Menstruation and Sports

Okay, time to cross the line again. I’ve written about this before (see Menstrual Taboos ) but the issue keeps popping up. In the recent 2015 Australian Open, the top ranking female tennis player in Britain, Heather Watson, suffered a first round defeat. In the subsequent interview, as she was being grilled about what might have gone wrong, she reluctantly and perhaps somewhat timidly admitted that it could have been ‘girl things’. I didn’t get the impression that she was blaming them for her defeat, as much as conceding that her period may have been a contributing factor.

But it seemed to have opened the old societal wound: the ‘She’s blaming it on her period. I knew she would!’ The age old reason for excluding women from activities that require stamina and perseverence –or at least considering them inferior as a group to men. The time-worn excuse for domination vindicated once again.

My first  instinct is to stand on a street corner and yell ‘Grow up, guys!’ If it weren’t for the physiology of menstruation none of us would even be here! The uterus has a lining of cells that cyclically prepares itself to receive and grow a fertilized egg, but if no egg arrives, it needs to cast off that old lining and renew itself for another try. Another egg. Another cycle…

There are many reasons why the very topic of menses, let alone its existential reality has engendered such discomfort in polite conversation and I have covered some of them in my previous essay. But what I am concerned about here is how menstruation may be misunderstood, mislabelled as an impediment, or assigned properties and attributes it doesn’t usually deserve. Not all periods are disruptive; not all periods –even in the same woman- are alike. Nor, unless she has developed an untreated iron deficiency anemia because of heavy menstrual loss, will the fact of periods necessarily interfere with performance.

And yes, they are surrounded by myth and euphemisms –just read Karen Houppert’s The Curse: Confronting the Last Unmentionable Taboo, Menstruation. There’s precious little good research addressing menstruation and sport except about ways to attempt to prevent menses altogether and to concede that there might  be an increased chance of injury because estrogen, for example, may render tendons and ligaments more lax. Pretty soft science, to say the least.

Now let’s be clear –I’m a male, and despite my training as a gyaecologist, I can never quite enter that other world. Some would go so far as to say that I can never even hope to understand it; that genes and physiology imprison me and afford only a poor approximation of what it would be like to be a woman; that there is an opaque curtain separating us, obscuring important details.

This argument reminds me of Plato’s allegory of the Cave –you know, where prisoners are chained inside a cave so they can only see shadows cast on the opposite wall from a fire burning behind them. It’s all they’ve ever known; they think they are seeing reality; that the shadows are all there is to it. Then one prisoner escapes and enters the sunlight outside and finally sees the real world and not just shadows. The Truth. Things as they actually are.

So, are we all just looking at shadows? All of us Homo Sapiens? Because if that’s the case, then both sexes are prisoners of the same misapprehensions. The same inability to judge the other… We’re both handicapped. We’re both deceived.

I cannot accept that; I will not. I may not know what its like to experience having a baby, for example, and yet I can understand the joy and suffering attending it. And I can experience, although once removed, the frustration and fatigue I see in my patients in the second stage of labour. Believe me, it is palpable anywhere in the delivery room. It is a human thing. Knowing another entails a melding of shadows. Seeing the same thing differently and yet comparibly. Empathetically.

No, I can never have menstrual periods; I can never truly experience what it must be like. But I do remember an incident in the office many years ago. A colleague from another hospital was away and I had agreed to see some of her patients for her. One of the patients had come in because of heavy and painful periods. All of the investigations –blood tests, ultrasounds, and even a D&C coupled with a laparoscopy to look directly into her abdomen under anaesthesia- were normal. She was not anemic, despite her heavy menses and was reluctant to take the birth control pill for fear of side effects. But she was desparate to talk to somebody about her periods.

I listened to her for a while before she stopped talking and stared at me. I looked sad, she said and reached out to touch my hand across the desk. I remember smiling, but even the smile looked pained, she said.

I suppose I was caught off guard, and responded with something lame like that her periods seemed awfully heavy and that it must be hard for her. I really did think she must be suffering.

