I want to clarify that “middle school” is not a topic that I willingly return to. For me, middle school was a time of bubblegum caught in braces, hormone-charged crushes, and embarrassing growths of every variety. It was also a time when my school first began tackling that universally blush-worthy topic: the human body. I recently spoke to a few of my male friends about their middle school sex education. And honestly, what the hell were they learning?

At my school, the boys were segregated from the girls when the time came to broach the puberty talk. I asked my male friends about sex education because I wanted to know what went on in their separate room. In the “girls room,” we talked about menstruation and were given little period packs filled with tampons and illustrated pamphlets. According to them, the boys had discussed puberty, sexual feelings, and morning erections. The school tailored the talks to the students’ anatomy. In the same way that I didn’t learn about penises and what happens to them in the morning, the boys didn’t learn about vaginas and what happens to them every month.

There were other differences, too. In the room I was in, unlike in the “boys room,” we didn’t talk about the normalization of sexuality, as if the absence of erections cancelled out the possibility of sexual feelings. I, and the girls in the room with me, didn’t talk about sex or dating in a classroom setting until three years later, when all eighth graders had to take a mandatory health class.

At the time, I didn’t think much about the gender separation, and it made sense that we were put in different rooms to discuss the issues that affected us. Like most everyone, I’d been taught from a young age that periods happen to girls and boners happen to boys—a reductive, cisnormative view that, among other issues, erases and stigmatizes the experiences of transgender children. Associating menstruation exclusively with girls can be particularly damaging to trans boys, who may already feel uncomfortable with their periods.

As I’ve grown older, I’ve come to understand other ways, too, in which this enforced segregation can have negative impacts. For instance,I was embarrassed buying tampons when my cashier was male. I didn’t like talking about my period around guys — although I would shamelessly use “period cramps” as an excuse not to participate in gym class (you could almost see my male gym teacher visibly shudder when the word “period” was mentioned). I internalized that periods didn’t just happen to girls, they were not to be acknowledged around men.

My discomfort discussing my period around men hinted at a broader question: Would I still be embarrassed if boys had been present in the room when I learned about menstruation?

I internalized that periods were not to be acknowledged around men.
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I believe that the answer is no. Segregating boys and girls during sex education sessions contributes to a culture in which periods are seen as taboo to talk about with men, or indeed in public at all. During my middle school experience, the physical separation of the girls and boys created the impression that periods are a topic to be discussed solely among women. It is this physical separation which directly contributes to a culture of stigmatization around the topic of menstruation.

The concept of separation leading to stigmatization also works in reverse: Stigmatization leads to separation. In certain communities, cisgender girls and women are required to live in a hut outside of their villages while they are menstruating. In India, for instance, the Gond and Madiya ethnic groups banish menstruating women outside the boundaries of the village for the duration of their periods (Kaur, “Banished for menstruating: the Indian women isolated while they bleed”). Last year, in Nepal, an 18-year old girl died of a snakebite that she sustained while isolated in a “menstruation hut” (Bhandari and Nashar, “Shunned During Her Period, Nepali Woman Dies of Snakebite”). In India and Nepal, women are placed into dangerous situations because of menstruation’s stigmatization.

The shame associated with menstruation also plays a part in religion. In traditional Jewish and evangelical Christian communities, a woman who is on her period is untouchable. According to Chapters 15 to 18 of Leviticus, if you touch a menstruating woman, you become “tum’ah,” or “impure.” The notion that menstruation is impure highlights its stigma. The enforced, unseen boundaries of menstruating women from those around them transforms internal stigma into physical separation.

How Sex Education Fails Queer And Trans Kids
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The twinned relationship between separation and stigmatization exists because of cisgender male aversion to menstruation. From a young age, boys’ lack of education about the topic leads to discomfort and even prejudice. In 1986, when Dr. J. Brooks-Gunn and Dr. Diane Ruble analyzed the reactions of college-age cisgender men and women to menstruation, they found that men, who had an inferential understanding of menstruation rather than an experiential understanding, believed that periods were more debilitating than women did. The male participants also believed that periods affected women’s “moodiness” more than the female participants. These viewpoints feed into misogynistic tropes about women: they’re moody or “hysterical;” they won’t work as hard as a man on the job because of their “debilitating” periods.

