Bloody Effluence:

Body Discipline in Medicine and Menstruation

by Sofia Hu

A thesis submitted in partial fulfillment of the

requirements for the degree of
Bachelor of Arts as a College Scholar

Kathleen Long, Advisor

Amanda Goldstein, Second Reader

Cornell University
Ithaca, New York

Spring 2017



Contents

Acknowledgements
Introduction 1
I. A Brief History 14
Pre-Modern & Early Modern 17
18th and 19th Century Europe & America 25
20th and 21st Century America 32
II. Medicine in Modernity 45
III. The Pain & Politics of Menstruation 54
References 91



Acknowledgements

This thesis would have been a much bloodier, messier, and leakier work had it not been for
Professors Kathleen Long and Amanda Goldstein, whose insights and guidance have been
instrumental to the growth of this project and my own academic interests. I am thankful for the
time and care both have invested in this project. Professors Long and Goldstein have, in their
own ways, reminded me that academic writing can and should be fun. I can safely say that
learning from them has been equally pleasurable.

I owe an unpayable debt to the late Professor Ann Johnson. She was an incredibly generous
advisor and dedicated teacher who sparked my interest in menstrual politics. I am lucky to have
had such a brilliant and supportive professor as her introduce the field of science and technology
studies to me. She is missed dearly.

The College Scholar program has been one of the best resources during my liberal arts education
here at Cornell, and I will continue wishing that a normal college education looks like the one
that this major has pushed me to pursue. I also received generous support from the Lynne S.
Able 62 College Scholar Endowment Fund to conduct research on this project.

This project would not have been possible without the encouragement of the ever-sunny Anne
Birien, to whom I owe so much. Her curiosity and energy for intellectual growth has been a
model I have aspired to. Though I have always doubted where it comes from, her faith in my
ability to succeed in the College Scholar program is one of the major reasons I have been able to
do just that. Any student advisee is lucky to have her in their corner.

I am proud to be submitting this thesis alongside four colleagues whose dedication and
determination to their theses have motivated me to finish my own. Their projects remind me that
no matter how loose my definition of interdisciplinary already is, it can always be pushed
wider. Thank you, Tamar Law, Jack Barnett, Zoe Ferguson, and a thousand times over, Joseph
Fridman.

I also thank the friends I have been so lucky to find here Beatrice Jin, Albert Chu, Jacob
Wang, Sidarth Raghunathan, Philippa Chun, Hema Surendranathan, Gabriella Lee, Jacob Krell,
Jack Jones, and Alex Brown who have been so kind as to share their time, thoughts, struggles,
and dreams with me over the past four years. And finally, I thank my parents, whose hard work
and sacrifices have made my growth and successes possible and who have graciously supported
my education even when they arent quite sure what its been about.



As she lay waiting for the examination to begin, blood emerged from her vagina.
Despite the clinical set-up, which rendered the patients body closer to the classic textbook illustration,
the red blood that seeped out attested to something else. It was contentious in its effluence.
Emilia Sanabria, Plastic Bodies

 1

Introduction

Periods today are enjoying an unprecedented media spotlight. National Public Radio

called 2015 the Year of the Periods. Newsweek ran a cover story announced that the fight to

end period shaming is going mainstream, alongside a photo of a woman visibly bleeding in bed.

The photo, originally posted on Instagram, was taken down twice before the platform put it back

up and apologized. The fight to free the tampon and end a sales tax levied on menstrual

hygiene products has gone national, as New York state repealed its tampon tax in the summer

of 2016. Just a month prior, New York City council unanimously passed a bill to provide free

menstrual products in the bathrooms of its public schools, homeless shelters, and prisons. NYC

councilmember Julissa Ferreras-Copeland, who sponsored this bill, called its passage an

important step towards menstrual equity a phrase that has became the rallying cry for a

movement calling for better access to menstrual products.

This was all, however, before Donald Trump. His election and inauguration has

threatened established reproductive rights, including the rights to legal and safe abortion, birth

control, and access to reproductive healthcare and education. In his first week as president,

Trump reinstated a policy that prohibited granting American foreign aid to NGOs that offer

abortion counseling or advocate for the right to seek abortion in international countries. Trumps

attorney general, Jeff Sessions, is staunchly anti-choice and has a record of voting against

protections for abortion clinic staff. Trumps Secretary of Human and Health Services, Tom

Price, is likewise anti-choice and previously sponsored legislation that would bar Planned

Parenthood from receiving federal funding. At a time when reproductive health rights appear at

risk under a uniquely authoritarian president, it sometimes feels misdirected to pay attention to

menstruation. Under Trump, access to abortion, birth control, and contraceptives may be
 2

threatened, but at least tampons and sanitary pads are accepted as necessary parts of the normal

lives of women and are not under similar threat.

Yet to act as if menstruation is not an issue worthy of attention is to give way to

patriarchal pressures that erase women and their labor and to allow a system of gender and body

discipline to continue unquestioned. It is also to ignore the people that the menstrual equity

movement seeks to reach: disenfranchised, marginalized, and socio-economically disadvantaged

women who do not have easy access or the material means to purchase menstrual products. The

menstrual equity movement attests to the fact that tampons and sanitary pads like abortion

and contraceptives remain contested political issues with real consequences for the health and

lives of women. The passage of NYCs menstrual equity bill will make menstrual products freely

available to 300,000 schoolgirls and 23,000 women in public homeless shelters. In a

sociopolitical climate that threatens womens reproductive rights, making menstruation

everyones issue is a political strategy with material consequences.

Thats not to forget that making menstruation everyones issue is a loaded mission.

Menstruation is not a single experience or a single narrative: whose menstruation is (given the

privilege of) being made everyones issue, and whose menstruation is left out? The Newsweek

cover story, for example, begins with a bold statement: Lets begin with the obvious: Every

woman in the history of humanity has or had a period. But this statement is not obvious, and

more importantly, it is not even true. Lets begin with the more accurate: not all women

menstruate, and not all people who menstruate are women, yet for many menstruators,

menstruation can be a constitutive process that produces a gendered and feminine body. Tying

menstruation closely with the female sex has political consequences, for it identifies an organic,

essentialist notion for what it means to be a woman. This necessarily excludes myriad groups of
 3

people trans, intersex, post-menopausal individuals as well as those who identify outside of

the gender binary, have a medical condition, have had a hysterectomy, or suppresses their period

with medication who are denied access to real womanhood. (The same New York City

prisons that will begin providing free tampons continue to house inmates based on their

genitalia, meaning transgender inmates may be housed with the sex they do not identify with.1)

The menstrual equity movement, in its enthusiasm to make menstruation everyones

issue, risks perpetuating normalized but misleading ideas about who menstruates. Teddy, a trans-

man who menstruates, said in an interview with an online womens magazine that menstruation

causes dysphoria because not so much the fact that I have periods, but the feeling that Im not

the gender I am because its not seen as a thing guys have.2 Making menstruation everyones

issue requires a nuanced investigation into what menstruation is to the various people who

menstruate. This is particularly important in identifying ways to make menstrual management

more accessible and less hidden: assuming a singular understanding of menstruation means

implementing policies that aid a specific population of menstruators while possibly marginalizing

others.

Perhaps this is most evident in the menstrual equity movements largely uncritical

endorsement of the feminine hygiene industry. In its push to make tampons and sanitary pads

easier to access and cheaper to purchase, the menstrual movement movement aligns itself with

an industry that co-opts feminist rhetoric while perpetuating misogynist beliefs of the

menstruating body as disgusting, dirty, and in need of concealment. The feminine care industry

(abbreviated as FemCare) is dominated by three large, international corporations Kimberly

Clark (which sells Kotex), Proctor & Gamble (Tampax, Always), Johnson & Johnson (Stayfree)

1
Keri Blakinger, A Look at How New York Houses Trans Inmates, NY Daily News, February 11, 2016.
2
V. Tanner, Why We Must Stop Calling Menstruation a Womens Issue, The Establishment, May 25, 2016.
 4

and registered $17 billion in sales in 2005.3 It is a growing business: the average women will

use roughly 11,000 tampons in her lifetime.4 By making menstruation into a problem of staining,

leaking, and exposure, the FemCare industry has created a consumer market for solutions. The

products offered shape our understanding of the menstruating body as something to be plugged

and covered. Phrases such as menstrual protection and menstrual hygiene products belies an

assumption that underwrites the FemCare industry that we must be protected from the filth of

menstruation.

To seek a more equitable approach to menstruation, we have to look further than the

commercial options pushed onto women. Cultural understandings of menstruation imagine the

female body as dangerous and disgusting for its fluctuation and seepages, but this is only an

intelligible concept in a context where a stable, inert, male body is created, idealized, and

normalized. Such a body is in fact non-existent, and it is only through consistent effort and

discipline that we can believe in and covet a stable body. If we can identify and understand the

myriad ways we invest in such a body, what more equitable or more authentic forms of

embodiment might we find? To ask this question is not to assume some prior, natural body that

we must seek to return to for no such body exists. But as bodies are continuously constituted

and shaped, particular embodiments and identities are culturally enabled at the expense of and

through the exclusion of others. Before feminist movements can reclaim the womens body,

we must first answer what specifically that body is, whether it exists, and whether attempts at

decolonizing the female body may be more than an issue of our bodies, our choices, to quote a

popular feminist chant. Ultimately, we are looking for ways to think and talk about menstruation

3
Chris Bobel, New Blood: Third-Wave Feminism and the Politics of Menstruation (New Brunswick: Rutgers
University Press, 2010). Bobel cites a 2006 Nonwovens Industry Report, accessed online in 2009, that is no longer
accessible.
4
Elissa Stein and Susan Kim, Flow: The Cultural History of Menstruation (London: Macmillan, 2009).
 5

that are more equitable and less exclusionary and that affirm rather than erase the nuances and

diversity of bodies.

This project examines the body through two main lenses, looking at its borders and its

depths. The borders, socially inscribed onto our body, circulate the identities and the

subjectivities that are available to us. Anthropologist Mary Douglas argued that rituals marked

certain substances as polluted and dangerous, defiling and defiled.5 These limits, in turn,

maintain social divisions and orders. Building on Douglas, Judith Butler argues that what

constitutes the limit of the body is never merely material, but the surface, the skin, is

systematically signified by taboos and anticipated transgressions.6 As this paper will explore,

our understanding of the body as modern depends on the imagining and policing of rigid bodily

borders, which contain within them a stable, controlled person. Menstrual blood and cyclic

conditions like premenstrual syndrome (PMS) and period pain are physical and psychological

challenges to the epistemological project of a body with rigid borders. Julie Kristeva locates

much of our anxiety about menstrual blood in abjection, the process of rejecting and feeling

disgust at what seeps through bodily identity and erodes division between subject and object.

This process originates and reinforces the borders of individual subjectivities by renouncing that

which comes from inside, such as vomit and excrement. In particular, Kristeva theorizes

menstrual blood as not only a threat to the self/other division, but also as a symbol of the porous

danger of femininity: it stand for the danger issuing from within the identity (social or sexual);

threatens the relationship between the sexes within a social aggregate and, through

internalization, the identity of each sex in face of sexual difference.7 Cultural norms that

5
Mary Douglas, Purity and Danger: an analysis of concepts of pollution and taboo (New York: Routledge, 2015).
6
Judith Butler, Bodily Inscriptions, Performative Subversions, in The Judith Butler Reader, ed. Janet Price and
Margrit Shildrick. (New York: Routledge, 1999), 90-118.
7
Julia Kristeva, Powers of Horror: An Essay on Abjection (New York: Columbia University Press, 2010), 71.
 6

understand menstrual fluids as disgusting thus reify the separation between the male and female

sex and stabilize individual identities.

The idea of bodily borders predicates an understanding of our bodies as deep, as

possessing an interiority that becomes progressively less accessible. In a quest to conquer these

depths, which portend filth and bloody messes, bodily management penetrates further into the

body. As hygienic tools, tampons, and scalpels dig deeper canals into the body, and as the bodily

exterior and interior become continuous, one wonders what bodily depth signifies that is

different from its surface. The material penetration of these deeper interventions is paralleled by

another intensification: as bodily depth becomes more accessible as surfaces, more of the body

becomes open to attention and regulation. The epigraph of this thesis quotes anthropologist

Emilia Sanabrias field notes of a gynecological examination in Brazil. At first, the patients

menstrual fluids begin to flow from her vagina contentious in its effluence belying the

rigidity and cleanness of the clinical setup. Sanabria observed further:

Without a word of warning, Dr. T. introduced the metal speculum, proceeding in an

explanatory mode as he shone the light into the canal made by the speculum. This
immediately filled up with menstrual blood, and again he commented on how much
blood there was. Ta vendo [See]? he asked. This was all about seeing. Seeing inside.
This rapid technical gesture, performed with the speculum, transformed the vagina. The
speculum produced a separation between the inside and outside of the body, disturbing
the boundary, that notwithstanding the leaky blood, had enclosed the inside of the vagina
from view.8

The clinic stages the opening of the body and the production of a separation between the inside

and outside of the body. Within this space, menstrual fluids are simultaneously normal,

disgusting, and contentious. Sanabria notes that in the clinic, menstrual fluids are not stigmatized

as disgusting because it is so frequently encountered; the fluids in these encounters, however, are

8
Emilia Sanabria, Plastic Bodies: Sex Hormones and Menstrual Suppression in Brazil (Durham: Duke University
Press, 2016), 64.
 7

discursively circumscribed through jokes and comments and are conceived of as a passive

patient-body, rather than an active social actor. Even as making menstrual fluids more visible

enables its normalcy, this also creates another opportunity for menstrual fluids to become

provocative and contentious. The flow of menstrual fluids can also contradict the presumed

passivity of the patient-body and alludes to the blurring between depth and surface. This

anecdote leads Sanabria to question not where the boundary between inside and outside is drawn,

but the distinction itself. Sanabria thus locates the object of Kristevas horror within not in the

unclean inside that leaks out, but the conduits that mediate the inside and outside and enable

this exuding attribute. Medical inspections and interventions into the body destabilize

understandings of bodily depth, as the body exterior begins to become continuous with the

interior. As a result, menstrual fluids attest to the bodys ability to enclose, hide, and obscure

boundaries from the ever-encroaching reach of the speculum. Menstrual blood is the site of a

contest between seeing the patient-body as passive and seeing the patient-body as subversive.

Importantly, it is the clinical space that allows these varying perceptions of menstruation to

coexist.

Ultimately, much of the management of menstruation such as sanitary hygiene

products and medical formulations of PMS and menstrual pain revolves around stabilizing

bodily borders and depths. Menstruation is not only a physical phenomenon where fluids seep

across inside/outside borders (and in the process questions the validity of those borders) but also

a metaphysical and ontological destabilization of bodily depth and constitution. As such a

productive site, menstruation then also becomes a site for contestation and regulation of what

gets to count as inside or outside. Here, inside and outside refer not only to flesh and skin, but

also to our individual subjectivities and where we locate divisions between ourselves and others.
 8

Norms that force menstruators to hide menstrual stains and fluids using hygiene products are

processes of self and societal discipline enacted not only on the body but also on the identity and

agency of the menstruators. Underwriting this discipline are debates about who gets to count as

menstruators and as women, whose bodies matter, and what bodies matter for. Thus, as a project

that seeks to interrogate the stability of our embodiments, this also becomes a project that

examines the borders and depths that sustain the stability of our individual subjects.

In fact, borders and depths are at constant risk of disintegration, and rituals that establish

borders and depths are continuously repeated, operating in a manner similar to Butlers theory of

the performativity of gender. Butler argues that gender is a bodily discourse that, through acts of

repetition, constructs the self. Through this performance, the actors and the audience come to

operate in their discursively-created, gendered subject positions and believe in the primacy,

naturalness, and fundamentality of those gendered positions. Gender performance is essential to

subject creation: the I neither precedes nor follows the process of this gendering, but emerges

only within the matrix of gender relations themselves.9 Gender performance is intimately tied to

the rituals that create and solidify bodily borders and depths, as both are essential to our current

method of establishing a coherent identity. Both processes are defined by an inexhaustible

repetition of exclusion and boundary drawing, in an infinitely flawed impersonation of an ideal

that no one can fully reach. Becoming purely gendered and bordered is impossible, but we

promulgate successive attempts at closer approximation.

These various rituals and routines of bodily management have become the internalized

discipline that Michel Foucault predicted. In The Birth of the Clinic, he traces a shift within 19th

century medicine that produced the medical gaze, an epistemology that objectified patients

9
Judith Butler, Bodies That Matter: On the Discursive Limits of Sex (New York: Routledge, 2011), 7.
 9

into bodies whose deficits became localizable pathologies that had to be closely inspected and

statistical deviances from the normal. Foucault argued that this medical gaze would press itself

closer and deeper into the body such that the objects of the gaze would internalize and reproduce

the gaze onto themselves. As Foucault goes on to argue in the later Discipline and Punish,

individuals submit to self-policing and self-surveillance without outside coercion. Feminine

hygiene consumer products, from sanitary pads to shampoos, are an everyday example of this

self-policing. Internalized discipline is the result of certain bodily constructions that necessitate

certain acts of bodily management. Nikolas Rose articulated these constructions as more broadly

as regimes of knowledge through which human beings have come to recognize themselves as

certain kinds of creatures, the strategies of regulation and tactics of action to which these regimes

of knowledge have been connected, and the correlative relations that human beings have

established within themselves, in taking themselves as subjects.10 These regimes pervade

society and accumulate authority through their reiteration by and assimilation into the

institutional vehicles of western medicine, the workplace in capitalist economies, advertising for

consumer markets, and media.

Here, I will dissect how the product of a specific regime of knowledge which I term

the modern body has intensified self-surveillance and discipline. The modern body is

stable, rational, contained, and well-defined, and the individuals who possess the modern body

are able to closely manage and control their body. The modern body lies at the heart of capitalist

modes of production, biomedical knowledge, and modern liberal democracies. The modern body

is efficient and productive; when it is not, its deviance becomes a pathology that medicine must

fix until the body returns to maximum production. Individuals with a modern body are free, self-

10
Nikolas Rose, Inventing Ourselves: Psychology, Power and Personhood (Cambridge: Cambridge University
Press, 1998), 11.
 10

owning, and autonomous the foundational citizens of the liberal state. The modern body

interprets itself as fundamental and natural.

Most importantly, the modern body policies itself. (Or, more accurately, populations of

individuals obeying the norms of the modern body police themselves, as the modern body is

never fully attainable.) Through investments in normalization,11 the framework of the modern

body labels bodily variation as deviance and pathology. The modern body thus exacts social

obedience from individuals who self-discipline and regulate themselves. This form of corporeal

compliance has two major consequences for individuals with bodily impairments, which scholars

David Mitchell and Sarah Snyder examine in their work in disabilities studies. First, for

individuals with bodily impairments who successfully integrate into modern society and

institutions, their integration is dependent on the masking and hiding of their disabilities and

impairments. Integration is therefore not a project of diversity, but a process of homogenization

of original bodily variation.12 Second, for individuals with bodily impairments who do not

successfully portray a modern body, they are isolated into cultural peripheries and labeled as

abnormal, discordant, and therefore unproductive and unhealthy for the body politic. Their

variant embodiments are identified as objects of (highly invasive) research research that

exploits their bodies as sources of embodied knowledge for the improvement of able and modern

bodies.13 Institutional and self-directed coercion thus emerges from this production and

classification of bodily deviance at the site of variant embodiment.

The modern body also exists in fear and opposition to the fecund body, which womens

psychology professor Jane Ussher describes in Managing the Monstrous Feminine. The

11
David Mitchell and Sarah Snyder, Cultural Locations of Disability (Chicago: University of Chicago Press, 2015),
64.
12
David Mitchell and Sarah Snyder, The Biopolitics of Disability (Ann Arbor: University of Michigan Press, 2015).
13
Mitchell, Biopolitics of Disability, 187-193.
 11

reproductive body of a woman is deemed dangerous and defiled, the myth of the monstrous

feminine made flesh, yet also a body which provokes adoration and desire Central to this

positioning of the female body as monstrous or beneficent is ambivalence associated with the

power and danger perceived to be inherent in womans fecund flesh, her seeping, leaking,

bleeding womb standing as site of pollution and source of dread.14 Ussher examines the

disciplinary practices that place the fecund body as a depository of all that is transgressive and

dangerous, all that is outside the boundaries of what a good woman should be.15 Labeling the

fecund body as dangerous and contaminated translates into labeling women as a grotesque

feminine. The fecund body is a pathologized, moralized, and socialized into an abject body, one

that constantly reminds us of the breakdown of the clean border between subject and object. The

modern body reacts negatively to the fecund body and defines itself in antithetical relation to the

fecund body. The modern body dictates a certain set of rules regarding embodiment and

subjectivity, and the perception of the fecund body cultivates an urgent necessity for the modern

body. Locating women at the site of the fecund body and monstrous feminine justifies

reproductive disciplining that reforms them into modern bodies. These two poles of feminine

embodiment lie on separate sides of the same coin, and it has become the womans job to ensure

she stays on the right side.

