Why does Aunt Flo have to come and visit?
Sofia Carlisle-Bell is a family friend of the Va Va Womb team, a third-year student at the University of East Anglia studying biology with education and we have the honor of sharing her work here as she delves into topics we love to shout about!
"I’m a third-year student studying Biology with Education at the University of East Anglia. This was written as part of my coursework for a science communication module that I am currently studying for my course. I remember feeling scared and ashamed when I was on my period at school, despite it being totally natural, which is one reason why I chose to write about this topic. I am one of billions of people who will have experienced the effects of the lack of communication or miscommunication surrounding periods, and ultimately, menstrual health issues. Outside of university, I also work as the Special Educational Needs and Disabilities (SEND) consultant for Diverse History UK."
It’s time to start communicating menstruation properly and shift societal norms. Period.
Bleeding is part of being a human - when children are injured and bleeding, their wounds are tended to, dressed, and looked after. The same cannot be said for the teenager who goes to the toilet, is met with menstrual blood as they begin their period and is faced with isolation, feelings which are unfortunately shared by 77% of women (ActionAid UK, 2018). Everyone is affected by menstruation either through direct or indirect experience and yet its discussion remains a taboo (Kissling, 1996). Societal discomfort is obvious and can have disastrous outcomes. Daloni Carlisle was diagnosed with womb cancer after experiencing abnormal vaginal bleeding, however, she delayed seeing her GP as she was too embarrassed to discuss her periods (BBC, 2016). Despite her occupation as a health journalist, Carlisle (2014) had never heard of womb cancer, evidencing the clear lack of communication surrounding reproductive health. Cancer was fatal in this case, however before her death in 2020, Carlisle voiced that she wanted “a future where women, including young women, know the symptoms to look out for” (Carlisle, 2015a; Bell, 2020). Receiving health-relevant information begins with successful and supportive communication - historically, this has not existed, but this is changing, albeit slowly (Rubinsky et al., 2020).
How far back does this go? A historical perspective
Communication about menstruation dates at least as far back as the Bible, where teachings stated “when a woman has her regular flow of blood, the impurity of her monthly period will last seven days” (Leviticus 15:19) and anything or anyone she touches is also unclean (Leviticus 15:19-30). Historical influences must be considered influential in constructing present-day societal norms as messages are passed through generations (Schrader, 2015). Humans act agentically, according to individual values and beliefs, however, these are influenced by society, culture, education and relationships, each of which is informed by history (Bandura, 2001; Lindlof, 2008).
Constructivist models of communication argue that societal standards are actively created by humans, meaning is dynamic and meaning-making activities are what dictate the nature of the world (Lindlof, 2008; Schrader, 2015). Conceptions of menstruation are influenced by experiences where active engagement occurs between the individual and the environment (DeVries, 2000; Lindlof, 2008; Cormick, 2022). Generations of menstruating people have been actively isolated and communication of this and other messages have led to societal norms experienced today: that women and people should not (and by proxy, cannot) engage openly about the (often debilitating) symptoms they experience monthly (Rubinsky et al., 2020). Careful construction of euphemisms and other language tools that avoid embarrassment by not using proper terms, such as ‘menstruation’, ‘period’, and ‘vagina’ has played a part in creating the embarrassment still experienced (Kissling, 1996; Schrader, 2015).
Silence! Menstruation must not be discussed (at least not obviously)
Euphemisms such as “Aunt Flo has come to visit”, “that time of the month”, and “the crimson wave” are often used in place of “periods” or “menstruation” in conversations, media and other forms of communication (Thorpe, 2016). While amusing, these linguistic strategies to communicate menstruation arise from feelings of shame and ultimately build social taboo (Kissling, 1996). After interviewing adolescent girls, Kissling (1996) found that feeling embarrassment was reported unanimously when talking about their periods. A survey by ActionAid (2018) reveals that 22 years later, this is largely unchanged as 46% of respondents reported feeling shame and embarrassment about their periods. Menstruation can only be discussed using terms unrecognisable to those who do not directly experience it, demonstrating the immense societal discomfort present (Rubinsky et al., 2020). Societal discomfort will remain as long as those voicing alternative opinions remain silent (Noelle-Meumann, 1974; Schrader, 2015; Rubinsky et al., 2020).