Since the 1980s, there have been a host of other studies that have confirmed that the way men and women perceive menstruation is different, and that men see periods more negatively. In 2016, three decades after the study conducted by Brooks-Gunn and Ruble, Tamara Peranovic and Brenda Bentley found that when male respondents were growing up, they saw periods as “taboo,” and shrouded in secrecy. This impacted their openness to discussing periods as adults, and led them to believe that periods were a “woman’s problem.” Similarly, Brooks-Gunn and Ruble’s study posits that the difference between how cis women and men see periods is due to information asymmetry. Interestingly, certain male respondents in the Peranovic and Bentley study were “dissatisfied with the education they received” about periods.

From a young age, boys’ lack of education about the topic of menstruation leads to discomfort and even prejudice.
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From my own experience as a teenager, I gathered that periods are seen as “dirty,” and are considered a “dirty” topic to talk to men about — my gym teacher’s wince was enough to teach me that men don’t like to think about menstruation. But why should that be the case? Menstruation is a natural function that affects half of the world’s population on a regular basis.

The way that sex education is organized depends on the state. Each state decides on its own sex education policy, and bills concerning sex education have to pass the state legislature. Currently, 24 states and the District of Columbia require public schools to teach sex education, and 33 states and the District of Columbia require students to receive instruction about HIV/AIDS. Decisions on how to actually approach sex ed, however, are mostly left up to individual school districts. It’s difficult to ascertain how many schools segregate puberty talks, or whether schools are even offering puberty talks.

Despite this, parsing the psychological literature about male and female attitudes towards menstruation demonstrates that men and women usually do not receive the same information or education about menstruation. Negative male attitudes towards periods, therefore, are largely down to information asymmetry or lack of male education on the topic.

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It’s time to de-segregate sex education so that cis women no longer feel embarrassed about a natural, biological process. What’s more, de-segregating the sex education space should work both ways. Girls should learn about sexual feelings and male puberty in the same ways that boys do. That way, natural cis male experiences, such as voice drops during puberty, are less likely to be ridiculed by those who do not understand the biological underpinnings of the phenomenon. Demystifying the human body contributes to an open culture in which questions are encouraged and bodies are no longer seen as a source of shame or embarrassment.

Those who favor gender segregation during sex education claim children will feel more comfortable asking questions about their bodies if they’re separated from children of the opposite sex. This viewpoint, however, not only enforces the idea that one should only be comfortable talking about one’s body around those of the same gender, but excludes the experience of transgender and nonbinary students. Educating children about sexual education in the same space ensures that nobody feels misplaced or excluded.

For those who feel this is sure to cause embarrassment, there are strategies. Some schools offer an anonymous question service where students have the opportunity to write their questions on a slip of paper for teachers to answer at the end of the sex education session. Sex ed teachers can hold office hours for students to ask questions they may not feel comfortable sharing with a group. Using these strategies, nobody has to feel embarrassed asking a question, and students of all genders can hear the answers.

The conversations we have with children affect the adults they become. Periods are nothing to be embarrassed about, and if students of all genders were taught about menstruation at the same time, women might not be so uncomfortable discussing their periods in front of their male counterparts — and men might not be so uncomfortable hearing about it.

So, when teaching students about sex education, let’s tackle the body’s processes in a more inclusive way. That way, middle schoolers can focus on the truly embarrassing things in life, like pimples and parents.

‘I promise you it’s totally possible to get rid of cramps through exercise.’

Editor’s note: The following is a satirical piece designed to lambaste despicable ideas surrounding reproductive anatomy, menstruation, and gender. To that end, it utilizes some cissexist and heteronormative language. As we’ve heard from readers since the piece’s publication, some usages of this language, sans the proper editorial note(s)/overt satirical markers, are erasive to some people assigned female at birth. We apologize for any harm caused and will aim to be more inclusive in our editorial process going forward.

Well, actually, I read that there’s no such thing as PMS. What happens during, you know, that time of the month, is that your body is reacting to a number of complex sociopolitical factors that make you think you’re experiencing cramps, headaches, and mood swings, but there’s no scientific basis for it. I don’t know if you’ve heard of the Stanford Prison Experiment? Basically, a bunch of Stanford students were assigned to be guards, and other students were prisoners, and the guards ended up waterboarding the prisoners and all this wild shit. They were trying to study Naziism, but if you think about it, it also explains why so many women think they have PMS. People are pretty suggestible—most of them will believe anything you tell them.

