Introduction

Menstruation is a natural bodily function that has been shrouded in myths, imbued with both good and bad symbolisms, and is the object of diverse taboos and rituals in all traditional cultures from as far back as historical records are available.

Many menstruation-related myths and cultural misperceptions persist to the present day and continue to find expressions in contemporary belief systems and attitudes toward normal and abnormal menstruation. More significantly, they have direct implications for reproductive health. They continue to exert major effects on the manner and extent by which women seek medical treatment for disorders of menstruation, particularly abnormal uterine bleeding, and related events such as menarche and menopause.

The objective of this chapter is to present an overview of how menstruation was and is perceived in various ethnic groups and cultures in the world, from ancient mythology and historical or traditional practices to contemporary belief systems.

Considering the increasing ethnic mixture of women seeking medical help in most countries and the globalization of current clinical practice, it is important that health care providers are cognizant of extant cultural and social views and attitudes regarding the menstrual function. The ultimate goal is to provide women with culturally sensitive and medically appropriate treatments for menstrual disorders. In view of the great variations in the experience of menstruation in women around the world, this biocultural approach to menstruation management is desirable.

The mythology of menstruation

Mythical tales about menstruation abound in the legends and prehistory of ancient cultures. These tales characterize menstrual blood variously as sacred, a gift from the gods, or a punishment for sin, but it is always magical and powerful. A few examples of these ancient beliefs illustrate the breadth and universal nature of these mythical and cultural views or dogmas.

In Norse mythology, the god Thor reached the magic land of enlightenment and eternal life by bathing in a river filled with the menstrual blood of “ Giantesses ” or Primal Matriarchs, the “Powerful Ones.” In Greek mythology, the gods were dependent on the miraculous power of menstrual blood. It was euphemistically called the “supernatural red wine” given to the gods by Mother Hera .

In the Vedas , the oldest scriptures of Hinduism, the origin of menstruation is narrated . The myth tells about Indra , the powerful God of wars, storms, and the heavens, who slayed his main enemy, Vritra , the demon of drought in the form of a dragon. However, Vritra was a Brahmin (member of a caste specializing as priests, teachers, and protectors of sacred learning across generations), and by his murder, Indra acquired the sin of Brahmahatya (the act of killing a Brahmin, which is considered a major sin). To free himself from the sin, Indra divided his sin into four parts and gave them to trees, water, fire, and women. It has been declared in the Vedas that women’s menstrual flow is a manifestation of that sin as women had taken it upon themselves a part of Indra ‘s guilt.

Mayan mythology explains the origin of menstruation as a punishment for violating the social rules governing marital alliance. The menstrual blood turns into snakes and insects used in black sorcery before the Mayan moon goddess is reborn from it .

A Cherokee mythical story demonstrates the power of menstrual blood . Stoneclad was a cannibalistic monster who was virtually indestructible because of his impenetrable stone skin. But Stoneclad had one weakness—he could not bear the sight of a menstruating woman. Although no Cherokee warrior could stop him, Stoneclad finally met his demise in the presence of seven menstruating virgins. One by one, they stood naked in his path, sapping his strength, until Stoneclad finally crumbled into a heap.

Persistence of myths. Even if they have no connection to reality, mythical stories about menstruation have continued to underpin current menstruation-related cultural beliefs and practices. Lunar and menstrual phase-locking and menstrual synchrony are two of the most persistent ideas crucial to the myths and rituals of traditional communities across the world.

Lunar and menstrual phase-locking. The terms “menstruation” and “menses” are derived from the Latin word mensis (month), which in turn relates to the Greek word mene (moon), the roots of the English words month and moon . Thus, the word “menstruation” is etymologically related to “moon.”

The idea that menstruation is—or ideally ought to be—in harmony with wider cosmic rhythms, such as the lunar phases, appears persuasive because of the fact that in humans, the menstrual cycle quite closely approximates the moon’s 29.5-day synodic cycle (time required for the moon to return to the same position relative to the Sun as seen by an observer on the Earth), unlike in chimpanzees (approximately 36 days) or bonobos (approximately 40 days) .

