Anita Diamant—journalist and author of 12 books including The Red Tent and Period. End Of Sentence—and Rebecca Dimyan—author of Chronic, a novel about her experience with endometriosis—join host Dr. Charis Chambers for a candid and emotional conversation about period stigma, its negative effects, and what you can do to challenge and/or overcome it.
Anita Diamant—journalist and author of 12 books including The Red Tent and Period. End Of Sentence—and Rebecca Dimyan—author of Chronic, a novel about her experience with endometriosis—join host Dr. Charis Chambers for a candid and emotional conversation about period stigma, its negative effects, and what you can do to challenge and/or overcome it.
Tales from the Uterus
Episode 1: Sticking it to Stigma
Introduction
Dr. Charis
Hello, hello, and welcome to Tales from the Uterus. My name is Dr. Charis Chambers. I will be your host. I am a board-certified OB/GYN and founder of the Period Doctor on all social media platforms. The title of this episode is Sticking it to Stigma. I'm going to have an engaging conversation with two incredible experts and folks who have also experienced period stigma.
So please, please stay tuned and join us. This podcast is for US listeners only and is intended to be listened to as it was originally produced by Pfizer and Sumitomo Pharma America. This podcast has been paid for by Pfizer and Sumitomo Pharma America and the participants have been paid by Pfizer and Sumitomo Pharma America for their time. The information provided is for educational purposes only and is not intended to replace discussions with a healthcare provider. This promotional activity is not certified for continuing medical education.
Welcome and thank you so much for joining us. So, to get this conversation started, I'd like to welcome Anita Diamant. Anita is a journalist and author of 12 books, including the novel, “The Red Tent”, and “Period. End Of Sentence”, a new chapter in the fight for menstrual justice. Welcome Anita, how are you?
Session 1 – Origins of Period Stigma
Anita Diamant
I'm fine, glad to be here.
Dr. Charis
Lovely. so, I want to start the conversation on period stigma just by, you know, leveling the field. So, what is period stigma? How do you define it?
Anita Diamant
Stigma is a strong feeling of disapproval or even disgust for something. So, period stigma is the feeling that I think is familiar to many of us that periods are icky, that they are something best not talked about, certainly not in quote/unquote mixed company. If one talks about periods, you know, you lower your voice because it's not, again, it's something we don't talk about.
And by making periods into something that's stigmatized, it leads to a lot of pain and suffering that is totally unnecessary in the world, because of course, without periods, there is no reproduction, there are no human beings. So, it's counterintuitive when you really think about it, but it's so normalized that we don't even think about the fact that we lower our voice when we say, “I've got my period.”
Dr. Charis
Yeah, so love how you how you set that up. So really stigma is it's a negative thing. It's not like there's some positive version of stigma. It's something that leads to shame, leads to silence, and certainly leads to really subtle ways in which we internalize the shame and alter our behavior. Because of the ever-present, you know existence of period stigma. Can you give me some more specific examples of period stigma? I know, there's that subtle kind of, okay, I'm whispering, but are there more glaring examples, more significant and more serious effects of period stigma?
Anita Diamant
There are very many. First of all, there are euphemisms for period. And the one that really expresses stigma the most, of course, is that it's “the curse”, that it's a curse, which is a malediction, which is something that's cast upon you. And that is the last thing in the world that you want. And internalizing the idea that you are in fact, in some way, even if you don't know it consciously cursed is bad for one’s sense of self and sense of purpose in the world. And the way that it gets lived out in the world ranges from very subtle to very unsubtle; from deciding not to go to school today because you're on your period and you're not sure that you have the products you need or you're afraid somebody's gonna just notice,
But there’s also this sense that there’s, that you’re always a little bit on edge if you’ve got your period. And it makes you uncomfortable in your own skin. And that’s, that undercuts the self-confidence of anybody who’s got a period. You’ve gotta be thinking about two or three things at the same time. It’s hard to try out for the track team or take a calculus test if you’re worried about bleeding through your clothes. So, it doesn’t have to be that way. If it was normalized, if periods were acknowledged to be a normal part of human life, like using the bathroom where you get toilet paper. That going to the bathroom means you also would find period products there, so you don’t have to worry about it. That could change life for a lot of people.
Dr. Charis
Absolutely. You know, “the curse”, when I hear that, it just kind of stings a little bit. Because I think when you really think about what it means to be cursed, it suggests that this is your burden to carry. It’s not something that you can affect or change. And it’s just, it’s really permanent, or there’s some permanency of it. There’s also a bit of a deserving part of a curse.
Right? Like I deserve to be cursed. Curses are often in punishment for something, a misbehavior, so you’re cursed. And so, I want to talk a little bit more about the origins of period stigma, because I know, you know, even from like a religious standpoint, the idea of cleanliness, or even just going back to just the patriarchal societies that a lot of us exist in, I feel like there’s some history there that really can shed light on why these the stigma exists in the way it does today. Can you tell us more about that?
Anita Diamant
I don’t think you can pinpoint where or why it happens, but I think there’s something about blood that is both powerful and frightening in a very elemental way. And as societies were organized, this question about why women, in particular, bled when they weren’t injured, and that it was inexplicable, so it was dangerous somehow.
Dr. Charis
You know, the inexplicable and things that are not understood are often dangerous, or, it’s very common that we fear what we don’t understand.
