Taiwanese adolescents? gender differences in knowledge and attitudes towards menstruation

Young Men's Attitudes and Understanding of Menstruation

PURPOSE

To identify sources of information, perceptions, and potential misinformation about menstruation among college-aged men in the United States.

METHODS

This is a mixed-methods cross-sectional survey study of students in the United States. Inclusion criteria included participants aged 17-29 years, male gender identity, enrolled as an undergraduate or graduate student, and no personal history of menstruation.

RESULTS

This study included 70 participants. Almost half of all participants (42.9%) first learned about menstruation from family members. More than two-thirds of respondents felt that menstrual education was essential or very important for all genders. The most common symptoms noted to be associated with periods included cramping (93.6%), mood changes (80.9%), and vague "hormonal" changes (36.2%). When asked how a menstrual period might affect someone's ability to perform daily activities, one-third reported debilitating or very burdensome symptoms, whereas one-fifth felt periods do not have much impact.

DISCUSSION

Comprehensive education and accurate reproductive health knowledge are critical in combating gender bias and stigma. Most males surveyed agree that education on menstruation is important, yet the majority do not have or do not remember formal education on this topic, instead relying on family members and friends as learning tools and resources. Most participants identified negative symptoms associated with menstrual periods, especially mental health concerns including mood changes and irritability. This association with mood changes, as well as vague "hormonal fluctuations," contributes to the societal bias against people who menstruate by marking them as prone to emotional instability, thereby exacerbating gender prejudices. It is therefore critical that accurate menstrual education be widely available for everyone, regardless of gender.

Period shaming behavior among male students in Luang Prabang Province, Lao People's Democratic Republic: A cross-sectional study

Period shaming is defined as any negative and/or disrespectful behavior in relation to the menstrual cycle and menstruating girls. It is suggested that period shaming may limit girls' potential and ability to fully participate in school and community activities. This study aims to examine the prevalence and factors associated with period shaming among male students in Luang Prabang Province, Lao People's Democratic Republic (Lao PDR). This was a cross-sectional study which was conducted during November 19-27, 2020. This study included 1,232 male students from secondary school grade 9 to 12 in Luang Prabang Province, Lao PDR. Informed consent was obtained from the participants, parents/guardians, and teachers prior to data collection. The data was collected by a self-administered questionnaire. Logistic regression was employed to examine factors associated with period shaming behavior among male students. The mean age of the participants was 16.4 years old. Of all the male students, 18.8% admitted that they had shamed girls during their menstruation at least once. Of those who committed period shaming, they shamed girls some of the times (63.2%). Male students who had consumed alcohol during the last month before the data collection day (AOR = 1.83, 95% CI 1.32-2.55, P<0.001), had heard of menstruation (AOR = 1.76, 95% CI 1.27-2.44, P<0.001), and those who had attended activities/classes about sexual reproductive health (AOR = 1.90, 95% CI 1.29-2.78, P<0.01), were significantly associated with period shaming behavior. In conclusion, a single focus on providing biological health education may not be enough to address menstrual stigmatization and taboos. The school curriculum should integrate other life skill education with reproductive health, such as respect and gender equality, to encourage behavioral changes among male students, to address menstrual stigma and to support and empower girls' menstrual health at school and in the community.

Period teasing, stigma and knowledge: A survey of adolescent boys and girls in Northern Tanzania