Her face brightened and I could see her mood change right in front of me. “You know,” she said, hardly able to contain her enthusiasm, “I never felt I could go to a male doctor and talk about this sort of thing. I mean, how could you ever understand?”

I must have looked puzzled, because she added, “My other doctor didn’t seem to want to talk about it. When all of the investigations came back normal, and I expressed reservations about the options she’d offered, she just shrugged -as much as told me to suck it up. Deal with it.

“And yet, you listened, tried to hear what I was going through. Obviously you don’t have to be a woman to empathize.”  She shook her head slowly and carefully, as if she had just figured something out. Then, as I recall, she sighed rather theatrically. “Who says men will never understand women..?”

I don’t think Ms Watson was necessarily blaming her loss on her period, any more than a man would attempt to blame his poor performance on, for example, a headache. Once the initial shock of mentioning the unmentionable has worn off, I imagine there will be nobody that will believe that she was using a normal and incontrovertibly organic event as an excuse. But, even if she were, so what? Things happen. And anyway, I suspect that she may have helped to remove yet one more shadow –if only an edge- from the reality that we are, all of us, members of the genus Homo –human- and of the species sapiens –knowing. Intelligent. Wise. And both sexes share far more physiology than separate us. Lets face it, we need each other. And, except for a tiny Y chromosome, we are each other.

The ramparts are coming down.

The Tampon Tax

I have to admit that I am sometimes puzzled. Not, you understand, to suggest that I am omniscient at other times, but merely that I, too, am apt to get lost in the various back alleys of our government. They seldom come with maps; they are not meant for untroubled navigation. In fact, I suspect they are purposely labyrinthine –not to encourage questions, but so you can be misdirected more effectively.

I recognize that to run a bureaucracy, decisions have to be made that may not be popular with some, and that for the sake of continuity and efficiency these should not be subject to change on a whim. But sometimes their perusal in daylight reveals egregious errors in judgement, wisdom and even fairness. I also realize that in a caring society, those less fortunate than the majority, those with unmet needs, and those who are unable to access the ears of government should be folded into its bosom. For example, items necessary for health or daily living are usually exempt from extra taxation –value-added taxes (Goods and Services Tax –GST in Canada). It is an assurance that those with special needs –incontinence products, for example- will not be unduly penalized. Admittedly, it is only a small concession, but at least it is an acknowledgement that we are all part of a community, an affirmation that we are all noticed and our differences accepted, if not totally underwritten. There are benefits accruing to membership in Society.

Of course in a democracy the majority will derive the most benefits, if only because it has chosen the government. As long as the minority is not oppressed, ignored, or denied the benefits offered to the rest, I think this is reasonable –or at least the most ethical compromise short of requiring them to abrogate their identity, or leave the country if this is not possible. No, Canada is a multicultural mosaic as we are fond of saying; we cherish difference and relish the weft and woof of our societal fabric.

And yet it seems a discrepant appreciation -an arbitrary one still rooted in attitudes so deeply ingrained that they are visible to those in power only through a public outcry when it threatens their incumbency.

I have long wondered about society’s attitude to menstruation:

Admittedly, we in the West have come a fair way already. The topic is no longer taboo in our public media and, except for the more provocative advertisements for menstrual products, barely provokes an eyebrow. Necessity is the Mother of conversation. And yet the Canadian Government –and the governments in several other countries as well, it would seem- has yet to hear it. If, as I have said, items necessary for health or daily living are granted a tax exemption, then what has it been thinking all this time? Or do Governments think?

Why menstrual products should be ignored as necessities is beyond me. It can’t be that the issue is a minority one that can be conveniently hidden, or assuaged by a few photo-ops like those assuring a small northern community that the government is indeed looking into building a skating rink for them; this is a 50% issue. Nor could it be construed as a definitional discrepancy: if contact lenses are covered by the dikat, then there’s certainly no argument to exclude menstrual products. Except…

Well, except that those taxes are probably a rich revenue source, for one thing. But, more troubling, is it a remnant of a long-buried attitude towards women and their place in our society? The previously ignored tip of a huge iceburg? A sleeping tiger that government would rather step around –ignore but not arouse?

