks, disposed cement bags, etc. Lack of access to  feminine hygiene  products affects women and adolescent girls around the world. [ 10 ]  This lack is directly tied to exploitation, school drop out rates, infection, early marriage and even  child trafficking . [ 11 ] [ 12 ] [ 13 ]  Quality washable menstrual pads are now helping as worldwide awareness is growing - also evidenced by the global initiative of  Menstrual Hygiene Day . Many  NGOs  are coordinating volunteers to sew effective washable pads with moisture barriers that, unlike disposables, can be used month after month. [ 12 ]


Effective management of menstruation is an under-recognized challenge for girls in low-income communities. A study in Uganda showed the effects of menstruation and education in communities of poor education, welfare, and health. Girls who received high-quality menstrual pads were less likely to miss school. The girls reported better concentration and participation due to not having to worry about staining their clothes. [ 14 ]


Studies have found that between 43% and 88% of girls and women wash and reuse cotton pads in  India , rather than utilizing disposable pads. These numbers are particularly dominant in rural areas and low socioeconomic regions. The cotton pads are sometimes not sanitized properly due to washing with soap and unclean water. Due to menstruation's taboo nature, women and girls dry their cotton pads indoors rather than in the sunlight, which may lead girls to reuse improperly sanitized pads leading to infection. [ 15 ]


In  Somalia , where girls may be absent from school for a week each month due to menstruation, a charity has trained victims of  gender based violence  to sew re-usable sanitary pads, which are then purchased for distribution to schools in  Mogadishu . [ 16 ]


Days for Girls  is a global movement based in the US which supplies girls with kits including reusable cloth pads, sewn by volunteers around the world. Each kit is in a draw-string cloth bag with  zip closure plastic bags  for clean and used pads and other hygiene needs, and enables the girls to continue their schooling with dignity. [ 17 ]


Through the ages women have used different forms of menstrual protection. [ 26 ] [ 27 ]  Women often used strips of folded old cloth (rags) to catch their menstrual blood, which is why the term "on the rag" was used to refer to menstruation.


Disposable menstrual pads appear to have been first commercially available from around 1888 with the Southall's pad. [ 28 ]   More widely successful disposable menstrual pads had their start during the  World War I , when French nurses used  Kimberly-Clark 's wood pulp bandages as a menstrual pad that could be thrown away after use. [ 29 ]   Kotex's first advertisement for products made with this wood pulp appeared in 1921. [ 30 ]


Until the advent of disposable pads, women used a variety of sewn or makeshift pads made from a variety of fabrics, often leftover scraps, to collect menstrual blood, although some women have used anything absorbent. [ 26 ]  Fabrics could generally be washed and used again.  When disposable pads were introduced, they were too expensive for many women to afford. When they could be afforded, women were allowed to place money in a box so that they would not have to speak to the clerk and take a box of  Kotex  pads from the counter themselves. [ 30 ]  It took several years for disposable menstrual pads to become commonplace.  However, they are now used nearly exclusively in most of the industrialized world.


Cloth menstrual pads made a comeback around 1970. [ 31 ]   With the number of cloth pad manufacturers and online communities devoted to this increasing in the 1990s and the early 2000s, they appear to be gaining popularity.


There are many cultural aspects surrounding how societies view  menstruation . Different cultures view menstruation in different ways. The basis of many conduct norms and communication about menstruation in western industrial societies is the belief that menstruation should remain hidden. [ 2 ]  By contrast, in some indigenous hunter-gatherer societies, menstrual observances are viewed in a positive light, without any connotation of uncleanness.  In most of India,  menarche  is celebrated as a rite of passage. [ 3 ]


A  menstrual taboo  is any social  taboo  concerned with menstruation. In some societies it involves menstruation being perceived as unclean or embarrassing, inhibiting even the mention of menstruation whether in public (in the media and  advertising ) or in private (among friends, in the household, or with men). Many traditional religions consider menstruation  ritually unclean , although anthropologists say that the concepts 'sacred' and 'unclean' may be intimately connected. [ 4 ]


The terms  menstruation  and  menses  are derived from the  Latin :  mensis ,  lit.   'month', which in turn is cognate with the  Ancient Greek :  μήνη ,  romanized :  mēnē ,  lit.   'lunar month', and the roots of the English words  month  and  moon . [ 5 ]


According to anthropologists Thomas Buckley and Alma Gottlieb, cross-cultural study shows that while taboos about menstruation are nearly universal, and while many of these involve notions of uncleanliness ( ritual impurity ), numerous menstrual traditions "bespeak quite different, even opposite, purposes and meanings." [ 6 ]  In some traditional societies, menstrual rituals are experienced by women as protective and empowering, offering  women a space set apart  from the  male gaze  and from unwanted sexual or domestic pressures and demands. [ 7 ]  In other words, the idea of the  seclusion  of the  menstruation hut  may be perceived as banishment of the woman seen to be impure and taboo, or as a welcome space and time free of the usual daily chores: isolation versus retreat.


An instructive example is provided by the anthropologist Wynne Maggi, who spent years living in the peasant society of the  Kalash people  of the  Chitral District  in  northwestern Pakistan . She describes the communal  bashali  (large menstrual house) as the village's 'most holy place', respected by men, and serving as women's all-female organizing centre for establishing and maintaining gender solidarity and power. [ 8 ]  Also see the interview conducted in Period Matters  [ 9 ]  with Kalash women where they describe themselves as being 'free' to make choices, and having the opportunity to rest during their period. According to one body of cultural evolutionary scholarship, the idea that menstrual blood marks the body as periodically sacred was initially established by female coalitions in their own interests, although later, with the rise of cattle-ownership and patriarchal power, these same beliefs and taboos were harnessed by religious patriarchs to intensify women's oppression. [ 10 ]


Metaformic Theory , as proposed by cultural theorist  Judy Grahn  and others, places menstruation as a central organizing idea in the creation of culture [ 11 ]  and the formation of humans' earliest rituals.