A number of studies have suggested that the lunar cycle is associated with a natural rhythm of electromagnetic radiation and with fluctuating melatonin levels , both of which are considered to have an effect on the human menstrual cycle. However, statistically significant lunar phase-locking has not been demonstrated in any surviving human population. A study of menstrual periodicity involving 10,416 women found that menstruation occurred at all times of the month, regardless of the lunar cycle, and concluded that there is “no justification for associating the date of menstruation or its rhythm with lunar phenomena” .

Menstrual synchrony. Menstrual synchrony is the alleged process whereby women who begin living together in close proximity experience the onsets of their menstrual cycles becoming closer together in time than previously . Although pheromones have been suggested to cause menstrual cycle synchronization , the most prominent mechanism assumed in myths and traditions was the synchronization of the menstrual cycle with lunar phases .

Among the Yurok Indians of northwestern California, “all of a household’s fertile women who were not pregnant menstruated at the same time, a time dictated by the moon; they practiced bathing rituals together …. If a woman got out of synchronization with the moon and with the other women of the household, she could get back in by sitting in the moonlight and talking to the moon, asking it to balance her” .

In some aboriginal tribes in Australia, the Rainbow Snake is a supernatural being that is interpreted as an indigenous way of conceptualizing the ideal of synchronized tidal, lunar, menstrual, and seasonal periodicities. Its overall harmony is believed to confer spiritual power and fertility . Details of such beliefs may be difficult to confirm because they are part of traditional “secret women’s business.”

The question of whether women do in fact synchronize their menstrual cycles when they live together has received undue attention in popular media with publications introduced with catchy titles such as “Do women who live together menstruate together” and “Do girls who go together flow together?” . Current evidence indicates that women do not synchronize their menstrual cycles .

The mythology of menstruation

Mythical tales about menstruation abound in the legends and prehistory of ancient cultures. These tales characterize menstrual blood variously as sacred, a gift from the gods, or a punishment for sin, but it is always magical and powerful. A few examples of these ancient beliefs illustrate the breadth and universal nature of these mythical and cultural views or dogmas.

In Norse mythology, the god Thor reached the magic land of enlightenment and eternal life by bathing in a river filled with the menstrual blood of “ Giantesses ” or Primal Matriarchs, the “Powerful Ones.” In Greek mythology, the gods were dependent on the miraculous power of menstrual blood. It was euphemistically called the “supernatural red wine” given to the gods by Mother Hera .

In the Vedas , the oldest scriptures of Hinduism, the origin of menstruation is narrated . The myth tells about Indra , the powerful God of wars, storms, and the heavens, who slayed his main enemy, Vritra , the demon of drought in the form of a dragon. However, Vritra was a Brahmin (member of a caste specializing as priests, teachers, and protectors of sacred learning across generations), and by his murder, Indra acquired the sin of Brahmahatya (the act of killing a Brahmin, which is considered a major sin). To free himself from the sin, Indra divided his sin into four parts and gave them to trees, water, fire, and women. It has been declared in the Vedas that women’s menstrual flow is a manifestation of that sin as women had taken it upon themselves a part of Indra ‘s guilt.

Mayan mythology explains the origin of menstruation as a punishment for violating the social rules governing marital alliance. The menstrual blood turns into snakes and insects used in black sorcery before the Mayan moon goddess is reborn from it .

A Cherokee mythical story demonstrates the power of menstrual blood . Stoneclad was a cannibalistic monster who was virtually indestructible because of his impenetrable stone skin. But Stoneclad had one weakness—he could not bear the sight of a menstruating woman. Although no Cherokee warrior could stop him, Stoneclad finally met his demise in the presence of seven menstruating virgins. One by one, they stood naked in his path, sapping his strength, until Stoneclad finally crumbled into a heap.