As a compilation of borders that parses what is human subject and exterior object, the

modern body closely relates to Bruno Latours definition of modernity as definitional purity and

as clear distinctions between what is nature and society, human and thing. Just as Latours

nature-culture hybrids proliferate despite and because of attempts to draw the line between

exact knowledge and the exercise of power, the modern body dissolves its own borders despite

14
Jane Ussher, Managing the Monstrous Feminine (New York: Routledge, 2006), 1.
15
Ussher, xiii.
 12

and because of its best efforts to cement its borders through body intervention and

management.16 The attempt to use medicine and technology to reform the body into its modern

mold simultaneously muddies its ontology (the notion of the body as a priori pure and

ontologically pristine is part of the ideological system that underwrites the modern body). The

modern female body is managed by tampons, sanitary pads, cosmetics, and other hygienic

products that are added into or onto the body. A coherent self-conception encompasses and

depends on these products, which enable us to pretend that we possess a different body. Rather

than conceiving of our identities and bodies as regularly leaking and fluid, we come to think of

ourselves as stable and predictable through the repeated acts of cleaning, hiding, and covering

the body. These acts of purification lead us to believe that the body is naturally pure and label

body instability as pathology.

In trying to be more human, we end up becoming more cyborgian, to use Donna

Haraways term.17 Her concept of the cyborg fluid creatures simultaneously natural and

cultural, animal and machine helps us reject the paradigm of the modern body and the

technologies of its enforcement without completely renouncing science and technology. Cyborgs

are not and do not aspire to an organic wholeness through a final appropriation of all the powers

of the parts into a higher unity,18 and to assume our bodies are organic wholes is to ignore a

deep landscape of experiences entangled with social and political forces. To be a cyborg is to

take responsibility for political, bodily, and social boundaries and to take pleasure in confusing

them. By recognizing that our bodies continuously confront and embrace the material and

technological, we can begin to study how technological interventions that seek to unify and

16
Bruno Latour, We Have Never Been Modern (Cambridge: Harvard University Press, 2002), 3.
17
Donna Haraway, A Cyborg Manifesto: Science, Technology, and Socialist-Feminism in the Late Twentieth
Century in Simians, Cyborgs and Women: The Reinvention of Nature (New York: Routledge, 1991).
18
Ibid., 150.
 13

control the body instead fragment and multiply our identities. We have never been modern,

Latour claims. This is as true for our society as it is for our bodies.

The modern body is an inexhaustible topic. In this project, I will focus only on how this

discursive frameworks specific construction of the female body underpins our cultural and

political understanding of menstruation and menstrual pain. Anthropologist Lara Freidenfelds

first described the modern period through the experiences of 20th century women as they

embraced consumer menstrual products and adopted medical terms like PMS.19 The first chapter

of this thesis traces the rise of the modern period and the parallel development of increasingly

invasive bodily management techniques that women were expected to perform. We begin with

this brief history of the cultural life of menstruation in the Western world in order to understand

that the period has never had a stable identity. Medical authorities have played a large role in

defining menstruation and regulating the spaces that menstruating women can access. In Chapter

2, we will investigate medicines active role imagining, creating, and maintaining the modern

body. With an understanding of medicine as a project of modernity, we turn to two specific

clinical entities of menstrual pain in Chapter 3. Premenstrual syndrome (PMS) and primary

dysmenorrhea are biomedical interpretations of menstrual pain. Importantly, they represent

increasingly internalized forms of discipline that reinforce the modern body. In dissecting the

forces that produce this self-surveillance under the guise of shaky medical categories, we can

find insight into replacing the modern body and its modern period with alternative forms of

embodiment. Here, we will draw from disabilities studies, as well as an anthropological study of

menstrual suppression in Brazil, to envision different ways of thinking and talking about the

menstruating body.

19
Lara Freidenfelds, The Modern Period: Menstruation in Twentieth-Century America (Baltimore: Johns Hopkins
University Press, 2009).
 14

Chapter 1: A Brief History

Cultural understandings of menstruation regulate and inscribe a womans place in

society. Religious authorities, medical practitioners, and commercial advertising of menstrual

hygiene products are among the forces that construct and reiterate stereotypes of menstruation.

Menstruation is variously interpreted as a healthy process, a pathological phenomenon, an

economic liability, a female debility, and a hygienic and moral problem. Often such meanings

ascribed to menstruation closely relate to cultural beliefs about womanhood, womens labor, and

procreation. Attitudes towards menstruation encompass complex and instable connections

between what it means to be a woman (physiologically, culturally, and economically) and what it

means to menstruate. Cultural and medical norms of menstruation are likewise unstable,

variously applied to menstruating bodies throughout time. A detailed history of menstruation

necessarily is a history of women in society, the way menstruation has become closely linked to

womanhood, and the reciprocal relationship between cultural ideas of menstruation and

culturally acceptable spaces available to women.

Today, we understand menstruation as the regular discharge of blood and mucosal tissue

from the inner lining of the uterus through the vagina.20 Menstruation, also called the period, is

part of the menstrual cycle. The cycle is understood as the regular hormonal changes that occur

in the female reproductive system which enables pregnancy. The menstrual cycle produces an

egg cell, called the oocyte, and prepares the uterus for a possible pregnancy. If fertilized, the

oocyte implants on the thickened uterine lining and begins to form the fetus and placenta. If no

20
Dee Unglaub Silverthorn and Bruce Johnson, Human Physiology: An Integrated Approach (Pearson Learning
Solutions, 2016).
Even outside of medical textbooks, menstruation today is largely defined and understood in scientific terms. Web
searches for terms like menstruation and period list pages from websites such as WebMD, the Mayo Clinic, and
MedlinePlus.
 15

conception occurs and the oocyte is not fertilized, the uterus sheds its lining, which passes

through the vagina and out the body. This flow of menstrual fluid contains the uterine lining,

blood, and other vaginal secretions this is the menstrual period. For humans,21 the first period

typically occurs between 12 and 15 years of age, at a point known as the menarche, and it does

not necessarily signal ovulation and fertility. Menstruation stops after menopause, a natural point

when a person is no longer able to bear children. Most menstrual cycles last from 21 to 35

days.22

This modern definition of menstruation is not self-evident. Crafting and sustaining this

definition requires extensive underground epistemological work. Scientific concepts like

discharge, female and hormonal changes rely on particular frameworks of the body,

empirical, positivist philosophies of science, and technology that extends medical access into the

body. Medical metaphors of menstruation as failed production of fertilized eggs and as a process

of deterioration indicate sexist and masculine assumptions underlying supposedly objective

modes of knowledge production.23 Similarly, societal acceptance of this medical understanding

of menstruation depends on the epistemological hierarchies that privilege scientific production of

21
Menstruation occurs not only in human females of sexually-reproductive age, but also in other mammalian
species. Humans, simians including Old World monkeys, New World monkeys, and apes, bats and the elephant
shrew have menstrual cycles. Some placental mammals undergo estrous cycles, where the uterine lining is
reabsorbed rather than discharged.
22
While menstrual cycles are often seen as regularly timed, the timing of the period often varies, especially after
menarche and before menopause. Also, many menstruators report having a period two weeks early or late at least
once a year (see Kirstine Mnster, Lone Schmidt, and Peter Helm, Length and variation in the menstrual cycle,
British Journal Obstetrics Gynaecology 99 (1992), 422-429). A 28-day long cycle is often cited as the average or
normal length of a menstrual cycle, though this number was largely established by how oral contraceptive pills
(known colloquially as the pill) are administered in 28-day regimens.
23
Emily Martin, The Woman in the Body (Boston: Beacon Press, 2003), 45-52.
Anthropologist Emily Martin first described these medical metaphors of menstruation in her landmark The Woman
in the Body. Examining contemporary medical textbooks from the 1970s and 80s, Martin finds that authors
assumed that the menstrual cycles sole purpose was to enable pregnancy and that menstruation was a process of
failed production. Additionally, descriptions of menstruation involved negative terms such as degenerate,
deteriorate, disintegration, endometrial debris, and deprived, even though analogous processes like the
disintegration of the stomach lining were described in more neutral terms like sloughing and renewal.
 16

knowledge. However, these metaphors existed before the rise of cotemporary biomedicine and

date back to ancient and pre-modern societies where anxieties about reproduction and taboos

against menstruating women proliferated. Lastly, this definition of menstruation relies on

ontological categories that appear clear but are in fact instable, including female and sex.

There are many instances where this medical definition excludes the menstrual experiences of

various populations and individuals. For example, transgender women and people assigned male

at birth cannot menstruate as they do not possess a uterus that regularly sheds its lining.

Currently, it is medically impossible to enable people assigned male at birth to become pregnant

or menstruate, even through sexual reassignment surgery.24 Additionally, while there has been

little medical research on this, informal reports indicate that transgender women may feel period-

like symptoms while on hormone replacement therapy, suggesting that the current medical

definition of menstruation may be too narrowly defined by the shedding of menstrual fluids.25

Transgender men or persons assigned female at birth may menstruate, though their menstruation

ceases when undergoing hormone replacement therapy. Intersex people assigned male at birth

may also menstruate, such as men with congenital adrenal hyperplasia. Alternatively, intersex

people assigned female at birth may not be able to menstruate, such as women with androgen

insensitivity syndrome. A supposedly clear scientific definition of menstruation belies the

complex interplay between gender, sex, and biology. That this definition is routinely accepted

points towards the continued marginalization of transgender, intersex, and non-binary peoples

24
However, recent progress with uterine transplantations suggests that this procedure may allow transgender women
to menstruate or become pregnant in the future. (See Dina Maron, How a Transgender Woman Could Get
Pregnant, Scientific American, June 15, 2016.) While no uterine transplantation has been done in people assigned
male at birth, there have been successful uterine transplants in people assigned female at birth, including one in 2014
that resulted in a successful pregnancy.
25
Sam Riedel, Yes, Trans Women Can Get Period Symptoms, The Establishment, May 31, 2016.
 17

from obtaining the modern body. Such cultural and medical exclusion performs some of the

epistemological work that sustains this scientific definition of menstruation.

Throughout history, menstruation has been continuously reimagined and redefined.

Philosophers, scientists, and laypeople have drawn on various political, cultural, religious, and

scientific beliefs to understand this bodily phenomenon. No matter where its origins lie, each

cultural understanding of menstruation is sustained by and in turn sustains cultural notions of

womanhood, gender, and reproduction. Over three loosely-defined subsections spanning pre-

modern and early modern times; 18th and 19th century Europe and America; and 20th and 21st

century America, I seek here to trace this shifting identity of menstruation and to illustrate how

public and medical discourse of menstruation shapes what it means to menstruate, what it means

be a woman, and the extent to which these two questions are treated as the same.26

Pre-Modern & Early Modern

Cultural attitudes towards menstruation during pre-modern and early modern times were

highly varied, as Hippocrates and Galen saw menstruation as a healthy process, while Aristotle

and religious authorities interpreted menstrual fluids as impure and indicative of female

inferiority. No single theory of menstruation dominated, and mixes of various theories

permeated. Amidst these theories, however, is an important absence: next to nothing is known

26
I am not a historian, nor is this intended to be a thorough historical account. This condensed history primarily
draws from the work of several menstrual historians and anthropologists most notably Louise Landers Images of
Bleeding, Sharra Vostrals Under Wraps, and Emily Martins The Woman in The Body to understand changing
perspectives on menstruation. This historical overview focuses on Western tradition and more specifically the
industrial United States and does not cover all menstrual narratives. This brief history, for example, begins with
Hippocrates, at the exclusion of ancient Egypt, Asiatic traditions, and other cultural locales that predate and parallel
ancient Greece. I would also like to emphasize that this historical account largely focuses on the experiences of
white or American women. Though racial issues undoubtedly influence the individual and cultural experiences of
menstruation, the intersection of race and gender at the site of menstrual issues is its own project that I cannot do
justice here.
 18

about how menstruators actually handled menstrual fluids and how they actually understood their

menstruation.27

As the father of modern medicine, Hippocrates (c. 460-380 BCE) pioneered much of

medical thought in ancient Greece, and his Hippocratic tradition and Corpus has heavily

influenced the practice of medicine for centuries onwards. Hippocrates popularized the humoral

theory, which posited that imbalances of the four humors black bile, yellow bile, phlegm, and

blood caused natural diseases and illnesses. Under this framework, menstruation was

interpreted as a normal and healthy process of excretion that allowed women to maintain a

healthy balance of the four humors. Only women menstruated because they possessed less heat

then men, who could sweat to remove impurities in their blood and maintain a balance between

the four humors. Hippocratic gynecological treatises thus treated regular menstruation as a

physiological process that distinguished women from men but was nonetheless normal. One

treatise described the womans body as loose textured glands and flesh, which were spongier

and excreted more moisture compared to mans firmer composition.28 Another treatise titled

Feminine Diseases argued that a rich, colorful menses indicates that the woman is healthy, and

that the volume, duration, and color of menstrual flow can indicate a womans disease.29 Thus,

while Hippocratic tradition viewed female bodies as quite different from male bodies,30

27
Sara Read, Thy Righteousness is but a menstrual clout: Sanitary Practices and Prejudices in Early Modern
England, Early Modern Women 3 (2008): 1-25. Read recounts a story of the late antique philosopher Hypatia
recounts how she threw her menstrual cloths at an unwanted suitor, but this is roughly as much as we might be able
to know about pre-modern and early modern menstrual practices.
28
Lesley Dean-Jones, Menstrual Bleeding According to the Hippocratics and Aristotle, Transactions of the
American Philogocail Association 119 (1989), 177-8.
29
Luigi Arata, Menses in the corpus Hippocraticum in Menstruation: A Cultural History, ed. Andrew Shail and
Gillian Howie (Basingstoke: Palgrave Macmillan, 2005), 15.
30
The particularities of the model of sexual difference that the Hippocratics subscribed to remains open to debate.
While Thomas Laqueurs argument that Hippocrates believed in a one-sex body has been widely accepted, many
historians have since questioned Laqueurs argument that the one-sex model dominated ancient and medieval
studies of anatomy and physiology and that the two-sex model is a modern development. Notably, Helen King has
identified and described another model that she terms Hippocrates Woman. King argues that the Hippocratic
corpus viewed women as radically different from men; their diseases and behaviors required a wholly different
 19

menstruation set women apart from men but was perceived as a healthy rather than pathological

process.

Menstrual fluids were also related to human reproduction in the Hippocratic tradition,

which believed that both the male and female parents must contribute seed for successful

procreation. Womens seed took the form of menstrual fluids, while mens seed took the form of

semen. However, both parents seed contained female and male characteristics, such that a

female could contribute male seed and a male could contribute female seed. Additionally, the

author of the Hippocratic treatise, On Generation/Nature of the Child, the sex of the child may

depend on when in the menstrual cycle intercourse takes place, as a female child is more likely to

be conceived during menstruation.

Aristotle (384-22 BCE) expanded upon this theory of menstruation as seed, but he denied

the existence of a separate female seed and defined different roles for the male and female

parents. Aristotle postulated that the male seed, transported in the vehicle of sperm, provided the

soul of a child, whereas the seed from females, in the form of menstrual fluids, only provided the

matter and nutrition from which the child is formed. Unlike men, women could not produce

semen as they did not possess sufficient heat to convert blood into semen and could only

produce menstrual blood: the menstrual blood is semen not in a pure state but in the need of

working up.31 For Aristotle, semen signals the male capacity for heat and thus purity, whereas

menstrual fluids represent female incapacity. Aristotle thus interpreted the excretion of menstrual

approach that necessitated a new form of medicine gynecology. Hippocrates Woman: Reading the Female Body
in Ancient Greece. In other texts including The One-Sex Body on Trial, King further refutes Laqueurs model by
supplying evidence that the two-sex body was not a modern development and in fact coexisted alongside the one-sex
body in medical practices from Hippocrates to the 19th century.
31
Aristotle. On the Generation of Animals in Complete Works of Aristotle, Volume 1: The Revised Oxford
Translation, ed. Jonathan Barnes (Princeton: Princeton University Press, 2014), 1162.
 20

fluids as signs of womens inferiority and enumerated negative properties of menstrual fluids. 32

While Aristotle did not necessarily pathologize menstruation itself, he essentialized menstruation

and the incapacity that it represents to the female body. For both Hippocrates and Aristotle,

menstruation was a clear indication of the difference between the female and male body, yet

Aristotle interpreted this difference as an inequality in ability while Hippocrates interpreted this

difference as a neutral discrepancy between male and female physiology.

Returning to the notion that menstruation is a normal process, Galen (130-210 AD)

proposed that menstruation is the shedding of excess blood, a normal physiological process to

rebalance the body.33 This excess blood was used in childbearing and nursing, but had to be

excreted regularly if the woman was neither pregnant nor breast-feeding. Monthly bleeding

allowed women to deplete her plethora of accumulated blood. The Hippocratic theory of

menstruation as purification and the Galenic theory of menstruation as excess are not necessarily

compatible, but neither are they incommensurate. Both frameworks interpret menstruation as a

healthy and normal element of womens physiologies; departures from this normal cycle were

interpreted as either the result or cause of diseases.

However, while these medical theories viewed the act of menstruation as normal for

women, religious and social taboos often treated menstrual blood as dirty and womens bodies as

32
Many historians trace menstrual taboos to Aristotle and The Generation of Animals. Such historians include
Lesley Dean-Jones in Womens Bodies in Classical Greek Science and Jennifer Schultz in Wholly Woman, Holly
Blood.
33
Galen. On the Natural Faculties, trans. A. J. Brock (Cambridge: Harvard University Press, 1916).
 21

inferior.34 The most often cited Biblical text on menstruation comes from Leviticus 15,35 a

passage that discusses the impurity of semen and explicitly prohibits sex during menstruation:

And if any mans seed of copulation go out from him, then he shall wash all his flesh in
water and be unclean until the evening.
And every garment and every skin whereon is the seed of copulation, shall be washed
with water and be unclean until the evening.
The woman also with whom a man shall lie with seed of copulation, they shall both bathe
themselves in water and be unclean until the evening.
And if a woman have an issue and her issue from her flesh be blood, she shall be put
apart seven days; and whosoever toucheth her shall be unclean until the evening.
And every thing that she lieth upon in her separation shall be unclean; every thing also
that she sitteth upon shall be unclean.
And whosoever toucheth her bed shall wash his clothes and bathe himself in water, and
be unclean until the evening.
And whosoever toucheth any thing that she sat upon shall wash his clothes and bathe
himself in water, and be unclean until the evening.
And if it be on her bed or on any thing whereon she sitteth, when he toucheth it, he shall
be unclean until the evening.
And if any man lie with her at all and her monthly discharge be upon him, he shall be
unclean seven days; and all the bed whereon he lieth shall be unclean.36

While the prohibition against sex during menstruation in Lev 15 is preceded by a discussion on

pathological emissions from both sexes and male impurities originating from semen (Lev 15:2-3,

15-16), the taboo on sex during menstruation is reiterated in Lev 18:19 and Lev 20:18 and does

34
Strains of this belief continue in contemporary times. Snow and Johnsons 1977 and 1982 studies examined
menstrual folklore espoused by low-income, poorly educated, multiracial clinic patients. Many of these folklore
interpretations understood menstruation as removing impurities that might otherwise cause illness or poison the
system.34 This belief parallels the Hippocratic belief that menstruation purifies the body. While these ancient texts
saw menstruation as healthy, menstruation elicited shame and embarrassment for the women that Snow and Johnson
interviewed. Snow and Johnson sought to interview this particular demographic in order to better understand
menstrual folklore that proliferates outside of contemporary biomedical perspectives.
35
While Leviticus 15 is most often cited in menstrual histories, it is not the only Biblical text related to
menstruation. In Menstruation and Childbirth in the Bible, Tarja Philip argues that priestly writings on
menstruation, such as Lev 15, largely focus on the impurity of the blood from the womb and ways to remove the
impurity while non-priestly writing approaches the topic of menstruation in relation to fertility. For example, in
Genesis 31:35, a daughter speaks openly about her menstruation to her father, and her menstruation frees her from
having to stand up before her father. In Genesis 18:9-15, menstruation serves a functional role in the story, as Sara
argues that she cannot conceive because she no longer menstruates. Philips close readings of these biblical texts
indicates that, like ancient Greek medicine, Judeo-Christianity did not espouse a monolithic view of menstruation
and understood menstruation not only through theories of impurity and female inferiority, but also through ideas of
fertility and procreation. This ties closely to Cathy McClives argument in Menstruation and Procreation in Early
Modern France that anxieties concerning reproduction outweighed misogyny in establishing menstrual norms.
36
Lev 15:16-24, 1599 Geneva Bible.
 22

not mention male impurities or fluids. Additionally, within Lev 15, the part discussing the

impurity of semen (Lev 15:16-18) is far shorter than the discussion on the impurity of menstrual

blood (Lev 15:19-24), and the severity of the impurities differs dramatically. Whoever touches

semen shall be unclean only until the evening, after the individual washes their body and clothes,

whereas menstrual blood defiles anyone who touches a menstruating women until the evening,

the menstruating woman herself for 7 days, and anyone who has intercourse with a menstruating

woman for 7 days. These passages thus appear to locate more severe impurities in the

menstruating women than the ejaculating man. Importantly, a mans semen defiles only when it

goes out from him (Lev 15:16), whereas a menstruating womans impurities extend throughout

and beyond her entire body, such that anyone who touches her, her bed, or anything she sits on

becomes impure, even if such contact does not involve directly touching her menstrual fluids.