Menstruation in synchrony with the moon is widely assumed in myths and traditions as a ritual ideal. [ 12 ] [ 13 ]  The idea that menstruation is—or ideally ought to be—in harmony with wider cosmic rhythms is one of the most tenacious ideas central to the myths and rituals of traditional communities across the world. One of the most thoroughgoing analyses of primitive mythology ever undertaken was that of the French anthropologist  Claude Lévi-Strauss , who concluded that, taken together, the indigenous myths of North and South America expressed men's worry that, unless women's periods were carefully monitored and synchronised, the universe might descend into chaos. [ 14 ]


In Aboriginal Australia, the supernatural being known as the 'Rainbow Snake' has been interpreted as, among other things, an indigenous way of conceptualising the ideal of synchronised tidal, lunar, menstrual and seasonal periodicities whose overall harmony (it is believed) confers spiritual power and fertility. [ 12 ] [ 15 ] [ 16 ]


To many, such  cultural  associations appear persuasive in view of the fact that in humans, the menstrual cycle quite closely approximates the moon's 29.5-day synodic cycle, unlike in  chimpanzees  (~36 days) or  bonobos  (~40 days). [ 17 ] [ 18 ] [ 19 ]  Statistical information from hunter gatherers is lacking, but where large-scale western studies focus on women's peak reproductive years—removing outlier values—the cycle length gravitates around 29.1–29.5 days, while the figure for women in their thirties shortens toward 28 days. [ 20 ] [ 21 ]  In no current human population has statistically significant lunar phase-locking been demonstrated.


In some historic cultures, a menstruating woman was considered  sacred  and powerful, [ 22 ]  with increased  psychic  abilities, and strong enough to heal the sick. [ 23 ]  According to the  Cherokee , menstrual blood was a source of feminine strength and had the power to destroy enemies. [ 24 ]  In  Ancient Rome ,  Pliny the Elder  wrote that a  menstruating  woman who uncovers her body can scare away  hailstorms , whirlwinds and lightning. If she strips naked and walks around the field, caterpillars, worms and beetles fall off the ears of corn. [ 25 ]  Menstrual blood is viewed as especially dangerous to men's power. [ 26 ]  In  Africa , menstrual blood is used in the most powerful  magic charms  in order to both  purify  and destroy. [ 27 ]
Mayan mythology explains the origin of menstruation as a punishment for violating the social rules governing marital alliance. The menstrual blood turns into snakes and insects used in black sorcery, before the  Maya moon goddess  is reborn from it. [ 28 ]


Where women's blood is considered sacred, the belief is that it should be ritually set apart. According to this logic, it is when sacred blood comes into contact with profane things that it becomes experienced as ritually dangerous or 'unclean'. [ 29 ]  An example of this is Indian Artist Lyla FreeChild who internalised this belief and harvested her menstrual blood to paint an image inspired by a dream where she saw herself as the powerful, bleeding goddess Lajja Gauri. In an essay accompanying her art she explains her belief in the creative and healing power of menstrual blood. [ 9 ]


Many beliefs about menstruation in the early modern period were linked to  humorism , the system of medicine introduced by  Ancient Greek  and Roman physicians. People believed that the human body contained four humours: blood, phlegm, yellow bile, and black bile. [ 30 ]  Illnesses and problems were understood as being caused by  dyscrasia , or an imbalance in the four humours. Treatments for disease had the aim of restoring a balance, curing the patient. The humoral model was a continuity during the early modern period, despite the fact that new medical theories began to arise in the second half of the eighteenth century, because these new ideas which used different treatments involving new chemicals were not as trusted since they were not properly established. [ 31 ]


In this way medical and popular beliefs about menstrual problems such as irregular menstruation,  amenorrhea  (absence of periods whilst fertile) or  dysmenorrhea  (painful periods) were thought of in relation to the four humours. [ 32 ]  In early modern western Europe, physicians believed that the womb could not be too cold, hot, moist or dry and that an excess in any of these could impact a woman's fertility. [ 33 ]  Significantly, people believed that warmth encouraged sexual pleasure and increased the probability of conceiving a child, meaning that the womb had to be warm during intercourse. If a woman was found to be having problems menstruating which would then impact their fertility, remedies which aimed to alter the humoral state of the body were used. Aphrodisiacs were a common remedy given to women with menstrual problems, since they were believed to have internal heating effects, stimulating menstruation by redressing the constitutional balance of a womb that was too cold. [ 34 ]


The sociological theorist  Emile Durkheim  argued that human religion in its entirety emerged originally in connection with menstruation. His argument was that a certain kind of action—collective ritual action—could establish simultaneously  totemism , law,  exogamy  and kinship in addition to distinctively human language and thought. Everything began, according to Durkheim, when a flow of blood periodically ruptured relations between the sexes. 'All blood is terrible', he observed, [ 35 ]  'and all sorts of taboos are instituted to prevent contact with it'. During menstruation, females would exercise a 'type of repulsing action which keeps the other sex far from them'. This same blood was thought to run through the veins of women and animals alike, suggesting the blood's ultimate origin in 'totemic'—part-human, part-animal—ancestral beings. Once menstrual blood had been linked with the blood of the hunt, it became logically possible for a hunter to respect certain animals as if they were his kin, this being the essence of 'totemism'. Within the group's shared blood resided its 'god' or 'totem', 'from which it follows that the blood is a divine thing. When it runs out, the god is spilling over'.


In  Judaism , a woman during menstruation is called  niddah  and may be banned from certain actions. For example, the Jewish  Torah  prohibits sexual intercourse with a menstruating woman. [ 36 ]  The ritual exclusion of niddah applies to a woman while menstruating and for about a week thereafter, until she immerses herself in a  mikvah  (ritual bath) which is basically intended only for married women. During this time, a married couple must avoid sexual intercourse and physical intimacy. Orthodox Judaism forbids women and men from even touching or passing things to each other during this period. While Orthodox Jews follow this exclusion, many Jews in other branches of the religion do not.


In the Torah ( Leviticus  15:19-30), a menstruating female is considered ritually unclean: "anyone who touches her will be unclean until evening" ( New International Version ). Touching a menstruating female, touching an object she had sat on or lain on, or having intercourse with her also makes a person ritually unclean. The extent to which these rules are observed in modern Judaism varies depending on the degree of conservatism/orthodoxy.


In Genesis 31:34-35, menstruation is referenced in a story, where  Rachel  was, or pretended to be in her  menstrual period :


Now Rachel had taken the teraphim, and put them in the saddle of the camel, and sat upon them. And Laban felt about all the tent, but found them not. And she said to her father: 'Let not my lord be angry that I cannot rise up before thee; for the manner of women is upon me.' And he searched, but found not the teraphim.