Persistence of myths. Even if they have no connection to reality, mythical stories about menstruation have continued to underpin current menstruation-related cultural beliefs and practices. Lunar and menstrual phase-locking and menstrual synchrony are two of the most persistent ideas crucial to the myths and rituals of traditional communities across the world.

Lunar and menstrual phase-locking. The terms “menstruation” and “menses” are derived from the Latin word mensis (month), which in turn relates to the Greek word mene (moon), the roots of the English words month and moon . Thus, the word “menstruation” is etymologically related to “moon.”

The idea that menstruation is—or ideally ought to be—in harmony with wider cosmic rhythms, such as the lunar phases, appears persuasive because of the fact that in humans, the menstrual cycle quite closely approximates the moon’s 29.5-day synodic cycle (time required for the moon to return to the same position relative to the Sun as seen by an observer on the Earth), unlike in chimpanzees (approximately 36 days) or bonobos (approximately 40 days) .

A number of studies have suggested that the lunar cycle is associated with a natural rhythm of electromagnetic radiation and with fluctuating melatonin levels , both of which are considered to have an effect on the human menstrual cycle. However, statistically significant lunar phase-locking has not been demonstrated in any surviving human population. A study of menstrual periodicity involving 10,416 women found that menstruation occurred at all times of the month, regardless of the lunar cycle, and concluded that there is “no justification for associating the date of menstruation or its rhythm with lunar phenomena” .

Menstrual synchrony. Menstrual synchrony is the alleged process whereby women who begin living together in close proximity experience the onsets of their menstrual cycles becoming closer together in time than previously . Although pheromones have been suggested to cause menstrual cycle synchronization , the most prominent mechanism assumed in myths and traditions was the synchronization of the menstrual cycle with lunar phases .

Among the Yurok Indians of northwestern California, “all of a household’s fertile women who were not pregnant menstruated at the same time, a time dictated by the moon; they practiced bathing rituals together …. If a woman got out of synchronization with the moon and with the other women of the household, she could get back in by sitting in the moonlight and talking to the moon, asking it to balance her” .

In some aboriginal tribes in Australia, the Rainbow Snake is a supernatural being that is interpreted as an indigenous way of conceptualizing the ideal of synchronized tidal, lunar, menstrual, and seasonal periodicities. Its overall harmony is believed to confer spiritual power and fertility . Details of such beliefs may be difficult to confirm because they are part of traditional “secret women’s business.”

The question of whether women do in fact synchronize their menstrual cycles when they live together has received undue attention in popular media with publications introduced with catchy titles such as “Do women who live together menstruate together” and “Do girls who go together flow together?” . Current evidence indicates that women do not synchronize their menstrual cycles .

Historical cultural beliefs and attitudes toward menstruation

A survey of historic cultures indicate that the belief systems toward menstruation have varied from an event that is sacred, powerful, beneficial, and positive (as the myths say) to one which is unclean, polluting, destructive, and negative .

Ancient Greece and Rome. In ancient Greece and Rome, menstruation was accorded great powers. Pliny the Elder, in his book, Historia Naturalis , wrote that a “menstruating woman who uncovers her body can scare away hailstorms, whirlwinds, and lightning. If she strips naked and walks around the field, caterpillars, worms and beetles fall off the ears of corn.”

Women writers of ancient Greece and Rome promoted the magical medicinal benefits of menstrual fluid. Salpe, Lais, and Sotira recommended menstrual fluid as a treatment for rabies, malaria, and epilepsy and as a contraceptive for donkeys. Salpe and Lais stated that “the bite of a mad dog and a tertian and quartan malaria are cured by menstrual fluid on wool from a black ram enclosed in a silver bracelet.” Sotira was more instructive: “To anoint the soles of the patient’s feet with menstrual fluid is the most efficacious cure for tertian and quartan malaria; it is much more effective if it is done by the woman herself without the patient’s knowledge. The same remedy also awakens an epileptic.” Lais also observed that “donkeys do not conceive for as many years as the number of grains of barley they have eaten contaminated with menstrual blood” .