This passage from Leviticus thus portrays the menstruating woman as uniquely polluted and

polluting.

The differences between Hippocratic, Galenic, Aristotelean, and Judeo-Christian theories

indicate the degree of variation in menstrual understandings. Each of these interpretations

heavily influenced ancient and medieval thought. For example, in line with Galenic medicine,

17th century British medical texts espoused: By this fluxe all a womans body is purged of

superfluous humours.37 Following in the humoral tradition, Edward Tilt hypothesized in 1857

that after menopause, the blood that was once excreted during the menses was instead turned into

fat.38 New medical ideas competed with humoralism and Aristolean beliefs, and religious and

37
Patricia Crawford, Attitudes to Menstruation in Seventeenth-Century England, Past & Present 91 (1981): 50.
38
Edward Tilt, The change of life in health and disease (London: John Churchill, 1857), 54.
Tilt erroneously hypothesized that during the transition to menopause, when blood could not yet be turned into fat, it
was released through other compensating means that included abundant mucous flows, hemorrhages, and more
voluminous urination: As for thirty-two years it had been habitual for women to lose about 3 oz. of blood every
month, so it would have been indeed singular, if there did not exist some well-continued compensating discharges
 23

cultural authorities often drew upon (explicitly or not) these three medical theorists to justify the

treatment of women and prohibitions regarding procreation. However, in turn, Galenic and

Hippocratic beliefs also competed with popular and religious beliefs that the menstruating

woman is polluted. The interplay between these three medical theories, as well as their

interaction with religious, cultural, and juridical forces, points to a complex history of

menstruation that cannot be easily summarized, for any one understanding of menstruation is in

fact a system of beliefs regarding sex, anatomy and physiology, and the role and ontology of

women.

Various interpretations of menstruation enabled certain societal treatment of women. For

example, in medieval and early modern periods where religious understandings of menstruation

were heavily influential, Biblical texts justified the subordination of women under patriarchal

forces. Historian Patricia Crawford argues that 17th century English understandings of

menstruation were predominantly influenced by Judeo-Christian texts. Drawing from passages

such as Leviticus, early modern European society construed menstruation in terms of female

inferiority, justifying female subordination and influencing medical theories.39 Taboos not only

prohibited menstruating women from engaging in sexual intercourse but also prohibited them

from entering church and receiving Communion. While menstruating women were not forbidden

contact with people or from conducting routine household tasks (as might follow from a strict

acting as waste-gates to protect the system, until health could be permanently re-established by striking new
balances in the allotment of blood to various parts.
39
Crawford, 47.
While most Biblical prohibitions were not strictly followed, preachers regularly discussed the prohibition against
copulating with a menstruating woman, and many theological writers endorsed the death penalty as punishment.
Over the course of the 17th century even as the Bible became less important in the face of scientific discoveries of
the ova, which suggested that the menstrual copulation did not deform a nascent child popular understandings
and menstrual taboos persisted.
 24

interpretation of Leviticus), menstruating women did follow informal restrictions on their

activity: many, for example, avoided pickling pork and salting bacon.40

However, negative beliefs concerning female ability do not fully account for the

complexity of pre-modern and early modern cultural understandings of menstruation. In critical

response to Crawfords studies,41 historian Cathy McClive argues that anxieties about

reproduction often outweighed attitudes toward women in the development of cultural beliefs

about menstruation. Complicating the myth of menstrual misogyny her term for historians

tendency to assume that menstruation was perceived negatively and as a direct signifier of (the

inferiority of) womanhood in early modern Europe McClive contends that, in their discussion

on how menstruation affected the success of reproduction, the majority of medical authors

rejected the notion that menstrual blood was necessarily harmful and instead expressed

ambivalence and uncertainty regarding the connection between menstruation and procreation.

Medicines inability to provide concrete answers opened the space for moralists to promulgate

procreative theology and the argument that sex during menstruation was sinful only because it

was not actively procreative.42 Reading Leviticus in the context of available dictionaries and its

early modern French translations suggests that Protestant and Catholic interpretations moved

away from the texts concern regarding physical impurities and towards an emphasis on conjugal

sexuality. This textual emphasis on marriage (paralleled by increasing state intervention in

marriage and family) is a move to protect procreation as a productive process of generating

healthy children in the name of a Christian god.43 McClives work importantly demonstrates the

40
Ibid., 61.
41
Cathy McClive, Menstruation and Procreation in Early Modern France (New York: Routledge, 2016), 13-15.
McClive criticizes Crawford for promoting an essentialist relationship between the category woman and
menstruation (a criticism that she also extends to Laqueur for his argument that the transition to the two-sex model
exclusively located menstruation in womens bodies).
42
McClive, 26-27.
43
McClive, 60.
 25

cultural tensions concerning who gets to define the cultural understanding of the menstruating

person, be it medical professionals, religious authorities, laypersons, and women or menstruators

themselves. This continual tension between the efforts of various groups to establish menstrual

norms becomes more prominent in the 18th and 19th centuries as debates concerning the role of

women in co-educational schools and professions became publically relevant. To define

menstruation is implicitly to delineate socially acceptable roles for women within patriarchal

spaces, and this becomes an economically crucial issue within growing industrial societies.

18th and 19th Century Europe & America

The 18th and 19th centuries continued to see a mix of positive and negative views of

menstruation. However, compared to the proliferation of menstrual narratives from various

cultural institutions during ancient and medieval times, medical professionals largely dominated

menstrual discourse in modern and industrial societies. The medical profession soon

monopolized the ability to define, classify, and treat disorders, bodies, and people. This

consolidated and secured the expert classes cultural power and autonomy, which was directed at

subordinating women and nonwhite people.

Unlike Hippocratic and Galenic models, most popular medical theories during this time

viewed menstruation as pathological and damaging, not only to potential offspring or sexual

partners, but also to the women themselves.44 Scientific and medical understandings of

44
In The Woman in the Body, anthropologist Emily Martin argued, Whereas in the earlier model, male and female
ways of secreting were not only analogous but desirable, now the way became open to denigrate functions that for
the first time were seen as uniquely female, without analogue in males. For our purposes, what happened to accounts
of menstruation is most interesting: by the nineteenth century, the process itself was seen as soundly pathological.
(34) Despite Martins reliance on Laqueurs inaccurate one-sex/two-sex model, her point that medical theories
became resoundingly negative regarding menstruation still stands. In a separate history of menstruation, historian
Sharra Vostral gives this rise of menstruation-pathologizing medical theories the name scientific menstruation.
For Vostral, scientific menstruation formed a way of knowing that relied on medicines power as a professional and
knowledge-making authority to politicize the menstruating body. Scientific menstruation, which appears
 26

menstruation entailed not only the anatomical and physiological knowledge held by professional

physicians, but also these doctors prescriptive advice on how women should behave. The

purported adverse effects of menstruation on womens health were used to explain restrictions on

the activities women could engage in and made desirable efforts to make menstruation invisible.

While this understanding of menstrual debility was highly contested, medical authorities both for

and against justified their arguments by making certain claims of the relationship between

women and the progress of human society. Menstrual discourse became an arena for

professionals to privilege and normalize certain embodiments over others as they positioned

women in subordinate but integral roles within a racially organized and sexually differentiated

civilization.

The rise in medical theories that saw menstruation as pathological is noticeable in

popular medical texts, which became widely reprinted and read in the 17th century. Many of

these popular medical guides interpreted menstrual sickness as a punishment for laziness and

promoted living a purposeful and industrious life. In his 1784 best seller Domestic Medicine; or,

A Treatise on the Prevention and Cure of Diseases, Dr. William Buchan wrote:

If a girl about this time of life be confined to the house, kept constantly sitting, and
neither allowed to romp around; nor employed in any active business, which gives
exercise to the whole body, she becomes weak, relax, and puny; her blood not being duly
prepared, she looks pale and wan [] We would therefore recommend it to all who wish
to escape these calamities, to avoid indolence and inactivity, as their greatest enemies,
and to be as much abroad in the open air as possible.
Indolence and inactivity became not only causes of physical ailments but also moral sins that

medical and religious texts warned women and children against committing. Such

recommendations have roots in the ancient medical theories of Hippocrates and Aristotle that

postulated the female body as less heated and therefore less active. Both these ancient

scientifically objective, is thus fundamentally political. See Sharra Vostral, Under Wraps: A History of Menstrual
Hygiene Technology (Lanham: Lexington Books, 2011), 22.
 27

interpretations and more modern understandings identify the male body as the normative

standard for heat, activity, and productivity. The female body is thus always compared to the

male body, and the difference between the two is always perceived as the womans deviance

from men (in parallel, this male standard becomes de-sexed and less visible). Under this

framework, women were expected to work hard in order to maintain their health. For example,

Dr. Thomas Ewell wrote in 1817, Like all animals breathing much air and eating freely, women

were made for exertion, their fluids for constant circulation. Each part must expend by exertion

so much of its irritability; or disease will appear.45 In order to support his belief that women

were made for exertion, Ewell assumes an inherent irritability in each part of a womans

body and argues that this energy can only properly be channeled into work. This establishes

labor as a form of health and posits it in a false dichotomy against disease.

Defining health in relation to industriousness, however, was less an objective scientific

claim than a cultural one, for the medical profession would soon argue that menstruation

represented an insurmountable weakness of the female sex, a sex doomed to physical and

psychological disability. Many texts recounting the cultural history of menstruation point to Dr.

Edward Clarke, whose arguments of menstrual debilitation were not only wide-spread, but also

overtly attempted to regulate the social spaces women had access to. A former Harvard Medical

School professor, Clarke published an influential book in 1873 called Sex in Education: or, a

Fair Chance for the Girls. This book quickly became a national topic as it went through 17

editions in 13 years. Relying on a then-popular medical theory that the body has a limited supply

of vital energy, Clarke argued that women who study alongside men in school and college would

deplete their vital force, which was otherwise necessary to developing a functional reproductive

45
Thomas Ewell, Letters to Ladies (Philadelphia: W. Brown, 1817).
 28

system. Girls who went to school while they were menstruating risked sterility and could

emasculate the boys who shared classrooms with them. Experience teaches that a healthy and

growing boy may spend six hours of force daily upon his studies, and leave sufficient margin for

physical growth. A girl cannot spend more than four, or, in occasional instances, five hours of

force daily upon her studies. Another detail is, that, during every fourth week, there should be

a remission, and sometimes an intermission, of both study and exercise [for a menstruating

girl], Clarke wrote.46 His recommendation that women must rest during their periods became an

argument against co-education.

However, Clarke did not extend the same privileges to working and lower-class

women. Sex in Education overlooked women laborers and housekeepers who quite obviously

continued to work while menstruating arguably a more physically taxing activity than

studying. Perhaps Clarke believed that lower-class women did not bear the burden to reproduce

and protect the race as higher class women did, or that they were not as susceptible to

depleting their vital force as well-brought men and women. Much of what motivates Clarkes

argument is his belief in the Darwinian idea that sex differentiation is essential to evolutionary

progress.47 For Clarke, co-educational classrooms would hinder differentiation between the male

and female sexes, damage the mental capacity of both male and female students, and stunt the

progress of his species, or, more specifically, the progress of the white upper class. Clarkes

recommendation that female student rest when menstruating thus forefronts a particular

embodiment and identity the weak, upper class, female, menstruating body through the

exclusion and exploitation other peoples, such as laboring women whose own menstrual cycles

46
Edward Clarke, Sex in Education; or, A fair chance for girls (Boston: Houghton Mifflin, 1884), 156-7.
47
Kimberly Hamlin, From Eve to Evolution: Darwin, science, and womens rights in Gilded Age America (Chicago:
University of Chicago Press, 2015), 74.
 29

are ignored and lower class men and women whose work undergirds upper class lifestyles and

elite educational institutions.

While Clarke comes from a long line of doctors using their medical authority to ascribe a

womans place in society, he is most notable in politicizing menstruation and linking this

physiological process to specific restrictions on a womans proper place. Clarkes arguments

faced both acclaim and contention. Dr. Thomas Emmet, founder and president of the American

Gynecological Society, promoted Clarkes theory, going as far to suggest that the evil is more

serious than [Clarke] has represented. He recommended that girls should spend the year before

their puberty and a few years afterwards free from all exciting influences There should be no

studying at night under any circumstances. Each menstrual period should be passed in the

recumbent posture until the system becomes accustomed to the new order of things, and the habit

of regularity is fully established.48 Importantly, for Emmet, menstruation is a debility not only

because it may deplete a womens vital force, but also because it signals a new order of things

within her body that causes her to be irregular. Beyond just pathologizing menstruation, Emmet

moves one step further than Clarke by pathologizing a more general irregularity of the body.

This framework potentially strips women from any autonomy over their bodies, for it positions

them as beholden to an irregular and uncontrollable body for which the only plausible treatment

is lying down. Such an approach foreshadows more intrusive forms of discipline that identifies

individual subjectivities rather than physical bodies as the site for intervention. Clarkes and

Emmets arguments for menstrual debility thus shaped not only what a woman could do within

society, but also how a woman could relate to her own body.

48
Thomas Emmet, The Principles and Practice of Gynaecology (Philadelphia: H. C. Lea, 1879), 21.
 30

Though Clarkes Sex in Education was widely popular, it drew harsh rebuttals from

laypersons and other physicians, including several women physicians. Dr. Mary Jacobi became a

prominent activist against menstrual debility when she won a prestigious medical essay contest

in 1877 with her submission, The Question of Rest for Women During Menstruation. In her

essay, Jacobi published the results of a questionnaire she sent to paid and unpaid white women

that asked about their educational backgrounds, medical health during college years, and

experiences of menstruation. A majority of women surveyed reported no problems with

menstruation. Jacobi thus argued that resting while menstruating was not only unhelpful, but also

an imagined luxury that presumed man might suffice for the necessities of the family, and the

woman only be obliged to look after the house and the education of the children.49 Jacobi

interpreted arguments for menstrual debility as justifications for limiting womens employment

and advancement in the workplace. However, while Jacobi advanced a critique against sexual

difference in the workplace, she continued to perpetuate the racial discrimination that runs

through Clarkes original arguments. Jacobi included only white women from her survey,

ignoring black women whose work as laborers and sharecroppers would likely better

demonstrate that menstrual rest was an imagined luxury than the forms of romanticized female

domesticity and gendered labor that Jacobi focused on. Jacobi did not view black women as part

of a civilized race and therefore did not believe they could suffer from menstrual debility, which

she understood as a disease of civilization.50 In line with this belief and her blindness to the

labor of non-white women, Jacob believed that marriage and domestic service constitute the

49
Mary Jacobi, The Question of Rest for Women During Menstruation (New York: G. P. Putnams Sons, 1887), 17-
20.
50
Sharra Vostral, Under Wraps: A History of Menstrual Hygiene Technology (Lanham: Lexington Books, 2011),
38.
Jacobi, 17-20.
 31

only natural equivalent for the paid industry of women.51 Not only did the public debate over

the meaning of menstruation exclude certain narratives and perspectives (most prominently,

those from marginalized and non-white populations), but much of what made this debate

important to those involved was their belief that the health and progress of the modern white race

was at stake.

In fact, most critiques of Sex in Education relied on implicit racial arguments. While

Jacobi found success only in small feminist circles, she was followed by Dr. Clelia Moshers

theory that women could overcome the physical symptoms of their periods with her exercise

regime. These exercises later termed Moshers could prepare women to adapt to the

demands of a civilized society and improve the white, Anglo-Saxon race. Mosher thus equated

menstruation and reproductive health with white racial vigor and civic duty. Young women

doing regular exercises to maintain menstrual health was akin to older women remaining fully

engaged in their communities, as both contributed to a civil society.52 Throughout this discourse

over menstrual debility, both proponents and critics focused on the female body through

womens positions within a racially organized civilization. Medical theories were often

subordinated or used to justify overarching political arguments over how women (but only upper

class, educated, white women) could best serve the progress of human society, an objective that

remained unquestioned. Even rebuttals to Clarke largely accepted the underlying energy theory

and therefore were generally limited to finding ways for women to overcome their limited

source of energy or providing proof that women involved in mans world were healthy and

productive. Despite Moshers and Jacobis opposition to Clarkes position on menstrual debility,

51
Jacobi, 20.
52
Vostral, 43.
Clelia Mosher, Functional Periodicity in Women and Some of the Modifying Factors, California State Journal of
Medicine 9, no. 2 (1911): 5-8.
 32

all three physicians implicitly spoke to the preservation and progress of white, upper class race

a notion closely aligned to the eugenics movement in 19th century America.

20th & 21st Century America

Clarkes ideas about menstruation prevailed for decades, and less explicit forms of his

theory persist even today. However, as women become important members of the workforce

following the World Wars and as their families began to enter and form the growing American

middle class, dominant cultural ideas about menstruation and menstrual pain shifted to permit

more women to enter the factory and office. I argue that these shifts, mapped closely to the rise

of the concept of the modern body, suggest that prevalent cultural ideas about menstruation

reflect and regulate what spaces are available to women be it co-educational schools, various

positions in blue or white collar workforce, or the home. Becoming modern in alignment with

20th century Progressive values of social reform, technological progress, and industrialized and

scientific control of natural processes required a particular self-presentation and self-control.

Whereas previously women used self-made rags and cloth belts to catch their menstrual fluids

and washed these fabrics in the spaces of their homes, now women were expected to buy and

dispose commercial products that were marketed as less offensive and more hygienic. Certain

behaviors and appearances were seen as prerequisites to joining the middle class and entering the

womens job market. American women conformed to such expectations and embraced modern

forms of bodily management promoted by capitalist markets because these new menstrual

management techniques proved useful at school and work and helped them attain self-perceived

social mobility.53 This bodily management encompassed the development of the modern body

53
Freidenfelds, 10.
 33

a well-controlled body that would not leak, smell, or appear unclean and therefore would be

efficient, productive, and predictable.54 The modern woman thus also had a modern period,

which was closely controlled and made invisible by commercially available, disposable products.

Based on her interviews with American women born and raised in different decades of the 20th

century, anthropologist Lara Freidenelds concludes:

American women adopted Progressive ideals of efficiency, education, and good

management, and applied them to menstrual management. Both women and men
idealized a body that could work and play at full efficiency all month, and a way of
handling menstruation that would force it into the background of self-presentation and
bodily sensation as much as possible.55

The modern body was predictable, efficient, and autonomous, allowing individuals with this

perfected body to obtain economic stability and purchasing power in a wide consumer market.

The menstrual hygiene products that became commercially available in the 20th century allowed

women to manage and hide their divergence from this idealized body. They offered women the

opportunity to pass as non-menstruating bodies and access these economic and social

benefits.56 Before the commercial availability of menstrual hygiene products, women generally

made and reused their own cloth pads, which often involved washing and drying their pads in

areas visible, if not to the outside public, then to members of their family.57 This was often a

source of embarrassment and shame, and even before commercial products enabled the routine

54
Freidenfelds, 2.
55
Freidenfelds, 191
56
Vostral, 17-19.
Vostral uses the technological politics of passing in order to interrogate menstrual management. Passing can be a
useful tool in negotiating and challenging social systems that deny individuals very existences, and technologies
often provide the props to pass, (10) and menstrual products such as tampons and pads enable menstruators to pass
as non-menstruators. Inherent to acts of passing are their normalization and obscuration, which heightens concerns
of exposure. Vostral further argues that passing as non-menstruating affects the menstruators outward and internal
identity: The act of technological passing presents an altered external identity, but also requires the technological
user to agree to a sort of temporary amnesia. (10-11) Acts of passing thus also obscure themselves from the actors
who commit them. Viewing menstruation through the frame of passing allows us to examine the consequences of
menstrual technology on how menstruators understand and formulate their identity as it relates to the menstruating
body. Acts of passing speak to historical shifts in representations of identity (19).
57
Freidenfelds, 30.
 34

disposal of used pads, women made effort to hide their use of their homemade pads. Because

these homemade cloth pads tended to be thicker and did not always fit the women who wore

them, the contours of the pads under clothing was generally more visible, and women avoided

wearing slacks in favor of looser dresses when they used these pads.58 Commercially available

menstrual hygiene products thus had an obvious appeal when these products entered the market

and offered menstruators an increased ability to hide their periods. The growing market for

feminine protection reflected not only womens own self-interest in entering the workforce,

but also a growing cultural acceptance of women workers by commercial manufacturers,

physicians, and schools. Underwriting this need to pass as non-menstruating bodies and as

efficient workers are longstanding menstrual taboos that date back to ancient and medieval

origins and modern medicines theories of menstrual debility. Beliefs that menstruating bodies

are inefficient align closely with Aristotelean thinking that women were defined by their

incapacity to generate sufficient heat and Clarkes ideas that menstruation depletes womens

energy. Though 20th century menstrual products enabled women to pass as non-menstruating,

such efforts reified menstrual taboos and shame that originate far earlier than the development of

modern society.