Anita Diamant
Right, right. So, so almost all of the large religious traditions of the world isolate women who are in having their menstrual periods. Jewish women, Jewish history has dealt with the bleeding of within couples is by asking the couple to refrain from touching or from having sexual relations during menstruation and then having a period of cleanliness after and then reconnecting. The curse of Eve is a kind of Christian locution that Eve by eating that apple was punished by giving birth in pain by having pain in childbirth. And this is part of that. So that the curse of Eve is not just childbirth, but it’s menstruation as well. And that’s where we get the word the curse from. Sometimes it’s extreme, sometimes it’s just sort of at home, but there are unspoken rules, and then there are rules that are handed down mostly from mothers to daughters that happen at home that are connected to their religious tradition and practice.
Dr. Charis
Yeah, and I think you bring up a great point, the handing down of rules, you know, from mothers to daughters or parent to child. And it’s not that, you know, it’s not so much that there’s always some male figure that’s imposing this period stigma. Some of the greatest perpetrators are menstruators themselves. But I’d like to argue, and I’ve definitely seen this in my practice and my care of adolescent patients, there is a huge multi-generational component of period stigma and just how we experience periods. I’m actually working on a book where I’m speaking on how intentional parenting can transform the puberty and period experience. And what I’ve seen is parents, they take their own experience and they kind of just sift through all of it and say, this I can keep, ah, I might wanna change that, you know. This hurt me, so I’ll try to flip that. But sometimes we’re perpetuating the same thing.
So, if someone had earlier development of breasts or so, those secondary sex characteristics that we’d say, that’s a womanly figure. If they think their child is gonna do the same thing, they say, wear this bigger t-shirt, cover this up. The things that they think may protect their child, but it’s still perpetuating some of the effects of stigma and the shame that says, your body’s not worthy of being seen because these changes are taking place.
Anita Diamant
Actually, the most vivid example of this I know is that there was this custom, folk custom of a mother slapping her daughter on her first period. This is an old Jewish custom. And so, people of my generation, I have heard stories of people getting slapped by their mothers and saying, I have no idea why I did that. My mother did that to me. Or a mother kissing both cheeks instead of slapping because they transformed it in their own, but explaining it that my mother slapped me, but I’m going to give you a kiss. But nobody knows where it came from. It’s not rooted in religious tradition. Nobody’s ever said you should do this. It’s just this folk custom about maybe you should be careful. Maybe it brings roses to the cheeks, but it’s not a lovely thing to do to a daughter who’s having her first period. But it’s less and less in use these days because it’s come to consciousness.
Session 2 – Impact of Period Stigma on Daily Life
Dr. Charis
Right, and the term come to consciousness is so powerful, but things come to consciousness when you have context, right? And context is created by discussing things and sharing lived experiences and sharing stories. And so I do want to, pivot a little bit to our other guest, Rebecca Dimyan. Rebecca is an author, editor and professor. Her new book, “Chronic”, details her experience with endometriosis. Welcome, Rebecca.
Rebecca Dimyan
Thank you very much. I'm excited to be here.
Dr. Charis
I'm excited to have you. I really want to dig into that personal experience, when you are really going through your period and how at a young age, how you specifically may have interacted with period stigma. So ultimately, what impact has period stigma had on your daily life from first period to most recent period, if you don't mind sharing that?
Rebecca Dimyan
Absolutely. So, I began menstruating at 13 years old. And from that very first period, I had discomfort, irregularity, bloating, I was just generally pretty miserable, plus of course, hormonal because I'm 13 and going through all these changes. And you know, I was told this was normal, by my mother, who gave me very limited information about what to expect. She was a product of an Irish, good Irish Catholic upbringing, you know, and her mother didn't talk about such things. So, I didn't really have a lot of information. And then of course, being a product of health education in the nineties, I mean, we're lucky we were told blood was involved. A lot of details were left out. And I think in the way that I was educated about menstruation, I wasn't told very much. I didn't know that severe pain, you know, wasn't normal. And I don't think that the education I got accounted for different experiences. You know, you're kind of like all periods are the same with sort of what we were told. So, there's no need to talk about it. That sort of reinforces the stigma. And then, um, as I got older, once I was in my early 20s, I started to have more severe frequent pain and it took me many, many years before I was formally diagnosed with endometriosis at 30. So obviously I'd been suffering from endometriosis, you know, for many years. And it was something that impacted all aspects of my life.
Dr. Charis
You know, you brought up a very interesting point, the idea that all periods are the same. And I love that you said that because if we believe that all periods are the same, what are you doing talking about it? How dare you bring up this very same thing that everyone since the beginning of time had to go through. So, what makes you think you're so special? And, you know, when you are taught that all periods are the same, the idea is, well, if it's the same, why am I failing to tolerate this?
Why am I the problem? And it really makes you say that if the period can't be different, it must be me. I must be the issue. So, I really, I love that you brought that up because that is a direct result of period stigma. It perpetuates the silence and silence makes the strong conclusions that are incorrect. And then we create standards based on incorrect conclusions. I really want to dig into that because I do think that could negatively affect you mentally. How has your physical and mental health been impacted by period stigma?
Rebecca Dimyan
So obviously just kind of going off of the mental health aspect of it when you can't talk about it, you know, to anybody, whether, you know, beyond just my immediate family, my immediate circle. You know, I couldn’t…I didn't feel like I could talk to even my closest girlfriends. You know, when you're going out for a drink on a Friday night and you're catching up on your week. You know, you can talk about everything, you could talk about hookups or whatever, but if you bring up, you know, period discomfort, like that's a mood killer, like nobody wants to go there. But that, unfortunately, you know, when you're suffering in silence, it can cause depression. I went through periods where I was very depressed, because I experienced, sometimes daily pain that was, interrupting regular normal activities.