Often, however, the effects of menstrual fluid were thought to be harmful. Pliny the Elder also stated, in apparent self-contradiction, that contact with menstrual blood “turns new wine sour, crops touched by it become barren, grafts die, seeds in gardens are dried up, the fruit of trees falls off, the edge of steel and the gleam of ivory are dulled, hives of bees die, even bronze and iron are at once seized by rust, and a horrible smell fills the air; to taste it, it drives dogs mad and infects their bites with an incurable poison.”

Ancient Egypt. In ancient Egypt, hsmn (old Egyptian word for menstruation, presumably pronounced “hesmen”) was treated ambiguously. Women viewed menstruation as a “time for cleansing.” It was generally considered to have a healing effect and was used for producing drugs for women but not for men. There was a recommendation in the Papyrus Ebers, for instance, that “sagging breasts should be covered with menstrual blood, and the woman’s belly and her thighs should be covered as well” . Ancient Egyptian women used menstrual “loin cloths” and throwaway tampons, probably made of papyrus or a similar grass.

Some Egyptologists tend to assume that there had been strong taboos against menstruation, but these taboos were not universal. However, there are indications that menstrual blood was considered impure for a man to touch. A Wisdom Text (ancient Egyptian textbook that taught a particular set of morals, ethics, and values) gives some examples of “negative” careers for men not to pursue “like that of a laundry worker, who even has to wash the loincloth of a menstruating woman.” This story implies that menstrual blood was impure and was something a respectable man did not touch .

Africa. The power of women shines in the menstrual habits of the !Kung, a contemporary hunting/gathering tribe of the Kalahari Desert. Because the !Kung women held positions in their society that were almost equal to those held by the men, sharing decision-making and labor, their menarches and menstruations were not objects of fear or taboo. The menarcheal hut (where girls with first menses were confined) is located within the village, and the men are free to watch the bawdy antics of the women as they celebrate. Regular menstruation is given minimal attention as cotton and water are scarce, and it is often neither possible nor necessary to conceal the blood. The !Kung do believe, however, that if a woman sees menstrual blood on another, she will start menstruating herself .

Cherokee Nation of Oklahoma. Like many tribal peoples around the world, Cherokees believed that a woman’s menstrual blood was a powerful substance. It was not dirty or polluting, but it was a source of feminine strength and a destructive force with the power to destroy enemies .

Menstrual blood was also a force to be contended with in everyday Cherokee affairs. For example, the destructive power of menstrual blood could be channeled against an enemy and thus was often evoked in sorcery, during war, and in ball game rituals. To keep their blood from becoming exhausted, Cherokees would engage in periodic rites of bloodletting as a prophylactic measure against illness. For example, a young ball player before a game or a warrior before battle would be subjected to ritualized scratching over much of his body. This rite not only purified and strengthened the recipients but also provided a deeply symbolic means by which Cherokee men could appropriate the fearsome power of menstruating women. Through episodic bleeding, Cherokee men became like menstruating women and thus were filled with destructive potential. In recognition of this power, Cherokee women were isolated in menstrual huts, far away from family and friends, during their menstrual periods .

China and Taiwan. The Chinese see all body refuse as being dirty because it was rejected by the body and ejected from the body by natural and normal systems. Of all the dirty bodily refuse, menstrual blood is the worst because it is dirty and polluting, and the blood that flows out is associated with danger, pain, and death, which in some cases would be also seen as the unborn fetus .

Among the Chinese, menstruating women are not to wash their clothes and their husband’s clothes together; they are not allowed to sit on a chair that a man will occupy. Menstruating women are not allowed to worship gods in public ceremonies, public temples, or even ancestral halls; however, they can worship the gods in private. They are also not allowed to attend weddings, funerals, birthday celebrations, or open houses.

