Erasure of Pain: Primary Dysmenorrhea and Mental Health
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Sachdeva, N(2020, October 14). Erasure of Pain: Primary Dysmenorrhea and Mental Health. https://www.beyondblood.org/post/erasure-of-pain-primary-dysmenorrhea-and-mental-health
Historically, women’s very existence in society has been subject to impositions and control by men. Second-wave feminists have argued about the reproductive roles played by women, often with no personal choice, which reduces them to birthing and caregiving roles, delegating them a weaker status because of their biology. The confinement to the private sphere and forced caregiving has left little space for any considerations for the health of women. Women’s health issues have been downplayed by men, often scapegoated as mechanisms to reinforce gender roles in the society. The narrative created in the society that continuously presents women to be weak, physically and emotionally, has created skewed perceptions of their health issues and its treatment. Seeing this, it does not come as a shock when one analyzes the trivial status menstruation has been relegated to in the male-dominated world of medical science. Menstruation has been a taboo for centuries and continues to be so.
Mental health experiences of women have been explained by men as issues originating from and because of their different biology and hormones, rather than as a result of their lived realities and oppressive interactions with families and the patriarchal society at large. Psychiatry, again dominated by men, has maintained its biases against women, Freud’s  view of women is one such example. His idea of castration anxiety translated into penis envy for women as he continued, through his work to paint women in an inferior light, down to their reproductive functions, immorality and plagued by their repressed sexual desires.     When the female orgasm, unless achieved through vaginal stimulation, whether it was mastubration, queer sex or clitoral was considered as a masculine imbalance, women’s body have been subject to only the male perspective to be less of, to be alien and to be ignored the legitimate concerns and issues of.
The common understanding about women’s bodies and their unique and distinct processes have been largely formulated in fields almost universally dominated by men, and the impact of that is created by forming misleading narratives about women’s bodies is still felt by women. The emphasis on the notion that menstruation is an experience that is universally attached to the very identity of being a woman, and the normalisation of menstrual pain, and in some cases, the romanticization of health problems emanating from menstruation as a part of the experience of being a woman, a body meant for reproduction and endurance, are just some examples. Hence, it is clear that the domain of menstruation and mental health is riddled with obstacles of medical gaslighting and erasure of physical, mental and emotional pain. This proves worse for people who experience menstruation but do not fall into the category of “women”.  The following attempts at understanding the effects of the erasure of pain in primary dysmenorrhea on mental health.
Menstruation is considered a taboo in a number of communities and cultures. Many communities in India, for instance, consider periods as impure. Hence, menstruation has a history of being shrouded in shame. Despite decades of research confirming the physical and psychological experiences around menstruation, premenstrual and menstrual conditions, acceptance of menstruation as a process is still pushed to the private domain and treated with shame. The common consensus around menstruation clearly dictates that it is best kept out of public sight and mind, this is seen in the way menstruation is talked about in private and public spaces. At home, menstruation is not adequately addressed, all discussions from menarche to menopause are done in hushed tones, despite any experience of pain, women are expected to perform their household and caregiving roles. Discussions of menstrual cycles do not always find place between intimate partners either. Outside of the home, a series of attitudes towards hiding all signs of menstruation are normalised, for instance, sanitary pads being hidden in black plastic bags, having separate sessions on periods only for girl students in schools, restricting oneself to home remedies for menstrual pain and insufficient sharing of the emotional and psychological pain before and during periods. There has been an active discourse on how advertisements for period products shape the perception of period. In India, a woman who initially feels the intense fear of staining her clothes is seen happy and confident, hustling and achieving in bright white pants because her friend secretly handed her the best brand of sanitary pads. Pain, PMS, PCOS, and menstruators who do not fit into the conventionally looks of a woman find no place or representation.
