Keywords: Menstruation, men, society, women’s health, India.

In the twenty-first century, there is still a taboo on frank discussion of menstruation in Indian society, particularly with men. This inadvertently widens the gender/equity gap in families and in society. Even men in the healthcare sector are uncomfortable talking about this because the societal norms often overpower professional knowledge. Indian society needs to move forward and normalise menstruation in the perceptions of boys and men in all settings. We highlight below some salient points on the orientation of men regarding menstruation.

Menstruation is either mentioned in hushed whispers or through euphemisms among the upper and middle class, whilst it remains a taboo topic among the lower sections of Indian society. Mothers, irrespective of education level, tend to be very conservative while talking about menstruation with their boys [1]. They ensure that even their daughters do not discuss this with male family members. The stigma starts here and continues lifelong, unless a medical emergency arises.

A natural physiological phenomenon which a female has to undergo every month from the tender age of 10 or 11 years with accompanying cramps, discomfort and, often, irregular cycles, has been stigmatised. The consequent lack of awareness or training on menstrual hygiene gives rise to several health issues, misconceptions on timings of natural contraception and mental harassment of women by debarring them from social activities, entering religious places, etc [2].

Indian men, including educated professionals are not only uncomfortable talking about menstruation, but also find it unmanly to do so [3]. This is compounded by the fact that they do not have to experience menstruation themselves. Few researchers have examined male perspectives on menstruation, whereas a clear understanding of the subject in society at large may save future generations from the general indifference of men and the unnecessary shame experienced by women [4]. Physiological premenstrual and perimenopausal syndromes cause a lot of distress. The few women who received support from male family members experienced better emotional and physical wellbeing [5, 6]. However, most women are expected to continue with household chores or report to work without any compromise.

Only when menstruation becomes pathological do family members take notice, but the regular cycles of dysmenorrhea and the 24×7 discomfort at a stretch create no ripples. Even female doctors have to deal with related health problems alone, just because they have the means and the understanding, despite their additional roles of wife and mother. Unfortunately, most medical professionals also view menstruation solely from a medical angle and not as a normal biological process, complicated by socio-cultural practices that need to be addressed [7]. As women age, perimenopausal symptoms appear, often catching them off guard. There is even less awareness about perimenopause and menopause among both women and men, complicating the issue further.

Families and educational institutions are crucial settings for sensitising and familiarising boys with menstruation early on. If a 10- or 12-year-old girl can endure menstrual pain, surely a boy of the same age could understand the issue and be of some help. Boys are not taught about menstruation till they hear about it from friends or male relatives and social media, often in a distorted manner, or read about it from textbooks, with unanswered questions lingering in their minds [8]. Educational institutions, starting from schools, need to provide sufficient and open information on the subject. School absenteeism, dropping-out and teenage pregnancy are all related to lack of awareness and support regarding this biological process. Textbook knowledge about menstruation needs to translate into empathetic attitudes. Life skills classes and workshops that include menstruation-related awareness building need to be conducted.

At the workplace, despite projections of gender inclusivity, menstruation remains a taboo topic. For example, rarely can a woman employee cite menstruation-related problems as the reason for seeking leave to their male colleagues or superiors. Instead, they inadvertently learn to be docile — a gendered behaviour, which the society needs to start addressing.

Therefore, it is time for academia, researchers and advocacy platforms to focus on the sensitisation of boys and men, engage stakeholders in creating public awareness, and normalise this natural biological phenomenon. Health communication needs to penetrate into all social circles. As a way forward, ice breaking sessions should be held in varied settings with the objectives of sharing myths and facts, addressing queries, imparting menstruation communication skills and forming support circles. It also calls for males in the healthcare sector to set an example by speaking up when menstruation-related issues are mentioned outside their professional environments.

Conflicts of interest and sources of funding: None to declare.

Nilanjana Ghosh ([email protected]), Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Guwahati, Assam, INDIA; Limalemla Jamir (corresponding author — [email protected]), Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Guwahati, Assam, INDIA.