Most Christian denominations do not follow any specific rituals or rules related to menstruation. Other denominations, such as those of  Oriental Orthodox Christianity , follow rules similar to those laid out in the  Holiness Code  section of Leviticus, somewhat similar to the Jewish  ritual  of  niddah . [ 37 ]   Pope Dionysius of Alexandria  held with regard to menstruating women that "not even they themselves, being faithful and pious, would dare when in this state either to approach the Holy Table or to touch the body and blood of Christ." [ 37 ]  As such, Oriental Orthodox Christian women, such as those belonging to the  Coptic Orthodox Church , do not attend church while they are menstruating. [ 37 ]


Some  Church Fathers  defended the exclusion of women from ministry based on a notion of uncleanness. [ 38 ]  Others held that purity laws should be discarded as part of the Old Covenant. [ 39 ]  The 4th century text  Apostolic Constitutions  says:


For neither lawful mixture, nor child-bearing, nor the menstrual purgation, nor nocturnal pollution, can defile the nature of a man, or separate the Holy Spirit from him. Nothing but impiety and unlawful practice can do that. [ 40 ]


Some Christian churches, including many authorities of the  Eastern Orthodox Church  and some parts of the  Oriental Orthodox Church  advise women not to receive communion during their menstrual period, [ 41 ]  not because menstruation is considered to be sinful, but for more intense preparation to approach Christ and due to the physical difficulties faced by women. [ 41 ] [ 42 ]  This is a fairly common practice throughout  Greece  and  Russia  and other historically  Orthodox Christian countries , as well as by Orthodox Christians in countries where they are in the minority, including Egypt, Kerala  [ citation needed ]  and Syria.


In 735 the  Latin Church  decided that women must be allowed to attend liturgies and receive Holy Communion during their menstruation. [ 43 ]


During menstrual periods, women are excused from performing prayers. Sets of rules are advised for women to follow while during menstruation. They should not fast and left over fasts of  Ramadan  are to be completed during other days. During menses pilgrimages are allowed; and  circumambulation  of the  Kaaba  is also permitted. They are permitted to enter the praying place of the mosque but are excused from prayer and are encouraged to be present at Muslim gatherings and festivals ( Eids ). After the period, a bath ( Ghusl ), which is also required of both partners after sex, is also required before prayer may continue.


And they ask you about menstruation; Say It is harm/unclean, so keep away from women during menstruation; And do not approach them until they become pure And when they have purified themselves, then come to them from where Allah has ordained for you; Indeed, Allah loves those who are constantly repentant and loves those who purify themselves. Your women are your tilth, so come to your tilth as you wish and put forth for yourselves; And fear Allah and know that you will meet Him; And give good tidings to the believers. (Al-Quran 2:222-223)


The traditional Islamic interpretation of the  Qur'an  forbids intercourse during a woman's menstrual period, [ 44 ]  but allows for physical intimacy and other sexual acts that are not intercourse. If a man is engaged in sexual intercourse with his wife and discovers that her period has started, he must immediately withdraw.


On authority of Urwa: [ 45 ]


"A person asked me, 'Can a woman in menses serve me? And can a  Junub  woman come close to me?' I replied, 'All this is easy for me. All of them can serve me, and there is no harm for any other person to do the same. 'Aisha told me that she used to comb the hair of Allah's Apostle while she was in her menses, and he was in  Itikaf  (in the mosque). He would bring his head near her in her room and she would comb his hair, while she used to be in her menses.'"


The Prophet said in Al-Bukhārī also reported in his Ṣahīh (no. 3835), “Your menstruation is not in your hand.” And further, “This is a matter which Allah has ordained for all the daughters of Adam.”


Some universities in strict Islamic contexts like Pakistan have become more open to helping their students during their period, and have made their institutions period friendly by installing vending machines, have quiet rooms for women to rest and considering instituting period leave as a policy. [ 9 ]


Still, within many modern contemporary Muslim communities, menstruating women are barred from fasting during Ramadhan, entering a mosque, praying and making the full pilgrimage to Mecca, despite the fact that the textual basis of these injunctions in the Quran is widely debated.  [ 46 ]


In Buddhism ( Theravada  or  Hinayana ) menstruation is viewed as "a natural physical excretion that women have to go through on a monthly basis, nothing more or less". [ 47 ]  However, in certain branches of Japanese Buddhism, menstruating women are banned from attending temples. [ 48 ]
In Nichiren Buddhism (Japan) menstruation is not considered a spiritual obstacle to religious practice, although a menstruating woman may choose not to bow, for comfort. [ 49 ]  During menstruation, women should not enter temples or shrines, being seen as polluted. In Sri Lankan Buddhism, this is also true for their husbands and other men, who have been in a home with menstruating women. [ 50 ]  In Bhutanese Buddhist traditions, menstruation was historically not considered impure according to the Vajrayana beliefs, in fact menstruation was considered holy and pure as a life source for enlightened beings. In Tantric Tibetan Buddhist texts the word for the vagina is 'pema' or lotus signifying the positive symbolism attached to a woman's body. [ 9 ]


Hinduism's views on menstruation are diverse. Menstruation is seen as a period of purification, and women may or may not be separated from place of worship or any object pertaining to it, for the length of their period. But, in contrast to  Abrahamic religions  and many other cultures across the world, one will also witness Hindus celebrating menstruation in various forms like the celebration of the onset of menstruation among young girls. [ 51 ]  This forms the basis of most of the cultural practices and restrictions around menstruation in Hinduism. [ 52 ]  In Guwahati, India a festival is celebrated  known as the Ambubasi Mela where devotees gather outside the Kamakhya Temple and fast for four days to honour the goddess Maa Kamakhya who is believed to be on her annual menstrual cycle. The temple doors are kept shut so that the goddess is not disturbed during what is believed to be the most powerful, sacred time for her. On the last day of the festival the head priest bathes the shrine of the goddess and performs rituals before opening the gates again. [ 9 ]


Menstruation does not lead to women being considered impure in Sikhism, and women's behavior is not restricted during the time when she is menstruating. [ 53 ]


In  The Feminine Principle in the Sikh vision of the Transcendent , Nikky Guninder Kaur-Singh writes:


The denigration of the female body "expressed in many cultural and religious taboos surrounding menstruation and child-Birth" is absent in the Sikh worldview. Guru Nanak openly chides those who attribute pollution to women because of menstruation. [ 54 ]


Bahá'u'lláh , the founder of the  Baháʼí Faith , in the  Kitáb-i-Aqdas  abolished all forms of ritual impurity of people and things and stressed the importance of cleanliness and spiritual purity. Menstruating women are encouraged to pray and are not required to fast; they have the (voluntary) alternative of reciting a verse instead. [ 55 ]


In Jainism, the bleeding that occurs in menstruation is thought to kill micro-organisms in the body, making the female body exhausted, causing cramps, and producing stress. [ 56 ]  Hence, women are expected to rest and not perform any religious duties for a duration of four days. In this time, the man of the house may take up the duties of the woman.


