Image Credit: Flo
As an individual who menstruates, I have seen throughout my own post-menarche life the stigma that not only surrounds periods but vaginal health at large. I have left school early because my period pain would make me throw up. I missed college lectures because Aunt Flo decided to come every other week as opposed to once a month, along with a wave of depression and physical pain that made sitting in a classroom an impossible task. I have sat in bathroom stalls balling my eyes out, hoping the Advil and Pamprin cocktail would stay down long enough to kick in. The thing about period pain is that it is so quickly written off as a natural consequence of menstruation: on one side it is taboo to talk about periods in and of themselves, and on the flip it is shameful to admit the extent of the pain because perceptions of pain tolerance delegitimize the pain experienced and the person in proximity to femininity. Period pain becomes a scale for reinforcing gender norms, such as the idea that femininity is indicative of hyperemotionality, weakness, vulnerability. All of these traits are viewed in society, in its praise of patriarchal values and toxic masculinity, as yet another reason to place women as the subordinate. Admitting that period pain affects daily life, then, ostracizes the individual from what society views as acceptable, and places the blame on the individual rather than the social constructs that inhibit their ability to seek medical guidance. I ended up getting birth control that stopped my menstruation altogether, but not everyone has access to contraceptives, nor is it a viable option for some menstruating individuals that have underlying medical conditions contraindicating birth control use. Therefore, it is crucial that research about period pain, specifically dysmenorrhea, is performed not only to help menstruating individuals that struggle with this symptomatology, but to break social stigmas that surround period and vaginal health.
In order to understand dysmenorrhea outside the social perceptions of pain tolerance as a negative consequence inherently tied to femininity, the first thing that has to be understood that there is a difference between standard period pain and dysmenorrhea. Dysmenorrhea has differential manifestations: primary dysmenorrhea describes the recurrent pain associated with menstruation cycles without cause from other diseases, while secondary dysmenorrhea results directly from disorders or infections of the reproductive organs, namely endometriosis, adenomyosis, pelvic inflammatory disease (PID), or fibroids (Cleveland Clinic 2020). Additionally, dysmenorrhea is estimated to impair the quality of life for a third of menstruating individuals (Hellman et al 1); however, due to the stigma surrounding periods, this may be a more conservative statistic than what is actually reflected in the population. What becomes important to reflect upon, then, is how younger women, specifically teenagers, become implicated in the side effects of dysmenorrhea, which not only affects their capacity for success in educational settings but sports, social life, and career paths immediately and later on in life. Periods should not be a sentence to a debilitating lifestyle, and part of the solution requires early intervention. A confounding issue, however, is the difficulty surrounding clinical diagnosis and treatment, especially early on. Though nonsteroidal antiinflammatory drugs, such as ibuprofen, can serve as a first line of defense against dysmenorrhea, hormone treatments, as achieved with contraceptives, tend to be much more effective (Klass 2020). Yet birth control options are much more difficult to obtain for menstruating individuals with limited or nonexistent health insurance coverage. Especially for teenagers who need parental consent to achieve such a prescription, the social implications of birth control in relation to sexual activity only dampen access to contraceptives further (Klass 2020). Underlying structural issues, such as endometriosis, also require much more invasive methods of diagnosis before adequate treatments can be explored. Specifically, laparoscopy and surgical excision of problematic tissue is not only an invasive, last resort option, but is expensive and scary, especially for adolescents who are groomed by society to silence and belittle period problems and do not yet have the cumulative or comparable experience to challenge these norms (Klass 2020).
Between the pervasiveness of period stigmas and the social and physical implications of seeking dysmenorrhea treatment, it is easy to become overwhelmed and disheartened; however, period pain and dysmenorrhea are not lost causes. First, it is important to recognize the symbolic power in simply opening conversations about menstrual and vaginal health. By writing articles, conducting research, or conversing with family, friends, and healthcare providers openly about the struggles associated with menstruation, society can begin moving towards destigmatization of periods and vaginal health, thereby opening even more avenues of discourse and, ultimately, more effective treatment plans. Second, it is imperative to recognize the bodies of medical research being actively conducted regarding dysmenorrhea, which seems to be growing as of late. In 2016, one study was able to connect somatic symptoms, specifically psychological, physiological, and neurological factors, to the development of chronic pelvic pain in dysmenorrhea patients, marking somatic symptomatology as a feasible and clinically visible method for early prevention and intervention strategies (Polnaszek et al 2016). Last year, another study established dysmenorrhea as having the strongest correlation to provoked bladder pain hypersensitivity, likewise indicating increased external and pelvic mechanical pain sensitivities (Hellman et al 2020). Though previous systematic reviews also concluded the connections between dysmenorrhea and mechanical, thermal, and visceral hypersensitivity, this study uniquely elucidated the need for visceral pain configurations in future studies, treatments, and diagnosis mechanisms concerning vaginal health (Hellman et al 2020). Even as recent as this year, a study investigating multisensory hypersensitivity (MSH) in patients with comorbid bladder and menstrual pain sensitivity found “brain-behavior relationships between cortical excitation and visual discomfort were moderated by visceral and somatic sensitivity,” suggesting other chronic pain management treatments be explored in patients at risk for MSH (Kmiecik et al 2021). In short, though there is a long road ahead in the destigmatization, research, and treatment of dysmenorrhea and other menstruation related problems, the growing body of work on the subject helps ensure menstruating individuals that their pain, physical and mental, is valid, and they are not alone in their struggles.
References:
Dysmenorrhea (2020, November 20). In Cleveland Clinic . Retrieved from https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea
Hellman, K. M., Roth, G. E., Dillane, K. E., Garrison, E. F., Oladosu, F. A., Clauw, D. J., & Tu, F. F. (2020). Dysmenorrhea subtypes exhibit differential quantitative sensory assessment profiles. PAIN, 1-10. doi:http://dx.doi.org/10.1097/j.pain.0000000000001826
Klass, P. M. (2020, February 3). Helping teenagers with menstrual pain. In The New York Times. Retrieved from https://www.nytimes.com/2020/02/03/well/family/teenagers-menstrual-pain-cramps-treatment.html
Kmiecik, M. J., Tu, F. F., Silton, R. L., Dillane, K. E., Roth, G. E., Steven E. Harte, S. E., Hellman, K. M. (in press). Cortical mechanisms of visual hypersensitivity in women at risk for chronic pelvic pain. medRxiv. doi:https://doi.org/10.1101/2020.12.03.20242032
Polnaszek, K. L. (2016). Cortical and psychological mechanisms of visceral pain. Master's Theses, Loyola University Chicago. https://ecommons.luc.edu/luc_theses/3352
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