Noelle-Neumann (1974) coined the term Spiral of Silence, theorising that public opinion is the outcome of individuals interacting with their social environments and those in disagreement with the public opinion become silent to protect themselves from social isolation. Menstruation is a victim of the spiral of silence, and the impact of this communication (or lack thereof) is that menstruation is considered dirty, shameful and embarrassing (Rubinsky et al., 2020). Denying a language to discuss periods denies an opportunity to challenge views (Noelle-Neumann, 1974).
New media generates new ideas
Young people are immersed in communication mediated by computers, phones, and technology (Schrader, 2015; Zeng et al., 2020). Social media is a powerful platform, encouraging the public engagement model of communication by promoting posts based on engagement metrics (Zeng et al., 2020). Accounts dedicated solely to discussion of reproductive health exist, but engage a niche audience: those actively seeking them out (Cormick, 2022). Increasing numbers of public figures are now discussing menstruation, meaning those who may not be actively seeking information may witness their favourite celebrities starting these conversations (Schrader, 2015). Interpersonal interactions are vital in constructing new ideas, so witnessing dialogue in the comments of such posts can influence knowledge creation, even without active engagement (Schrader, 2015).
Kourtney Kardashian, an international celebrity with a large follower base, used Instagram to celebrate Menstrual Hygiene Day in 2019 (Figures 1 and 2). The caption references the absurd nature of period-related embarrassment and encourages mothers to teach their boys about menstruation
(Figure 2) (Kardashian, 2019). Currently, the post has over 1 million likes on Instagram. Figure 1 (left) and 2 (right): Screenshots taken from Kourtney Kardashian’s Instagram account, dated 28th May 2019, when she posted a picture of herself and another person in bikinis on a beach captioned "'Is my tampon string showing?' @steph_shep whispered to
me. The source of life shouldn’t be embarrassing or hard to talk about. Mothers, teach your sons too.” (Kardashian, 2019).
In line with social cognition, people build their expectations based on observations of others, motivating them to act agentically (Bandura, 2001). If the desired future is one where menstruation can be discussed freely, witnessing interactions like these can regulate the behaviour taken to reach this future (Bandura, 2001). Social media breaks barriers to menstrual education, allowing information that may be different to what is taught in school to reach increasing audiences (Kissling, 1996; Schrader, 2015). Efficacy beliefs play a key role in behaviour regulation and motivation but are prey to social influences which dictate the values and interests deemed acceptable to discuss (Bandura, 2001). Increasing perceived self-efficacy is crucial in facilitating change; people must believe their actions have power (Bandura, 2001). Reception of communication from celebrities, many of whom are idolised, may stimulate increased self-efficacy beliefs while shifting cultural values (Bandrua, 2001;
Schrader, 2015). Inspired by social influences, people may believe they are change-makers and express their own messages to others around them (Bandura, 2001).
Cultivation supports this idea, arguing that exposure to media messages, including social media, breeds acceptance of these attitudes (Shanahan et al., 2004). Many influential people are engaging in discussions about their own experiences regarding menstruation, and this efficacy is one driver to making change (Bandura, 2001). Social media is only one media form to cultivate change and messages on television play an important role too (Shanahan et al., 2004).
Not so silent anymore! Adverts help shift attitudes
A Malaysian campaign called “Period is Period” was launched by Libresse (specialising in sanitary products), in 2018, creating characters based on menstruation euphemisms that appeared in various posts, videos and blogs (Livelibresse, 2018). This was culture-specific as characters are inspired by Malaysian euphemisms, however, framing periods and sanitary products in terms of bread and other characters highlight the bizarre nature of these euphemisms while providing humour to the audience. Part of the campaign involved these characters in a series of informational posts (Figure 3), providing an anchor for more serious messages to support adults having open communication about periods (Libresse, n.d.).