In Japan, the religion of  Shinto  did and still does play a part in their society. The  Kami , the spirits they worshiped, would not grant wishes to those who had traces of blood, dirt, or death on them. While menstruation is not entirely blood, the ancient Japanese did not know that. As a result, women who were menstruating were not allowed to visit any of the Kami shrines for the duration of their menstrual period. Even today, women are not allowed to enter Shinto shrines and temples during menstruation, and in some instances, women are completely banned from climbing the tops of sacred mountains due to their 'impurity'. Furthermore, the tradition is kept somewhat alive in the belief that the shedding of the endometrial lining is a kind of death. The tradition relates to the thought that any death in the family brings impurity and those experiencing this must wait a certain amount of time before being able to return to shrines and other holy areas. [ 57 ]


In Chinese belief systems, women are not supposed to touch sacred statues, make offerings, or pray to sacred statues on their menstrual cycle. Before the revolution some temples only permitted men, and women who were very old or very young, to attend. [ citation needed ]  Chinese views of menstruation are still deeply influenced by Confucianism values of virtue and chastity. Many women feel empowered and feminine in their early years of starting their menstrual cycles. [ 58 ]


Menstruation is mentioned in some  Wiccan  and  pagan  texts. There are collected books and material on Witchcraft and menstruation at the  Museum of Witchcraft and Magic . [ 59 ]


In the 2010s public Wiccan and pagan practitioners began sharing rituals, spells and histories of menstruation in these belief systems. [ 60 ]  Pagan rituals and histories of menstruation is also discussed in books such as  Penelope Shuttle  and  Peter Redgrove 's  The Wise Wound: Menstruation and Everywoman. [ 61 ]


The views of menstruation in various religions including Judaism, Christianity and Islam are primarily responsible for the current shame, stigma and censure that surrounds menstruation and menstrual practices in many societies including Western societies like the United States and the United Kingdom.  [ 46 ]  Many cultures considered Western heap various restrictions on menstruating women with studies showing that secular women in countries like the United States, Great Britain, Canada and Mexico endorse many taboos, myths and negative feelings around menstruation, and which are often perpetuated by mass marketing that portrays menstruation as dirty and polluting, consequently necessitating its secretive management with sanitary products.  [ 62 ]   The contemporary stigma and shame surrounding menstruation is reflected in the use of euphemisms that involve shame and censure to speak about menstruation rather than addressing menstruation using simple, neutral and scientific terms as a normal biological process.  [ 46 ]   Judaism, Christianity and Islam constitute about 54% of the world's contemporary population such that their lessons on menstruation which are inherently rooted in patriarchal ideology have become widely accepted throughout the world.  [ 63 ]


One of such dominant views of menstruation attributable to the  Judeo-Christian-Islamic  heritage is the view of menstruation as a curse, and in communities influenced by these three religions, the view of menstruation as a curse is conjoined with the notions of stigma and pollution. Through these notions, menstruating women and girls are ostracized as posing symbolic danger which necessitates various measures against them.  [ 46 ]  The view of menstruation as a curse within these religions is not only restricted to religious communities; even in the absence of religion, menstruators are still viewed with disgust and stigma, and required to verbally and spatially separate from non-menstruators.  [ 46 ]  Consequently, taboos around menstruation and views of menstruation as a curse and activity to be restricted spread beyond religious contexts centered around Jewish, Christian and Muslim communities to become universal and conventional expectations concerning menstruation.  [ 46 ]


Across the continent of Africa, a wide variety of menstruation-related customs have been recorded. In 2014  UNESCO  reported that an estimated 10% of girls in Sub-Saharan Africa do not go to school while menstruating. [ 64 ]   This is likely due to a lack of resources rather than cultural customs of exclusion, but it depends on context and country and tribe and customs.


Religious taboos and social stigma concerning menstruation contribute to a lack of access to school for girls in Ghana. In rural areas of the country 95% of girls have reported missing school during their periods. The  World Bank  estimates that 11.5 million women in Ghana do not have access to adequate hygiene and sanitation. [ 64 ]


A cloth torn from the traditional wrap ( chitenge ) is worn, part tied around the waist and part looped under the crotch, to catch menstrual fluid. [ 65 ]   Menarche  (the first menstrual cycle at puberty) is traditionally treated as a sign that the girl is probably ready for sex and marriage, as well as for adult duties in the household.  Initiation rites  on menarche include instruction on sex and marital relations as well as on menstrual management. This is conducted by older women. It is taboo to talk about menstruation with men, or to learn from one's own mother. [ 66 ]


In some portions of South Asia, there is a menstrual taboo, with it frequently being considered impure. Restrictions on movement, behaviour and eating are frequently placed. [ 67 ]  According to a 2018 study, more than one-third of girls across South Asia do not go to school during menstruation. [ 67 ]  However, there are many perspectives from across the region which show the great diversity in how menstruation is experienced depending on caste, class, socio-economic background, religion and gender. A more intersectional approach allows for a fuller appreciation of the different challenges menstruators' experiences. [ 9 ]


For instance the Christian women of the Lahore sweeper community face specific challenges around menstruation because of their gender, position as a minority in a Muslim country, their occupation with dirt, and lack of toilets in public spaces where they work. [ 9 ]  In Bangladesh female factory workers in the retail garments sector experience constraints around long working hours, clean, female only toilets, disposal facilities and basic privacy. [ 9 ]


A small study in a rural area in Laos (Savannakhet) found that menstruation is considered taboo and shameful. [ 68 ] : 40   This creates difficulties in sharing knowledge at school and at home. Also, there is a low level of  menstrual hygiene management . This has a negative effect on social opportunities in achieving good health, moving around freely and going to school. [ 68 ] : 40   Some menstruating women (16%) wear double-layer skirts ( sinhs ) while in the private sphere, compared to 54% who wear  disposable pads . [ 68 ] : 28


In most of India, menarche is celebrated as a positive aspect of a girl's life. For example, in  Andhra Pradesh , girls who experience their menstrual period for the first time are given presents and celebrations to mark the occasion. [ 69 ]  In South Indian tradition, the first period is celebrated as a rite of passage in the  Ritu Kala Samskaram .