Emerging evidence suggests that menstruation-related teasing is a common experience among adolescent girls with ramifications on their school participation, yet empirical evidence on the prevalence and determinants of period teasing in schools remain scarce. Menstrual hygiene research and policies almost exclusively focus on girls and women, leading to a dearth of knowledge of male attitudes. We conducted the first quantitative survey of period teasing in schools in sub-Saharan Africa, focusing on 432 male and 524 female students in four co-educational secondary schools in northern Tanzania. Period teasing is prevalent; 13% of girls have experienced period teasing, and more than 80% fear being teased, especially by male classmates. Girls’ fears are associated with insufficient menstrual hygiene management resources and practices. Girls cope by reducing school attendance, participation, and concentration in the classroom during periods. Boys engage in period teasing because they perceive periods as embarrassing, especially visible markers of periods (odor or stains). Social norms, such as peer behavior and home restrictions on menstruating women, are associated with more teasing. Boys believe it is strongly inappropriate for girls to reveal period status or to discuss periods with males, including male teachers. In contrast, boys are well informed about basic biological facts of menstruation (scoring 60% on a knowledge quiz, not statistically different from the girls) and have received information from school curricula and health workers. Lack of suitable menstrual hygiene practices and restrictive social norms is correlated with period teasing, which hinders gender equality in educational opportunities. Providing narrowly bio-medical focused education about menstruation may not be enough to reduce period teasing in contexts with period stigma.

Status and Factors of Menstrual Knowledge, Attitudes, Behaviors and Their Correlation with Psychological Stress in Adolescent Girls

BACKGROUND AND OBJECTIVE

Adolescent girls perceive menstruation as a negative experience, which can affect adolescents' physical and mental health. The aims of this study were to describe the menstrual knowledge, attitudes, and behaviors of adolescent girls in China and to examine their association with psychological stress. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A cross-sectional study was conducted among 1349 adolescent girls aged 11-14 years in Changsha, China. Participants anonymously completed questionnaires that assessed sociodemographic characteristics, menstrual knowledge and attitudes, dysmenorrhea self-care behaviors, and perceived stress. One-way analysis of variance and Pearson r correlation and multiple linear regression analyses were conducted to examine the differences and associations among variables.

RESULTS

The mean age of menarche was 11.70 (±0.82) years. A total of 1053/1349 (78.1%) of girls had a knowledge of menstruation before menarche and their mothers were the main source 931/1349 (69.0%) of their knowledge. More than half (53.4%) of adolescent girls experienced different degrees of dysmenorrhea. The mother's education, family monthly income, family type, and the girls' age, grade, menstrual status, age at menarche, sanitary napkin change frequency, menstrual restrictions, and dysmenorrhea influenced menstrual knowledge, attitudes, and practice. Psychological stress was affected by age, grade, age at menarche, sanitary napkin change frequency, menstrual restrictions, dysmenorrhea, and menstrual knowledge, attitudes, and practices.

CONCLUSION

Psychological stress management during menstruation should be a focus of health education programs for adolescent girls. During adolescence, health care providers should not only pay attention to the physical changes of adolescence girls, but also provide stress management skills to help them cope with menstrual-related concerns.

Male perception about the inconveniences associated with monthly bleeding for their partner - an international survey

OBJECTIVE

To assess men's perceptions about monthly bleeding and associated inconveniences for their partner, as well as men's attitudes regarding the desired menstruation frequency for their partner and knowledge about hormonal contraceptives.

METHODS

A 15 min quantitative online survey was conducted among 5044 men aged 18-45 years, who had been in a relationship for more than 6 months, across 13 European countries (Austria, Belgium, Czech Republic, France, Germany, Hungary, Italy, Latvia, The Netherlands, Poland, Portugal, Spain and Switzerland). Responses were compared to those obtained in a similar study among European women.

RESULTS

Most men perceived that their partner considered her menstrual flow as moderate, lasting an average of 5.2 d, slightly longer than previously reported by women. Almost all men reported that their partners experience menstruation-related symptoms. However, prevalence of mood-related symptoms was perceived to be more frequent and physical symptoms less frequent, relative to women's self-reported symptoms. Given the option, 71% of men would choose longer intervals between their partner's periods. Maintaining the couple's sex life, social life and relationship quality were key factors cited in their preference. Overall, 42% of respondents stated that women taking hormonal contraceptives needed to have monthly periods.

