Lived experiences of menstrual health and hygiene among persons of transgender and non-binary identity in India
Creators: name: Dubey, Priyanka
Publisher: name: University of Iowa
Year: 2026
Subjects: menstrual health
menstrual hygiene
trans health
transgender and non-binary
India
Menstruation

description: Most global research on menstrual health and hygiene (MHH) focuses on cisgender women and girls, with limited evidence on the experiences of transgender and non-binary (TNB) people. Social marginalization of TNB people may increase challenges for them in accessing MHH resources. In this dissertation, I used the socio-ecological model of health behavior to identify the individual, social, contextual, and environmental factors that help explain MHH among TNB people. Using a mixed-methods approach, I conducted three unique but complementary studies that contribute to the understanding of the MHH status among TNB people.
description: For the first study, I conducted a systematic review of global quantitative and qualitative studies of the lived experiences of MHH among TNB populations. The review established a need for more evidence on the topic. Four overarching themes emerged from data analysis and synthesis, which are (i) perceptions about cis-normative menstruation in a binary society, (ii) experiences of managing menstruation, (iii) accessing healthcare, and (iv) potential intervention points. Studies described menstruation as a source of gender dysphoria. Amenorrhea, the absence of menstruation, is a welcome relief. Quantitative studies focused on investigating the effectiveness of various contraception and hormonal therapy options to achieve amenorrhea, whereas qualitative studies focused on MHH’s physical, emotional, and environmental aspects. ‘Othering’ of the TNB population in all aspects of MHH, including the association of menstruation with women alone, accessibility of public bathrooms, and availability of menstrual products, was highlighted. Three areas for intervention emerged that could assist TNB individuals in managing menstruation and improving overall health: (i) creating inclusive and safe public spaces, (ii) improving menstrual and sexual and reproductive healthcare, and (iii) de-gendering menstruation.
description: The second study was a qualitative study conducted in India. I conducted 13 semi-structured interviews with TNB adults aged 19-40 years in three major Indian cities in collaboration with community organizations. We asked participants to share their experiences of managing menstruation in multiple spaces of life, e.g. at home, school, workplace, and other public spaces. I identified three major themes in MHH for TNB urban Indians: (i) gendering of menstruation, (ii) navigating physical aspects of menstruation, and (iii) challenges beyond bleeding. ‘Gendering of menstruation’ shaped overall experiences of MHH among participants. Gendered expectations upon menarche triggered gender dysphoria. Participants reported having little knowledge about menstruation prior to menarche, which led to a state of confusion and shame, and exacerbated their dysphoria from gendering of norms around menstruation. ‘Navigating physical aspects of menstruation’ was less challenging in familiar, private surroundings, however, accessing public spaces and bathrooms remained a major challenge and stressor. Though many participants reported undergoing hormonal replacement therapy (HRT) in part to suppress menstruation, they continued experiencing menstrual symptoms which triggered continued dysphoria. Participants reported facing ‘challenges beyond bleeding’ which included burden of multiple diseases, mis-gendered healthcare services, and lack of social support.
description: Using the findings from the first two studies, I cross-culturally adapted the Menstrual Practice Needs Scale—a 36 items validated scale measuring aspect of menstruation - including developing new items within the original scale for assessing TNB peoples’ menstrual needs, as well as developing a new scale around menstruation-related dysphoria. The adaptation process entailed multiple steps, each informing the following. These steps involved systematic translation, followed by consistency comparison between the original and translated scale. The above steps resulted in modifying items to ensure contextually appropriate language and adding four new items. This step was followed by interviews with experts to review the adapted scale with no significant modification but a few suggestions on the sensitivity and training of administrators of this scale.
description: Together, results from these studies indicate that the menstrual health for TNB populations is a complex phenomenon being influenced by factors at each level of the ecological model. Documenting the lived experiences of menstrual health and hygiene among TNB people supports the call to ‘de-gender’ menstruation and ultimately bodies. The studies highlighted several challenges and unique needs for MHH vocalized by TNB populations, as well as an urgent need for more research to guide intervention and program development.