The first menstrual products sold were Listers Towels by Johnson & Johnson in 1896.

Sales of this product were initially low as women continued to use homemade rags, because

store-bought pads were only available to women with a disposable income and were not as well

constructed as homemade ones. These sanitary pads were novel not only because they could be

bought, but also because they were disposable goods, to be thrown away after a one-time use.59

58
Freidenfelds, 32.
59
Freidenfelds, 149-150.
The concept of disposability was a new one in the 19th century but has grown into a fundamental principle of todays
consumerism and throw-away society. Initially, disposable menstrual products presented women with the issue of
 35

Facing cultural taboos about menstruation, these early disposable pads were not successful, due

to limited advertising and promotion. However, with the end of World War I, medical

practitioners began to discourage homemade menstrual products as unhygienic and smelly. For

example, Dr. William Robinson wrote, The hygiene of menstruation can be expressed in two

words: cleanliness and rest. [] Rags, unless recently washed and kept wrapped up and

protected from dust, should not be used. Unclean rags may lead to infection. I have no doubt that

many cases of leucorrhea date back their origin to unwashed rags.60

This comment foreshadows an increasingly interconnected relation between the medical

profession and the consumer market; in the 20th and 21st century, medicine would quickly grow

from philosophical inquiries that defined Hippocratic and Aristotlean thought and behavioral

prescriptions that characterized Clarkes and Moshers work to the development, marketing, and

sales of products that would help women manage their menstruation. Modern medicine does not

stand isolated from capitalist or consumerist relations, but in fact is intimately involved in the

production of the modern body which serves the dual role of worker and consumer. Aligned with

medical thought on menstruation as debility and disease, manufacturers and advertisers made

menstruation into a problem of staining, leaking, inefficiency, and exposure thereby

creating the possibility of a consumer market of solutions.

In the 1920s, Kimberly-Clark Corporation sold one of its wartime products, cellucotton,

as sanitary pads under the name Kotex (Cotton-like texture).61 These products were marketed as

disposing these products discretely. Companies in the 1920s advertised that it was possible to take apart and flush
used products, though women generally found this process difficult and distasteful. Freidenfelds recounts that
women born before 1940 developed elaborate ways of wrapping used Kotex so that it would not be seen or
smelled [carrying] newspaper, paper bags, plastic bags, or some combination into the bathroom with them. By
the 50s and 60s, use of menstrual products was institutionalized as public buildings installed infrastructure for
menstrual pad disposal.
60
William Robinson, Sex Knowledge for Women and Girls (New York: Critic and Guide Company, 1917), 51-53.
61
Vostral, 65.
 36

necessary products for the modern woman, an ideal of femininity that has morphed throughout

the years to serve advertisers and marketers need. Originally, sanitary napkins were marketed

towards delicate women. A 1920 Kotex ad features a woman, dolled up in a gown, sitting on a

bed and fanning herself, next to a large box of Kotex and the words: A list of the wardrobe

essentials of Her Royal Daintiness, the modern woman, would be incomplete without at least one

package of Kotex (emphasis added). Within menstrual advertising, hygiene and modernity

became closely linked. A woman could not be modern without first being clean. For example, a

1922 ad in The Cosmopolitan claimed, Kotex are hygienic, convenient, and so low in cost that

they form a new sanitary habit.62 These ads also featured medical authorities that promoted

tampons and pads as a hygienic product. An ad in Macleans, a popular Canadian news

magazine, was from the perspective of a fictitious nurse Ellen Buckland. She warned, 60% of

many ills, common to women, according to many leading medical authorities, are traced to the

use of unsafe and unsanitary makeshift methods. Hygienic authorities charge almost 80% of the

lack of charm, poise and immaculacy, expected of women in this modern day, to the same

mistake in hygiene.63 The growing market for menstrual products was built by a large volume

of advertisements like these that envisioned these products as necessary tools to obtaining

modern womanhood. In its first nine months of existence, Tampax spent $100,000 on

advertisement. By 1941, the company was one of the 100 largest advertisers in the United States

by 1941.64 Companies selling menstrual technology not only had to stand out against competing

brands, but they also had to manufacture a need to buy their products. To this end, their

advertising depicted young females whose participation in upper-middle-class activities such as

62
Cellucotton Products advertisement, The Cosmopolitan, February 1922.
63
Kotex advertisement, Macleans, February 1925.
64
Freidenfelds, 124.
 37

Figure 1. A Kotex ad published in a 1922 issue of The Cosmopolitan claims that school girls,
active in athletics... have found that Kotex completes their toilet essentialsguards against
emergencies.
 38

Figure 2. Tampax ran an ad in 1944 in the Journal of Nursing claiming that its products can
enable women to stay on the job where they are so vitally needed.
 39

vacationing, attending parties, and playing golf was predicated upon their use of menstrual

products. These ads imagined the modern body as fundamentally classed, thereby establishing

menstrual products as indispensable for social mobility and self-identification as a member of a

professional or middle and upper classes.65 Freidenfelds notes that by the 1940s, clear class

lines would be drawn between the mass of women who enjoyed the middle-class comfort of

Kotex and the truly poor women who could not afford them and continued to use cloth pads.66

By the mid-20th century, using homemade cloth pads was a marker of poverty, and women

purchased disposable products even if they did not consider themselves middle class or had the

discretionary income to purchase other goods.67

Becoming a middle-class, modern woman required possessing a well-managed body, and

advertisements promoting menstrual products imagined various forms of bodily deviance that

women had to either manage or risk public embarrassment over. These included visible

menstrual stains, noticeable use of tampons and pads (such as conspicuous wrinkles or contours

underneath tight clothing), and offensive odors. Menstruation, and womens management of it,

was expected to be completely invisible. Commercial products increased womens access to

spaces that were closed off to menstruating bodies, but they in turn reinforce cultural taboos

surrounding menstruation.68

65
Freidenfelds, 121.
66
Freidenfelds, 32.
67
Freidenfelds, 135.
68
Visibly menstruating bodies continued to be prohibited from public spaces, and menstruating bodies were
accepted only in so far as their appearances confirmed to normative modes of embodiment. This relates closely to
David Mitchells and Sharon Snyders work in disability studies and their criticism of the neoliberal promise of
inclusion. Mitchell and Snyder argue that inclusion that typifies neoliberal institutions is the embrace of certain
forms of difference by making them unapparent: The magical resolution of diversity-based integration practices is
achieved by making bodies that look different invisible, more normative. [] meaningful inclusion is only worthy
of the designation inclusion if disability becomes more fully recognized as providing alternative values for living
that do not simply reify reigning concepts of normalcy. (The Biopolitics of Disability, 5-6) We will revisit
Mitchells and Snyders work in the following chapters.
 40

Much of the attention of the growing FemCare industry focused on young women who

were either studying in college or working. Ads, such as the Kotex one in The Cosmopolitan,

highlighted the fact their widespread use by these groups: At many girls schools and colleges

Kotex has been accepted as the most satisfactory article of its kind. Endorsement of Kotex by

critical directing heads, responsible for the welfare of thousands of girls, warrants reflection.

Through both design and advertising, menstrual products were framed in relation to young women,

though they comprised the minority of all menstruators. In 1927, Johnson & Johnson

commissioned Lillian Gilbreth for her services as an efficiency expert. Gilbreth, who believed

strongly in scientific management of menstruation, was tasked with designing a better sanitary

napkin. Her market research focused exclusively on young women in college, even though they

were not the majority of all menstruating women, because she believed their daily needs would be

more difficult to satisfy than other women. Of course, it is ironic that she did not include women

like herself who reared and cared for numerous children, Vostral comments.69 Gilbreth and her

team sent questionnaires to college and high school students, held focus groups at several colleges,

and interviewed college administrators and faculty. Gilbreths mock-up of a new sanitary pad for

Johnson & Johnson was the Invisos, which stressed the products invisibility, to be advertised

directly to young women, rather than their mothers. Gilbreths expert background in mechanical

engineering and home economics underlies this mock-up, which Vostral summarized as such:

Gilbreth argued that if educated women applied scientific management to the home and
made use of manufactured items, they would gain more time for leisure and mental life.
Through home economics and the systematic application of efficiency, women could
more professionally manage their homes. Part of being the most efficient meant
purchasing manufactured goods. Gilbreths interest in efficiency models easily
translated onto womens bodies. If manufacturing processes could be streamlined, so too
could elimination of waste from the body. Developing a new and efficient sanitary
napkin had the potential to offer women control and agency through better body
mechanics during menstruation, and a tool to manage debility and facilitate passing as

69
Vostral, 71.
 41

normal. By purchasing sanitary pads, women could maximize efficiency of the body and
minimize menstrual angst.70

For Gilbreth, menstrual management is an inherent part of obtaining a modern body, which she

defined in terms of scientific management and efficiency. Young women, in particular, were

expected to make their bodies and homes as efficient as possible. The likening of menstrual

products to home and kitchen appliances indicates the growing reach of capitalist consumerism

into the menstruating body. Bodily management, like home management, is increasingly

outsourced to externally provided products, which is to say that womens autonomy to shape

their embodied identities is displaced by commercially available products and their

materialization of certain forms of being. The guise of efficiency hides the fact that decisions

over what menstrual product to use displaces decisions over how to relate to and handle ones

period.

The connection between menstrual management and productive efficiency extended

beyond Gilbreth. Throughout the 20th century, as women took on more waged and salary

positions in the workforce, various industries sought to promote menstrual management in order

to decrease worker absenteeism and increase female workers productivity. Ideas of menstrual

debility were replaced with beliefs that menstrual pain, called dysmenorrhea in academic and

medical literature, could be overcome and managed. The Metropolitan Life Insurance Company

conducted a study published in 1931 on its young women clerks, 523 of them, who had reported

to the companys rest room space repeatedly due to menstrual discomfort. The company

carefully watched these women over a few months, documenting their menstrual history and

requiring them to do daily exercises, including the exercise regime designed by Julia Mosher and

sit-ups. If their menstrual pain did not improve, they received a pelvic examination and

70
Vostral, 69.
 42

underwent daily group exercises or were referred to a private physician. Dr. Ruth Ewing reported

that 81 percent of women saw an improvement and suggested that psychological factors, like a

lack of self-discipline, may have played a part in the treatment. There has been a considerable

saving in time lost, both from absences from work because of dysmenorrhea and from visits to

the rest rooms at the Home Office of the Metropolitan Life Insurance Company through the

treatment of severe dysmenorrhea and through watchful supervision of the milder cases, Ewing

concluded.71 Though the constant surveillance and implication that the women were

undisciplined if their dysmenorrhea did not improve likely inflated the results, Ewings study

indicated companies growing interest in reducing female worker absenteeism by regulating their

menstrual cycles. Similar studies were conducted, such as Dr. Margaret Sturgis in a large

department store72 and an Ohio rubber companys study comparing the absenteeism of its female

and male workers.

Not all studies sought to prove that women were effective workers, and the interwar

periods also saw an influx of papers describing menstrual debility, as women were forced from

the jobs they had gained in wartime.73 The most prominent of which is Robert T. Franks 1931

paper on premenstrual tension. Widely believed to be the first person to describe this condition,

Frank argued that women were heavily affected by the hormonal cycles of their reproductive

system.74 He wondered how this influenced their employment: My attention has been

increasingly directed to a large group of women who are handicapped by premenstrual

disturbances of manifold nature. It is well known that normal women suffer varying degrees of

71
Ruth Ewing, A Study of dysmenorrhea at the home office of the Metropolitan Life Insurance Company, Journal
of Industrial Hygiene 13, no. 7 (1931): 245.
72
M. C. Sturgis. Observations on dysmenorrhea occurring in women employed in a large department store,
Journal of Industrial Hygiene 5, no. 2 (1923), 53-56.
73
Martin, 120.
74
Robert Frank. The hormonal causes of premenstrual tension, Archives of Neurology & Psychiatry 26, no. 5
(1931), 1053-57.
 43

discomfort preceding the onset of menstruation. Employers of labor take cognizance of this fact

and make provision for the temporary care of their employees.75 By describing physiological

fluctuations as disturbances that can handicap women, Franks definition of premenstrual

tension follows in the footsteps of Clarke, who argued that women become uniquely weak when

menstruating. However, while early proponents of menstrual debility recommended

menstruating women to rest, Frank took the perspective of womens employers and seeks to find

ways to make premenstrual disturbances unapparent in the workplace. By putting forth a new

clinical entity of premenstrual tension, Frank made possible research into treating premenstrual

tension. Such treatment is akin to menstrual products in so far as, if successful, they both allow

the menstruating body to pass as non-menstruating. Any diagnosis and treatment of premenstrual

tension, however, takes this act of passing a step further, for the not-yet-menstruating but

fluctuating body replaces the menstruating body as the locus of intervention. Increasingly more

nebulous deviances are pathologized and scrutinized, as Franks original definition of

premenstrual tension laid the basis for premenstrual syndrome (PMS), a more ambiguous and

loosely-defined disorder. As we will see in the following chapter, PMS and other medical

categories describing menstrual symptoms, such as dysmenorrhea and premenstrual dysphoric

disorder (PMDD), intensified attention and judgment on womens bodily and mental

fluctuations. Such is the project of the modern body: its corporeal compliance is never fully

complete, as more and more bodily fluctuations are coded as deviances and pathologies from a

normative standard. During ancient times, this normative standard was often the male body that

was believed to generate more heat than females, but throughout the 20th century, this normative

standard is that of the efficient and productive worker. Women managed and hid menstruation in

75
Frank, 1053.
 44

order to approximate this normative embodiment, which in cultural imaginations and commercial

marketing was closely tied to social mobility, professional and upper class status, and modernity.

The pathologization of physiological fluctuations connected to the menstrual cycle also

created commercial opportunities for biomedical intervention. Alongside the growth and

proliferation of menstrual products was a slower, initially more restricted, development of

medical products to regulate menstruation and reproduction. Sex hormones were first tested in

clinical trials during the mid-1920s as a treatment for menstrual irregularities. These treatments

contraceptive nature was treated as a side effect, as it would take several decades for the sales of

contraception to become legal and socially accepted in the United States. The Comstock Act of

1873 prohibited the advertisement, information, and distribution of birth control. Margaret

Sanger, a nurse and reproductive rights activist, coined the phrase birth control in 1914, but

she faced public backlash and prosecution for breaking obscenity laws.76 In 1938, a federal

appeals court ruled, in a case involving Sanger, that the federal government could not interfere

with doctors providing contraception to patients. In 1960, the FDA approved the use of Enovid,

the first oral contraceptive pill.77 Though promoting contraceptives remained illegal in many

states, 6.5 million American women were taking the pill within five years of its FDA approval.

In 1965, the Supreme Court ruled in Griswold v. Connecticut that married couples had the right

to use birth control, but it would take 7 more years for the court in Baird v. Eisenstadt to legalize

birth control for all citizens, regardless of their marital status. In the decades after, the pill was

followed by a stream of hormonal birth control methods: intrauterine devices (IUDs) were first

76
In 1916, Sanger founded the countrys first family-planning clinic, which faced repeated closures from police
authorities. Sanger was repeatedly arrested and prosecuted for running this clinic. Sanger also founded the American
Birth Control League, the precursor to the Planned Parenthood Federation. In the 1950s, backed by a wealthy widow
named Katherine McCormick, Sanger worked with biologist Gregory Pincus to produce synthetic hormones. In
1956, the Food and Drug Administration approved the use of these hormonal pills for the treatment of menstrual
irregularity and severe menstrual disorders.
 45

introduced in 1968; controversies over the health effects of the pill continued until the 80s; the

injectable Depo-Provera was introduced in the 90s; the FDA approved Seasonale, which reduces

the frequency of periods to four times a year, in 2003.

The pill and other forms of hormonal contraceptives established in cultural imaginations

the regular 28-day menstrual cycle, as women took a pill everyday for 21 consecutive days,

followed by a placebo pill everyday for the next 7. During the 7 days of the placebo pill, women

experience a mock period a withdrawal bleed that is often incorrectly believed to be a

menstrual period. Original developers of the pill included a pill-free period to purposefully

induce this withdrawal bleed every month, because it was important for users (who relied on

their regular menstrual period as reassurance of nonpregnancy) and for doctors (who promoted

the pill as a form of natural contraception during the early years of medically prescribed

contraception). Biomedical interventions, by regulating the menstruating body to a specific cycle

and frequency, has in turn facilitated a cultural imagination of a regular menstrual cycle and

updated cultural norms of menstruous embodiment. The modern body, in regulating itself,

obscures its prior, unregulated or lessor-regulated state and prompts further notions of

conforming embodiment. This is evident in the rise of menstrual suppression, which is the use of

hormonal contraceptives to reduce the frequency of or completely eliminate menstrual bleeding.

Menstrual suppression has gained medical and public attention following the FDA approval of

Seasonale which reduces the frequency of these withdrawal so that users experience a 3-

month cycle and the publication of the English translation of Dr. Elsimar Coutinhos Is

Menstruation Obsolete? (1999).78 Proponents of menstrual suppression such as Coutinho argue

that it improves the quality of would-be menstruators lives, though the long-term health

78
Sanabria, 3.
 46

consequences of continuous consumption of oral contraceptives to achieve menstrual

suppression remain unclear.79

Throughout the 20th and 21st century, consumer markets and medicine have offered an

increasing number of products for women to regulate their menstrual cycle with. From sanitary

pads to tampons to oral contraceptives, these products have become not only more numerous and

accessible, but also more intrusive into the menstruating body. Medicine has created the

opportunity for more invasive and controlling interventions, and in the following chapter we will

examine PMS and primary dysmenorrhea (the medical term for menstrual cramping pain) as a

case study to interrogate medical epistemologies that enable corporeal and gendered discipline.

While the types and varieties of menstrual products have proliferated (one can pick between

Tampax, Kotex, StayFree and other companies for their sanitary pads and then further select the

thickness, length, scent, and presence of wings; similarly, one can choose between Seasonale, the

NuvaRing, the Minera, and others for contraceptive use), all commercially available products

hide, stabilize, or eliminate menstrual bleeding. The development of these markets has paralleled

the rise of the modern body and the belief that menstruation must be closely managed in order

for women to become efficient and productive members of society. In fact, the developments of

commercial products and cultural expectations have mutually reinforced and sustained each

other. By the late 20th century, women were expected to manage menstruation in ways that did

not exist a century prior: they had to manage medical issues such as PMS, take care not to

expose their menstruation, and make invisible any of their efforts to control their menstruation.

79
A meta-review concluded that continuous dosing of contraceptives for a 3-month cycle is a reasonable approach
compared to traditional 1-month dosing cycle, but also admits that the studies in its meta-review are too small to
address efficacy, rare adverse events, and safety. (See Alison Edelman, Acceptability of Contraceptive-Induced
Amorrhea in a Racially Diverse Group of US Women, Contraception 75, no. 6 (2007): 450-53.)
 47

Chapter 2: Medicine in Modernity

Medicine is a project of modernity of both Foucaults modernity as increasing

panoptic discipline of the person and Latours modernity as clean distinction between nature and

culture. Medicine strives to describe, define, and thus enclose the biological human body,

stabilizing it as a site for treatment but also discipline. In so doing, medicine both helps us

achieve and maintain health, but also redefines health recursively such that it becomes an

unattainable standard. Medicine has increased longevity, improved generally quality of life,

promoted the prevention and treatment of illnesses and injuries, and given people a language and

system through which to understand their bodies. These benefits have come from and alongside a

particular conception of health that has also marginalized and disenfranchised certain peoples

and certain bodies. Within biomedical frameworks, health is explicitly defined by the statistical

normal and implicitly aligned with embodiments that are at maximal economic production.

Georges Canguilhem criticized biomedical science for depending on statistical norms to

understand and define pathology as a deviance from a normal standard of health.80 This model

of pathio-physiology, which remains the current system of medical meaning, replaced nosology

in the 18th century, as Foucault describes in The Birth of the Clinic. Established medical practices

in the 18th century primarily focused on documenting and classifying the diversity of diseases.