I couldn't go to work without, sometimes without having some sort of flare up. And you know, it takes a pretty big mental toll. And when you're also bringing it up to your healthcare provider and not necessarily getting the progress that you would like to see, it took me so many years to just get a diagnosis and I didn't really have any effective treatments either. So, that contributed to the continued physical suffering. But, but really the mental I think was almost, almost worse at some points because you're just, it's very isolating, to experience something that you're told you shouldn't be feeling.
Dr. Charis
You know, you bring up kind of addressing this with the healthcare provider and delayed diagnosis. And you also said you knew that this didn't feel normal from the beginning. So, if you had your first period at 13 and you got diagnosed at 30, that's a long time. That's 17 years, as Anita mentioned, of unnecessary suffering. I think it's the unnecessary suffering part that really gets me.
Because there are opportunities sometimes where we're bringing this up to healthcare providers and other people. And because there's still that belief that all periods are the same, or pain is normalized, we're stuck. And the other piece is, sometimes our family members don't know. Because their periods were abnormal, they're using that as the metric, then that says it's normal. You didn't deviate from my abnormality, thereby we're the same and we must be normal. And I do think that speaks to the importance of having these conversations with our parents and grandparents and across generations, because how will we know otherwise? You know, not everyone gets a health class. I got a health class, it was taught by my social studies teacher. And I knew as a seventh grader, I said, I don’t believe you have the credentials to be teaching this. She taught me more than, than anyone else on the matter until I got into my medical training. But yeah, you bring up some really, really valid points. I do want to touch briefly on how your period and just period stigma also may have impacted productivity at work and at school. So how did you navigate missed school days, missed athletic events, missed, you know, work, or did you ever even miss it? Did you just power through? How did you deal with the need to show up in these spaces without the voice or the agency or the permission to speak about your period?
Rebecca Dimyan
I've been an adjunct professor at multiple universities for the past decade. And so, I didn't have, you know, I didn't feel I had the permission to express my ailments. And so, I just kept my mouth shut and I powered through, and I showed up even when I probably shouldn't have. And my only solutions I came up with were to when I could, you know, sneak off to my office, turn off the lights and just kind of, you know, crouch down in a corner and hope the pain would pass, so literally hiding. So, that certainly impacted productivity. But I mean, I always I always got through it and it's weird too, I always felt like I couldn't share this information. It felt like complaining. Just suck it up, get through it. Like, so what it's, it's period pain, deal with it. Everyone else does. And that's something I actually saw as well, with students in the 10 years that I've been teaching, I've maybe had one or two students, who've actually, you know, talked to me about their periods. Like, they've had to miss class because they've had some sort of, you know, pain. But even when it comes up, it's always like, I have my period. I really can't make it to class. Like, it’s, you know, brought up in hushed tones. You know, we're not supposed to say period. Oh no, I said the word. Like, oh, I'm gonna lose credit. I don't wanna get penalized for missing this class. And I've always, of course, been very understanding. I'm like, yes, please take the time, you know, do what you need to do. And that's always followed by an apology. I'm so sorry, I know I haven't, I know I should get, it's like this expectation that we've all put on ourselves that like, well, I should be able to, you know, suck it up and get through this, but when I can't, I'm so sorry. Please don't be mad at me.
Dr. Charis
Yeah. And so that's a great point. It's the I should be. The standard is you push through. And so, when I can't push through, instead of saying, my pain is so bad that I can't push through, it's like I'm so weak that I can't push through. And it shifts the blame and the issue and the problem to yourself. And then internalizing that is going to have terrible effects. Certainly, it affects self-esteem. And, you know, the other piece is like, well, I can't complain. I think we've been taught, especially as menstruators as women, you should be happy to be here. You're a professor, you need to show up. Do you know how lucky you are to be in that number? You know? You're a physician, you need to show up. You're an author, you're a journalist, you need to show up because if we don't show up, if we blame our period, how does that affect other folks' periods? So, you know, there's so many things that we have to consider as it relates to just our periods and just getting through life.
So, I'll pivot a little bit. So, we talked about work and school, but what impact has period stigma had on your social life and like romantic relationships specifically? So missing social events, not feeling desirable or wanting, any type of intimacy or physical affection. Can you tell me a little bit more about the relationship side of dealing with period stigma?
Rebecca Dimyan
Yeah absolutely. I've been very lucky. I've been with the same man for 13 years and he's been very loving and supportive. And…but it has this pain, this stigma. You know, it's been a third party in our relationship. You know, there are times I am not feeling well, and I don't want to be intimate. And he's always been very understanding. But there is also this guilt too you know. This is a part of our relationship you know. It's how we express our love for each other. I should be able to do this.
Like even though I don't necessarily want to and of course, he's never done anything other than supportive, and he has this desire, you know, to understand, what I'm going through. And he suffers in a different kind of way. You know, I'm having my pain, but he has a different kind of pain, you know, that the sadness, it almost looks like guilt, you know, like I can't fix this for you, and I want to.
And you know, it's a different kind of suffering, but I mean, ultimately I do believe that this experience, you know, brings us closer and it's made him more comfortable talking about women's issues. You know, a father of a daughter, he knows the importance of being able to make her feel comfortable coming to him and talking to him. He's still of course, is hoping that she'll go to me first. As a backup plan, he wants to be able to, you know, talk to her about these things as well.