In some traditions in central and north India, girls and women face restrictive taboos relative to menstruation, such as being denied entry to the kitchen or eating meals separately from their families. [ 70 ]  In areas around the  Jhabua district  of  Madhya Pradesh , the belief is that "menstruation is a disease and not a normal biological process", and therefore women who are menstruating are not allowed to sleep on beds, enter kitchens, touch male members of their family or eat spicy foods. [ 71 ]


In a 2014 study conducted in India, the researchers found that as many as 42% of women who participated in the study did not know about sanitary pads or the anatomical origin of their menstruation. The researchers noted that women reused old rags to deal with their menstrual discharge, and that "Most of them were scared or worried on first menstruation." [ 70 ]  88% of menstruating women in rural India use alternatives to sanitary pads such as old fabric, rags, sand, ash, wood shavings, newspapers and hay. [ 72 ]


A study conducted in six villages Uttar Pradesh in 2018 found that 87% of women had no knowledge of what a period was until their first menstruation experience and  most men also did not have any idea what it involved until they got married. [ 9 ]


Keddaso  (also  transliterated  Keddasa, and also known as Bhumi Puje, and in  Tulu  as  keḍḍasa   ಕೆಡ್ಡಸ ), is popularly known as the "festival of worshipping Mother Earth" in the  Tulu Nadu  region of  Karnataka  in  South India . It is believed that on this day,  Bhoomi Devi  undergoes menstruation and the day is celebrated holistically in Tulu Nadu. This is an important four-day festival celebrated in the closing days of the  Tulu month  Ponny (Gregorian month of February). [ 73 ]


Sabarimala Temple  is situated at  the place of that name  in Pathanamthitta District,  Kerala . [ 74 ]  Women of reproductive age were not permitted to worship there; the ban was said to be out of respect to the celibate nature of the deity to whom it is dedicated,  Shasta , an underage teenage male. [ 75 ]  A Kerala high-court judgement had legalized this interpretation, and forbade women from entering the temple since 1991. [ 76 ]  In September 2018, a judgement of the  Supreme Court of India  ruled that all Hindu pilgrims regardless of gender can enter. The  Constitution bench  of the Supreme Court held that  any exception placed on women because of biological differences violates the Constitution  – that the ban violates the right to equality under  Article 14 . [ 77 ] [ 78 ] [ 79 ] [ 80 ] [ 81 ]  This verdict led to protests, demonstrations and violence by millions of Ayyappa devotees (both male and female) supported by the Hindu right-wing  Bharatiya Janata Party  and opposed by the  LDF  led  state government . [ 82 ]  About ten women attempted to enter Sabarimala, despite threats of physical assault, but failed to reach the  sanctum sanctorum . [ 83 ] [ 84 ]  Defying such protests, two women activists belonging to the previously barred age group associated with the ruling  Communist Party of India (Marxist)  finally entered the temple through the rear gate, on the early hours of 2 January 2019, with the help of police and local administration. When this alleged action was brought to the notice of the temple priests and authorities, the temple was closed for ritual purification. [ 85 ] [ 86 ]  Controversy regarding the implementation of this verdict continues.


Assamese and Bengali Hindus adhering to  Shaktism  celebrate the menstruation of the goddess  Kamakhya  during the  Ambubachi Mela  ( অম্বুবাচী ), an annual fertility festival held in June, in  Kamakhya Temple ,  Guwahati ,  Assam , India. [ 87 ]  The temple stays closed for three days and then reopens to receive pilgrims and worshippers. It is one of the most important pilgrimage sites in India, attracting millions of visitors each year, particularly for Ambubachi Mela which draws upwards of 100,000 pilgrims per day during the four-day festival. [ 88 ]  Before the temple is closed for Ambubachi, a white cloth is placed over the  yoni  (vulva)-shaped stone in which the goddess Kamakhya is worshipped in the temple. At the end of Ambubachi, when the temple is reopened and Ambubachi Mela is held, the assembled devotees are provided with fragments of that cloth, now reddened to signify menstrual blood. This cloth, known as  Raktobostro  ( रक्तवस्त्र ), is considered especially holy by Hindus since it has been stained by the 'menstrual blood' of Kamakhya, the Mother of the Universe. [ citation needed ]


In  Bali , a woman is not allowed to enter the kitchen to perform her usual duties, nor is she allowed to have sex with her husband while menstruating. She is to sleep apart from the family and has to keep her clothes that she wears while menstruating away from any clothes that she could wear to the temple. One of the most important regulations is that a woman is not allowed to attend temple while menstruating. [ 89 ]  Additionally, menstruating women are restricted from cooking, having sex, entering a Hindu temple or touching certain objects that belong to men.  [ 90 ]


In  Sumba , women keep their cycles secret, which makes men see them as deceitful. Women from Sumba believe that because of their secrecy, they will always have control of the men. "Men will never know how much we really can do to control these things. We have all kinds of secrets, and they should always believe that we can control even more than we really can". [ 91 ]


Women are supposed to avoid intercourse while menstruating. It is believed that sexually transmitted diseases are the results of women deceiving men and having intercourse while they are menstruating.  Gonorrhea  translates as 'disease you get from women' in Sumba; it has become a social problem. When a man gets this disease, the only way it is believed he can rid himself of the painful sores is to pass it to a woman. The reasoning is that a woman's body can absorb infection and purge it during a cycle. [ citation needed ]


Hindus in  Nepal  traditionally keep women isolated during menstruation; women who are menstruating are not allowed in the household for a period of three nights. This practise was banned by the  Nepalese Supreme Court  in 2005 but still continues. [ 92 ]  Community and organizational actions exist to combat the practice. [ 93 ]  In January 2019, local authorities demanded the destruction of  chhaupadi  huts in Bajura, the municipality in which a woman and her two young sons died in a hut. This resulted in the removal of 60 sheds, and the deployment of law enforcement to patrol for further removal. [ 94 ]


