The role of menstrual attitudes and body shame in sexual decision-making

Menstruation is a natural process, yet it continues to be commonly considered an aspect of biology that should not be seen; a topic that should not be discussed. Historically, menstruation has been seen as something that is dirty or disgusting, and many women feel shame when they are seen with a menstrual product, or accidentally bleed through clothing. The media portrayal of menstruation as a process that needs to be hygienically controlled, and the increasing popularity of contraceptives that suppress menstruation probably exacerbate this problem. Despite the comfort that some women have with their bodies, it is still common for women to feel confused about their genitalia, and to use euphemisms to avoid naming them.

Previous research has suggested that attitudes to menstruation are associated with sexual decision-making. Therefore, this study aimed to clarify whether there is a direct link between these characteristics, or whether other thoughts, feelings, and attitudes are involved. A total of 199 female students from a university in the United States were asked to complete a series of questionnaires in order to assess their:

  • Menstrual attitude
  • Body shame (negative feelings about the body and desire to hide it)
  • Sexual assertiveness
  • Lifetime sexual experience
  • Sexual risk-taking
  • Religiosity (i.e. how religious they considered themselves to be, and how regularly they practiced their religion).

The majority of participants were White (67%), with a significant minority of Asian women (19%); the average age was 19 years (17-23); and nearly all of them identified as heterosexual. The average body mass index (BMI) of participants was 22.7 kg/m2, accurately reflecting the population as a whole, and the average age at which they started menstruation was 12 years.

When the questionnaires were analysed, results indicated that roughly half of the women had had sex before, and most of these women had only had one partner. Most (87%) had used contraception the first time they had sex, and a similar proportion used contraception during their most recent sexual activity (88%). There was a clear link between women whose mothers were well-educated, and lower levels of body shame, and between Asian women and low levels of sexual experience. In addition, women who were more religious reported that they felt less able to use condoms or other contraceptives when they had sex.

Women with positive attitudes to menstruation were more likely to be sexually assertive; use condoms; and feel comfortable and confident about their bodies than women with negative attitudes. Those women who were comfortable with their bodies tended to be more sexually assertive and sexually experienced, and more likely to practice safe sex.

Statistical methods were used to generate a model which explained all of the associations found in this study, and a simplified version of this model is shown in Figure 1. The model indicates that menstrual shame is connected to reduced sexual experience and increased sexual risk-taking via body shame and sexual assertiveness. Of course, this was a small study, and conclusions should be drawn with a little caution, but the overall results support the concern that silencing the topic of menstruation may make it difficult for women to feel confident during sex.

Future work should focus on understanding how ethnic background and socioeconomic status impact menstrual attitudes, and attitudes among sexual minorities not represented in this study should be investigated. In addition, it will be important to explore how menstrual shame might relate to behaviours such as self-esteem, dieting choices, and general well-being. Reducing menstrual shame and creating channels for open discussions about menstruation among adolescents may be important for their sexual decision-making as they mature, and this is an important consideration for sexual educators. Promoting positive attitudes towards menstruation could be a starting point in protecting young women from the sexual threats they face.

Until then, we can do our own research by charting our own cycles and listening to our own bodies.