Sexual intercourse during menstruation is taboo for the Chinese. If sexual intercourse occurs during menstruation, then the man will absorb the polluting essences of the woman and he will become polluted and will result in penis sores and a condition called crushing red , which results in other diseases and even death.

Religion and the impurity of menstruation

Religion is arguably the most significant factor that has, over the course of many centuries, spawned the belief that menstruation should be looked at with shame and fear.

The various world religions, except Sikhism, have generally negative attitudes and prohibitions regarding menstruation and menstruating woman. Because menstruation is associated with impurity in one or the other form, all religions imposed restrictions on women, although at times, these restrictions bordered on taboo and excesses. All religions also have some form of cleanliness or purification ritual that women are compelled to follow after their menses.

A cursory review of how menstruation is viewed and how the menstruating woman is treated in the major religions will prove this “menstrual blood is dirty” premise.

Abrahamic religions (Islam, Judaism, and Christianity)

Islam. Islam does not have a prejudiced view of haidh (menstruation). Islam allows the man to eat, sit, and live a normal life with his menstruating wife. One of Prophet Muhammad’s wives narrated , “While I was laying [sic] with the Prophet under a single woolen sheet, I got the menses. I slipped away and put on the clothes for menses. He said, ‘Have you got “ nifas ” (menses)?’ I replied, ‘Yes.’ He then called me and made me lie with him under the same sheet.”

What a man is not allowed to do is to have sexual intercourse with a menstruating woman because menstruation is adha (a harmful thing). The Qur’an clearly states this prohibition, which is that Allah says, “They question thee (O Muhammad) concerning menstruation. Say: It is an adha , so let women alone at such time and go not in unto them till they are cleansed.”

During menstrual periods, women are excused from performing prayers and fasting. Respect for women during their period is valued. They are advised to not enter the mosque without any important purpose, but are encouraged to be present at religious services. After the menses, the woman is required to perform a ghusl (spiritual bath), which is also required of both partners after sex and before prayer and fasting are continued.

An important distinction of the Islamic view of menstruation is that haidh has a defined duration with a minimum of three days and a maximum of 10 days. Therefore, if a woman sees blood for less than 3 days, it is not considered haidh. If the blood is seen for more than 10 days, the first ten days will be counted as menstruation, and the blood seen after that will be regarded as istihazah (irregular bleeding). The woman who has istihaza h is known as mustahazah. There is no minimum or maximum limit for the discharge of istihazah . Depending on the amount of blood, it is divided into three categories: qalilah (slight bleeding), mutawassitah (medium bleeding), and kathirah (profuse bleeding) .

Because istihazah is not considered as menstruation, the mustahazah is not prohibited from prayers, but the validity of her prayers depends on fulfilling the acts that are required of her. These acts include changing of sanitary napkins and performance of wudu (ablution) or ghusl before every salat (prayer), which is done five times a day. The frequency of these acts and whether they are wahib (compulsory) or mustahab (recommended but not essential) depend on the amount of bleeding. Sexual intercourse is not restricted for a mustahazah with slight bleeding. However, for a mustahazah with medium and profuse bleeding, sexual intercourse is lawful only if she has performed the ghusl or ghusls that is required of her. The only act forbidden for the mustahazah is for her to touch the writings of the Qur’an before wudu and ghusl .

Judaism. Judaism, through the Torah and Rabbinic law, imposes very stringent rules and prohibitions regarding menstruation.

Niddah is a Hebrew term describing a woman during menstruation or a woman who has menstruated but has not yet completed the associated requirement of immersion in a mikveh (ritual bath). The Biblical definition of niddah is any blood emission occurring within 7 days from the beginning of the menstrual period. Leviticus 15:19-23 specifies that a menstruating woman must be “separate” for 7 days. Any object she sits on or lies upon during this period becomes a midras l’tumah (carrier of impurity). One who comes into contact with her during this period becomes tamei (ritually impure).