You might not have realized that you can actually die from tampons if you leave them in too long. There’s this disease called tampon shock syndrome that basically causes your whole body to go into shock. This one girl lost her leg. You’re supposed to change your tampon every one to two hours, during your, you know, red sea, so you don’t get TSS. Like how guys have to shave every day or we end up with a 5 o’clock shadow. Sometimes it’s hard to remember things like this, but I’ve found that the more you apply discipline to one specific area of your life, the more disciplined you become overall. Have you read the Tim Ferriss book The 4-Hour Workweek? It’s about how you can actually fit a week’s worth of work into four hours. I think you’d dig it.

Well, actually, the reason tampons are taxed is that they’re non-essential goods. Like candles. The way to tell whether something is essential or non-essential is to ask yourself: Would I die if I didn’t have this? There are other ways to deal with your, you know, barbecue sauce bath, that aren’t tampons, so that makes them non-essential. Another way taxation works is that it’s used to disincentive certain behaviors. Like, for instance, there’s a tax on cigarettes because smoking gives you lung cancer. Are you familiar with how supply and demand works? Basically you draw two lines — the supply curve, and the demand curve — and where they meet is called the point of parity. Basically, if there were no tax on tampons, demand would outstrip supply, and then prices would skyrocket, and you’d be way worse off.

Trust me on this — I read that some tampons are actually made with hay and dental floss, because they’re cheaper than synthetic fibers, and they work just as well, for stopping the, you know, crimson tide. There’s this concept in economics—my sophomore year roommate actually minored in Econ—that explains that manufacturers prefer to use cheaper raw materials to maximize their profits. Like, if I were a chef, I would buy slightly expired ingredients, because they’re cheaper, and that won’t really affect the quality of the food. I found out that you can actually drink milk more than a week past its expiration date. Tim Ferriss talks about that in The 4-Hour Chef, which is pretty much my bible for weekly meal prep. If you want to start eating healthier, you should definitely check it out.

You probably didn’t realize that in some countries, women are ostracized during their, you know, lady leakage. They have to wear these red cloaks with white bonnets, and they’re called handmaids for those few days. That part is just in Syria. Actually, women used to be ostracized in the U.S. too. It makes sense, if you think about it, because of all of the estrogen. I read that large amounts of estrogen in the human body are actually more dangerous than large amounts of testosterone. In women’s prisons, the cycles of all the inmates actually sync up, and the guards have to be careful about riots. That’s what happened in this documentary I saw, Orange Is the New Black.

I promise you it’s totally possible to get rid of cramps through exercise. What’s the lady Advil called? Midol? Too much of that stuff can kill you. And it doesn’t actually work, either. I read it had the same effect as a placebo in a study of a dozen women who had their, you know, female flood. Exercise usually does it for me when I’m not feeling great. Have you read The 4-Hour Body? You might actually find it helpful. Tim Ferriss talks about how you’re supposed to work different muscle groups on different days, otherwise the lactic acid builds up, and your muscles explode. It happened to this one guy who did too much CrossFit. But I’d definitely recommend the book. Switching up your workout routine can actually help reduce body fat too.

Well, actually, prostate exams are supposed to be a lot more painful than cramps. A lot of men rate them as a nine out of 10 on the pain scale, which is one away from a 10. I think guys just talk about it less when we feel pain, you know, because of how we’ve been socialized. It’s way more socially acceptable for women to complain about cramps during, you know, your scarlet spillage. But when we drink milk that’s gone bad or something and our stomachs are completely messed up, we’re just supposed to grin and bear it. I actually don’t think epidurals would have been invented if men were the ones who had babies. It’s another one of those mind over matter things, you know? I could totally give birth if I had to.

In Naturalis Historia, the Roman naturalist Pliny the Elder wrote that period blood has the power to stop whirlwinds, kill bees, and drive dogs mad…

If you feel compelled to chuckle, keep in mind that nearly 2,000 years later, menstruation is still shrouded in myth, taboo, and beliefs that are nearly as bizarre as what ‘ol Pliny was peddling.

In fact, the actual science of why people have periods is almost stranger than the myths. And while periods are part of the everyday lives of over half the population, the answer to the simple question “why do they exist?” is far from being common knowledge.