Figure 3: A series of screenshots taken from the “Period is Period” campaign by feminine hygiene brand Libresse, launched in Malaysia in 2018. The campaign used characters based on Malaysian euphemisms for menstruation, who appeared in various videos and adverts to try and promote proper terms for menstruation being used. The characters also provided a narrative for a series of short posts to help people discuss menstruation. Available at: https://www.libresse.com.my/our-world/campaigns/period-is-period/intro/
Blog posts on the website of a sanitary product company may only be witnessed by the niche audience actively seeking out such information, however combining these with advertising could widen this audience (Cormick, 2022). After seeing public adverts, people may be inspired to do follow-up research and be presented with new conceptions, for example the need to educate everyone, rather than just those who menstruate (Figure 3) (Lindlof, 2008; Libresse, n.d.).
Adverts are powerful communication tools, reaching a wide audience as they appear across a variety of contexts; Bodyform, the UK brand of Libresse, released a controversial advert in 2017 (Figure 4) (Hinde, 2017). Similar to their campaign in Malaysia, Bodyform hoped to normalise periods (Hinde, 2017, Libresse, nd).
Figure 4: An advert from Bodyform promoting their sanitary pads, using red to mimic the blood and show their absorbency (Hinde, 2017).
This was the first advert to use red liquid to represent blood, instead of blue liquid often opted for (BBC, 2017; Hinde, 2017; Reid, 2020). The large viewer base of adverts extends beyond science-literate audiences as many people see adverts daily (Schrader, 2015; Cormick, 2022). In line with cultivation theory, exposure to such attitudes can facilitate shifting internal attitudes; adverts provide a starting point for new societal constructs to form (Shanahan et al., 2004). Internalised values and beliefs motivate actions, and communication plays a large role in allowing new values to be internalised (Rubinsky et al., 2020). Imagery was not the only powerful aspect of this advert as the consequent media flurry across a variety of sources (Figures 5 and 6) flooded news channels and social media (BBC, 2017; Hinde, 2017; Reid, 2020).
Figures 5 (left) and 6 (right): Screenshots of headlines from the BBC (2017) and The Telegraph (Reid, 2020) respectively in response to the advert released by Bodyform, in which red liquid was used for the first time to represent period blood (BBC, 2017; Reid, 2020).
Menstruation discourse challenged the absurdity of previous adverts, exposing wider audiences to these messages, cultivating a potential attitude shift and providing a conversation starter for open communication (Shanahan et al., 2004; BBC, 2017; Hinde, 2017; Reid, 2020). Societal discomfort remains present, however, is significantly less than as was evidenced by Kissling (1996), as people are not only using proper terms for menstruation, but are showing it as it is: red, bloody, and often debilitating (BBC, 2017; Hinde, 2017; Reid, 2020). As communication continues to evolve, these messages will reach more people and improved discourse may break period taboos.
Discomfort in society can be traced as far back as our Biblical ancestors, however, a myriad of communication methods are evidenced in lessening this discomfort.
The rise of social media, influential people engaging in open and honest discourse, and media messages are a few of the causes driving this change. Women like Daloni Carlisle continue to exist, and late intervention proves fatal in cases like hers. Before her passing, Carlisle (2015b) said “good, trusted information helps women to take better care of ourselves. It helps give us the language to talk about what’s happening to our bodies”. Communication influences attitudes, so let the future be privy to open communication, honest language and good, trusted information for all.
ActionAid UK. (2018). More Than One in Three UK Women Face Period Stigma. https://actionaid.org.uk/latest-news/more-one-three-uk-women-face-period-stigma Bandura, A. (2001). ‘Social Cognitive Theory: An Agentic Perspective’ Annual Review of Psychology, 52(1), pp. 1-26.