There are braver souls, however. Individual colours that have managed to disengage themselves from the wallpaper we all wear. Patterns previously unappreciated as they slept undisturbed and unprovoked in the background:

It would be well for those in charge to walk carefully. The tiger is huge. Feed it. Nourish it. Befriend it.

Menstrual Taboos

Culture shapes behaviour, attitudes and beliefs -or is it the other way around? The chicken or the egg? This has puzzled me since I was a child wondering why everybody I knew wore jeans but in pictures the people living in, say, India did not. And the members of my family –uncles, aunts, grandparents, cousins- all went to church and sat in seats. None of them prostrated themselves on little rugs on the ground. Did each of us have to be Protestant? Was there a choice? Or, was there something about my family that made them that way? I don’t remember choosing.

Why do we end up believing or doing something that seems arbitrary when compared with other parts of the world? Why do we often think that only the way we do things is appropriate? Correct? How many correct ways are there..?

Could imitation be something akin to an infection? If everybody we know does the same thing, why would we even suspect it? Maybe it’s contagious and causes a psychological compulsion to fit in –like fashion, or expresssions in language that identify us as a member of a group or region. We seldom question it, but then again, there is no reason to: everybody around us is doing the same thing so it infrequently rises to a conscious concern. It’s an outrageous thought experiment of course and yet such curious congruity does give one pause for thought.

But in our islands of similarity we do notice difference; it makes us feel uneasy –as if perhaps there was a choice. Another way to do something. Another way to be in the world. And depending on the status of the innovator, we may see the novelty as interesting but peculiar –perhaps even something we should adopt for ourselves- or we may consider it simply wrong. Strange. Evil. Something to be shunned, avoided at all costs -even at the expense of the defector. Even if the apostate is tolerated under other circumstances when seemingly adhering more closely to the accepted norms.

I use the word apostate advisedly. Society is a religion, and one that is often disdainful of heretics, aberrations that tug at the pattern in the fabric. Anomalies. Discrepancies sometimes strain cohesion and make us question who we are and why we have come to behave the way we do. We are creatures of custom.

Of course I realize it is difficult, if not impossible, to apprehend difference without judgment. Even curiosity suggests analysis: comparison and evaluation. Some things, however, seem difficult to assign merely to custom; the difference is more appropriately attributable to fear. Unintended ignorance. Naivete.

The menstrual taboo is a case in point. There have been some recent articles in both the BBC News: and the Huffington Post: that discuss problems surrounding menstruation and how it interferes with education for young girls especially. Menstruation is a natural process for renewing the uterine lining every month: shedding the old cells to make way for new ones that may be required to grow a baby. But natural does not necessarily mean acceptable or discussable for everybody.

Culture deems some things embarrassing, things best kept private or at least not shared outside a family or circle of friends. Bodily functions and intimate relations probably top the list. And yet necessity sometimes trumps personal feelings; where adequate facilities do not exist, an accommodation, a compromise usually springs up to fill the need. So while communal ablution may never rise to the level of a societal norm, a variation of it may be tolerated under some circumstances. Safety and vulnerability constrains many compromises, with strict gender separation often necessitating extreme measures such as waiting until the relative safety of darkness for a woman to relieve herself. Even this atrocious compromise is fraught with danger, as recent reports of rape and sometimes murder in parts of rural India attest. That the practice should even need to exist is unconscionable to most of us; that those with the authority and power to change it in the region have not managed to remedy it is worse.