Dr. Charis
Yeah, so his experience with you and you being able to be open with him about what you're going through, you feel probably would make him a better dad to your daughter, which is another point of like, you know, the possibility of sharing. I do want to pivot a little bit because you touched on two interesting or important things, kind of the guilt of not being able to be intimate or not desiring to be intimate. And I do want to bring Anita back in just because there is some history there, some religious components, certainly.
I think there's a verse in the Bible that says, you know, wives shouldn't withhold themselves from their husbands. You know, so, there's certainly areas of guilt and there is some guidance religiously on how couples are supposed to navigate periods and times of periods. And so, I'd love it if Anita could touch on that, um, a little bit more the historical impacts of, period stigma.
Anita Diamant
I think I talked about this a little bit before. All religious traditions, or the major religious traditions of the world, do deal with married sexual relationships. It doesn't really acknowledge others. But, and it's usually, it's a form of separation so that there's a pause in sexual relations before, during, and or after one’s cycle.
And it can be seen and in some cases, it really is a form of punishment. In others it is, in some places in the world, menstruating women are not allowed to sleep under the same roof as the rest of their families for fear that will cause illness. In fact, even death. This is in rural Nepal. This has been a custom. Women would take even their young children off into the woods to sleep while they were still having their periods, and in some cases died of suffocation, of frostbite, of attacks by animals and/or men. And so that's kind of an extreme example of a religious tradition that is still in some places, some rural places, still in effect. There are lots of people, and women in particular, in those communities who are working to explain that that's actually not the case, but it's an old tradition, so it dies hard. That's an extreme one. Others are much more subtle. So Muslim women are exempt from attending prayer services during Ramadan if they're on their periods. And some women that I've talked to, they find that that's fine with them. It's okay because they don't necessarily feel great. Others just go anyway, because no one's gonna challenge them. So, in the world we live in today, there's a lot more choices. So, it's complicated.
Dr. Charis
That's such a good point. Um, I feel like, you know the religious component definitely can cause those feelings of guilt because we want to be not just good people, but good Christian, good, you know, whatever faith or religion you actually subscribe to. And so, I think that is another like added weight of just not quite doing exactly what's necessary.
The other thing I think is important that you mentioned, and I remember reading your book, “The Red Tent”, and just kind of getting more of a visual. That was the first time I really had a visual understanding. Obviously, it's a fictional book, but still with some really good historical references or context, rather. And it's not like that these separate homes are ever like super glamorous. It lacks ventilation. It can be terrible. I do think it highlights the idea of like a punishment. It's some downgraded, separate, potentially poorly ventilated, traditionally unclean area that they have to be isolated to for this time.
Anita Diamant
That's still true in some places in rural India, and women have gotten pneumonia because they're exposed. But there are several examples in traditional cultures where menstruation is celebrated and honored as part of life, and that fathers give their daughters in New Zealand a gift, a particular gift of jewelry, when their daughter reaches the age of menstruating.
In some Native American cultures, there's a very elaborate physical challenge and dance and party with the entire tribe, which acknowledges the strength and power of this new young person. So, it’s…most of the examples we have, I'm afraid, are pretty negative, but that doesn't mean it had to be that way, it has to be that way. It can be celebrated, and I know families where the fact that a daughter has gotten her period means flowers for her. It means a special day out with mom, just the two of you. It means taking a day off from school to celebrate, not to hide. So, it's up to us at this point to claim what hurts as pain and to claim, and also to say this is part of being a healthy human being with a uterus, and this is the beginning of this next part of my life.
I have to say the thing with it. When I was having my period, I never felt like I got it right. I never knew when it was coming. I never knew it was gonna end. It's, I always felt like I got it wrong. And I had cramps, they weren't terrible. But I was always like, why don't I know how to do this? So. Yeah.
Dr. Charis
That's such a good point. You know, you're like 13, you're like, I'll get better at this. And then you're like 35 and you're like, I missed it again. Like, how did I not, you know, and I think part of really improving or addressing, sticking it to stigma, honestly, is having conversations amongst menstruators about how we don't get it right. How in two decades in, it's like, this little period still outsmarts me sometimes because it is our body doing something without permission.
Without, you know, all of the predictable warning signs every time, our body doesn't have to follow these rules. And I think some people really do think I've had to teach my patients and even their mothers and grandmothers. The words I actually use is that your uterus doesn't have a calendar. It does not know it's a leap year. It does not know that February only has 28, like it has no idea. And so, your expectation that your period must start on the second of every month is not rational. Okay? You're just going to have to learn your body and pay attention to the science, and you still may not quite catch it. And that's okay.
Anita Diamant
Yeah. And I think humor is really important as we try to unstick ourselves from stigma. And Michelle Wolf, the comedian Michelle Wolf has this great line about having your period is like having an outdoor cat. You know it's gonna come back eventually, but you don't know when. You just have to live with that.
One of my favorite, humorous sticking it to stigma stories is a group of young girls in the Midwest went to their principal of their school and they said we think we should be there were middle I think sixth grade seventh grade They went to the principal and said we think there should be period products in the bathrooms and he said no because people would take advantage of it So, they went home and they baked tampon cookies. They made cookies that look exactly like white frosting a string a red
a splash of red frosting and they put it on, Twitter. And it exploded. And so, the principal, it got back to him, and he relented because it was embarrassing that this, and they won in their period products. But these girls, how old is sixth grader? 11, 12 year-old girls going, “uh-uh, no, you're wrong.” There's no reason that we shouldn't have these in the bathroom.