Yet, despite laws criminalizing these huts and activists calling for the same, communities still continue to use them. For these communities, these huts 'menstrual huts' are spaces for contemplation, relaxation and spiritual renewal for menstruating women.  [ 90 ]  In essence, the continuity of this practice demonstrates the need to consider the multiple voices and perspectives aimed at seeking effective ways to address the restrictions, and dangers, of some menstrual taboos.  [ 90 ]


According to a 2018 study, two-thirds of girls in  Sri Lanka  received no information about menstruation before reaching  puberty . [ 67 ]  The lack of education leads to many girls getting sick due to being ill-informed about their bodies and menstrual cycles. In addition, at least one-third of girls missed school during their periods due to a lack of accessible toilets or pads. [ 95 ]


There is also a ritual surrounding young girls, [ 9 ]  which starts with their first menstruation and ends with them receiving soft sex education. Throughout this ritual the girl can not be left alone and must always have another girl with her. If that girl must be away, she leaves an iron axe to prevent spirits from trying to influence the girl in the ritual. This part of the process continues for three months after the completion of the majority of the ritual, meaning the girl is potentially a woman before she receives any education on sex. [ 50 ]


Traditionally, the  Yurok  in North America practiced menstrual seclusion. Yurok women used a small hut near the main house. [ 96 ]  Menstruation among the Yurok of Northern California also varied by social class and status, with aristocratic women celebrating their periods with ten days of rituals that accrued prestige to them by heightening spiritual powers, while women who identified as commoners lacked the same privilege.  [ 90 ]  The variations of menstrual experiences as defined by power structures and local value systems demonstrates the existence of multi-layered perspectives on menstruation across various societies, and which should be recognized in the conduction of any menstruation enquiry.  [ 90 ]


A survey conducted in 1981 showed that a substantial majority of U.S. adults and adolescents believed that it is socially unacceptable to discuss menstruation, especially in mixed company. Many believed that it is unacceptable to discuss menstruation even within the family. [ 97 ]  Studies in the early 1980s showed that nearly all girls in the United States believed that girls should not talk about menstruation with boys, while more than one-third of girls did not believe it appropriate to discuss menstruation with their father. [ 98 ]


A 2018 survey of 1,500 women in the US showed that 60% of women feel embarrassed when they menstruate. [ 99 ]


In 2017, Scottish MSP  Monica Lennon  began work to present an 'Ending Period Poverty' bill to government. [ 100 ]  In 2019 it was officially lodged and debated in Holyrood. [ 101 ]  It was approved in November 2020 and made Scotland the first country in the world to make it a legal requirement for period products to be available for free to anyone who needs them. [ 102 ]


In 2019, the  Government Equalities Office  launched a Period Poverty Taskforce to research and end the problem of people who cannot afford menstrual products. [ 103 ]


Menstruation education is frequently taught in combination with sex education in the US, although one study suggests that girls would prefer their mothers to be the primary source of information about menstruation and puberty. [ 104 ]  A Nigerian study showed the following breakdown in menstruation education: "parents of 56%, friends of 53%, books of 46%, teachers of 44%, internet of 45%, and health centers of 54%" held the most influence in terms of menstruation education. [ 104 ]  Information about menstruation is often shared among friends and peers, which may promote a more positive outlook on puberty. [ 105 ]


The quality of menstrual education in a society determines the accuracy of people's understanding of the process. [ 106 ]  This is in part due to the segregation of male and female peers during educational sessions. Failure to teach an accurate understanding of menstruation to students of all genders has social implications for gendered relationships and the objectification of women's bodies. Discomfort arises when students do not have access to the same information, reinforcing the belief "that menstruation is gross and should be kept hidden". [ 107 ]  Girls are encouraged to conceal the fact that they may be menstruating in order to be considered desirable. Sexual harassment and teasing about menstruation cause girls anxiety as they must struggle to ensure that they give no sign of menstruation. [ 107 ]


Effective educational programs are essential to providing children and adolescents with clear and accurate information about menstruation. Several education and sexual health experts have studied the key features necessary for such programs. Some experts maintain that schools are an appropriate place for menstrual education to take place because they are an institution that young people attend consistently. Schools are intended to expand students' knowledge and thus serve as an appropriate site for conveying menstrual education. [ 108 ]


Other experts argue that programs led by peers or third-party agencies are more effective than those taught in the school classroom. This may be due to the use of small group interactions, the ability of these programs to target specific populations, or the possibility that many teenagers choose to participate voluntarily in these programs, rather than being mandated to attend school programs. [ 108 ]


Menstrual product advertising began in the early twentieth century. [ 109 ]  Early ads included print magazine campaigns from Tambrands Inc ( Tampax ), Kimberly-Clark ( Kotex ) and brands that have since been discontinued. Advertising for menstrual products outside the US began somewhat later. [ when? ]  In Norway,  SABA  began openly advertising after the Second World War, driving a brightly colored bus around the country to provide information to consumers. [ 110 ]


Historically, menstrual product advertising has had to balance frankness and information with taboos and censorship laws against discussing or showing menstrual themes. Educational pamphlets and school outreach has been an important way of marketing to young consumers during the twentieth century. [ 111 ]


One common way that sanitary-product advertising avoids depicting menstruation is by pouring a blue, rather than red, liquid on the sanitary product to demonstrate its absorption. Historically, this has been due to strict censorship rules regarding menstrual product advertising. [ 112 ]


In 2010, the  Always  feminine hygiene brand created the first feminine hygiene ad to ever feature a tiny red spot, representing blood. The ad was created by intern and artist William Chyr who was working at Always' advertising agency,  Leo Burnett . Originally the ad was created for the intern's personal portfolio, but then it caught the attention of the chief creative officer at Leo Burnett, and was subsequently published as an actual ad. There was some controversy when the ad was first released. [ 113 ] [ 114 ]  In June 2016 the presence of red blood in a UK  Bodyform  commercial was greeted with approval in social media for its attempt to challenge the stereotypical menstruation ad, by showing women who struggle despite bleeding from cuts, blows and bruises they receive while playing various sports. [ 115 ] [ 116 ]  Later, Bodyform's owner,  Essity , launched campaigns featuring blood-like liquid in the campaign "Blood Normal". [ 117 ]


While menstrual products have helped women and girls all over the world better manage their reproductive health, feminists and women's rights activists have actively critiqued the production and advertising of menstrual products arguing that they have structured menstruation as a problem to be managed, hidden and suppressed in secrecy using commercial menstrual products rather than a normal biological process.  [ 118 ]  Advertisements for menstrual products have actively communicated the taboos associated with menstruation by emphasizing secrecy, avoidance of embarrassment and freshness. Advertisements for menstrual products use allegories such as flowers and hearts, light colors such as blue rather than red, hence euphemistically communicating secrecy and view of menstruation as a curse to be hidden.  [ 119 ]  As such, advertisements for menstrual products prey on the fear of menstruating women on being discovered menstruating because discovery means stigma.  [ 119 ]  Consequently, menstrual products are advertised and made as to not be visible under one's clothes, or absorb all fluids and odors, be small enough to carry around unobtrusively and easy to discard without noticibility.  [ 119 ]  By design, this is meant to ensure that menstruating women are able to keep their menstruating status secret, and thus escape the stigma that comes with discovery.