CONCLUSIONS

Men's perception regarding their partner's periods was generally consistent with that previously reported by women. Most men would prefer less frequent bleeding episodes for their partners. Although, the present data suggest that couples are discussing periods, knowledge about contraception could be improved. Health care professionals should intensify counselling to better inform both partners about their contraceptive options.

Influencing factors of dysmenorrhoea among hospital nurses: a questionnaire survey in Taiwan

OBJECTIVES

Nurses are at high risk of dysmenorrhoea while working with patients. The study objectives were to: (1) describe the demographic and menstruation characteristics of dysmenorrhoea, knowledge about dysmenorrhoea and menstrual attitudes towards menstruation among dysmenorrhoeal and non-dysmenorrhoeal hospital nurses; (2) identify significant differences between the groups; and (3) examine factors influencing dysmenorrhoea.

METHODS

This cross-sectional survey used a structured questionnaire, administered at two hospitals in southern Taiwan. Participants included hospital nurses at least 18 years of age who agreed to participate. All participants were recruited through random sampling. The questionnaire included demographic data, the Dysmenorrhoea Knowledge Scale and Menstrual Attitude Scale (MAS).

RESULTS

A total of 420 nurses completed the questionnaire. Among them, 297 (70.7%) had experienced dysmenorrhoea in the past 6 months and 123 (29.3%) had not. Significant differences in age (P<0.001), marital status (P<0.001), childbearing status (P<0.001), age at menarche (P<0.05) and rotating three shift ratio (P<0.05) were identified between the dysmenorrhoea and non-dysmenorrhoea groups. Analysis of the MAS results revealed significant differences between the groups regarding consideration of menstruation as a debilitating (P<0.001) or bothersome event (P<0.05), anticipation and prediction of menstruation onset (P<0.01) and denial of any effects from menstruation (P<0.001). Results of the multiple logistic regression showed that predictive factors included age <40 years (4.46 vs 1.00), working three shift rotations (2.07 vs 1.00), marital status (2.59 vs 1.00), acknowledging menstruation as a debilitating event (2.72 vs 1.00) and denial of effects from menstruation (2.59 vs 1.00).

CONCLUSIONS

These findings could help nursing managers to create a caring and friendly work environment for hospital nurses at risk of dysmenorrhoea.

'We do not know': a qualitative study exploring boys perceptions of menstruation in India

BACKGROUND

In low-middle income countries and other areas of poverty, menstrual hygiene management (MHM) can be problematic for women and girls. Issues include lack of knowledge about menstruation and MHM, and stigma around menstruation, also access to affordable and absorbent materials; privacy to change; adequate washing, cleaning and drying facilities; as well as appropriate and accessible disposal facilities. In order to effect change and tackle these issues, particularly in patriarchal societies, males may need to become advocates for MHM alongside women. However, little is known about their knowledge and attitudes towards menstruation, which may need addressing before they can assist in acting as advocates for change. The present study was undertaken to explore knowledge and attitudes about menstruation among adolescent boys across India, in order to gauge their potential to support their 'sisters'.

METHODS

The study was undertaken across three states in India, chosen a priori to represent the cultural and socio-economic diversity. Qualitative data using focus group discussions with 85 boys aged 13-17 years, from 8 schools, was gathered. Data were analysed using thematic analysis.

RESULTS

The results were organised into three main themes, reflecting the key research questions: boys' knowledge of menstruation, source of knowledge, and attitudes towards menstruation and menstruating girls. Knowledge comprised three aspects; biological function which were generally poorly understood; cultural rites which were recognized by all; and girls' behaviour and demeanour, which were noted to be withdrawn. Some boys learnt about puberty and menstruation as part of the curriculum but had concerns this was not in-depth, or was missed out altogether. Most gathered knowledge from informal sources, from overhearing conversations or observing cultural rituals. Few boys openly displayed a negative attitude, although a minority voiced the idea that menstruation is a 'disease'. Boys were mostly sympathetic to their menstruating sisters and wanted to support them.