Humans — along with old world primates and certain types of bats — are one of the few species on Earth that menstruate. In these species, a drop in the levels of the hormone progesterone triggers the breakdown of the inner lining of the uterus. What follows is an extraordinary process of scar-free wound healing. The uterus can break down and regenerate every month, hundreds of times in a lifetime — all without ever leaving a scar.

This incredible process is practically unheard of in adult tissues, but, as many of us know, periods can also be debilitating. So biologists have been puzzled as to why this phenomenon should have evolved. And, more specifically, why did it only evolve in humans, old world primates, and certain bats?

Recent research suggests that the answer lies in an ancient conflict. It’s in the best interests of the father (or parent providing the sperm) for the mother (or parent providing the egg) to pour as much energy and resources into pregnancy as possible. But it’s in the best interests of the mother to balance the needs of pregnancy with maintaining their own health. In humans, this conflict has left its mark on our very DNA.

We each have two complete copies of the human genome: one paternal and one maternal. Usually, the two copies are equally active. But sometimes, the father or mother modifies their copy so that certain genes are “off” — most of the genes that are modified in this way are involved in fetal growth.

Herein lies the rub.

If both copies of those parental genes were active, the fetus would grow abnormally large. So, in the copy of the genome she provides, the mother’s body gets the hell in there and shuts those genes off.

Likewise, there are certain genes that repress growth, and if both copies of those genes were on, the fetus would be abnormally small. The father goes in and shuts those genes off. The size to which the fetus will grow is ultimately determined by this genetic tug-of-war.

This conflict has also driven the evolution of a particularly gruesome kind of placenta: the hemochorial placenta.

Some types of placentas don’t invade maternal tissues at all. But the hemochorial placenta — which all menstruating species have — burrows through the walls of the uterus and hooks into the mother’s bloodstream. Once the invasion is complete, the placenta can control the mother’s entire body by releasing hormones into her blood. So it was necessary for people with wombs to develop a defense system to mediate placental invasion.

This was particularly crucial because of another strange quirk of human biology: Human embryos are 10 times more likely than other mammals to carry an abnormal number of chromosomes. Some variation in chromosome number can be tolerated: For instance, three copies of chromosome 21 in Down Syndrome or only one copy of the X chromosome in Turner Syndrome. But in general, embryos with large parts of their genomes missing or duplicated will not be able to develop.

Why We Must Stop Calling Menstruation A ‘Women’s Issue’
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Because so many human embryos are actually inviable, our species has an incredibly high rate of miscarriage. Fifteen percent of clinically recognized pregnancies end in miscarriage, but counting pregnancies that aren’t clinically recognized, that number is actually closer to 50%. Unfortunately, society tends to tell pregnant people that something is wrong with them if they experience miscarriage, when really, a high chance of miscarriage is just part of being human.

Periods result from an adaptation to those two things: the invasive, hemochorial placenta and the prevalence of chromosomal abnormalities. One thing that humans, old world primates, and menstruating bats all have in common is a phenomenon called “spontaneous decidualization.”

Decidualization is the remodeling of the uterine lining that occurs in preparation for pregnancy. In other animals, decidualization is triggered by the presence of an embryo, but menstruating species have taken control of that process. In these species, decidualization occurs cyclically, whether there is an embryo or not.

A high chance of miscarriage is just part of being human.
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So why is this a good thing? Here’s why. Many people believe that the uterine lining thickens and changes in order to provide a hospitable environment for an embryo, but that’s not the whole story. Once the cells of the uterine lining turn into decidual cells, they gain the ability to sense whether or not an embryo is developing normally, even before it implants. If it is, the cells permit the invasion of the placenta. But if it’s not, the cells quickly self-destruct. By making the transformation into decidual cells occur cyclically, our species has made sure it’s prepared to defend against potentially harmful pregnancies before the embryo implants.

Some biologists argue that periods are just the coincidental result of combining spontaneous decidualization with cycling hormone levels. Once cells are decidualized, a drop in progesterone will trigger them to self-destruct. And, so long as pregnancy doesn’t occur, progesterone levels rise and fall each month.