This classification operated on the belief that diseases follow a natural course, and physicians

tasked themselves with providing treatment that allows the disease to run its course (which,

depending on the disease was either a cure or death).81 Civilized society, with its myriad

complications, was seen as an impediment to the diseases natural course, and nosological

approaches viewed the family as the most natural social space and therefore the best place for a

80
Georges Canguilhem, The Normal and the Pathological (Cambridge: Zone Books, 2007).
81
Michel Foucault, The Birth of the Clinic (New York: Routledge, 2010), 3-20.
 48

disease to run its natural course. The arrival of pathio-physiology, however, disrupted this

understanding of disease. From an understanding of epidemics as repeated instances of a specific

disease, medical science became interested in the causes of outbreaks and then in the causes of

all diseases. Following the rise of epidemic medicine, a patients individual disease was no

longer localized to their own identity and environment but was instead seen as the singular

instantiation of a general disease. The patient is stripped to their body and disease in order to

become the object of the medical gaze, which dehumanizes the patient into a site for disease

identification and medical knowledge production. Foucault summarizes the epistemological

transition from nosology to pathology with two questions: while in the 18th century, the

physician would ask, Whats the matter with you? the 19th century physician would ask,

Where does it hurt?82

The development of this medical gaze was supported through institutional and nationalist

changes: as restoring health from epidemics and plagues became a national issue, hospitals

displaced families and local communities as the state-sanctioned (and state-supervised) providers

of care. Medicine shifted its responsibility from the negative restoration of health (such as curing

a disease) to a proactive creation and maintenance of the nation bodys vigor and ability. The

medical gaze performs empirical vigilance for the state, and medicine provides ontological tools

for labeling and classifying deviant and diseased bodies, as well as setting and justifying

normative embodiments that compel corporeal compliance. On this new role of medicine,

Foucault wrote: In the ordering of human existence [medicine] assumes a normative posture,

which authorizes it not only to distribute advice as to healthy life, but also to dictate the

82
Foucault, xviii.
 49

standards for physical and moral relations of the individual and of the society in which he

lives.83

The 18th century medicine of localized health shifted into a 19th century medicine of

pathology that linked the patient body to the nation body. A medicine of pathology is

foundational to the development of the modern body, which is most importantly a norm that

negatively defines itself through the labeling and pathologizing of deviant behavior and

embodiment. The elusiveness of modern body perpetuates individuals pursuit of it, and the

processes of discipline and corporeal control operate in this never-ending chase of the modern

body. The modern body is unobtainable partially because complete health within medicine is

likewise unobtainable. The model of pathology presumes a conceptual and qualitative continuity

between pathology and healthy physiology. Canguilhem, however, sees in this continuity the

dangerous and never-ending appeal to scientifically restore the norm [so] that in the end it

annuls the pathological.84 But because the pathological constitutes and destroys the normal,

because there is no life without disease and death within pathio-physiology, medicine continually

propels itself. No healthy man becomes sick, for he is sick only insofar as his health abandons

him and in this he is not healthy. The so-called healthy man thus is not healthy. His health is an

equilibrium which he redeems on inceptive ruptures. The menace of disease is one of the

components of health, Canguilhem states. The normal, the standard of health, cannot be

understood directly, for it is only known through its absence. Modern pathology puts us in a life

of perpetual treatment that promises to restore full autonomy and control. Under this guise,

medicine yields a growing ability to minutely probe and evaluate the patient and enforce strict

norms for the patients body. The modern body is built upon and submits to this self-propelling

83
Foucault, 34.
84
Canguilhem, 43.
 50

engine of medicine. By creating modern bodies (or, more accurately, sustaining the illusion of

modern bodies and individuals pursuit of the modern body), medicine enacts a form of

discipline that shapes bodies fit for capitalist economies and neoliberal states.

No matter how dangerous the institution and power of medicine is in the policing bodies,

it also remains true that it cures and treats bodies, their impairments and diseases. Medicine has,

materially and practically, improved the lives of individuals and conditions of populations this

I doubt can be overstated. Importantly, medicine provides the knowledge and language through

which many understand their lives and their bodies. The naming and classification of diseases

can be at once disempowering in the ways it labels and stigmatizes bodies and empowering in

the ways it becomes a tool for individuals to conceptualize and handle their bodily experiences.

That medicine is largely effective in the diagnosis, treatment, and prevention of disease,

however, further extends its disciplinary reach, for individuals submit to and internalize medical

ways of thinking about their bodies. Patients undergo medical treatments without facing

excessive force or explicit coercion. Modern medicine is a disciplinary institution much like the

Panopticon that Foucault describes.85 As a project of knowledge production and scientific

research, medicine is able to constantly observe and record bodies. As a system of beliefs and

epistemological framework, medicine is also easily internalized by the individual who self-

disciplines and self-regulates their body to comply with medical norms. Even as we understand

medicine as a disciplinary project, we must also understand medicine as a project of alleviating

disease and illness. The enhancement, prolongation, and improvement of life through medicine

both justifies and becomes possible through the regulation, policing, and discipline of bodies.

85
Michel Foucault, Discipline and Punish (New York: Vintage Books, 2009).
 51

Medicine and the modern body perpetuate and necessitate themselves, not only through

the material benefits both systems have provided, but also because both define themselves

through the negation and exclusion of deviant bodies an exclusion that is never fully

realizable or complete. This is because exclusion is the means by which we emerge as stabilized

bodies and as bounded, individual personhoods: that which is excluded is a part of and

perpetually constitute of the human. The subject is produced by norms (such as sex and the

economic ability to produce) that, through regulation and injunction, materialize the body. Such

norms are compelled by what Judith Butler calls the constitutive outsidethe unspeakable, the

unviable, the nonnarrativizable that secures and hence fails to secure the very borders of

materiality.86 The illusion of stable and coherent identities, of which the modern body is one, is

masked through constant reiteration and the normative force of performativityprocesses that

gesture towards yet also refuse to articulate these identities constitutive exclusions. These

excluded sites come to bound the human as its constitutive outside, and to haunt those

boundaries as the persistent possibility of their disruption and rearticulation, Butler argues.87

Systems that seek stable ontological categories, like medicine, thus must sustain an illusion of

successfully coherent identities to perpetually justify themselves.

Within contemporary neoliberal contexts, one of the most frequent strategies to do so is

for institutions to promise and pursue diversity and inclusion as a means to mask the forms

of exclusions that originate the institutions themselves. As previously-mentioned disability

scholars David Mitchell and Sharon Snyder argue, neoliberal institutions achieve inclusion by

integrating diverse and variant embodiments such that their differences become invisible and

86
Butler, 140.
87
Butler, xvii.
 52

thus more normative.88 Purported acts of inclusion thus stabilize borders to the constitutive

outside, further excluding the sites beyond those borders (which in this process of abjection

become only more persistently haunting). This purported inclusion therefore denies variant

embodiments and further obscures the foundational acts of exclusion that underwrites

personhood, citizenship, and nation. Modern liberal states extend the rights of citizenship and

civic participation to a wider population of persons and bodies, but only through the

homogenization and erasure of diversity (of bodies and otherwise). Legal scholar Barbra Welke

uses the concept borders of belonging as a tool to understand how law constructs consequences

for identity markers such as sex, race, and ability. The law played a fundamental part in creating

shared identity, that it did so by investing elements of identity with legal consequences of

inclusion and privilege or exclusion and subordination, and that the inclusion and privilege of

some, in part, was defined by and depended upon the exclusion and subordination of others,

Welke states.89 Welke divides citizenship and legal personhood, arguing that citizenship

represents a set of mutual obligations between the state and an individual while personhood

represents ones rights to ones own body and labor. Though the acquisition of rights creates

legal personhood, citizenship gives added meaning to personhood by bestowing on the citizen

the ability to call on the state to defend their interests. Rights alone do not always guarantee state

protection and support. Modern liberalism presupposes the universal human the most

particularized legal unit as white, male, heterosexual. As citizenship is continually expanded

to encompass more people outside of these demographics and as the white patriarchys legal

88
David Mitchell and Sarah Snyder, The Biopolitics of Disability, 14.
89
Barbara Welke, Laws and Borders of Belonging (Cambridge: Cambridge University Press, 2010), 8.
 53

power has been partially dismantled over the course of the 20th century, the work of reinforcing

the borders of belonging were passed onto regulatory and bureaucratic elements.90

The state legitimates a particular identity and embodiment through its legal code, which

achieves normative and regulatory power through institutions like the medical profession.

Though materializations of the body and the borders to the constitutive outside are not stable,

they are nonetheless of practical and material consequences meted out through the partnership of

modern bureaucracy and medicine. Under a strong ethical obligation to treat people, medicines

enforcement of borders of belonging are subtler than the overt exclusion wrought by 18th and 19th

century American law. However, biomedical frameworks also normalize and make intelligible

particular embodiments at the exclusion of others. Medical tools, with increasingly higher

resolution and reach into the body, can parse bodily differences into various identity groups,

investing elements of patient identity with cultural consequences: medicine therefore helps

determine who belongs and who counts as a person.

For example, medical systems of knowledge and praxis begrudgingly (if at all) accept

those who exist outside of the gender binary. Non-consensual surgical and hormonal

interventions are often performed on intersex people. Genital surgery, such as masculinizing and

feminizing procedures, has been commonly used to manage intersex individuals since the 1970s.

Anne Fausto-Sterling pointed to the inability to think outside of gender dimorphism in the gap

between acceptable genital size (less than 1 cm for a clitoris and more than 2.5 cm for a penis in

a newborn).91 These normal standards of genital length are often used to justify surgery in

intersex children to reduce the size of the clitoris or enlarge the penis. Compelling these invasive

90
Welke, 146.
91
Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York: Basic
Books, 2000).
 54

treatments is an underlying need to preserve borders that exclude culturally inarticulate

embodiments. As another example, medicine also polices who can access social spaces and

participate in the workplace: children must receive vaccinations in order to enroll in public

schools; when students or employees are sick, they sometimes require a doctors note to affirm

their absence from school or the workplace; workplace drug testing is commonplace in many

industries, though no federal law specifically authorizes drug testing. Medicine also plays an

important role in defining both the abled body and the disabled body, categories which have their

own legal and social consequences. For example, approval for Social Security disability claims

requires medical evidence or an examination of the claimants conditions. Medicine plays a key

role in the decision-making of what qualifies as a state-sanctioned disability. A physicians

ability to support a disability claim is also the ability to determine when a patient must return to

work. At the heart of these practices are political concerns of who belongs and whose bodies

matter, defined by medical norms of health and ability.

Subsequently, health in the context of modern medicine is not only a norm towards which

individuals must continuously work, but also represents the maximal ability to work and produce

within modern statehoods founded upon capitalism. To be unproductive (willingly or not)

becomes defined as pathological deviance that must be rectified through medical intervention.

This belief pervades medical culture: in academic papers, biomedical research on specific

diseases is often justified by the cost of the disease in terms of lost working hours, healthcare

spending, or other economic impacts. Medicine helps perpetuate capitalist modes of class

domination by reinforcing a society where people are valued based on their ability to produce.

Medicine, which treats the laborer, has limited capacity to treat the social and environmental ills

of labor. Medical sociologist Howard Waitzkin observed:

 55

Doctors, for instance, regularly deal with patients' anger, anxiety, unhappiness, social
isolation, loneliness, depression, and other emotional distress. Often these feelings derive
in one way or another from patients' social circumstances, such as economic insecurity,
racial or sexual discrimination, occupational stress, and difficulties in family life. Such
emotions, of course, are one basis of political outrage and organized resistance. How
health professionals manage these sentiments is an interesting question. One of
medicine's effects may be the defusing of socially caused distress.92

To push Waitzkins observation further, medicine not only defuses socially caused distress, but

also sustains the standards of production and embodiment that causes individuals to experience

stress as a result of their deviance from those norms. Medicine is integral to the project of the

modern body, since it serves as this projects epistemological infrastructure, masks the political

and social forces at play with a veneer of objective and scientific thought, and promotes

disciplinary processes through the promise of health.

92
Howard Waitzin, A critical theory of medical discourse, Journal of Health and Social Behavior 30, no. 2
(1989): 228.
 56

Chapter 3: The Pain & Politics of Menstruation

After detouring from menstruation, we now return back to it and specifically two medical

entities of menstrual pain: premenstrual syndrome (PMS) and dysmenorrhea. The effects of

menstruation on womens capacity to work were hotly debated in the 19th and 20th century as

women began entering wage labor. Both PMS and dysmenorrhea were viewed (and continue to

be viewed) as potential obstacles to women being reliable, productive workers. The formulation

of clinical categories of menstrual pain participates in a process that legitimates the modern body

and pathologizes deviances from it. Interrogating the political, economic, and disciplinary forces

at play in medical approaches to menstrual pain, however, does not mean forgetting that

menstrual pain is realthat menstrual pain is a varied but nonetheless lived experience for many

menstruators.

Recognizing this enables a clearer investigation in the ways menstrual pain is interpreted,

understood, and addressed. A culturally collective understanding of menstrual pain arises from

but does not necessarily stay true to individual experiences of menstrual pain. Emily Martin

argued that the degree of impairment that menstrual symptoms were thought to have on women

often correlated with the relative need for female workers.93 In 1931, Robert T. Frank described

premenstrual symptoms of fatigue, irritability, pain, and lack of concentration and grouped these

disturbances under the clinical entity of premenstrual tension, the precursor to PMS. Frank

pointed to the female sex hormones as the direct cause of premenstrual tension and

recommended x-ray treatment against the ovaries for severe cases. Importantly, Frank expressed

concerns about how premenstrual tension affects family and work life: Employers of labor take

cognizance of this fact and make provision for the temporary care of their employees. These

93
Emily Martin, Premenstrual Syndrome, Work, Discipline, and Anger in The Socialist Feminist Project, ed.
Nancy Holmstrom (New York: Monthly Review Press, 2002), 63-71.
 57

periodic attacks are incapacitating and lead occasionally to extreme unhappiness and family

discord. While Frank does not deliberately intend to regulate womens societal roles, he draws

the connection between menstrual symptoms and womens ability to fulfill their roles, opening

up the door for medical (and supposedly value-neutral) authority to inscribe the place of women.

This medicalization of premenstrual symptoms occurs at a time when women faced

pressure to give up the waged work they gained during World War I. Can it be accidental that

many other studies were published during the interwar years that showed the debilitating effects

of menstruation on women? Given this pattern of research finding women debilitated by

menstruation when they pose an obstacle to full employment for men, it is hardly surprising that

after the start of World War II, a rash of studies found that menstruation was not a liability after

all, Martin wrote.94 Both researchers and employers took a keen interest in menstruation: as

noted earlier, the Metropolitan Life Insurance Company reduced absenteeism of their young

female clerks through requiring them to follow exercise regimes and mandating medical

examinations, though the pendulum swung both ways, and other companies also used higher

absenteeism in female workers as a reason for reduced wages. Menstrual symptoms came to

represent the incongruence between female bodies and a workplace designed for men; employers

negotiated this incongruence by reinterpreting and reforming the bodies of women workers to fit

the factory and office. Medicine played a crucial role in this process, by making this

incongruence tangible and controllable as the clinical entities of menstrual disorders and by

promoting an understanding of health as the maximum ability to work and produce in these

occupational environments.

94
Martin, 64.
 58

In 1953, researcher Katherina Dalton co-published the first paper on premenstrual

syndrome based on work conducted in the post-World War II period. Dalton and co-author

Raymond Greene argued that Franks premenstrual tension did not encompass the various

physical and psychological discomfort women faced every month and should be further

expanded to include more symptoms and more degrees of severity.95 Thus, Dalton and Greene

included, within the category of PMS, medical impairments such as lack of concentration and

forgetfulness and physical symptoms like headache and nausea. While Dalton continued to

conduct research on PMS, the disorder did not become widely known until 1980, when PMS

grabbed headlines after the murder charges of two female defendants were mitigated because

they were found to have been experiencing PMS during the time of the murder.

By the time PMS entered popular culture as the disease of the 1980s, studies abounded

claiming that in the premenstrum, women were more likely to commit crime,96 have accidents,97

crash airplanes,98 have sexual fantasies,99 and do poorly in school100 ultimately costing their

employers and society billions of dollars.101 These studies were methodologically unsound,102

but were widely cited and become fodder for a feverish cultural imagination of PMS. The

validity, etiology, and prevalence of PMS as a clinical entity were debated and continue to be

today, spanning the controversy over the 2000 addition of Premenstrual Dysphoric Disorder

95
Katherina Dalton and Raymond Greene, The Premenstrual Syndrome, British Medical Journal 9, no. 1 (1953):
1007-1014.
96
Katharina Dalton, Menstruation and crime, British Medical Journal 2, no. 5269 (1961): 1752-53.
97
P.C.B. MacKinnon and I. L. MacKinnon, Hazards of the menstrual cycle, British Medical Journal 1, no. 4966
(1956): 555.
98
R.E. Whitehead, Women pilots, Journal of Aviation Medicine 5 (1934): 47-49.
99
Therese Benedek, Parenthood as a Developmental Phase: A contribution to the libido theory, Journal of
American Pschoanalytical Association 7, no. 3 (1959).
100
Katharina Dalton, Effect of menstruation on schoolgirls weekly work, British Medical Journal 1, no. 5169
(1960): 326-328.
101
Katharina Dalton, Once a Month: Understanding and Treating PMS (Alameda: Hunter House, 1999).
A. Parker, The premenstrual tension syndrome, Medical Clinics of North America 44 (1960): 339-348.
102
Mary Parlee, The Premenstrual Syndrome, Psychological Bulletin 80, no. 6 (1974): 454-65.
Mari Rodin, The Social Construction of PMS, Social Sciences and Medicine 35, no. 1 (1992): 49-56.
 59

(PMDD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR) as a more

severe and disabling form of PMS.103 Despite the controversial and shaky evidence for PMDD

and PMS, the pathologization of premenstrual symptoms is well-established, medically and

culturally.

PMS is widely defined and encompasses any unspecified but recurrent physical,

physiological, or behavioral disorders. The Menstrual Distress Questionnaire, a survey created

by Rudolf Moos to assess a patients menstrual problems, lists over 150 symptoms related to

PMS. This questionnaire was the predominant method used in subsequent studies on PMS,

despite criticisms for focusing almost entirely on negative symptoms and relying solely on verbal

and recalled information.104 Several decades after it burst into the cultural limelight, PMS is still

ambiguously defined around mostly negative premenstrual conditions yet remains a medical

condition commonly diagnosed and treated. PMS was more divisive politically. While some

feminists embraced the new attention on the negative effects of menstruation and some

menstruators found solace in having a medical name for their experiences, others saw PMS as

further medical encroachment onto the female body and interpreted it as backlash against

second-wave feminism.105

103
The DSM is the professional authority for North American psychology, where it is used as a standard, shared
language and classification of psychiatric disorders. It thus holds vast influence on medical and psychological
practices. The U.S. Food and Drug Administration has approved antidepressants for PMDD, accepting PMDD as a
valid diagnosis. However, PMDD is not accepted by the International Classification of Diseases. Critics of PMDD
argue that such diagnoses present symptoms as merely psychological and locate pathology within menstruating
bodies, obscuring environmental, societal, and other external stressors that may contribute. See Alia Offman and
Peggy Kleinplatz, Does PMDD belong in the DSM? Challenging the Medicalization of Womens Bodies, The
Canadian Journal of Human Sexuality 13, no. 1 (2004): 17-26.
104
Rudolf Moos, The development of menstrual distress questionnaire, Psychosomatic Medicine 30, no. 6 (1968),
853-67.
Mary Parlee, Stereotypic beliefs about menstruation: a methodological note on the Moos menstrual distress
questionnaire, Psychosomatic Medicine 36, no. 3 (1974): 229-40.
105
Sophie Laws, Seeing Red: The Politics of Premenstrual Tension (London: Hutchinson, 1985).
Susan Markens, The problematic of experience: a political and cultural critique of PMS, Gender & Society 10, no.
1 (1996).
 60

Importantly, PMS signaled another form of menstrual management that women in the

20th and 21st centuries having already learned to use tampons and sanitary pads to manage the

flow of menstrual fluids were expected to adopt. PMS thus extended the bodily reach of

corporeal compliance by codifying premenstrual fluctuations as an issue requiring medical

intervention. Anthropologist Lara Freidenfelds observed, Women [in the early decades of the

20th century] became convinced that they ought to be able to get menstruation under control if

they only employed the right technologies, techniques, and attitudes. Once all these modes of

menstrual management were in place, women were ready to take seriously the proposal of yet

another way they should better manage their menstruating bodies, keeping emotions as well as

blood flow in check.106 Many of the menstruators Friedenfelds interviewed, who were born in

the 40s and 50s amidst a culture where menstrual management was well established, largely

accepted that PMS had to be controlled in order to maintain a regular life. One women said of

PMS:

I think there probably really is something to the fact that theres mood changes, and its
physiological. But I think we should try to carry on a normal life anyway, in spite of it,
rather than using it as some kind of an excuse for murdering someone that day.
[Laughter] [] So Im glad everyone knows about it and can accept it, but I dont think
you should plan your life around it.107

PMS, as a stigmatization of not only physical but also psychological fluctuation, instantiates the

cultural and medical urge to define the body as stable and rigid. Having learned to hide the

bloody evidence of their leaking bodies, menstruators were then told that their mental and

emotional fluctuations also needed to be managed to conform to linear, consistent ways of

thinking and feeling. This is a standard mode of operation for the modern body: because it is

unattainable, it continuously compels new forms of bodily management and discipline. It was not

106
Friedenfelds, 113.
107
Friedenfelds, 115.
 61

enough that movement across bodily borders had to be policed by hygienic products: temporal

variation and emotional instability were marked as abnormal and had to be controlled. When

men and women publically spoke about PMS, it became a way to insist that women manage their

moods. Friedenfelds quotes one woman who said, Men can use it negatively against women to

just say, Oh, its just PMS, like Oh, shes being a bitch, or something like that.108 The

modern body not only had to have a modern period, but also had to think and feel in a modern

way (which is to say, linearly, rationally, and consistently). In comparison to beliefs of menstrual

debility that characterized 19th century medicine, by the time PMS emerged, menstruation

became something to work around and manage.