Bell, J. (2020). ‘Daloni Carlisle obituary’, The Guardian. 11 November. [Accessed 5 December 2022]. Available at:
https://www.theguardian.com/media/2020/nov/11/daloni-carlisle-obituary BBC. (2016). ‘‘I was too embarrassed to talk about my periods’’, BBC. 9 May. [Accessed 5 December 2022]. Available at: https://www.bbc.co.uk/news/health-36225590
BBC. (2017). ‘Bodyform Advert Replaces Blue Liquid with Red ‘Blood’’, BBC News. 18 October. [Accessed 5 December 2022]. Available at:
Carlisle, D. (2014). ‘Womb Cancer: The Most Common Diagnosis You’ve Never Heard of’, The Guardian. 21 September. [Accessed 4 December 2022]. Available at: https://www.theguardian.com/lifeandstyle/2014/sep/21/womb-cancer-fourth-most-co mmon-women
Carlisle, D. (2015a). ‘Daloni Carlisle Shares Her Story of Being Diagnosed with Womb Cancer’, The Eve Appeal. 1 March. [Accessed 4 December 2022]. Available at: https://eveappeal.org.uk/blog/daloni-carlisle-shares-story-diagnosed-womb-cancer/
Carlisle, D. (2015b). ‘Trusted, Tailored Information Will Help Women Take Better Care of Themselves’, The Eve Appeal. 20 April. [Accessed 4 December 2022]. Available at:https://eveappeal.org.uk/blog/trusted-tailored-information-will-help-women-take-bet ter-care/
Cormick, C. (2022). ‘We Need to do Better: Five Noteable Failings in Science Communication’ Sustainability, 14(14), pp. 8393.
DeVries, R. (2000) ‘Vygotsky, Piaget, and Education: A Reciprocal Assimilation of Theories and Educational Practices’ New Ideas in Psychology, 18(2–3), pp. 187–213. Available at: https://doi.org/10.1016/s0732-118x(00)00008-8.
Hinde, N. (2017). ‘Bodyform’s New Advert Depicts ‘Period Blood’ Instead of Blue Liquid in UK First’, HuffPost. 17 October. [Accessed 4 December 2022] Available at: https://www.huffingtonpost.co.uk/entry/bodyforms-new-tv-advert-depicts-real-period-b lood-in-uk-first_uk_59e4959de4b03a7be581deaa
Leviticus 15: 19-30, Holy Bible. English Standard Version.
Libresse. (No Date). Period is Period. Available at:
https://www.libresse.com.my/our-world/campaigns/period-is-period/intro/ Livelibresse (2018) Libresse - Bread vs Period Slang [online video]. Available at: https://www.youtube.com/watch?v=DRMSwtqfB5Q
Lindlof, T. (2008). ‘Constructivism’, The International Encyclopedia of Communication. Available at: https://doi.org/10.1002/9781405186407.wbiecc129
Kardashian, K. 2019. ‘'Is my tampon string showing?' @steph_shep whispered to me. The source of life shouldn’t be embarrassing or hard to talk [...]’ [Instagram]. 28 May. [Accessed 5 December 2022]. Available at:
Kissling, E.A. (1996). ‘“That’s Just a Basic Teen-age Rule”;: Girls’ Linguistic Strategies for Managing the Menstrual Communication Taboo’ Journal of Applied Communication Research, 24(4), pp. 292-309.
Shanahan, J., Scheufele, D., Yang, F., Hizi, S. (2004). ‘Cultivation and Spiral and Silence Effects: The Case of Smoking’ Mass Communication and Society, 7(4), pp. 413-428. Noelle-Neumann, E. (1974). ‘The Spiral of Silence: A Theory of Public Opinion’ Journal of Communication, 24(2), pp. 43-51.
Reid, R. (2020). ‘The New Bodyform Advert is a Bloodshed Moment for Women’s Advertising’, The Telegraph. 3 July. [Accessed 5 December 2022]. Available at: https://www.telegraph.co.uk/women/life/new-bodyform-advert-bloodshed-moment-wo mens-advertising/
Rubinsky, V., Gunning, J.N., Cooke-Jackson, A. (2020). ‘“I Thought I Was Dying:” (Un)Supportive Communication Surrounding Early Menstruation Experiences’ Health Communication, 35(2), pp. 242-252.
Thorpe, J.R. (2016) ‘15 Old Euphemisms For Periods Worldwide’, Bustle. Available at: https://www.theodysseyonline.com/its-that-time-of-the-month-again [Accessed 4 December 2022].
Zeng, J., Schafer, M.S., Allgaier, J. (2020). ‘Reposting “Till Albert Einstein is TikTok Famous”: The Memetic Construction of Science on TikTok’ International Journal of Communication, 15, pp. 3216-3247.