The Torah deals with the problem of prolonged menstrual bleeding and the process the woman must undergo to regain her state of purity. Any blood found after the 7 days of the niddah is considered zavah (abnormal) blood and is subject to more stringent requirements. Because of possible confusion in determining when menstruation began and ended and thus whether blood was niddah or zavah , it became the accepted practice that all women treat any emission as a zavah gedolah (continued abnormal flow), which requires counting 7 abnormal discharge-free days from the end of menstruation. All orthodox and some conservative authorities rule that these “seven clean days” must be observed.

Leviticus 15:25-30 states, “Now if a woman has a discharge of her blood for many days, not at the period of her menstrual impurity, or if she has a discharge beyond that period, all the days of her impure discharge she shall continue as though in her menstrual impurity; she is unclean …. When she becomes clean from her discharge, she shall count off for herself seven days; and afterward she will be clean. Then on the eighth day, she shall take for herself two turtledoves or two young pigeons and bring them to the priest, to the doorway of the tent of meeting. The priest shall offer the one for a sin offering and the other for a burnt offering. So the priest shall make atonement on her behalf before the LORD because of her impure discharge.”

In the Orthodox Jewish community, women may test whether menstruation has ceased; this ritual is known as the hefsek taharah . The performance of a hefsek taharah is required to initiate the counting of 7 days of absence of blood discharge. The woman takes a bath or shower near sunset, wraps a special cloth around her finger, and swipes the vaginal circumference. If the cloth shows only discharges that are white, yellow, or clear, then menstruation is considered to have ceased. If discharge is red or pink, it indicates that menstruation is continued. If it is any other color, like brown, it is subject to further inquiry, often involving consultation with a rabbi. The ritual requires that the cloth used to perform this test is first checked carefully to ensure that it is clean of any marks, colored threads, or specks; the cloth itself can be any clean white cloth, although there are small cloths designed for this ritual known as bedikah (checking) cloths .

The Torah, in Leviticus 15:19–30, 18:19, and 20:18 prohibits sexual intercourse and physical intimacy with a woman in her niddah state, and the prohibition has been maintained in traditional Jewish law. Orthodox Judaism even forbids women and men from even touching or passing things to each other during this period. The Torah imposes the punishment of kareth (cutting off or exclusion from the people) on both man and woman if the prohibition is violated. This issur (prohibition) component of physical relations with the niddah is considered in full effect and mandatory for all children of Israel .

Christianity. Most Christian denominations do not follow any specific rituals or rules related to menstruation. Some Christian denominations, including many authorities of the Eastern Orthodox Church and some parts of the Oriental Orthodox Church (Russian, Ukrainian, Greek, and Indian Orthodox Church), distinct from the Roman Catholic Church, advise women not to receive communion during their menstrual period . Other denominations follow the rules laid out in the Holiness Code section of Leviticus, somewhat similar to the Jewish ritual of niddah . Healthy women have adequate outflow during this cycle, which renders them impure for sacred devotions, even more so in public.

Jesus’s best known encounter with menstrual taboo is the miracle he performed on the woman with the “issue of blood for twelve years,” the so-called “ Haemorrhoissa ” . In present-day gynecological practice, this would be a case of a woman with “medically unresponsive abnormal uterine bleeding.” The Gospels (Mark 5:21–43, Matthew 9:18–26, and Luke 8:40–56) recount the meeting: “And a woman having an issue of blood for twelve years, which had spent all her living upon physicians, neither could be healed of any, came behind [him], and touched the border of his garment: and immediately her issue of blood stanched. And Jesus said, Who touched me? When all denied, Peter and they that were with him said, Master, the multitude throng thee and press [thee], and sayest thou, Who touched me? And Jesus said, Somebody hath touched me: for I perceive that virtue is gone out of me. But Jesus kept looking around to see who had done it. Then the woman, knowing what had happened to her, came and fell at his feet and, trembling with fear, told him the whole truth. He said to her, “Daughter, your faith has healed you. Go in peace and be freed from your suffering.”