And another story like the troop of Girl Scouts who went and asked for a closet. And it was a parochial school, so they didn't have pockets in their uniforms, so they couldn't even carry. And they said, there's no money for this. So, they built one. The Girl Scout troop built a cabinet in one of the bathrooms. It's just like, well, you're wrong, but I need this. So, I'm gonna take care of myself. And I think they're teaching us, I think those kids are teaching us how to take charge of our lives. And with humor, and with hammers and nails.
Dr. Charis
Absolutely, I love that. The humor component is huge because humor is used universally, you know, to really reach people, to talk about topics that are difficult to discuss. And of course, there's times in which humor, you know, just, isn't appropriate or you just don't feel quite up to it. You're like, I'm not feeling super humorous today. And so, Rebecca, to pivot back to you, I want to talk about some of those times where humor just really wasn't something we could really use. It wasn't an available resource. Can you describe any specific examples of when you were potentially even discriminated against or experienced mistreatment associated with your period or associated with being a menstruating person, if you don't mind.
Rebecca Dimyan
Yeah, absolutely. But I actually wanted to just interject for a second. When you were talking about the calendar and how, you know, your uterus doesn't know if it's a leap year, I was actually told, my mother always told me to write the start date of my period on the calendar because that would tell me when I was, the exact day I was going to get it the next month. I know, and it never, it never worked. So, it just, it just reinforced the whole idea that I was doing it wrong. Like I was just I was messing up. I'm like, why isn't it showing up on the 21st of June?
Dr. Charis
Exactly. You know, there is some validity to tracking periods, right? But because we don't talk about it fully, we get pieces of the context. It's like write it down on the calendar because there's some predictability there. And so, if you don't get the full story, you say, if you mark it here, your calendar slash uterus knows that it must start here. No, it's more and just from my medical training that if you can see how many days it is from the first day of one period to the first day of the second period, you get an idea of how long your cycle is. And there's predictability in that cycle. And so, if you have a 33-day cycle, then you can actually have that cycle 33 days from that very first one. So that gives you predictability. Now, also with us saying this happens once a month, that's another issue. Someone says you have a 33-day cycle, which means you can get on the 31st of one month and skip an entire month of 30 days and get it in the other month. I will have patients come to me and say, I did not have a period this month. So, I was like, okay. And their mother's like, “she did not. I know it, all of June, there wasn’t any blood.” And so, we look at this calendar and together, I will counsel that mom and that daughter or that grandma say, I know we've always said that you have a period once a month and that's normal. And I'm so sorry that was not descriptive enough.
The fact is, you know, there's a range. And for adolescents, it could be as long as 45 days. For adult women, it can be as long as 35 days, which means your little normal self can skip a period or not have a period in a month, and it is not abnormal for you.
Session 3 – How Period Stigma Manifests
Dr. Charis
So anyway, apologies. Back to the original question at hand, discrimination associated. Any experience of discrimination from having your period or associated with being a menstruator.
Rebecca Dimyan
Absolutely. So, I could recall one specific instance when I was probably about 22 or 23 years old and it turned out I had rupturing ovarian cysts, but I was experiencing a great deal of pelvic pain and I went to the emergency room and immediately my pain was dismissed because I was a 23-year-old sexually active woman and it was assumed that it was probably some kind of STI that was, you know, ignored, but it was a very emotional experience for me because it made me feel like I was just looked at as this, you know, slutty girl who probably deserved to be in pain and whose, you know, whose pain really wasn't taken seriously. And it did prevent me in the future from going to the emergency room when I did have other especially painful flare ups of endo, or you know cysts again I wouldn't go to the hospital because I was like what's the point I'm a sexually active woman. I already know how I'm gonna be treated so why bother.
Dr. Charis
That's so disheartening. And I say this as a medical provider, because I remember being trained that if someone comes in and they have pelvic pain and they're sexually active, you have to consider that it's probably an STI, it's probably pelvic inflammatory disease, which is that catch-all term that they use for painful pelvic inflammation and the presence of an infection that's caused and impact inflammation in the pelvis.
And I remember hearing that as like the default diagnosis. It's like, just because we're women of this age and we're sexually active, this is our default diagnosis. That's really messed up. And then being like, I would be mortified if I presented here. And it really taught me, I don't wanna just show up in the ER either. Even though I am a physician. And so, I do think that it conditions you, as you mentioned at one point, that this is not a safe space.
This is a space in which I'm going to be thought of as, you know, either unable to tolerate basic period pain, because that's supposed to be normal, in more extreme scenarios. I've seen people say, “oh, they're just a drug seeker. They just want pain medicine.” Right? And so, for fear of all of these labels, or they're just promiscuous and they're deserving of the pain. For fear of all of those labels, it can teach you not to interact with healthcare providers, which is, again, so detrimental to health and wellness and confidence.
You know, it's so unfortunate that healthcare providers might be discouraging you from talking to healthcare providers. And I always say, if you are, you know, sharing your symptoms and really sharing your lived experience and you're being dismissed or ignored by your healthcare provider, you have every right to find a new provider. And that's easier said than done. You know, there's different access to medical providers. There's certainly in the ER you can't say, oh, I don't want you, you know, you can, but you can be labeled as difficult if you say, you're not treating me correctly, I need another provider. And so, the practice is not as simple as, you know, the statement, but you have every right to have a provider who does listen to you, who does care, who does not label you, and who believes that you're in pain and believes that your pain is worthy of treatment. So, shifting almost to like a humorous side of things.