This view of PMS aligns with the cultural pressure to continuously pursue the modern

body. PMS stigmatized womens deviance from feminine roles, but cultural rhetoric about PMS

also portrayed a woman with PMS as someone who lacked control of their body and was subject

to the mercy of their raging hormones.109 As a label, PMS not only pathologizes mental and

emotional fluctuations, but also denied that those who experience PMS possess bodily autonomy.

This implication of the medical category of PMS further amplified by the cultural trope of the

woman with raging hormones alienates menstruators from their bodies at the level of

individual experience. An inability to moderate bodily fluctuations is read as a personal failure.

In one interview, one women expressed frustration with herself when she experiences PMS:

Interviewer: What are you feeling when you get this sort of tension and pressure?
Response: What am I feeling? I guess annoyed at myself, I want to stop the way I am, but
I cant I get quite frustrated by my body, cos, I know Im doing it, and I know theres
no reason for me to do it, but I cant stop. And thats very difficult. Very, very
difficult.110

108
Friedenfelds, 118.
109
Anne Figert, Women and the Ownership of PMS (Berlin: A. de Gruyter, 1996), 11-18. Sophie Laws, Issues of
Blood: The Politics of Menstruation (London: Macmillan Publishers, 1996).
110
Ussher, 55.
 62

This menstruators response exemplifies Foucaults thesis that discipline becomes internalized

within someone to the point that he is his own overseer and she, her own overseer.111 I want

to stop the way I am articulates an internalized disciplinary force that derives from a norm of

bodily control. Such norms interpret an inability to fully control ones body as decreased

efficiency and lowered work performance, and this process of internalized discipline facilitates a

capitalist economy that has equated health with productivity. As the individual takes up the

burden of overseeing themself and forcing corporeal compliance, the norms to which the

individual holds themself up to are outsourced to institutions like modern medicine. The clinical

category of PMS not only facilitates particular cultural understandings of menstruation, but it

importantly also influences the way individual menstruators perceive their own bodies and

identities.

While PMS entered popular culture, the clinical entity of dysmenorrhea has remained in

the medical shadows.112 Dysmenorrhea describes painful menstrual cramps of uterine origin,

according to the British Medical Journals Clinical Evidence Book. There are two types of

111
Michel Foucault, The Eye of Power in Power/Knowledge: selected interviews and other writings, 1972-77, ed.
Colin Gordon (New York: Pantheon, 1980), 155.
112
While certainly not the most accurate measure of popularity, Google n-gram results reflect a sharp rise in the
number of times PMS was printed in 1980 while dysmenorrhea has a much lower, if consistent, print frequency.
 63

dysmenorrhea. Primary dysmenorrhea is menstrual pain without organic pathology113 or in

the absence of pelvic pathology114 a peculiar definition that we will interrogate further.

Secondary dysmenorrhea is pain associated with a known pathology, such as endometriosis or

ovarian cysts.

Primary dysmenorrhea is the most common gynecological complaint. As many as 90% of

adolescent girls and more than 50% of menstruating women report experiencing primary

dysmenorrhea, with 10 to 25% describing this menstrual pain as severe and distressing.115

Comparatively, the prevalence of PMS is approximately 30 to 40% of the reproductive female

population.116

Generally, primary dysmenorrhea begins a few hours before or at the start of

menstruation and is most intense at the onset, with the pain of menstrual cramps waning over

two or three days. It is sometimes accompanied by nausea, vomiting, diarrhea, headache, fatigue,

nervousness, and dizziness. Despite its wide prevalence and wide acknowledgement that it is one

of the largest causer of lost working hours,117 it is barely studied. (One might wonder how

researchers can know that primary dysmenorrhea is the largest cause of absenteeism and lower

113
Pallavi Latthe and Rita Champangeria, Dysmenorrhea in British Medical Journal Clinical Evidence Handbook,
American Family Physician 85, no. 4 (2012): 386-387.
114
Michelle Proctor and Cynthia Farquhar, Diagnosis and Initial Management of Dysmenorrhea in British Medical
Journal, American Family Physician 89, no. 5 (2014): 341-346.
115
Karen Berkley, Primary Dysmenorrhea: An Urgent Mandate, International Association for the Study of Pain
21, no. 3 (2013).
Pallavi Latthe et al., WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health
morbidity, BMC Public Health 6, no. 1 (2006): 177.
However, estimates of the prevalence of primary dysmenorrhea do vary widely, from as low as 16.8% to as high as
81%. These estimates of prevalence vary widely because (1) affected individuals often do not seek treatment for
primary dysmenorrhea; (2) adult women seem to suffer from primary dysmenorrhea at lower rates than adolescents,
and as a result, prevalence changes based on the age populations surveyed; (3) definitions of dysmenorrhea and
standards for assessing the severity of dysmenorrhea vary; (4) menstrual pain is often underreported or not equated
to the clinical category of primary dysmenorrhea. The numbers supplied
116
Ashraf Direkvand-Moghadam et al., Epidemiology of Premenstrual Syndrome, Journal of Clinical and
Diagnostic Research 8, no. 2 (2014): 106-109.
117
Olavi Ylikorkala and M. Yusoff Dawood, New Concepts in Dysmenorrhea, American Journal of Obstetrics
and Gynecology 130, no. 7 (1978): 833-47.
 64

worker productivity if they do not accurately know how prevalent it is.) Searches of the

biomedical literature database PubMed indicated that less than 1 percent of pain papers

mentioned dysmenorrhea (5868 dysmenorrhea papers out of 674,213 pain papers in January

2017). Searches of NIH RePorter show that while 3310 grants in the USA investigate pain, only

10 of those focus on dysmenorrhea.118 If primary dysmenorrhea is of equal or greater prevalence

than PMS, why is it that PMS has lived a much more vibrant cultural life than dysmenorrhea?

What explains the difference in the cultural significance invested in PMS versus primary

dysmenorrhea?

PMS represents a larger and thus more alarming deviance from societally expected roles

for women than primary dysmenorrhea does. PMS is connected to as many as 150 different

symptoms from poor concentration to irritability and headaches that can noticeably impair a

womans ability to work, take care of their families, and fulfill other expected and gendered

responsibilities. Primary dysmenorrhea, by comparison, describes just one symptom: pain, which

nonetheless can impair ones ability to participate and produce in society but is also less

noticeable and more easily hidden. Additionally, PMS is generally thought to occur from 5 to 10

days before menstruation, while primary dysmenorrhea occurs close to the start of menstrual

bleeding. The more nebulous temporal range of PMS allowed it to applied regularly and to more

social contexts.

But perhaps most importantly, PMS speaks more directly than primary dysmenorrhea

does to cultural fears of the violent and angry woman, and it thus serves as a better tool to control

the behavior of women. The womans body is a body deemed dangerous and defiled, the myth

118
Researchers often employ searches of scientific databases to judge the extent of research on specific clinical
entities. It is only an estimate, but the numbers for primary dysmenorrhea are particularly stark. Researchers often
employ searches of scientific databases to judge the extent of research on specific clinical entities. It is only an
estimate, but the numbers for primary dysmenorrhea are particularly stark.
 65

of the monstrous feminine made flesh associated with the power and danger perceived to be

inherent in womans fecund flesh, her seeping, leaking, bleeding womb standing as site of

pollution and source of dread, Ussher writes.119 A woman with PMS attests to this myth of the

monstrous and fecund body than a woman with primary dysmenorrhea, especially as the effects

of PMS especially emotional and behavioral symptoms like irritability, mood swings, and

social withdrawal play out in social interactions, spilling from the woman to the people

around her. PMS named womens deviance, instability, and agitation as a physiological

phenomenon that should be treated and also labeled it as the cause of social discord, unhappiness

felt by the husband and children, lowered performance in the workplace, and violent crime. In

pathologizing deviance from socially-acceptable behavior, PMS becomes more than a medical

classification: it also serves as a tool for regulating what women can or cannot do.

Primary dysmenorrhea, by comparison, is less visible and less public. The only person

who truly knows the pain of a womans menstrual pain is the woman herself. When a womans

feelings of pain are voiced, it is usually less likely to impact those in her social surroundings as

some symptoms of PMS are likely to. Caring for a person in pain differs from treating a person

with PMS because pain, as a subjective and personal experience, is usually only understood

through listening to a persons expression of their pain experiences. While we associate images

of angry, screaming women with PMS, the stereotypical image of menstrual pain is a woman in

pajamas clutching her abdomen and lying down. In contrast, the pain of menstrual cramps is

largely confined to the individual who experiences them and is normalized as a regular part of

menstruation. While cramping pain during menstruation is typified as normal, cyclic physical

119
Ussher, 10.
 66

and psychological changes during the premenstrum are not. PMS is the public face of painful

menstruation, and primary dysmenorrhea is its private side.

Medicine as well has a more tenuous relationship with dysmenorrhea than it does PMS.

While papers on PMS rose sharply in the 1980s, dysmenorrhea has seen no such increase. A

search of the ScienceDirect database found 7,913 papers on premenstrual syndrome and 6,181

papers on primary dysmenorrhea. Additionally, as pain associated with menstruation in the

absence of underlying organic disease,120 primary dysmenorrhea is an awkwardly-defined

clinical entity. Such a definition places primary dysmenorrhea as simultaneously a superfluous

medicalization of menstruation and a validating affirmation of female pain. It is bizarre for an

institution, dedicated as it is to naming and localizing pathologies, to define a clinical entity as an

absence of the thing it is supposed to be.

How can menstrual pain, whose categorization as primary dysmenorrhea makes it a

medical pathology, occur in the absence of pathology? There are two plausible explanations:

one, that this is only a temporary definition as more research on primary dysmenorrhea will

discover its etiology, or two, that this represents an irreconcilable epistemological question that

the medical profession, out of lack of interest in clarifying menstrual pain or lack of resources, is

not invested in answering. Both indicate a failure of medicine to take seriously the unanswered

question of menstrual pain.

As a result, primary dysmenorrhea both legitimizes and delegitimizes womens claim to

pain. The paradoxes of primary dysmenorrhea exemplified by its epistemological

entanglements reflect the tricky balance between wanting to give menstruators the ability to

stop having periods if they so choose and not wanting to pathologize menstruation or interpret it

120
Karen Berkely, Primary Dysmenorrhea: An Urgent Mandate, International Association for the Study of Pain
21, no. 3 (2013).
 67

as a nuisance. It also reflects the tension between wanting primary dysmenorrhea to be better

studied and understood medically and wanting primary dysmenorrhea not to be medicalized or

pathologized in a way that stigmatizes the menstruating body. These tensions speak to the

doubleness of medicine: it treats and cures, yet it does so through disciplinary practices and a

language of pathology. Primary dysmenorrhea fits precariously between these two tensions: it is

not fully treated or cured as many other diseases in medicine are, but neither is it used like PMS

is to police and stigmatize certain behaviors and bodies. Primary dysmenorrhea validates the pain

of menstrual cramps by providing a clinical and scientific label (an oft-controversial move for

other instances of female pain, such as fibromyalgia and vulvar pain), yet this labels definition

denies this pain pathological status. Simultaneously, physicians widely acknowledge primary

dysmenorrheas prevalence but call it a common and sometimes normal phenomenon. Pain

becomes a normal part of menstruating, of being a woman.

Consequently, primary dysmenorrhea is poorly treated and often disregarded by

caregivers,121 even though studies have shown that dysmenorrhea can be considerably painful122

and substantively lower the quality of life of those affected. Cross-sectional studies have found

that menstrual pain can negatively affect family relationships, friendships, and social interactions

as well as restrict physical activity.123 Such studies are important to understanding primary

121
Stella Iacovides, Ingrid Avidon, and Fiona Baker, What We Know About Primary Dysmenorrhea Today,
Human Reproduction Update 21, no. 6 (2015): 762-78.
122
One reproductive health professor has described menstrual pain as being almost as bad as having a heart attack.
See Olivia Goldhill, Period pain can be almost as bad as a heart attack. Why arent we researching how to treat
it? Quartz, February 15, 2016.
123
MI Ortiz et al., Prevalence and impact of primary dysmenorrhea among Mexican high school students,
International Journal of Gynecology and Obstetrics 107, no. 3 (2009): 240-3. M. Aryan et al., Pain levels
associated with renal colic and primary dysmenorrhea, Archives of Gynecology and Obstetrics 286, no. 2 (2012):
403-9. Gulsen Eryilmaz et al., Dysmenorrhea prevalence among adolescents in eastern Turkey: its effects on school
performance and relationships with family and friends, Journal of Pediatric and Adolescent Gynecology 23, no. 5
(2010): 267-72.
Li Ping Wong and Ee Ming Koo, Dysmenorrhea in a multiethnic population of adolescent Asian girls,
International Journal of Gynaecology and Obstetrics 108, no. 2 (2010): 139-42.
 68

dysmenorrhea and its impact on those who experience it, yet this research has also promoted

primary dysmenorrhea as an issue of productivity and work. Despite not knowing how prevalent

dysmenorrhea is, various researchers cite dysmenorrhea is the primary reason for school and

work absenteeism for young women, for whom rates of absenteeism range from 34 to 50%.

Primary dysmenorrhea is estimated to result in an annual loss of $2 billion in the U.S. and of

approximately 600 million working hours,124 but because relatively few individuals report their

menstrual pains, these may be drastic underestimates.125 There is a certain value in assigning

these numbers to primary dysmenorrhea these statistics helps us understand its scope and

impact and mobilize resources to study and treat it yet these numbers legitimate primary

dysmenorrhea as an economic concern at the expense of framing it as an issue of real,

experienced pain.

Because primary dysmenorrhea significantly impacts those affected and their ability to

participate in society and work, the overlooking of menstrual pain is a bizarre outlier in a general

cultural pattern of the pathologization and treatment of impaired abilities to function and produce

within todays capitalist economies. This lack of attention is unfortunate, for the undertreatment

of primary dysmenorrhea decreases the quality of life of a large population. But it also represents

an opportunity to formulate nuanced ways of thinking and understanding menstrual pain. In fact,

critical investigations into primary dysmenorrhea remain an open field. While feminists, medical

124
Ylikorkala, 835.
125
Iacovides, 763. Because menstrual pain is often perceived as a normal part of menstruation, those affected often
do not report their pain and may receive inadequate treatment and therapies to manage their discomfort. Though
surveys indicate that young women perceive pharmacological methods to be more effective than non-
pharmacological methods, 30 percent of adolescents do not take over-the-counter medications for their pain, and
only 18% use prescription medications.125 In comparison, in a survey of nearly 300 female adolescents, 98%
reported using at least one non-pharmacological therapy for their pain and discomfort (such as tea, use of heating
pads, sleep, rest, physical exercise, and dietary changes) even though they perceived these therapies as not very
effective. (See Mary Ann Campbell and Patrick McGrath, Non-pharmacologic strategies used by adolescents for
the management of menstrual discomfort, Clinical Journal of Pain 15, no. 4 (1999): 313-20.)
 69

anthropologists, and sociologists have questioned the logic behind PMS, almost no one has

thought of primary dysmenorrhea. Widely-cited projects on the menstruating body, such as

Emily Martins The Woman in the Body and Louise Landers Images of Bleeding, devote

chapters to PMS but not primary dysmenorrhea. What might become of primary dysmenorrhea,

if left critically unexamined?

Primary dysmenorrhea is a much more slippery clinical entity than PMS, not only

because of its relative lack of publicity, but also because it explicitly defines a certain type of

pain. Pain is a political battleground as various agents fight over whose pain matters, who can

judge pain, and how those in pain should be treated. It is also a medical quagmire, as it exists

across disease categories and cannot be quantitatively measured and compared across

individuals. Pain is both a powerful unifying force and a deeply individualizing and isolating

experience. Over the past century, pain has entered the foreground as one of the most hotly

debated medical and societal issues a dispute characterized by the post-war question of

disability compensation for veterans, president Bill Clintons infamous I feel your pain reply to

an AIDS activist, to todays opioid epidemic and growing prevalence of chronic pain. Pain

presents an immensely powerful tool for disciplining, defining the borders of belonging, and

regulating ones sociocultural standing because it welcomes an irrefutable claim that those in

pain are to blame for feeling pain. Yet pain also offers an opportunity to combat dominant and

oppressive ideologies, by forcing those in pain to interrogate their personal standpoint, alerting

them to their marginalization, and unifying various groups in pain.

Primary dysmenorrhea not only shares the epistemological difficulties of pain, but it is

further complicated by its three characteristics: it is a chronic, cyclic, and essentialized as female

pain. This combination, I suspect, can enable primary dysmenorrhea to widely stigmatize
 70

menstrual pain as a means to discipline women. PMS, with its nebulous parameters, has been

used to shame women for deviance from their feminine roles. The pain of primary

dysmenorrhea, less visible and more ambiguous, could further marginalize women and become a

tool to shame their bodies as leaking, fluctuating, and disgusting. Worse, it marks womanhood as

a painful experience a punishment. As the language and epistemology of primary

dysmenorrhea concretizes, it could become, like PMS, another way for regimes of knowledge to

influence the way women think of themselves and their menstrual pain.

Biomedical research fails to grasp pain, much less treat or soothe it. Its grasp becomes

even more tenuous when it comes to female pain. Physicians routinely underestimate and

disregard pain reported by females. A 2008 study of an urban emergency room found clear

gender bias in the treatment of acute pain: of all patients reporting severe abdominal pain, men

were 13 to 25 percent more likely than women to receive high-strength opioid pain medication.

Women who did receive the pain relievers waited on average 16 minutes longer to receive

them.126 The widely-cited study The Girl Who Cried Pain concludes that while women

experience and report more frequent and greater pain, they are more likely to be less well treated

than men.127 (One can only imagine how the medical profession treats the pain reports of

transgender or intersex people: there are few studies evaluating the medical treatment of these

marginalized groups, though informal reports of medical mistreatment of transgender patients

has led one journalist to coin the term trans broken arm syndrome. This term describes

healthcare providers assumption that a transgender persons medical problems are always a

126
Esther Chen et al., Gender Disparity in Analgesic Treatment of Emergency Department Patients with
Abdominal Pain, Academic Emergency Medicine 15, no. 5 (2008): 414-8.
127
Diane Hoffmann and Anita Tarzian, The Girl Who Cried Pain: A Bias Against Women in the Treatment of
Pain, Journal of Law, Medicine, and Ethics 29 (2001): 13-27.
 71

result of that person being trans.128) There remains a lack of interest in studying the pain of non-

male people. While the medical profession has clearly acknowledged that dysmenorrhea is a

common and sometimes debilitating condition, it seems studying other sorts of pain is sexier.129

The prevalence and severity of the most common gynecological problem remain unclear.

Research for dysmenorrheic symptoms reported by transgender people on hormone replacement

theory is unlikely anytime soon. Even when medicine does take an interest, it usually does more

to problematize and pathologize its object of attention than to support its patient.

But if we are to push medicine to attend more closely to the issue of primary

dysmenorrhea, what kind of attention should that be? If menstrual pain is not talked about

enough or given the attention it deserves, then how should we talk about primary dysmenorrhea?

Taking PMS as a cautionary lesson, we have a basic understanding of how not to talk

about menstrual symptoms. When it comes to cultural understandings and imagination of

menstrual disorders, PMS is an important case study on the stigmatization and stereotyping of

the experiences of people who experience menstrual fluctuations. Yet even though PMS has a

controversial cultural life, it importantly does describe a material reality lived by some women.