CONCLUSIONS

These findings provide some optimism that males can become advocates in moving forward the MHM agenda. The reasons for this are twofold: boys were keen for knowledge about menstruation, searching information out despite societal norms being for them to remain ignorant, they were also largely sympathetic to their menstruating sisters and fellow classmates and understanding of the issues surrounding the need for good MHM.

A cross-sectional study of the beliefs and attitudes towards menstruation of Chinese undergraduate males and females in Hong Kong

AIMS AND OBJECTIVES

To explore the beliefs and attitudes towards menstruation of Chinese undergraduates in Hong Kong and to compare those of (1) male and female undergraduates with those of (2) undergraduates studying health-related vs. nonhealth-related programmes.

BACKGROUND

Menstruation is typically viewed as a forbidden topic or a troublesome experience. These negative beliefs and attitudes result from existing myths and taboos associated with cultural factors and health education levels.

DESIGN

A cross-sectional survey was conducted in all universities in Hong Kong. Undergraduates were invited through convenience sampling to complete a questionnaire assessing their attitudes and beliefs towards menstruation.

METHODS

A questionnaire on 'beliefs about and attitudes towards menstruation' was adopted. Questionnaires were self-administered by the respondents.

RESULTS

A total of 450 questionnaires were distributed, and a response rate of 96.6% was obtained; 416 completed questionnaires were collected and analysed. Many Chinese undergraduates agreed that menstruation is annoying, causes disability, involves prescription and proscription and is not pleasant. When comparing the beliefs and attitudes towards menstruation of Chinese male undergraduates with those of female undergraduates, females tended to disagree that menstruation should be maintained secret, but tended to agree that it was annoying. When comparing the beliefs and attitudes towards menstruation of Chinese undergraduates studying health-related programmes with those under nonhealth-related programmes, the latter group exhibited a higher level of belief in prescription and proscription for menstruation than the former group.

CONCLUSION

Chinese undergraduates in Hong Kong were influenced by the traditional Chinese culture and social environment, resulting in negative attitudes towards menstruation. This study recommends that sex education, especially reproductive health education, be extended to tertiary education.

RELEVANCE TO CLINICAL PRACTICE

This study provides relevant information on planning the content of sex education or reproductive health education for Chinese undergraduates.

Attitudes and practices of school-aged girls towards menstruation

The purpose of this study was to (i) investigate attitude and menstruation-related practices in Jordanian school-aged girls; (ii) identify the influence of premenstrual preparation on girls' attitude and menstruation-related practices. A descriptive cross-sectional design was used. Data was collected from a convenience sample of 490 school-age girls (12-18 years) from different districts in Jordan. Self-report instruments [Menstrual Attitude Questionnaire (MAQ), and Menstrual Practices Questionnaires (MPQ)] were used to assess the study variables. Descriptive statistics, correlation and chi-square tests were used to analyze the data. It was found that menstrual attitude and practices were positively correlated. Poor attitude toward menstruation and low menstrual practices were significantly associated with inadequate premenstrual preparation. There is a need to prepare girls for menstruation before menarche. The role of the schools and teachers should be reinforced through formal and well planned reproductive health educators for girls and their mothers.

Premenstrual syndrome and attitudes toward menstruation in a sample of nursing students

OBJECTIVE

The aim of this study was to evaluate baccalaureate nursing students' attitudes toward menstruation, and to analyze the frequency of premenstrual syndrome (PMS) symptoms, as well as the relationship between attitudes toward menstruation and PMS symptoms.

METHODS

This cross-sectional study was carried out between February 15 and March 10, 2009, in Ankara Turkey. The study participants were 250 undergraduate nursing student volunteers. Data were collected using a demographic questionnaire, the validated Turkish version of the Menstrual Attitude Questionnaire (MAQ), and the validated Turkish Premenstrual Syndrome (PMS) Scale. Obtained data were analyzed using SPSS version 15.0.