It makes sense that periods might not have intrinsic benefit, because in the natural state, periods are pretty rare. Our ancestors, who were more frequently pregnant, only had about 40 periods in a lifetime. But some biologists think that menstruation does have intrinsic benefit. Because the uterus is able to repeatedly break down and rebuild itself, it may be able to learn from previous reproductive events and adapt. If this is true, it might explain why most pregnant people who experience miscarriage eventually go on to successfully conceive.

Menstruation is, in many ways, a potent symbol of the socio-cultural stronghold the patriarchy still wields. In a society that has become increasingly inured to the ubiquity of sex and violence, periods remain largely unmentionable, further complicating our long history with the uterine lining. But I tend to believe that — although he may have been oh-so-wrong in the specifics — Pliny the Elder was damn right when he wrote “over and above all this there is no limit to woman’s power.”

There’s one thing cis and transgender people agree on—trans women and transfeminine people don’t get periods.

Those of us who were assigned male at birth (AMAB) generally came out of the womb without ovaries or a reproductive system that can support a pregnancy, so we don’t bleed every month in preparation for one. It’s generally seen as one of the net positives about being a transgender woman as opposed to a cisgender gal; before and after I started transitioning, my cis girlfriends came to me with their tales of woe — bloating, cramps, violent mood swings, nausea — all sometimes too intense for them to reasonably get out of bed. “You’re so lucky,” they’d moan, and I would shrug sheepishly, implicitly agreeing that I was fortunate to never share in those experiences. That would be impossible. Right?

Imagine my shock, then, when I talked with my friend Ashley last month, just before she went into the hospital for a few weeks. Nervous about the length of time she would have to stay, she told me the reason for her reticence: “I’m due for my period in a couple days, and that’s going to really suck.”

Uh, what?

Ashley’s a 23-year-old trans girl who’s been on hormone replacement therapy (HRT) for over a year. She takes a cocktail of the antiandrogen spironolactone and estradiol, a form of estrogen. About five months into her treatment, she began experiencing a predictable pattern of symptoms: First would come the soreness and swelling in her chest along with bouts of nausea; the next day, she’d endure painful abdominal cramping lasting minutes at a time, as well as constant nausea, hot flashes, dizziness, photosensitive migraines, and bloating. This cycle, she says, lasts for about six to seven days and repeats roughly every five weeks.

About five months into her HRT treatment, she began experiencing a predictable pattern of symptoms.
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If those symptoms sound familiar, it’s because billions of cis women all over the world experience similar symptoms while menstruating. Along with insomnia, general muscle fatigue, joint pain, acne, and a host of other side effects, all the afflictions Ashley reported are symptomatic of premenstrual syndrome (PMS) and/or premenstrual dysphoric disorder (PMDD). (Debilitating symptoms can be indicative of endometriosis and shouldn’t be considered a natural part of menstruation for people with uteruses — folks, call your doctors!)

Intrigued by Ashley’s disclosure, I put out a call online for trans women to get in touch with me if they had experienced regular symptoms like hers since they began HRT. It turns out, Ashley’s not alone in her experiences — it’s not impossible for me to develop a “period” after all.

The respondents to my question varied in age, length of time on HRT, dosage level, and administration method — while some trans people take their hormones in pill form, others choose to use patches or intramuscular injections — but they all reported similar results. Most seconded Ashley’s accounts of pain and nausea, and added that they experienced intense mood swings. One agender respondent, Blue, reported immobilizing cramps that were 30 seconds long, extreme mood swings and depressive episodes, and constant headaches — all beginning six months after starting HRT, and appearing regularly for the past five months.

Aspen, a 24-year-old trans girl, said that although she almost always felt nauseated in the morning, she’d recently experienced excruciating “morning sickness” for a nearly weeklong stretch before it abated — almost without a trace. Still another respondent, who requested to remain anonymous, said they had “a lot of really bad period shits where it’s practically explosive it’s so horrible.” (Menstrual diarrhea isn’t as known or discussed as other symptoms, but it is definitely a thing — to nobody’s relief.)

After speaking with about 10 diversely identified people who identified as having PMS-esque symptoms, I saw only one possible explanation: AMAB trans people can and do seem to experience period-like symptoms as a part of HRT. Just like cisgender women, our period experiences range from barely noticeable or almost nonexistent to debilitating. I haven’t identified a hormonal cycle of my own, but it was clear that others had, and they weren’t limited to feeling sad and wanting chocolate (though Ashley did wryly note that she “had to be talked out of putting chocolate syrup on [her] hot dog” during a recent cycle).