Jokes about women who are PMS-ing illustrate how a clinical category created to describe real

and lived experiences has grown into something beyond that. PMS, however shaky a medical

category it may be, refers to physical and psychological fluctuations that some menstruators do

in fact experience, and these lived experiences often gets lost and spoken over in the cultural

imagination of PMS. What we call PMS thus encompasses menstruators bodily experiences of

PMS symptoms and both the publics and menstruators understanding of those experiences.

128
Mary OHara. The Trans Broken Arm Syndrome and the way our healthcare system fails trans people, The
Daily Dot, June 16, 2016.
129
Karen Berkley and Stacy McAllister, Dont Dismiss Dysmenorrhea! Pain 152, no. 9 (2011): 1940-1.
 72

The same can be said of dysmenorrhea. Some, if not most, menstruators experience

menstrual pain. That counts as primary dysmenorrhea. But what also counts are the conceptual

attempts to categorize and understand their pain, from its medically given name of primary

dysmenorrhea to its clinical definition as common cramping pain without underlying

pathology to the ways we talk about and oftentimes dismiss primary dysmenorrhea. In

acknowledging this, we can be mindful not to speak over the lived realities of PMS and primary

dysmenorrhea, while still criticizing and investigating the conceptual frameworks we use to

describe those experiences (which are the very same frameworks that lead us to sensationalize

PMS while sidelining primary dysmenorrhea). These bodily realities originate the need for a

societys collective understanding and imagining, and taking them seriously can give us the

capacity to challenge our understanding of female pain.130

PMS specifically has grown into a cultural object embedded in the struggles to define the

expectations for womens behavior and bodies. The bodily experiences that PMS now denotes

the expansive list of mostly negative symptoms form the starting point of the cultural myth of

PMS, one that characterizes women as fundamentally irrational and emotional. The move to

instantiate the concept of PMS, to classify and collect those experiences into this concept, and to

research and publicize this concept are all steps in the process of creating a collective

understanding of those bodily experiences. Such cultural imaginations of these bodily

experiences are inherent to the process of talking about those experiences; though this cultural

imagination can then shame and dismiss the experiences upon which they originate, they can

also serve as rallying points for research, activism, and collective identification. As primary

130
Of course, to acknowledge the difference is not to divorce these two entirely, for the way we talk about menstrual
pain affects the way menstruators experience it, just as the way menstruators experience it affects the tools and ideas
we might mobilize to describe and treat it.
 73

dysmenorrhea (hopefully) grows into a better publicized and studied clinical entity, how can we

take care to shape a cultural understanding of primary dysmenorrhea that does not shame

menstruators like PMS does to women? How can we talk about primary dysmenorrhea in a way

that gives voice to lived experiences of menstrual pain while preserving and establishing

menstruators bodily autonomy and without making menstrual pain into a misogynist myth in the

way that PMS has become?

Essayist Leslie Jamison poses a similar question in her essay, Grand Unified Theory of

Female Pain, when she asks: How do we represent female pain without producing a culture in

which this pain has been fetishized to the point of fantasy or imperative? Fetishize: to be

excessively or irrationally devoted to. Here is the danger of wounded womanhood: that its

invocation will corroborate a pain cult that keeps legitimating, almost legislating, more of itself.

The myth of the wounded woman can be traced in literature from Anna Karenina to Miss

Havisham in Great Expectations to contemporary societys trope of the young woman who

drinks too much and has sex with too many men. This cultural obsession of women in pain

from Sylvia Plaths agony to Stephen Kings Carrie to the cult horror film Teeth risks

transforming their suffering from an aspect of the female experience into an element of the

female constitutionperhaps its finest, frailest consummation.131 Speaking from her own point

of vulnerability and exasperation, Jamison seeks to break away from societys paradoxical

valorization of the wounded woman and dismissal of melodramatic, wallowing women, for she

knows that, behind this paradox, she and other women hurt. Jamison names one strategy that

women have adopted in the face of this problem: the post-wounded voice, a stance of numbness

or crutch of sarcasm that implies pain without claiming it, that seems to stave off certain

131
Leslie Jamison, Grand Unified Theory of Female Pain in The Empathy Exams (Minneapolis: Graywolf Press,
2014).
 74

accusations it can see on the horizonmelodrama, triviality, wallowingand an ethical and

aesthetic commandment: Dont valorize suffering women. But in its rejection of the image of

the wounded women, this post-wounded voice can never appreciate the complexities of pains

and wounds and therefore never approach caring for them. Ultimately, Jamison concludes that

the best way to proceed is to not to act as if female pain does not exist, but to undercut the myth

of the wounded woman by returning to and fully accepting all the wounds and pains the myth

feeds upon. It means insisting that we never have the right to dismiss the trite or poorly worded

or plainly ridiculous, the overused or overstated or strategically performed. In the conclusion of

her essay, Jamison writes:

Pain that gets performed is still pain. Pain turned trite is still pain. I think the charges of
clich and performance offer our closed hearts too many alibis, and I want our hearts to
be open. I just wrote that. I want our hearts to be open. I mean it.

In refusing to abandon the pain and experiences of women, Jamison reminds us that these myths

and clichs of wounded womanhood (and various other feminine expressions and embodiments)

seek to monopolize the narrative of the female experience. To shy away from talking about the

experiences (and talking about them honestly) of being a woman and being a woman in pain

reinforces the myth we seek to dismantle. Jamisons proposed strategy for dismantling this myth

feels, however, lacking. I want our hearts to be open suggests a mode of empathetic acceptance

and imagination and unabashed embrace of vulnerability but open to what? What about the

pain that never gets performed or voiced? Pain that has never had the opportunity to become trite

in the first place?

Jamisons essay is fruitful because it points to how the cultural imagination of female

pain be it emotional, causeless, PMS or dysmenorrhea affects the phenomenology and

expressions of pain of the people who feel it. Perhaps opening our hearts can create the spaces
 75

for menstruators to voice those underground pains, but is that really enough? How do open hearts

fare in the face of medical ideology, patriarchy, and misogyny? Though this is not a reason not to

pursue it, we know open hearts inevitably fail because, however open our hearts may be,

however accepting of pains we may be, we can never fully know or feel the pain of another. This

inevitably constrains the action and agency we have to care for and counteract the pain of others.

Essayist Elaine Scarry articulates this inevitability as the difficulty of imagining other people.

Empathetic imagination, or Jamisons localized version of open hearts, is a poor enforcer of

political and cultural generosity. Scarry writes:

The difficult of imagining others is both the cause of, and the problem displayed by, the
action of injuring. The action of injuring occurs precisely because we have trouble
believing in the reality of other persons. At the same time, the injury itself makes visible
the fact that we cannot see the reality of other persons. It displays our perceptual
disability. The human capacity to injure other people is very great precisely because
our capacity to imagine other people is very small.132

While Scarry talks about inflicting physical pain onto others, we can imagine that, like the

human capacity to injure other people, our investments in caring for and understanding others

pain is inversely related to our ability to imagine their selves and their pains. Importantly, not

only is our capacity to imagine other people rather small, but also often misdirected and

marginalizing rather than empowering. (We only have to turn back to Jamisons exposition on

the cultural imagination of female pain for find such a case.) These imaginatory failures are

predicated upon sensorial gaps: we cannot inhabit anothers body nor anothers life, and our

abilities for imagination do not dissolve bodily and physical barriers. It is within these gaps that

body and gender discipline operate. For while there are material and insurmountable differences

that condition these gaps, the normalization of the modern body also stabilizes these gaps and

132
Elaine Scarry, The difficulty of imagining other people, in For Love of Country? ed. Martha Nussbaum and
Joshua Cohen. (Boston: Beacon Press, 2002), 102.
 76

enforce a rigid conception of individual body and subjectivity. The difficulty of imaging others is

in part a consequence of our material reality and in part the successful achievement of the

individualizing project of the modern body.

Identification with sex plays an important role in the latter, Judith Butler argues. As the

materiality of the body will not be thinkable apart from the materialization of that regulatory

norm, [sex is] one of the norms by which the one becomes viable at all, that which qualifies a

body for life within the domain of cultural intelligibility.133 Within this framework,

performativity moves beyond the act of a subject bringing into being what they name but the

reiterative discourse that produces the phenomena, or the regulatory norm, that it regulates and

constrains. Importantly, the subject is constituted not only through reiteration of this regulatory

norm and through cultural formation of identities, but also through the creation of

uninhabitable zones of social life. These abjected and excluded domains of life will

circumscribe [the subjects] own claim to autonomy and to life. In this sense, the subject is

constituted through the force of exclusion and abjection, one which produces a constitutive

outside to the subject, an abjected outside, which is, after all, inside the subject at its own

founding repudiation.134 Butler, then, would locate the difficulty of imagining others at our

founding repudiation: we must exclude and abject others in order to form our individual

subjectivities, and the abjected outside that delineates our borders also becomes inwardly

constitutive. This both constrains and opens up strategies for us as we seek new ways to

understand and relate to each other. So long as remain intelligible and individual Is, we cannot

stop excluding or abjecting others. However, these operations of exclusion are reiterative,

pointing to possibilities of challenging normative and exclusionary social discourses such as

133
Butler, 2.
134
Butler, 3.
 77

gender. This is why Butler calls on us to not only interrogate bodies that are constructed but also

the bodies that are not constructed and further, to to ask after how bodies which fail to

materialize provide the necessary outside, if not the necessary support, for the bodies which, in

materializing the norm, qualify as bodies that matter.135 In thinking about bodies that fail to

materialize, we can better understand the forces of exclusion and abjection that originate our

issue surrounding the difficulty of imaging others.

Through Butlers framework, we can see that asking about the difficulty of imagining

others is a question that obscures the location of the other: in the process of abjecting, we believe

that we have located the other in the outside, uninhabitable area of social life that requires

imagination to access, but because this abjection is constitutive of ourselves, it in fact exists

within us. The difficulty of imagining others may be an inevitable impossibility of imagining

difference, but it is also the difficulty of articulating the other within ourselves.

Though bodies exist on a continuum of variation, we rely on cultural categories to parse

ourselves and others into generalizable groups. This cognitive process gives us conceptual tools

to grip onto in thinking, at an abstract and therefore more accessible level, about the diversity of

human experience, yet this is also the level at which political oppression of and biopolitical

control over populations operate. Political strategies centered around empathetic imagination are

not productive or sustainable, for they reinforce rather than nuance difference and obscure

systems of power that profit from such divisions. This, however, does not invalidate the

importance of answering Jamisons question: how can we give voice to female pain when we

routinely fetishize and mythologize the wounded woman and when speaking to female pain often

amplifies this myth?

135
Butler, 16.
 78

Her question ties closely to one that scholars David Mitchell and Sharon Snyder confront

in their field of disabilities studies, an academic field where the focus on the continued

oppression of nonnormative bodies can help us think about how the modern body continuously

establishes a normative embodiment and marginalizes those who deviate from it. In Cultural

Locations of Disability, Mitchell and Snyder name the cultural predicament of disability as the

paradox of devaluation in the midst of perpetual discussion about the meaning and treatment of

disability What does one do when confronted with too many studies and not enough

meaningful insight?136 In their study tracing the cultural spaces developed especially for people

with disabilities, Mitchell and Snyder argue that modern medicine often oppresses disabled

people through invasive research on their bodies. Though this scientific research focuses on their

bodies as sources of embodied knowledge, such research continues historical efforts to

concretize cultural fantasies about biological difference137 and treat disabled bodies as

objects rather than agents of research. Medical classifications of deviance not only enact

pathology within disabled bodies (and compels compliance through the form of treatment) but

also enable cultural fetishes that deny the agency of disabled people in collective understandings

of disabled bodies.

In the face of this oppression, people and bodies with disabilities remain important

political sites of resistance and insurrection, because they will always exist outside of acceptable

embodiments, border the definition of the modern body, and occupy spaces that are unproductive

for a nation and economy built around modern bodies. In their later book, The Biopolitics of

Disability, Mitchell and Snyder further theorize disability as nonnormative bodies that hold the

potential to force the collapse medical categories of deviance through the weight and pluralities

136
Mitchell, Cultural Locations of Disability, 20.
137
Mitchell, Cultural Locations of Disability, 34.
 79

of permutating embodiments. Mitchell and Snyder examine online patient-expert groups (PEGs)

as a forum for expressing human variation (a variation so expansive that it threatens to

destabilize medical classifications) and an example of the creative capacity of disabled people

(whose bodily relations are so anomalous that they bring new bodies into being).138 PEGs are

online groups of parents, caregivers, physicians, researchers, and people with the impairment

who trade information, experiences, and tips about a specific impairment. In their study of PEGs

for people with esophageal atresia, Mitchell and Snyder find that the extensive sharing of various

narratives and perspectives result in losing voices into the ether of the infinite variations

comprising human embodiments. This consequent chaos has a productive potential, however, in

that it serves as a force that undo norms rather than simply expand them.139 Users anonymous

stories and exchanges multiply the forms of existence and experience of a single medical

category, proliferating what counts abnormal to the point where specifying debility becomes

impossible and the identity categories become unwieldy. It is Mitchell and Snyders political

vision that such strain might increase to the point of the collapse of medical classifications and

the normative values of ability and disability. PEGs, then, can be viewed as radically political

and epistemologically productive sites, because they push the level of individual differentiation

and produce greater appreciation for variation. PEGs perform what Mitchell and Snyder believe

is a crucial tenet of disability studies: bringing new bodies into being through revelations of

ways to creatively navigate an inaccessible world with a significantly stigmatized body.140

This political strategy offers a more forceful and oppositional approach to deconstructing

the modern body and its consequent coercion and discipline. Disability studies also point to the

138
Mitchell, The Biopolitics of Disability, 177.
139
Mitchell, The Biopolitics of Disability, 177.
140
Mitchell, The Biopolitics of Disability, 178. Mitchell and Snyder cite Michael Warner, Trouble with Normal
(Cambridge: Harvard University Press, 2003), 12.
 80

ableist obstruction and marginalization inherent to strategies of open hearts and imagining

others: to see ourselves as receivers of and imaginary creators of others presumes that the task

of sharing otherized pain falls on those who are other. Our responsibility is not so much to be

empathetic towards difference and to imagine (and to fetishize) it, but to actively seek and

embrace it and to understand that nuance permeates all life and all society, a universality that has

been constantly hidden by neoliberal and capitalist organizations of society in order to maximize

production and to normalize this state of maximal production. Mitchell and Snyder specifically

criticize the neoliberal promise of inclusion, which involves accepting select forms of

difference by making those differences unapparent in ones ability to participate in normative

modes of production. Meaningful inclusion is only worthy of the designation inclusion if

disability becomes more fully recognized as providing alternative values for living that do not

simply reify reigning concepts of normalcy.141 Within neoliberal contemporary society,

disability articulates the unrealizable project of the modern body and speaks to the ongoing

refusal to recognize nonnormative modes of being. The act of bringing new bodies into being (of

expressing and proliferating differential embodiments, from the people who live and directly

experience those embodiments) thus offers a creative potential for living outside of the bounds of

modernity as definitional purity and internalized discipline. Rather than understanding

disabilities as socially constructed, Mitchell and Snyder study disabilities through a cultural

model that situates physical and cognitive impairments as real experiences with logistical and

practical consequences.142 One important consequence is that individual experiences of body

impairments and the social understandings of the body produce knowledge of and from

disability: impaired embodiment points to how bodies require discursive work to become legible,

141
Mitchell, The Biopolitics of Disability, 5.
142
Mitchell, Cultural Locations of Disability, 10.
 81

stable, and normal. This never-ending project to make bodies with impairments intelligible and

to live with impairments is profoundly knowledge-generating and creative. Embodiment is a

never-ending process, as bodies are reiteratively materialized and as culturally available modes

of being are continually shaped and defined.

Disability, which medicine and current political structures see as a form of difference that

only seeks to be undone, also points to the inevitable failures of economic systems that seek

conformity and infinitely increased production. The myth of female pain is akin to the neoliberal

promise of inclusion of disabled people for both, while pretending to raise awareness of specific

issues, only reify normative behavior. Mitchells and Snyders work on disabled bodies offers a

viable approach to the issue of menstruation and primary dysmenorrhea, as we can begin to

understand both of these medical concepts as classifications to begin straining through the

proliferating expression of variant menstrual and dysmenorrheic embodiments. However, unlike

bodies with disabilities or impairments which are systematically deemed abnormal, bodies

experiencing menstruation and menstrual pain stand at the dual site of variant embodiment that is

both pathologized and normalized. Menstruators and people experiencing primary dysmenorrhea

do not face the same political, social, or economic oppression as many disabled people do, and

therefore, care must be taken not to appropriate the tactics and resources of disabilities studies

and not to privilege the issue of menstruation at the expense of the expression of other

embodiments.

As weve seen, the project of the modern body can and must be opposed on multiple

fronts. Embodiment is a continuous project of constituting and reconstituting the body,

presenting numerous sites for contestation and intervention. This ties closely to the Brazilian

idiom of being produzida, or produced. For anthropologist Emilia Sanabria, produzida

 82

symbolizes the plasticity of bodies and refers to the elaborate panoply of hygienic and esthetic

procedures that women adopt before a date, a party, or other public events. The idea is not of

aligning the body with a preexistent real self. It is about making producing a body in a

rather distinct way.143 The produced body in Sanabrias studies is understood as malleable and

plastic, as readily open to biomedical interventions which formulate the body and its boundaries,

rather than breaching them.

Sanabria investigates menstrual suppression in the Brazilian city Salvador da Bahia,

where hormonal contraceptives are widely prescribed and used for controversial aims including

regulating and suppressing menstruation, body shape, mood swings, and libido. Adolescents are

often prescribed hormonal contraceptives before menarche in order to delay their first period,

manage irregular menstrual bleeding once their periods do start, and to prevent acne. Dr. Elsimar

Coutinho, the Brazilian gynecologist who first argued that periods are obsolete and should be

suppressed through contraceptives, operates a private gynecological clinic and research center in

Bahia. Coutinho is a locally and globally recognized advocate of menstrual suppression as a

means to free women from menstruation and menstrual cycle-related health disorders. Despite

medical and political controversies surrounding menstrual suppression,144 menstrual suppression

is common in Bahia. Off label uses of these hormones abound as well. For example, travestis, as

they refer to themselves, are people assigned male at birth who take female sex hormones to

transform their bodies.145 Brazilians participate in procedures of bodily intervention, such as

taking sex hormones and undergoing cosmetic surgery, at much higher rates than in the U.S. In a

143
Sanabria, 191.
144
Coutinho has controversially proposed administering low-income teenage girls a low dose of the contraceptive
Depo-Provera to curb teen pregnancy. Additionally, the long-term health consequences of continuous dosages of
hormonal contraceptives remain unclear and understudied.
145
Sanabria, 21.
 83

country where the body has a plastic ontology open to change and improvement, the distinctions

between cosmetic, medical, and hygienic procedures are considerably blurred as nearly all

interventions are presented as ways to improve ones self-esteem and quality of life.146 Sanabria

argues that, for Brazilians, there is no natural body to return to, and instead, such bodily

interventions are interpreted as producing a certain body in order to attain certain identities,

social positions, or improvements in quality of life. Bahians do not participate in a discourse or

invest in a pretense that enacts the body as ontologically pure or stable, and they are therefore

less delusional about the plasticity of their bodies than their Western counterparts are.147

Because of their fluidity in interpreting the body, The Bahians offer an alternative

approach of menstruation and menstrual fluids. In Brazil, women routinely undergo

gynecological examinations and other clinical encounters such as family planning consultations

and IUD consultations. In these clinical settings, Sanabria observed:

Menstrual blood is seldom a cause of disgust in clinical contexts, although it is also

carefully managed here. Jokes or comments are a means of circumscribing this blood.

[] In my experience, when menstrual blood formed part of the medical examination, it

was normal and not a cause of disgust for doctors. One doctor did not even use gloves for

IUD removals or insertions, although her dexterous use of the instruments meant her

hands did not come into direct contact with the patients body or bodily products.

Similarly, during vaginal or cesarean births, blood flows freely, often onto the

obstetricians ward-clothes or shoes, with no apparent discomfort.148

146
Alexander Edmonds and Emilia Sanabria, Medical Borderlands: Engineering the Body with Plastic Surgery and
Hormonal Therapies in Brazil, Anthropology & Medicine 21, no. 2 (2014): 202-16.
147
Sanabria, Plastic Bodies, 197.
148
Sanabria, Plastic Bodies, 61-2.
 84

The medical protocols that produce the patients as bodies legitimate menstrual fluids as a neutral

bodily product. Clinical set ups, medical procedures, and comments from doctors stabilize and

materialize menstrual blood. Outside of these processes, when the full social person reappears,

menstrual blood is commented on in a way that signals a move from the blood legitimate within

normal clinical practice to the more ambivalent blood of the person.149 The clinic thus becomes

a unique place where menstrual fluids can flow without stigma, but only through the discursive

and logistical work that circumscribes and confines menstruation into an acceptable and

manageable space. The vagina, as a liminal and ambiguous site that straddles the bodily interior

and exterior, is likewise subject to close regulation and practices that render it more acceptable.