FINDINGS

The average age of participants was 19.89 ± 1.43. The MAQ's five subscales' mean scores ranged from 2.67 ± 0.58 to 3.37 ± 0.52, indicating natural to moderate attitudes toward menstruation. The mean PMS score was 114.86 ± 35.15, indicating moderate PMS symptoms. PMS symptoms were detected in 36.4% of the nursing students. Thirty one percent of the students reported having dysmenorrhoea during every menstrual cycle. Students who had PMS symptoms scored significantly higher on the debilitation subscale and scored significantly lower on the denial subscale of the MAQ (p < 0.05).

CONCLUSIONS

The findings of this research showed that menstruation was considered to be a natural event by most of the nursing students. In addition, dysmenorrhea was found to be the most common menstrual problem and the rate of PMS was found lower than that found in previous researches conducted in Turkey.

Cultural practices relating to menarche and menstruation among adolescent girls in Taiwan--qualitative investigation

STUDY OBJECTIVE

The aim of this study was to qualitatively record the cultural attitudes and practices associated with menarche and menstruation in Taiwanese girls, particularly with respect to coping mechanisms.

PARTICIPANTS

Forty-eight adolescent girls participated.

INTERVENTION

Adolescent girls were individually interviewed to investigate the effects of their cultural practices, coping mechanisms, and physiological symptoms during menarche and menstruation.

MAIN OUTCOME MEASURE(S)

The qualitative investigation revealed mixed reactions to menstruation, such as eating chocolate, using sanitary napkins, and feeling irritable or embarrassed. Cluster construction suggested that adolescents were prepared for menarche but required emotional support; in addition, the new generation employed the Internet to learn how to cope.

RESULTS

A phenomenological approach showed that menarche and menstrual attitudes among Taiwanese adolescents were comprised in 4 dimensions: self-perception, information, and cultural practices with regard to menarche; physiological symptoms and psychological reactions during menstruation; coping mechanisms during menarche and menstruation; and methods for coping and cultural practices for menstruation. Cultural beliefs and the Internet have changed cross-cultural contacts.

CONCLUSIONS

Educators and health professionals should seek to understand this generation of girls, who perceive the world as more flexible and available and have more creativity and new eating behaviors and hobbies.

Pubescent male students' attitudes towards menstruation in Taiwan: implications for reproductive health education and school nursing practice

AIM

To explore male students' attitudes towards menstruation.

BACKGROUND

Menstruation is a biological event that is often surrounded by secrecy and social stigma that causes anxiety amongst many young girls. A key element of this is the attitudes of young males towards this reproductive health issue. However, the literature around what young males think and feel about menstruation is limited.

DESIGN

Qualitative.

METHODS

A sample of 27 male students aged between 10-12 years participated in five focus groups. Data were then subject to a thematic analysis.

RESULTS

Five themes emerged from the data analysis that reflected the boys' feelings, experiences and attitudes towards menstruation: 'A silent topic', 'An unimportant issue', 'Errant information about menstruation'. In addition, according to their experience, participants gradually came to see menstruation from the 'menstrual stereotype' viewpoint. In their social life, they made choices that resulted in gradually regulating their behaviour that affected their 'relationships with girls'.

CONCLUSION

Young boys have misguided knowledge about menstruation and this helps to perpetuate the stigma surrounding this element of reproductive health. Boys also express a desire to learn more but are often restricted in this by home and school. School nurses are the best placed professionals to address this issue.

RELEVANCE TO CLINICAL PRACTICE

Menstrual education with boys should take a greater prominence than it often does in sexual health education in schools. Such inclusion will provide boys with a balanced and accurate knowledge base and therefore help towards reducing the social stigma around menstruation that is often experienced by young girls.

A systematic review and meta-ethnography of the qualitative literature: experiences of the menarche

AIM

This article is a report of a systematic review and meta-ethnography of women's experience of menarche.

BACKGROUND

Adolescents may experience menarche at different ages, but menarche remains an important milestone in the female maturation process, representing the transition from childhood to womanhood.