Scientifically, I was puzzled; were these symptoms strictly psychosomatic, driven by knowing feminization of these individuals’ bodies? Or were they a direct result of the physiological effects of HRT, an awakening of latent femininity in AMAB bodies? After all, there’s only one gene separating testicles from ovaries in adult humans, and all human embryos are primed to develop ovaries until a chain of genes on the Y chromosome get involved. Plus, animals of all kinds (like frogs and hawkfish) change sex frequently in response to environmental stimuli. I certainly didn’t consider my informal surveys to be comparable to a clinical trial, but the anecdotal data I rounded up was strong.

Just like cisgender women, our period experiences range from barely noticeable or almost nonexistent to debilitating.
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In fact, I even heard from a cis woman whose mother was prescribed HRT after having her ovaries removed, and who experienced cyclical back pain, bloating, and frequent urination/defecation — “everything but the bleeding.” “[My mother] actually has a healthier, regular cycle without most of her reproductive system than I do while still having mine,” griped the respondent. Given the dearth of medical literature regarding the effects of HRT on transgender people, why wouldn’t it be possible for AMAB people to experience something akin to a bloodless period? After all, side effects like bloating, cramping, nausea, and breast soreness are well-documented side effects of estrogen therapy. Is it such a stretch to believe that these effects could be experienced cyclically?

This is a phenomenon that clearly requires greater study — in all of my research on the topic, I couldn’t find a single scientific examination of the matter. Perhaps part of the problem is that so few people know about it. The general cis population is understandably in the dark, because lots of trans people aren’t aware of it as a broad phenomenon either. Though a few of my respondents had discussed their symptoms in private trans groups online, most had assumed they were the only ones who were getting their “periods.”

There is one group with strong views on the matter, however. If you listen to trans-exclusionary radical feminists (TERFs), we actually can’t experience period-like symptoms . . . because, well, we just can’t. After I put out the call for interviewees on my Tumblr, the TERF brigade leapt all over my post and covered it in some of the most vicious, unprovoked vitriol I’ve ever seen — from accusations of sexism, to claims that those talking about this were “delusional” and “parasites,” to outright threats (“i’ll gladly help them if they want to bleed from their genitals once a month”).

I was shocked and confused — I had gathered enough anecdotal evidence to suggest a truly fascinating hormonal phenomenon, but these people had no interest in challenging their preconceived notions of what was possible for transgender people (notions that, I’ll reiterate, I used to share as well).

But then again, perhaps this shouldn’t have come as such a surprise to me. Whether it’s in a conversation with our medical providers, friends, or even immediate family, trans people — AMAB folks in particular — have historically been met with violent opposition when discussing their feelings and medical needs. We’re often told we’re exaggerating things, seeking attention or sympathy, and that our reality can’t possibly be as we describe it. Sometimes these verbal assaults turn physical. When I asked how these attacks made them feel, Blue laid down some truth:

“I’ve always been terrified to mention [these symptoms] to anyone for the reason of feeling as though it wouldn’t go over well with anyone . . . My neurodivergency alone makes me feel as though I have to slowly kill myself at school or work (when I was in either) in order to be accepted and acknowledged. I don’t respond to criticism well at all, so I am horrified. It’s an especially odd topic for someone like me, an agender individual, who dreams every night that they might wake up AFAB instead of AMAB, [but] doesn’t really desire to relate to these symptoms in the end. It’s sad that it might not be easy to find a safe way to ever have a discussion on them.”

Trans people have historically been met with violent opposition when discussing their needs.
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On the other hand, Ashley said she tries to focus on the positive. Although her mother has accused her of exaggerating her symptoms in the past, and she’s afraid to contradict those who say she’s just “looking for attention,” Ashley tries to educate those cis women who say she’s “lucky” not to bleed. “Well, actually,” she grins, “I don’t have a uterus, but I have some of the downsides.” At the end of the day, she’s glad to have a little more solidarity with her trans siblings now that she knows some of them share her experiences: “It’s good to know I’m not alone.”

Hopefully, one of these days, the medical community will dive into the matter and confirm what Ashley already knows — that periods aren’t just for vaginas anymore.