When advertisers use words such as "fresh" and "untainted" in describing the advantages that women might gain from using their products, women consequently adopt many of the themes in the advertisements with regards to menstruation.  [ 119 ]  British women who were questioned about their experiences with menstruation echoed many of the themes in the advertisements reporting being self-conscious of menstruation, preferring tampons because they were less noticeable than pads, believed that menstrual blood is distasteful and finally supported the taboo against sex during menstruation.  [ 119 ]  Indeed, the stigma associated with menstruation does affect how women view themselves, making them feel self-conscious during menstruation and motivated to conceal their menstrual status as a consequence of the negative attitudes and stigmatized status of menstruating women. [ 120 ]  As such, these advertisements and the design of menstrual products communicate the idea of menstruation as a polluting and dirty phenomenon, even among menstruating women themselves, despite the advantages that modern menstrual products offer women and girls with regards to their sexual and reproductive rights.


Menstrual art engages with menstrual themes, including blood, pain, menopause and  menstrual stigma . Although not new in the twentieth century, a noted increase in artistic engagement began in the late 1960s, at the time of  second-wave feminism , with artists including  Shigeko Kubota ,  Carolee Schneemann ,  Judy Clark ,  Judy Chicago ,  Catherine Elwes ,  Marina Abramović ,  Gina Pane ,  Ana Mendieta , and later  Orlan . Since the 1960s, artists have continued to take an interest in menstrual art. [ 121 ]  Menstrual art highlights different issues regarding activism around shame, menstrual creativity, feminine power, taboos and pain. [ 122 ]  Several South Asian artists including Anish Kapoor, Rah Naqvi and Lyla FreeChild have been working in different mediums such as acrylics, embroidery and menstrual blood. [ 9 ]


In 2015, artist  Rupi Kaur  was censored by  Instagram  for posting menstrual art series  Period. [ 123 ]  Kaur critiqued Instagram's position, writing: "Thank you Instagram for providing me with the exact response my work was created to critique.... I will not apologize for not feeding the ego and pride of misogynist society that will have my body in an underwear but not be okay with a small leak, when your pages are filled with countless photos/accounts where women ... are objectified, pornified, and treated [as] less than human". [ 123 ]  She also questioned why Instagram was so keen 'to help keep the public safe from periods. [ 9 ]


Instagram later reversed their decision, and menstrual art has since flourished on the platform.


Art history has recently begun to explore this theme in art, drawing on a longer historiography of gender and the body in modern and contemporary art explored by feminist  art historians , activists, feminists and academics for example Farah Ahamed. [ 9 ]
, Ruth Green-Cole, [ 121 ]   Camilla Mørk Røstvik  [ no ] , [ 124 ]  Kathy Battista, [ 125 ]  and Bee Hughes. [ 126 ]  In 2022 through a QR code in a book, Indian classical dance was explored as a form of menstrual art, where the dancer Amna Mawaz Khan expressed the feminine power she felt during menstruation while also rejecting period shaming and patriarchy through strong, gestural movements based on traditional dance steps to raag music, and red paint on her feet. [ 9 ]
This is the first time in modern times that a menstrual experience has been depicted in a South Asian dance, Raqs-e-Mahvaari.


The 2015 conference of the  Society for Menstrual Cycle Research  sponsored a group exhibition, curated by artist Jen Lewis, which resulted in a catalogue. [ 122 ]  In 2020, Norwegian museum  Telemark Kunstsenter  held an exhibition about menstruation named SYKLUS. [ 127 ]


Movies and television also reflect the taboo nature of menstruation. Typically menstruation as a topic is avoided, except for scenes involving  menarche , a girl's first period. For example, as Elizabeth Arveda Kissling explains in her article, "On the Rag on Screen: Menarche in Film and Television", the 1991 film  My Girl  contains a scene where the main character, Vada, experiences her first period. The explanation given to her by a female role model of what is happening to her is done off-camera and the subject is never mentioned again, save when Vada pushes Thomas across the porch telling him, "Don't come back for five to seven days." [ 128 ] [ 129 ]


In an article for  Vulture  examining the history of menstruation depictions on screen, critic Tina Charisma wrote, "Periods have traditionally been used as symbols in storytelling, usually to signal a character’s  coming of age  and often accompanied by disgust, fear, or shame. While there’s nothing inherently wrong with that narrative, over time it’s built a subconscious image of how menstruation should be orchestrated and perceived. Very rarely is a period portrayed as what it is like for almost everyone who experiences it — mundane." [ 129 ]


In the 1976 horror film  Carrie , the title character has her first period in high school, and becomes hysterical in the gym shower believing she is dying. [ 129 ]  The other girls tease her by throwing  tampons  and  sanitary pads  at her. The gym teacher tries to calm Carrie down, and eventually must explain the concept of menstruation to Carrie (because Carrie's mother had never done so). When Carrie returns home, announcing that she is a woman and inquiring why she was never told about periods, her fanatically religious mother yells at her and locks her into a closet, fearing that menstruation will bring men and the sin of sex. Later in the movie, her classmates mock her ignorance of menarche again by pouring pig's blood on her at the prom. Critics noted that the period scene "is intentionally gory, traumatic, and horrific" and mirrors the cultural "perception of menstruation as something gross and embarrassing". [ 129 ]


The 1979 novel  Endless Love  by  Scott Spencer  has a 20-page love scene in which menstrual blood is no barrier to the obsessive union of the couple. [ 130 ]


In the 1991 Japanese animated film  Only Yesterday , one of the girls is found to be going through menstruation and is later teased about it, especially when a group of boys tell the others not to touch a ball she had touched by saying, "You'll catch her period".