Its perceived openness or closedness is carefully negotiated both in medical settings and social

contexts. Sanabria observed that while doctors encourage their patients to relax and open their

vaginas during gynecological examinations, this also provided doctors the opportunity to judge

the laxness of the patients genitals. For example, she noted following one medical procedure in

a public hospital:

[The patient] lay unconscious on the examination table of a public hospital. The marks on
her body gave an indication of her humble background. The doctor called my attention to
the limpness of her transverse perineal muscles. Pointing to the way that the musculature
had sagged, he inserted three gloved fingers into the patients vagina, shaking them
while stating: Olha pra essa vagina to frouxa, os msculos esto todo afastados, essa
mulher deve ter parido um bocado de filhos [Look at this totally loose vagina, the
muscles are all tax, this woman must have birthed a bunch of children]. This lax vagina
seemed to index for the doctor what many middle-class Bahians see as an unbridled
reproductive capacity among the poor.150

For Bahian women, being open or closed through their genitals are both valued in different

moments, and this speaks to their understanding of their bodies as continuously produced.

Understandings of a womans sexuality, class position, and personality stem from how open or

149
Sanabria, Plastic Bodies, 62.
150
Sanabria, Plastic Bodies, 64.
 85

closed her body is interpreted to be. Even as menstrual fluids serve as a symbol for how open a

persons body is, menstruation refuses a clear boundary between interior and exterior and

therefore a definite answer to how closed a body is. Despite the persistence of cultural and

medical management of menstruation, from taboos to comments such as the one made by the

physician above to medical inscriptions like PMS and dysmenorrhea, menstruation nonetheless is

symbolically and materially uncontainable. This is, not, however to discount medicines ability

to regulate and discipline menstruation. As Sanabria alludes to, menstrual fluids can quickly

transition from the acceptable blood of a patient to the ambivalent blood of a person and social

agent. This transition attests to medicines doubleness: it can treat a body without shaming it and

simultaneously problematize and pathologize that same body. As a result, for the Bahians who

understand the body as always becoming, medicine plays a key role in allowing women to obtain

and produce new embodiments without inhibition or guilt. However, these new embodiments

come at the expense of the stigmatization and marginalization of other types of embodiments,

not to mention the sexist, racist, and classist reasons that make certain embodiments valued over

others.

Understanding this tension presents an opening into interrogating discourses that enact

stable bodies and mask the plasticity and production of modern bodies. Such discourses follow

the belief that individual subjectivity emerges from visceral interiority, which must then be

carefully managed and monitored. This highly connected and closely regulated relationship

between personhood and body characterizes the modern body, which derives much of its

normative power by interpreting bodily deviance as an individuals personal failure to follow

social, political, and capitalist norms. Within such a context, menstrual fluids become more than

bodily products. Their emission and outward flow, linked symbolically to female sexuality and
 86

the fecund body, attest to the impossibility of a clearly bounded body and furthermore to the

futility of constituting autonomous, proper personhoods. The project of the modern body

operates at the muddy boundary between bodily interior and exterior, policing the menstrual

fluids that flow outwards and encouraging the use of medical treatments that penetrate inwards in

order to stabilize its specific mode of bodily discipline. While medicine instantiates a particular

mode of being, menstruation as persistent (material and symbolic) seepage offers the opportunity

to bring new bodies into being.

Though medicine sustains the modern body at the expense and oppression of other

discourses and embodiments, it likewise offers opportunities to support nonnormative and

variant embodiments. Inextricable from our understanding of self and body, medical ways of

thinking cannot be abandoned and can inform interventions into the modern body, from

disabilities research to menstrual management. Medicine can serve as a tool for producing

knowledge and respect for variant embodiments, but doing so requires undermining its

epistemological operation of norms, deviance, and pathology that produce the modern body. The

devaluation of disabled bodies and menstruating bodies in part results from a medical imperative

to undo difference, and the medicine that pathologizes variance needs to be transformed into a

medicine that yields the ability to study, respect, and support difference. The question, of course,

is how. As we can learn from the Bahians, there exists within medicine the space for new

conceptions of the body. There is room to maneuver and to learn from nonnormative and variant

embodiments, deemed unfit for full participation in society, which are creative sources of

knowledge and unproductive and nonproductive labor. Yet a consequence of appreciating and

incorporating this knowledge and nonproductive labor into medical frameworks is the extension

of medical policing and discipline. Much of what makes medicine powerful and beneficial is its
 87

ability to closely observe and regulate the body to enforce a normative standard of health and

productivity. Without changing this standard, the appeal and disciplinary power of the modern

body still stands. Insights from nonnormative and variant embodiments point to new spaces and

strategies from which to challenge the modern body and to transform medicines disciplinary

practices and language of pathology.

Having detoured significantly, we now return to our original question: How can we talk

about primary dysmenorrhea in a way that respects individuals experiences of menstrual pain

and leads to better medical treatment, without fetishizing menstrual pain as a cultural trope about

women? Though there is no full answer, we have at least a starting point: understanding and

shaping subjectivities and cultural narratives of such subjectivities begin with the body and not

through its transcendence or abandonment.

Rather than repudiating medicine and the bodily borders it instantiates, we must take

responsibility for where and how we draw those borders. The discourse that creates cultural

locations and medical classifications for disabled and menstruating people must center their

voices. Mitchell and Snyder observe that medical research continues the oppression of people

with disabilities by identifying them as objects, rather than agents, of research. The devaluation

of disabled bodies stems from a wide chasm between those who conduct this research and those

who are researched. Bridging this gap is a key, if incredibly difficult, political struggle over who

gets to define cultural understandings of the body, but bringing such discourses ever closer to

these sites of the marginalized performs important deconstruction of ontological categories that

facilitate the labeling, marginalization, and erasure of populations of people.

 88

To apply this insight to our understanding of menstrual politics, research and public

discussion about dysmenorrhea should center the voices of menstruators and menstruators-in-

pain. Importantly, this means that cultural stereotypes of who menstruate which foster

discrimination against menstruators who do not fit these stereotypes must be dismantled. It

bears repeating that not all women menstruate and that not everyone who menstruates is a

woman, and uncoupling menstruation from womanhood is an important step to studying,

researching, and talking about menstruation and dysmenorrhea in ways that do not fetishize

female pain and bodies.

Degendering menstruation is, however, just one way of respecting the variation of

experiences and identities surrounding menstruation and of reinterpreting deviant and

pathologized bodies as variant, fluctuating, and innovative forms of being. The modern body

interprets health as the ability to work productively and efficiently within capitalist economies,

and nonnormative bodies are often unhealthy in so far as they do not supply productive labor.

Menstruators must pass as non-menstruating in order to be productive and in order to be granted

access to public spaces like the workplace and the classroom. These forms of corporeal coercion

deny nonnormative bodies as sources of embodied knowledge about innovative and alternative

navigation of life. Disabilities, impairments, and physiological fluctuations can therefore disrupt

and resist systems of discipline and oppression that privilege normative and modern bodies.

Interrogating the marginalization and devaluation of these bodily phenomena opens

investigations into the capitalist and neoliberal systems that underwrite the modern body and its

discipline.

Cultural taboos of menstruation and the cultural silence surrounding menstrual pain

circumvent and devalue the dissemination of embodied knowledge produced from menstrual
 89

experiences. Medical classifications and metaphors facilitate such devaluation, not only by

pathologizing bodily deviance, but also by informing cultural tropes of PMS and female pain.

Thus, cultural narratives about menstruation and menstrual pain should move away from

monolithic biomedical definitions and instead towards a proliferation of permutating

embodiments that hobble the definitional power of medical categories. I am ultimately arguing

for individual and collective awareness and resistance to medical and public discourse that

establishes our bodies rigid, stable, and modern and our embodied variations and bodily seepages

as deviance. Menstruation attests to the futility of the disciplinary forces of the modern body and

presents diverse ways forward to theorizing and understanding our bodies.


 91

References

Arata, Luigi. Menses in the corpus Hippocraticum. In Menstruation: A Cultural History,

edited by Andrew Shail and Gillian Howie. Basingstoke: Palgrave Macmillan, 2005.

Aristotle. On the Generation of Animals. In Complete Works of Aristotle, Volume 1: The

Revised Oxford Translation, ed. Jonathan Barnes. Princeton: Princeton University Press,
2014.

Aryan, Murat, Erkan Sogut, Ufuk Tas, Fikret Erdemir, Mehmet Sahin, Mustafa Suren,
Ziya Kaya, and Fazl Demirturk. Pain levels associated with renal colic and primary
dysmenorrhea, Archives of Gynecology and Obstetrics 286, no. 2 (2012): 403-9.

Benedek, Therese. Parenthood as a Developmental Phase: A contribution to the libido theory.

Journal of American Pschoanalytical Association 7, no. 3 (1959): 389-417.

Berkely, Karen. Primary Dysmenorrhea: An Urgent Mandate. International Association for the
Study of Pain 21, no. 3 (2013).

Berkley, Karen and Stacy McAllister. Dont Dismiss Dysmenorrhea! Pain 152, no. 9 (2011):
1940-1.

. Primary Dysmenorrhea: An Urgent Mandate, International Association for the Study

of Pain 21, no. 3 (2013).

Blakinger, Keri. A Look at How New York Houses Trans Inmates. NY Daily News, February
11, 2016.

Bobel, Chris. New Blood: Third-Wave Feminism and the Politics of Menstruation (New
Brunswick: Rutgers University Press, 2010).

Buchan, William. Domestic medicine; or the prevention and cure of diseases. London: A.
Straman, 1784.

Butler, Judith. Bodily Inscriptions, Performative Subversions. In The Judith Butler Reader, ed.
Janet Price, Margrit Shildrick. (New York: Routledge, 1999), 90-118.

. Bodies That Matter: On the Discursive Limits of Sex. New York: Routledge, 2011.

Campbell, Mary Ann and Patrick McGrath. Non-pharmacologic strategies used by adolescents
for the management of menstrual discomfort. Clinical Journal of Pain 15, no. 4 (1999):
313-20.

Canguilhem, Georges. The Normal and the Pathological. Cambridge: Zone Books, 2007.

Cellucotton Products advertisement, The Cosmopolitan, February 1922.

Chen, Esther, Frances Shofer, Anthony Dean, Judd Hollander, William Baxt, Jennifer Robey,
Keara Sease, Angela Millis. Gender Disparity in Analgesic Treatment of Emergency
 92

Department Patients with Abdominal Pain. Academic Emergency Medicine 15, no. 5
(2008): 414-8.

Clarke, Edward. Sex in Education; or, A fair chance for girls. Boston: Houghton Mifflin, 1884.

Crawford, Patricia. Attitudes to Menstruation in Seventeenth-Century England. Past & Present

91 (1981): 47-73.

Dalton, Katharina and Raymond Greene. The Premenstrual Syndrome. British Medical
Journal 9, no. 1 (1953): 1007-1014.

. Effect of menstruation on schoolgirls weekly work. British Medical Journal 1, no.

5169 (1960): 326-328.

. Menstruation and crime. British Medical Journal 2, no. 5269 (1961): 1752-53.

. Once a Month: Understanding and Treating PMS. Alameda: Hunter House, 1999.

Dean-Jones, Lesley. Menstrual Bleeding According to the Hippocratics and Aristotle.

Transactions of the American Philogocail Association 119 (1989), 177-8.

Direkvand-Moghadam, Ashraf, Kourosh Sayehmiri, Ali Delpisheh, and Satar Kaikhavandi.

Epidemiology of Premenstrual Syndrome. Journal of Clinical and Diagnostic Research
8, no. 2 (2014): 106-109.

Douglas, Mary. Purity and Danger: an analysis of concepts of pollution and taboo. New York:
Routledge, 2015.

Edmonds, Alexander and Emilia Sanabria. Medical Borderlands: Engineering the Body with
Plastic Surgery and Hormonal Therapies in Brazil. Anthropology & Medicine 21, no. 2
(2014): 202-16.

Emmet, Thomas. The Principles and Practice of Gynaecology. Philadelphia: H. C. Lea, 1879.

Eryilmaz, Gulsen, Funda Ozdemir, and Turkan Pasinlioglu. Dysmenorrhea prevalence among
adolescents in eastern Turkey: its effects on school performance and relationships with
family and friends, Journal of Pediatric and Adolescent Gynecology 23, no. 5 (2010):
267-72.

Ewell, Thomas. Letters to Ladies. Philadelphia: W. Brown, 1817.

Ewing, Ruth. A Study of dysmenorrhea at the home office of the Metropolitan Life Insurance
Company. Journal of Industrial Hygiene 13, no. 7 (1931).

Fausto-Sterling, Anne. Sexing the Body: Gender Politics and the Construction of Sexuality. New
York: Basic Books, 2000.

Figert, Anne. Women and the Ownership of PMS. Berlin: A. de Gruyter, 1996.
 93

Foucault, Michel. The Eye of Power. In Power/Knowledge: selected interviews and other
writings, 1972-77, ed. Colin Gordon. New York: Pantheon, 1980: 146-166.

Foucault, Michel. The Birth of the Clinic. New York: Routledge, 2010.

. Discipline and Punish (New York: Vintage Books, 2009).

Frank, Robert. The hormonal causes of premenstrual tension. Archives of Neurology &
Psychiatry 26, no. 5 (1931), 1053-57.

Freidenfelds, Lara. The Modern Period: Menstruation in Twentieth-Century America. Baltimore:

Johns Hopkins University Press, 2009.

Galen. On the Natural Faculties, translated by A. J. Brock. Cambridge: Harvard University

Press, 1916.

Goldhill, Olivia. Period pain can be almost as bad as a heart attack. Why arent we
researching how to treat it? Quartz, February 15, 2016.

Hamlin, Kimberly. From Eve to Evolution: Darwin, science, and womens rights in Gilded Age
America. Chicago: University of Chicago Press, 2015.

Haraway, Donna. A Cyborg Manifesto: Science, Technology, and Socialist-Feminism in the

Late Twentieth Century. In Simians, Cyborgs and Women: The Reinvention of Nature.
New York: Routledge, 1991.

Hoffmann, Diane and Anita Tarzian. The Girl Who Cried Pain: A Bias Against Women in the
Treatment of Pain. Journal of Law, Medicine, and Ethics 29 (2001): 13-27.

Iacovides, Stella and Ingrid Avidon, and Fiona Baker. What We Know About Primary
Dysmenorrhea Today. Human Reproduction Update 21, no. 6 (2015): 762-78.

Jacobi, Mary. The Question of Rest for Women During Menstruation. New York: G. P. Putnams
Sons, 1887.

Jamison, Leslie. Grand Unified Theory of Female Pain. In The Empathy Exams. Minneapolis:
Graywolf Press, 2014.

Kotex advertisement, Macleans, February 1925.

Kristeva, Julia. Powers of Horror: An Essay on Abjection. New York: Columbia University
Press, 2010.

Lander, Louise. Images of Bleeding: Menstruation as Ideology. Orlando: Orlando Press, 1988.

Latour, Bruno. We Have Never Been Modern. Cambridge: Harvard University Press, 2002.

Latthe, Pallavi and Rita Champangeria. Dysmenorrhea in British Medical Journal Clinical
Evidence Handbook, American Family Physician 85, no. 4 (2012): 386-387.
 94

Latthe, Pallavi, Manish Latthe, Lale Say, Metin Glmezoglu, and Kahlid Khan. WHO
systematic review of prevalence of chronic pelvic pain: a neglected reproductive health
morbidity. BMC Public Health 6, no. 1 (2006): 177.

Laws, Sophie. Issues of Blood: The Politics of Menstruation. London: Macmillan Publishers,
1996.

. Seeing Red: The Politics of Premenstrual Tension. London: Hutchinson, 1985.

MacKinnon, P.C.B. and I. L. MacKinnon. Hazards of the menstrual cycle. British Medical
Journal 1, no. 4966 (1956).

Markens, Susan. The problematic of experience: a political and cultural critique of PMS.
Gender & Society 10, no. 1 (1996): 42-58.

Martin, Emily. Premenstrual Syndrome, Work, Discipline, and Anger. In The Socialist
Feminist Project, ed. Nancy Holmstrom. New York: Monthly Review Press (2002): 63-
71.

. The Woman in the Body. Boston: Beacon Press, 2003.

McClive, Cathy. Menstruation and Procreation in Early Modern France. New York: Routledge,
2016.

Michelle Proctor, Michelle and Cynthia Farquhar. Diagnosis and Initial Management of
Dysmenorrhea in British Medical Journal, American Family Physician 89, no. 5 (2014):
341-346.

Mitchell, David, and Sarah Snyder. Cultural Locations of Disability. Chicago: University of
Chicago Press, 2015.

. The Biopolitics of Disability. Ann Arbor: University of Michigan Press, 2015.

Moos, Rudolf. The development of menstrual distress questionnaire. Psychosomatic Medicine

30, no. 6 (1968): 853-67.

Mosher, Clelia. Functional Periodicity in Women and Some of the Modifying Factors.
California State Journal of Medicine 9, no. 2 (1911): 5-8.

OHara, Mary. The Trans Broken Arm Syndrome and the way our healthcare system fails
trans people, The Daily Dot, June 16, 2016.

Offman, Alia and Peggy Kleinplatz. Does PMDD belong in the DSM? Challenging the
Medicalization of Womens Bodies, The Canadian Journal of Human Sexuality 13, no.
1 (2004): 17-26.
 95

Ortiz, Mario, Eduardo Rangel-Flores, Lourdes Carrillo-Alarcn, and Humberto Veras-Godoy.

Prevalence and impact of primary dysmenorrhea among Mexican high school students.
International Journal of Gynecology and Obstetrics 107, no. 3 (2009): 240-3.

Parker, A. The premenstrual tension syndrome. Medical Clinics of North America 44 (1960):
339-348.

Parlee, Mary. Stereotypic beliefs about menstruation: a methodological note on the Moos
menstrual distress questionnaire. Psychosomatic Medicine 36, no. 3 (1974): 229-40.

. The Premenstrual Syndrome. Psychological Bulletin 80, no. 6 (1974): 454-65.

Read, Sara. Thy Righteousness is but a menstrual clout: Sanitary Practices and Prejudices in
Early Modern England, Early Modern Women 3 (2008): 1-25.

Riedel, Sam. Yes, Trans Women Can Get Period Symptoms. The Establishment, May 31,
2016.

Robinson, William. Sex Knowledge for Women and Girls. New York: Critic and Guide
Company, 1917.

Rodin, Mari. The Social Construction of PMS, Social Sciences and Medicine 35, no. 1 (1992):
49-56.

Rose, Nikolas. Inventing Ourselves: Psychology, Power and Personhood. Cambridge:

Cambridge University Press, 1998.

Sanabria, Emilia. Plastic Bodies: Sex Hormones and Menstrual Suppression in Brazil. Durham:
Duke University Press, 2016.

Scarry, Elaine. The difficulty of imagining other people, in For Love of Country? ed. Martha
Nussbaum and Joshua Cohen. (Boston: Beacon Press, 2002).

Silverthorn, Dee U. and Bruce Johnson. Human Physiology: An Integrated Approach. Pearson
Learning Solutions, 2016.

Stein, Elissa and Susan Kim, Flow: The Cultural History of Menstruation (London: Macmillan,
2009).

Sturgis, M.C.Observations on dysmenorrhea occurring in women employed in a large

department store. Journal of Industrial Hygiene 5, no. 2 (1923), 53-56.

Tanner, V. Why We Must Stop Calling Menstruation a Womens Issue. The Establishment,
May 25, 2016.

Tilt, Edward. The change of life in health and disease. London: John Churchill, 1857.

Ussher, Jane. Managing the Monstrous Feminine. New York: Routledge, 2006.
 96

Vostral, Sharral. Under Wraps: A History of Menstrual Hygiene Technology. Lanham: Lexington
Books, 2011.

Waitzin, Howard. A critical theory of medical discourse. Journal of Health and Social
Behavior 30, no. 2 (1989).

Welke, Barbara. Laws and Borders of Belonging. Cambridge: Cambridge University Press, 2010.

Whitehead, R.E. Women pilots, Journal of Aviation Medicine 5 (1934): 47-49.

Wong, Li Ping and Ee Ming Koo. Dysmenorrhea in a multiethnic population of adolescent

Asian girls. International Journal of Gynaecology and Obstetrics 108, no. 2 (2010):
139-42.

Ylikorkala, Olavi and M. Yusoff Dawood. New Concepts in Dysmenorrhea. American Journal
of Obstetrics and Gynecology 130, no. 7 (1978): 833-47.