Um, and I know my answer to this question, but I do want to ask you, Rebecca and Anita, you can chime in as well. Have you ever had to resort to using an atypical or DIY method to manage your menstrual bleeding, um, due to lack of access to menstrual hygiene products?
Rebecca Dimyan
Definitely toilet paper.
Dr. Charis
Yes, the toilet paper roll, we all know it. We know. I mean, you really learn very quickly that there's really something to those pads. That absorbency, that little liner in the back, that little plastic thing, that matters. Yeah, no one I mean, the effectiveness of a toilet paper, is never going to be the same as like an actual pad but you know, we can laugh about this, but we've all been in scenarios in which we don't have the products we need, right? And it's good that we can talk about this, but you know, I know that even just talking about periods on social media or in other social settings, even with a joke, you know, it's not always well received. Rebecca, have you ever experienced that? Like I want to talk about my period, or I'd like to talk more about this topic, but maybe people won't respond to it well or, you know, just being discouraged from talking about period-related situations?
Rebecca Dimyan
Yeah, so I joined Instagram within the last year. My students pressured me to do it. They said you can't, you can't, be an author without an Instagram page. So, I got on Instagram and as I was trying to come up with content, um, to promote the new book, I was searching through different pages and I was like, Oh, no, that's too explicit. Like I found it within myself. Like I still have the stigma there. You know, I wrote a whole book about it, but I'm still awkward and maybe even a little embarrassed to put this out on social media. And you know, how are people going to respond to this, this woman who's talking about periods and period pain. And it's out there on social media for everyone to consume and to respond to. And I was very nervous to put it out there. And so, like I ended up leaving out the more explicit passages because I was just like, not ready for that yet. Maybe in a couple months. But yeah, it's like almost a year later and I still haven't really gone there on social media yet.
Dr. Charis
It's hard. It's hard sometimes. And I know, you know, when I was thinking of a name for my Instagram, I, you know, there's so many things. Oh, I could just do Dr. Charis, or I could say, you know, something of the sort. I said, I'm going to say the Period Doctor. I want people to have to say period to even reference my handle, even just accurately describe what I do, I want them to say period. It's been very fun, if not just entertaining, to see people have to say, oh, the founder of the Period Doctor, you know. And it's like, yeah, it's a thing. And that's what I discussed. It's the most accurate description. And so, you know, that embarrassment is something that we really do internalize. We don't even have to have someone reminding us of stigmas, this ever-present deal. And I wanna shift to you, Anita. You know, at what age do you feel that menstruators really start experiencing that period stigma, start internalizing that embarrassment, you know? Can you speculate where this is learned from?
Anita Diamant
Well, it's embedded in the culture, for sure. I mean, no one's talking about it, although, you know, it's changed a little bit. We live in a time of “Are You There, God, It's Me, Margaret”, as on the big on the big screen, which was the guidebook for so many. My daughter told me that was a big guidebook for her as well, that there was a there was somebody actually talking about periods. And that book, by the way, is one of the most banned books in America since it was published.
And it's just about when am I gonna get my period? It's about being a girl and trying to and being among other girls and talking about it. So, it's part of the culture. It's undergoing change. But, yeah it's just everywhere. And when I started doing research on this book, The Period Project, which did the film about menstruation was getting a tremendous amount of email, and one girl wrote in from Oakland, California saying when she was in school, and her family couldn't afford period products, she used socks. She used old socks. And that's what there is, that's what's available. So, you use whatever's available.
And I always try to tell, this is a problem, not just in the developing world, or just among poverty-stricken folks. This is every zip code. There are people who can't access what they need to take care of themselves on a basic level. So, which is why it needs to be a universally available resource, not taxed the way it is that, you know, in many places, period products are taxed, and fireworks are not taxed, for example, in some parts of the country. Yes, absurd.
So, it's still, it's off the table. It's really off the table. And one of the things I learned doing the research for this book was about what the meaning of the word “intersectional” really means. And that poverty and race and country of origin and all of these things, your zip code to some extent too, uh, the state you live in, all of these things intersect to enforce period stigma in a way. And, in terms of the medical stuff, I know that for Black women who show up in the emergency room with pelvic pain are totally dismissed. And there's evidence showing that medical students still think Black people don't feel as much pain as White people. So, if you show up with a PID of some kind, or a suspected, you know, whether you're a doctor or not, it doesn't make any difference. It depends on the color of your skin. And that, to this day, we're not talking about 50 years ago, is still true.
And if you're in the most horrific situations, you know, if you're imprisoned, if you're in a refugee camp and you have your period, what do you do? If you really think through what it takes to take care of yourself and how little attention is paid to the basic, it's a basic human need. This is not a frill; this is nothing special. But the poorer you are, the more discriminated against you are, the more marginalized you are, if you're a menstruator, you're really in trouble. If you're homeless, all of these things, uh, it becomes a catastrophe rather than a problem.
Dr. Charis
That's such, such a great point. And I think the answer to the question is, you know, as early as they start bleeding, even prior to bleeding, menstruators are experiencing period stigma. We're all experiencing it. And the degree to which we experience it depends primarily on that intersectionality. How many categories do you fall into? How many, uh, barriers do you have? Uh, and I really love that you brought that up because, you know, this is an every zip code problem, as you said, but it's really a problem that can be solved with just basic decency and humanity, right? We want, you know, and deserve to navigate our life with dignity.