Clueless , the 1995  cult classic  teen movie, contains an oft-cited line about periods. [ citation needed ]  Protagonist Cher, when receiving a second tardy for being late to class, uses the euphemism of "riding the crimson wave" as her reason for receiving her second tardy. [ 131 ]


In the 2007 movie  Superbad , Seth discovers menstrual blood on his jeans after dancing with a woman. He reacts with disgust, as do other men in the scene. The scene has been described by critics as "[encapsulating] the attitudes of disgust and shame associated with periods." [ 129 ] [ 132 ]


Netflix's  Big Mouth  features Jessi Glaser, played by  Jessi Klein , getting her period for the first time on a school trip to the Statue of Liberty in season one episode two. As Jessi frets in the bathroom her male friend, Andrew Glouberman, played by comedian  John Mulaney , finds her a menstrual product. [ 131 ]


The 2018 Bollywood comedy-drama  Pad Man  was inspired by the life of social activist  Arunachalam Muruganantham . As a newlywed, he wishes to help his wife get better access to sanitary products after finding out that she has to live in separate quarters during her period. He works hard in order to create a low-cost pad accessible to every woman in India. His journey was chronicled by  Twinkle Khanna  in her fictional story  The Legend of Lakshmi Prasad . [ 133 ] [ 134 ]


The 2020 film  Borat Subsequent Moviefilm  features a scene that uses humor and  irony  to subvert taboos surrounding menstruation. In the scene,  Borat  and his daughter  Tutar  do a "fertility dance" at a  debutante ball , and the audience is enthusiastic about the dance until Tutar lifts her dress to reveal she is menstruating, which prompts disgust and walkouts amongst the crowds. The scene was praised by writers for its satirization of common menstruation stigmas. [ 135 ]  As said by Lindsay Wolf of  Scary Mommy , since society has "been conditioned…to basically pretend that periods don't exist, putting them in the spotlight like [the film] did forces us to confront that 1) they happen, and 2) we need to get over it and stop treating girls like dainty little prizes who secretly have them." [ 135 ]


More realistic and accurate representations of periods onscreen have increased with the number of women in production roles in TV and film, with notable examples including films  The Runaways [ 136 ]  and  Turning Red , [ 137 ]  and the TV series  Broad City , [ 136 ]   Orange is the New Black , [ 136 ]   I May Destroy You , [ 129 ]  and  Yellowjackets . [ 138 ]   Yellowjackets , a series which involves a group of female characters who must learn to survive while stranded in the wilderness, received praise for not ignoring the subject of periods in comparison to other survival dramas. [ 138 ]  In the fifth episode of season one, the series addresses the issue of the girls' periods and how they must improvise in the wild with makeshift  pads . [ 138 ]


Though  Turning Red  does not explicitly address menstruation, it is used as a metaphor for a girl's coming-of-age. The film sparked controversy amongst critics who thought the topic of menstruation was inappropriate to reference in a children's movie, [ 137 ]  while others disagreed and emphasized the importance of normalizing a process that is a part of growing up for girls. [ 139 ]


The essay "Menstruation in Fiction" in the 2022 book  Period Matters: Menstruation in South Asia  examines the  male and female authorial gaze  on menstruation and how more than twenty writers from different cultures have depicted it in their writing, including  Philip Roth ,  Milan Kundera ,  Stephen King , and Nurudeen Farah. [ 9 ]  According to the essay, male authors have tended to objectify and dehumanize their female protagonists when depicting them on their periods. In contrast, female authors such as  Shashi Deshpande ,  Doris Lessing ,  Petinah Gappah  and  Bapsi Sidwa  are shown to be more sympathetic in their portrayal of menstruation in their fiction, highlighting cultural, religious and socioeconomic constraints. [ 9 ]


With the recent [ when? ]  FDA approval of menstrual suppression medications, researchers have begun to shift their focus to the attitudes of American women toward their periods. One study in particular found that 59% of the women they surveyed reported an interest in not menstruating every month.  Of these, one-third said they were interested in not menstruating at all anymore. [ 140 ]


Anthropologists  Lock and Nguyen (2010) have noted that the heavy medicalization of the reproductive life-stages of women in the West mimic power structures that are deemed, in other cultural practices, to function as a form of " social control ". [ 141 ]  Medicalization of the stages of women's lives, such as birth and menstruation, has enlivened a feminist perspective that investigates the social implications of  biomedicine 's practice. "[C]ultural analysis of reproduction... attempts to show how women... exhibit resistance and create dominant alternative meanings about the body and reproduction to those dominant among the medical profession." [ 141 ]


Menstrual suppression as a form of violence against disabled girls and women


While  menstrual suppression  has been touted as an embodiment of bodily sovereignty and autonomy among menstruating women, menstruation has emerged as a key site for discrimination and violence against women and girls with disabilities. Despite there being international laws curtailing preventing the violence and discrimination with regards to menstruation, many governments continue to sanction sterilization and other coercive responses to the menstruation of women and girls with disabilities.  [ 142 ]  In this case, forced sterilization is used as a means of menstrual management consequently violation the rights of these women and girls to consent to any medical procedure performed on them as well as their autonomy over their reproduction, contravening their rights guaranteed by the Convention on the Elimination of all Forms of Discrimination Against Women  (CEDAW) .  [ 143 ]  As a form of menstrual control, women and girls with disabilities are subjected to various forms of sterilization including but not limited to hysterectomy, tubal ligation, and endometrial ablation.  [ 142 ]


In some instances, ‘less restrictive’ alternatives to sterilization, particularly menstrual suppressant drugs are used and justified on the basis that they are ‘temporary’ and ‘non-invasive’ thus rendering them subject to less legal and political scrutiny. The justification of these procedures on the premise that they do not impact significantly on the autonomy and bodily integrity of the victims ignores the fact that they are non-consensual and basically a violation of these women's and girls' rights.   [ 142 ]  Essentially, these practices reflect the ableist narratives that women and girls with disabilities should conceal and control their menstruation in line with the menstrual stigma that surrounds menstruation and that since they are incapable of doing so without assistance, it is therefore unnecessary for others such as their caregivers to support them as they menstruate.  [ 142 ]


Sterilization of disabled women and girls and other non-consensual menstrual practices are sanctioned in various regions of the world including Australia, the United States, Germany, New Zealand and France.  [ 142 ]