DESIGN

Systematic review and meta-ethnography.

METHODS

Electronic databases were systematically searched and supplemented with reference lists searching. Qualitative studies of women's experience of menarche were purposely selected and questions proposed by the critical appraisal skills programme was adapted and used to assess papers prior to synthesis. Key themes and concepts were extracted and synthesised using meta-ethnography.

RESULTS

Fourteen studies on menarche experience were identified. The majority of studies were descriptive. Five key concepts were identified from all 14 papers as being descriptive of women's experience of menarche. These included: menarche preparation, significant others' response to menarche, physical experience of menarche, psychological experience of menarche and social-cultural perspective of menarche.

CONCLUSIONS

Menarche experience had a major impact on women. Women went through physical, psychological and social-culture changes when their first menstrual flow came. Menarche preparation has been shown to have a beneficial impact on the menarcheal woman. School nurses have accurate knowledge about sexual health; they can and should provide appropriate menstrual education.

RELEVANCE TO CLINICAL PRACTICE

The findings can be used by school nurses working with adolescents as the basis for a framework of intervention strategies directed towards helping adolescents to better accept their menarche and transition into womanhood.

Menstrual and menarche experience among pubescent female students in Taiwan: implications for health education and promotion practice

AIMS AND OBJECTIVES

This study aimed to explore the menarche and menstruation experiences of young females aged 10-12 years in elementary education in Taiwan.

BACKGROUND

Menarche is a significant milestone in a woman's life and for female adolescents it is a sharply defined biological event that can be a traumatic and uncomfortable time. If used, school nurses can make a significant contribution in educating young people and help to ameliorate these problems. Understanding how young women feel about menstruation is a central element to sexual health education practice.

DESIGN

A qualitative research design was employed using focus groups.

METHODS

Data were collected from 20 female students, aged between 10-12 years. Focus groups were recorded, transcribed and subject to a thematic analysis.

RESULTS

Three themes emerged from the data analysis reflecting the menstrual experience of participants. These were: 'Changing bodies: the physical effects of menarche and menstruation', 'Emotional issues: the psychological impact of menarche and menstruation' and 'Social dimensions of the menarche and menstruation'.

CONCLUSION

Our findings show that young females can experience significant physical and emotional difficulties around menstruation - many of which stem from poor information and the reactions of their peer group to menstrual activity. The potential for school nurses to contribute to this education is significant and schools should explore the manner in which nurses can contribute to this area of health education.

RELEVANCE TO CLINICAL PRACTICE

Nurses involved in health education work with young people and ensure that menstruation education addresses the social and psychological impact of the menarche as well as the physical elements of menstruation. Boys should not be absent from this education and the impact of their attitudes towards menstruation upon their female peers should be addressed in health education work.

Menstrual health care behavior and associated factors among female elementary students in the Hualien region

The purposes of this study were to measure menstrual knowledge, assess menstrual health care behavior and investigate the factors associated with menstrual health care behavior among fifth and sixth grade female students. The subjects were 417 female students from 12 elementary schools in the Hualien region of Taiwan. The stratified cluster random sampling method was adopted. The questionnaire used in the study consisted of three sections: personal information, a menstrual knowledge questionnaire, and a menstrual health care behavior questionnaire. The results of this study show that the majority of the respondents felt that menstruation had an influence on their emotions (74.8%), daily life (73.1%), schoolwork (61.6%), and social interaction (50.1%). The total correct response rate for the menstrual knowledge questionnaire was 45.1%. There was a significant difference between aboriginal and non-aboriginal female students in terms of the correct answer rate for the menstrual knowledge questionnaire. The mean score for menstrual health care behavior was 2.66 (SD = 0.82). Elementary level female students who had better menarche preparation scored higher on the menstrual knowledge questionnaire, and those whose first period had already occurred felt more confident in their ability to execute proper menstrual health care behavior. The results prompted the recommendation to families and elementary schools to encourage students to improve their menstrual health care behavior during menses.