Session 4 – How Can We Solve the Problem
Dr. Charis
And so, I do wanna shift to, you know, the brighter side of things and really talk thoughtfully about how we can solve this problem. So, you know, and Anita, you brought this up, the education component. And Rebecca, you mentioned this as well, talking about periods openly and without shame. Do you think it's important, uh, to include all genders in the conversation? And how early should this happen? How often should this happen? What are your thoughts there?
Anita Diamant
Well having interviewed health educators, health education in some schools starts in third grade and it's about how does the blood work and what's your heart and how do we poop, muscles and bones. And at that point the uterus and menstruation should be mentioned and the penis and whatever. It should all be mentioned. You don't have to go into tremendous detail for third graders, but this is what the body looks like. Let's not leave out these parts. by the time you're in sixth grade or seventh grade and you go back to it, it's like, oh right, I remember this, I remember that word, I remember that. So, the earlier the better, the more comprehensive the better, and the more everybody in the same room the better.
And it obviates children who are not sure what room they should go to. Nobody has to make that choice. And it teaches empathy to everybody so that boys have a sense that, oh, this happens to my sister and my mother and you. And he, this one teacher said, I see them being able to figure out what that means in their lives, how to talk to somebody who's having a cramp and not make fun if something happens. And so, it's just a humanizing kind of thing. And it's still very radical and it's still very rare, I'm afraid. And there's a lot of pushback on what's called sex education, which is really health education. We have to stop calling it sex education. It's not what it's about. It's about the body.
Dr. Charis
Absolutely. Yeah, it's not. It's health education, if we wanna say specifically to periods, reproductive health education. And Rebecca, you mentioned this, how talking with your incredibly supportive husband openly about what you're dealing with can inform how he shows up for your daughter in the future. Of course, he hopes that maybe that would be a “you” thing. But, you know, so the including of all genders, can you talk to how maybe that might, how you feel on that matter, including all genders in the conversation and maybe how early you might plan to talk to your daughter about some of these things.
Rebecca Dimyan
I do believe it's really important to include everybody in these conversations. By leaving out, you know, by separating men and women and, you know, into different groups. I mean, what are we teaching them that it's not appropriate for you to understand what's going on with my body?
Are we teaching you that, you know, it's shame, I should be embarrassed? We're just reinforcing that stigma. And I think by having a more inclusive health education program in schools, I think that really is the first step in promoting these conversations, which will ultimately, I think, stick it to stigma.
Dr. Charis
Yeah, love that. Rebecca, for you, you know, one of the issues was not really understanding the normal versus abnormal parts of periods. So, is this severe pain or is this normal cramping? Am I having heavy menstrual bleeding? Am I hemorrhaging? Like where the difference is and not really understanding that. What are some thoughts on how we can solve, um, the issue around period health symptoms and understanding where the difference lies between normal and abnormal?
Rebecca Dimyan
I think again, kind of going back to not to put it all in health education, but I think if we include that information and, you know, teach, you know, our students, teach our children that, you know, this is what is considered you know, in the normal range, but you know, if you're experiencing you know, particularly heavy bleeding, what does that look like? Let's use specific language when we are talking about pain, because, what is pain? Pain for me might be different than pain for you, like, what does that feel like? What does pain mean? Trying to find the most specific word choice, most specific language that we can, to have these conversations. That’ll be another tool that we can use to promote understanding the differences.
Dr. Charis
Yeah. And the language is big. Because if you don't talk about it, you don't have the language. And if you don't have the language, when something, you know, occurs, it's like, how do I communicate this? You know? And another thing that we kind of mentioned, uh, was, you know, bringing in a bunch of other people into the conversation. I specifically have noted that when I'm educating my patient, my adolescent patient, for example, I've got to get mom in the room.
I do not want to educate this patient in silo and just say, you get to understand what periods are. Because if we do, we send that menstruator back into their family unit where they're empowered. Like periods are normal, but everyone at home says they're not. And so, when you are being pushed up against, you know, by that type of opposition and your entire family and everyone in your nuclear home and in that household says you're the problem, this is abnormal, you're really setting them up for failure. And so, I do want to, kind of reiterate that there's some validity and some importance in saying, let's bring the adults into the conversation. You know, not every mom got this talk. You know, they might be the daughters of a Catholic mom who just said, no, no, no, you know, this is just what it is. Don't talk about it. And so really undoing that, that unlearning needs to take place across generations.
Anita Diamant
You know, one thing we haven't talked about is information that's more widely available today than ever before on the internet, on the web. And there's great stuff and there's not great stuff. So, I think health education, has to include what to trust online. And maybe, your health teacher giving you a list of, these are really good websites, this is two really nice gynecologists who are gonna explain everything to you. Don’t go to the chat rooms. You know, go to these places because that's where a lot of kids get a lot of their information. If you're lucky enough to have an older sister, um, you may get information about your period from that person because they've already been through it. But the web stuff, I can't tell you the number of young people, including middle schoolers, who are creating content to put online for their peers. So, I think we need to be savvy about how kids are getting there, are learning stuff like this that they can't ask their mother or father or anybody in their world. So, you go online, and you look up menstruation.
