# Menstrual stigma

Menstrual stigma refers to the negative social and cultural perceptions, beliefs, taboos, and practices surrounding menstruation. It encompasses the perception of menstruation as impure or shameful and often leads to secrecy and emotional distress. The manifestation of menstrual stigma varies across cultures and may have profound effects on mental health, social participation, and opportunities. Strategies aimed at addressing menstrual stigma typically involve educational and awareness initiatives.

## Stigmatization
### Cultural variations

Menstruation, deeply intertwined with intricate cultural beliefs, is often accompanied by taboos, myths, stigmatization, negative emotions, and feelings of shame. The associated beliefs and practices exhibit variations influenced by factors like country, religion, and social status. Cultural norms play a pivotal role in determining whether menstruation is a source of social stigma that is concealed or observable. For instance, in the United States, menstruation is predominantly concealed owing to societal norms of secrecy. In certain societies like Nepal, the onset of menstruation is commemorated through public rituals, and those undergoing menstruation may be secluded.
The notion that menstruation is a cause of impurity and danger has persisted into the contemporary era. According to a survey conducted by the World Health Organization involving women from 10 different countries, certain cultures still view menstruating women as impure, leading to restrictions in their religious or social activities. The WHO survey not only recorded both negative and positive attitudes toward menstruation but also highlighted culturally enforced sanctions (such as being prohibited from cooking) and self-imposed restrictions (such as refraining from washing one's hair).

### Euphemisms

People often use euphemisms like "time of the month," "Aunt Flow," and "on the rag" to refer to menstruation, highlighting the discomfort and stigma associated with it. This stigma is a global phenomenon, with menstruation often seen as something impure that should be kept private. Many individuals, from a young age, are taught that menstruation is something to be concealed or hidden for women to lead their everyday lives. The media plays a role in perpetuating this stigma through advertisements that stress secrecy, avoidance of embarrassment, and freshness. They also use euphemistic images and colors (like blue instead of red) to describe menstruation. Menstrual stigma can be passed on through educational materials, communication (or lack thereof), and the language used to discuss it (e.g., euphemisms).

### Activism

Feminists and various activists have countered negative depictions of menstruation by advocating for positive perspectives. They do so primarily through educational and media campaigns, consciousness-raising efforts, and by challenging conventional representations of menstruation. These actions aim to promote more affirming views of menstruation within various institutions like education, healthcare, families, and media. While feminist scholars and activists have endeavored to encourage the celebration of menarche and menstruation, their positive messages may be eclipsed or obscured by the prevailing stigmatizing narratives.

## Consequences

The menstrual stigma can have detrimental effects on various aspects of women's lives, including their overall well-being, somatic and mental health, social status, and sexual activity. Women who internalize these negative attitudes often take active measures to hide their menstrual status, such as wearing loose clothing and avoiding certain activities to prevent any signs. This constant effort to conceal their menstruation leads to increased self-awareness, heightened vigilance, and a sense of shame related to their periods. Failing to hide it can make them feel as though they've fallen short of societal expectations of proper menstrual etiquette. The stigma can have adverse effects on women's sexual lives since engaging in sexual activity during menstruation is often viewed as socially unacceptable. Both men and women may use derogatory terms like "disgusting," "smelly," "awkward," "dirty," and "messy" when referring to menstruation and sex during this time. Younger, single individuals with less sexual experience are more likely to avoid intercourse during menstruation and use negative language to describe it. In contrast, older, more experienced couples are more inclined to see sexual activity during menstruation as acceptable and enjoyable.

## Interconnected stigmas

Menstrual stigma is a significant element of the broader issue of endometriosis stigma. The negative attitudes toward menstruation play a pivotal role in perpetuating the stigma surrounding endometriosis. While much of the existing research on endometriosis stigma has primarily focused on menstrual pain and the associated stigma, it's crucial to recognize that chronic pain, in general, carries its own societal stigma. Considering that endometriosis involves persistent pain during menstruation, sexual activity, and pelvic symptoms, this pain-related stigma can exacerbate the overall stigma associated with endometriosis, leading to adverse mental health outcomes. Furthermore, infertility stigma is another factor contributing to the overall stigma surrounding endometriosis. Many individuals with endometriosis experience infertility issues, and this aspect of the condition can lead to feelings of depression and anxiety.
It's important to note that stigma operates on multiple levels, including self-stigma (internalized negative attitudes), perceived stigma (how individuals believe society views them), and experienced stigma (actual instances of discrimination). These various forms of stigma have been observed to have a significant impact on the well-being of individuals living with various chronic illnesses, including endometriosis.