But let’s not allow the unreasonable social diminution of women in one area blind us to an even more pervasive inequity in many developing nations around the world: the cultural taboo about menstruation. Femme International has documented some of the more egregious offenders in its website

Culture is a tricky thing. Both intriguing and covert, it exerts an inordinate amount of influence on thought and action. The sources of its traditions are often historical, bound in a delicate weave with myth and legend, and are at best opaque. To question it, therefore is difficult and usually seen as insulting and provocative –it is what separates us from them, precluding further analysis, further understanding. “It’s just how we do things,” is the usual response to questions from foreigners. “You wouldn’t understand.”

The menstrual taboo is like that… and not. Attitudes are seldom fodder for experimental investigations, and yet occasionally there are aspects that are historically discoverable. The enforced seclusion or restrictions on the activity of menstruating women are usually ascribed to ignorance –lack of education about the function and meaning of menstruation- or fear of some theological punishment.  And yet Femme International, political correctness notwithstanding, has intimated there may be a more obvious, historical reason for the concern, albeit uncomfortable to state.

Traditionally, menses have been a source both of embarrassment as well as inconvenience for a woman –especially if she is required to be in public places such as the market -or school in more modern days- for any extended period of time. How to cope with the menstrual blood? Only recently have effective measures been available, but even these are priced beyond the means of many girls in isolated villages. In Kenya, for example, the BBC article reveals that the cheapest package of sanitary pads costs almost half the average daily wage, so they may be seen as more of a luxury item than a necessity. ‘As a result, girls will resort to using alternative methods of menstrual management, such as rags, leaves, newspaper, bits of mattress stuffing, even mud.’ The Femme International again: ‘Menstruation is the number one reason why girls miss school. Sometimes girls will attend school on their periods, but will refuse to sit down, or once seated, refuse to move. Many schools do not have appropriate latrine facilities, and girls are unable to wash themselves during the day. When latrines are shared between boys and girls, they are teased and mocked during their period.’ Indeed it has been suggested that because of some of these practices, the odour alone may have given rise to some of the fear of contagion and restrictions placed on the menstruating woman.  For example, the BBC reports than in ‘regions of Kenya, girls are forbidden from touching livestock, preparing food or consuming animal products for fear of contamination.’ And in India ‘there is generally a silence around the issue of women’s health –especially around menstruation. A deep-rooted taboo feeds into the risible myth-making around menstruation: women are impure, filthy, sick and even cursed during their period.’

Femme International has suggested at least one acceptable option: menstrual cups. ‘Menstrual cups provide an affordable and sustainable solution to menstrual health management. A menstrual cup is made of medical grade silicone and is worn inside the vagina during menstruation to collect fluid. Menstrual cups are more cost-efficient and environmentally friendly than tampons as they can be washed and reused for up to 15 years. Unlike [expensive] pads and tampons, the cups only need to be emptied every 12 hours. Thus girls can attend school without worrying about the availability of private washroom facilities, or revealing their period to peers.

There are other remedies of course and they, too, need to be pursued. Once again the Femme International: ‘Young women who lack the knowledge and resources to safely and effectively manage their periods not only miss school but face stigma and shame from their male and female peers. When girls do not understand why their body menstruates each month, they easily believe that it is something to feel shame about, something to keep hidden and something that is a source of humiliation. This type of behaviour is strongly influenced by the widespread stigma that surrounds menstruation in the majority of communities. When women are unable to manage their periods, they are less able to participate in daily life. Addressing the issue of menstruation through health education, positive reinforcement and the provision of management materials reduces these gender specific barriers.’

Yes, it’s a step to be sure, but one that may require a generation to succeed. We must not give up because the progress seems slow and the task insurmountable. Attitudes do shift, cultural mores and folkways change, governments fall. And with the almost ubiquitous availability of social media, one hopes the results might be noticeable even in our time. The curtain of mystery that has always separated the two sexes need not be rent asunder, though –mystery, after all, can be a source of awe and wonder. And not all mysteries have to be solved -sometimes just acknowledged and appreciated for their charm and excitement. No, the fabric need not be torn -merely parted enough to reveal that what differences do exist between the sides -between males and females- are nothing to fear. We were made for each other, after all.