Medically, while there are a number of explanations of menstruation and menstrual conditions, the deeply entrenched gender bias results in less research. The themes relating to menstruation have been relegated such a secondary status that they were not seen worthy of feminist scholarship as well, up until the 1980s. While new research is being created at an astoundingly slow rate, the existing research is not easily accessible, and sometimes biases persist despite the research. Period pain, dysmenorrhea is a common experience for menstruators across the world. Dysmenorrhea is of two kinds, primary and secondary. While the secondary kind is caused by conditions such as endometriosis, the primary kind is said to have no distinguishable and identifiable cause behind it. However, an abundance of research has shown primary dysmenorrhea and its effect on mental health.
The limited research shows some possible reasons behind the kind of pain that an individual experiences with primary dysmenorrhea, some of the contributing factors being family history and stress. Pain catastrophizing, which is a negative view of pain, makes the experience of pain worse. (Walsh et al, 2003) This means that a person who is stressed by the idea and experience of pain is likely to experience worsening of the pain. The worst experience of pain will further affect their overall stress level and start a cycle of worsening pain and stress levels. Simply put, the anticipation of period pain acts as a trigger for creating distress, which then amplifies the pain that the individual is already experiencing.
The anticipation of the experience of the worst form of pain is bound to create anxiety for the person, since they cannot anticipate the degree of pain and mobilize sufficient resources to deal with it. The lack of attention attributed to the seriousness of the period pain by family, peers and medical professionals is an important factor here. The ingrained idea of endurance of the pain can further restrict the individual from seeking any help at all. The stigma attached to menstruation does not aid the process of seeking help, when the person does not find the environment at home, school or work welcoming enough to disclose they are going through their period and the pain that comes with it. Stigmatising and dismissing period pain which comes from the private and the public space leaves the individual alone with the experience of period pain and pain catastrophizing. Both of which would otherwise require work with medical and mental health professionals. The inequality of access to healthcare in the country which already undermines the health issues of womxn and persistently gaslights them makes the situation far worse.
Primary dysmenorrhea research in India, though limited has focused on how the condition affects the quality of life. (Shewte & Sirpurkar, 2016) set in central India suggests the correlation of primary dysmenorrhea and mental health, as the subjects of the study who experience higher levels of pain have lower Health-related quality of life (HRQoL)levels. Similarly, (Sharma et al, 2008) set in Delhi shows that experiencing pain with primary dysmenorrhea severely affects the quality of life in terms of everyday routine and productive days of study and work. Both of the studies done in India, are set in medical colleges where the subjects have knowledge of menstruation and the treatment for their conditions, whether active or passive, remedies or allopathic solutions. However, these researches are limited to a particular strata, and hence the applicability of the results cannot be univocal. This does not represent the diverse population and their varied experiences of womxn living in diverse conditions.
The experience of pain leads to absenteeism and hence loss of number of working days. (Iacovides et al., 2015) The implications of this can range from the reluctance of employers to hire female employees and difficulty in coping with work, especially in the unorganised sector and insecure jobs which do not provide for the security of the employees. In addition to this, those who experience the pain are likely to be agitated and experience anxiety and depression.
While the effect of primary dysmenorrhea has been proven, there are two conditions which are likely to make it worse for the menstruator, both pertaining to the erasure of the pain and its effects. One way of erasure is largely by society, with the expectations of endurance by the female body.  Menstruation, which is already saturated with shame, is kept out of public discussions and most menstruators are unlikely to find support within their families as well. Experience of pain during menstruation is dismissed as natural and individuals are told by their families, peers and even educational and workplace to endure the pain. As sought with contestations the idea of menstrual leave for the formal sector is, it is still a far reality for menstruators, all the while keeping out those who work in the informal sector or are involved with work at home.
The other way of erasure of pain is medical gaslighting. Womxn, trans individuals, and other marginalised people already face bias at the hands of doctors due to bias and stereotyping. The orientation of pain management is male oriented which insufficiently understands the biological and social tolls that the female body and mental health suffers through. The rampant lack of attention in medical research and the ignorance and gaslighting of patients in practice adds to the toll. The implicit bias leads to delay in diagnosis and often misdiagnosis. Lastly, brushing off women’s experiences as hormonal or hysterical manifests in gaslighting, making the experience of primary dysmenorrhea worse.
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