Dr. Charis
Yeah, that's a good point. Another, effect of the stigma, if you can't ask at home, you look online and maybe that influencer that's just your same age seems like the most comfortable resource for you. But it's not just about finding information, it's about finding the right information. Yes, a lot of, so many of my visits with adolescents are combating TikTok things. Well, I saw on TikTok, you know, or I saw on this platform that if I drink a little lemon juice, my period will come in two weeks. I say, okay. And part of understanding why even people are susceptible to that level of misinformation, it highlights that I need to do a better job with my education. Say, well, let me walk through this again. I know I did this at your first visit. Let's walk through how your period works and you tell me if that makes sense. And if I walk through it one more time, they typically say, I don't see how lemon juice would affect that. I say, ding, ding, ding. Very good, yeah.
We talked about this a little bit earlier, you know, we're trying to bring this up at home or someone wants to incorporate their family into the conversation, their dad, their brothers. How do we, you know, encourage them to do that? What tool can they use to have this conversation and really try to make sure that folks are comfortable talking about it openly?
Anita Diamant
You put period products in your bathroom at home. On the counter, not in a drawer, I have a pretty little ceramic thing that has a few pads and a few tampons sitting in plain view right next to the soap. If you're a member of a religious institution, a church or a synagogue or a mosque, are there products in the bathrooms for, in any of the bathrooms? If you have an office that includes lots of different people, are there period products in the bathrooms? If your museum that you go to, are there period products there? If you put them out in your own home and you have a private conversation with someone in your home, that's easier than asking the administrator at your church to put period products out.
But, in so many churches, so many synagogues, so many institutions are collecting period products because the fact of period poverty, especially for homeless or sheltered or incarcerated, people who menstruate, it's a big thing now to collect and distribute that. At food banks, I know period products and diapers are the most requested items.
Dr. Charis
Yes, yes, they really are. And you know, it's kind of bringing it out to the forefront, as you mentioned. This is a necessary piece. And so, this should be the case. And we're seeing certain countries and institutions leading the cause, uh, for some more period-friendly policies, like Spain, um, doing the pay period leave. And there's other corporations and things really instituting these changes. And I think, as you mentioned, Anita, it has a lot to do with the younger generation and social media and people really mobilizing around this topic and saying, we're not going to stand for it. Like the Girl Scouts, you know? We deserve more and you're “no” is not going to stop us.
And I think, we can advocate for improved access, of course, for menstrual products, but it does have to include everyone. So, you mentioned having, period products in every room, in every restroom. But we really mean every restroom, the restrooms that you've decided are for women and the ones that are for men in every gendered restroom, because not everyone needs to decide, how am I presenting today? Do I feel comfortable going into the restroom where the period products are? Just like you need a baby changing station in the men's restroom too, you know? Because it teaches you something. It says that the people who deserve period products are the ones who are female presenting. The people who need to be handling the baby's diaper and changing and caring for children are the ones who align with the gender of a woman. And I really think there's an opportunity in these spaces, as we're advocating, to make sure we're being thoughtful and inclusive to the LGBTQIA community and our gender fluid teens who are still kind of sorting through exactly how they want to identify and what they're feeling, which is a very real thing.
So, you know, the advocacy in this space is nuanced, it's beautiful, it's blossoming. Uh, and we've really seen some exceptional things take place with the help of social media and larger platforms and people having voices. But also, you know, everyone having a voice and everyone having a platform doesn't mean they're an expert. It doesn't mean that there's someone you need to listen to about health-related things. Going to someone who knows you, who knows the medicine, who knows the literature, who is highly trained is also really important.
I wanna give you both Rebecca and Anita an opportunity to share any last points, anything that we didn't emphasize or something that you would love for our listeners to take away from this conversation.
Anita Diamant
Be brave. I think when we stop ourselves from talking, I think we've talked about this today, that's internalized shame and stigma and fear. And it's remarkable, anyway, my experience, that when I overcome my own hesitancy, it's not as bad. And nobody's ever run away shrieking that I'm talking about menstruation.
So be brave. There's lots of opportunities, there's lots of television now that mentions periods in ways they never did. Humorous, serious, all of it. So that's also a platform for talking about something we're not used to talking about.
Dr. Charis
Absolutely. Rebecca?
Rebecca Dimyan
I love that being brave. And it's so hard to be brave. I mean, that's why it's bravery. But it makes me think of this woman that I met several weeks ago at a reading. And she's in her mid-60s. And she came up to me afterwards. And she shared with me that for the last more than 50 years of her life she has suffered in silence from endometriosis, and she's been too embarrassed to share her story and her pain with anybody, like anybody at all. And I was the first person that she had brought this up to and it was a very emotional moment for me, and it made me realize how important these conversations truly are.
Outro
Dr. Charis
I love what you both said. So, it's like, the conversation is important. It needs to be had. And, the ability to have it is improved when there's honesty and transparency, potentially a little bit of humor and a little dash or maybe a heap of bravery. Um, so, I really want to thank you both for being with me today and having this conversation talking about how we can stick it to stigma. Uh, I want to thank our listeners for sticking with us throughout this journey from the beginning to now.
I do want to also thank Pfizer and Sumitomo Pharma America for sponsoring this discussion and giving us this platform to have this much needed conversation. And I also want to put a little plug in for our next episode, entitled “She Copes Therefore She Is”, which is going to be super, super exhilarating. Another lively discussion where we will be, you know, speaking about Tales from the Uterus. So, thank you all for listening. Have a great day.