HYDERABAD: In India, about 50 per cent of women aged 15-24 years still use cloth for menstrual protection, as per National Family Health Survey - 5. While according to government data, more than 70 per cent follow hygienic practices, it is important to ensure that they follow quality menstrual health practices and use products that are safe not only for their own health but also for the environment. Here are a few excerpts from the conversation we had with city-based doctors guiding us on the significance of maintaining proper menstrual hygiene, what kind of infections or diseases can occur in the lack of proper hygiene and what are some of the tips to follow to maintain the same.
“The 2023 Menstrual Hygiene Day theme is making menstruation a normal fact of life by 2030. The overarching goal is to build a world where no one is held back because they menstruate by 2030. Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware of menstruation so they face many difficulties and challenges at home, schools, and workplaces,” said Dr Rajini, Consultant Gynaecologist, CARE Hospitals, Banjara Hills.
According to doctors, there are a number of barriers due to which women fail to follow efficient hygiene practices. One is inaccurate or incomplete knowledge about menstruation. Second is the stigma and taboos associated with the subject of menstruation that do not allow women to talk openly about it or discuss their issues. Third is “the lack of access to menstrual devices. It requires a lot of money to buy various products available in the market and the alternative is cloth or paper which is more easily available. Therefore, women, mostly in rural areas tend to use cloth,” said Dr Swathi Gogineni, Consultant Obstetrician and Gynaecologist, Apollo Cradle, Jubilee Hills. She also added that in India, the lack of toilets is also a major issue.
Possible risks
Dr Swathi pointed out that the risks associated with poor menstrual hygiene include reproductive tract infections like Candidiasis, Bacterial vaginosis; urinary tract infections which could further lead to fertility issues and birth complications. “The vaginal tract is permeable and can allow infections to seep through easily. Therefore it is important to change sanitary pads or tampons frequently. Using bad-quality pads or tampons can also lead to serious diseases such as Cervical cancer or Ovarian cancer,” added Dr Padmavathi Kapila, Chief Consultant Obstetrician & Gynaecologist, Renova Hospitals, Langar House.
Steps to follow
Products to use
Sanitary pads being advertised are actually more prone to increase the risk of infections as include some harmful chemicals that alter the vaginal PH level. Even some of the menstrual cups being used are made of plastic-related products such as polyester or polypropylene which are not bio-degradable but take hundreds of years to decompose. “These days, products which are of vegetable material (cotton, cellulose, etc) available in the market are better to use. In my understanding, pads are easier to use than cups as the latter require proper training in insertion and removal of fluid, etc,” said Dr Swathi.
“Implementation of modern techniques like incineration can help to reduce waste. Also, awareness should be created to emphasise the use of reusable sanitary products or natural sanitary products made from materials like banana fibre, bamboo fibre, sea sponges, water hyacinth, and so on,” said Dr Rajini.
Dr Padmavathi is of the view that if the menstrual cup is properly used, it is completely safe. “The maximum fluid it can hold should be around 60-80ml. Frequent removal of fluid is important and it can be cleaned using soap and water. Apart from that, biodegradable pads can also be used but they should not be used by someone else. The vaginal area should be cleaned properly. It should be kept dry at all times to prevent infections,” she said.
Take special care of those with disabilities
Doctors suggest that education should start right from adolescence as it is important to dispel myths and taboos. Social norms, poverty, and gender inequality are some of the problems that hinder women to talk openly about menstruation. Women who have just delivered a baby should also take special care as the trauma the birth canal has gone through makes it more prone to diseases.
“It is important that young girls are educated by elder sisters or mothers in such a way that they feel completely comfortable sharing their problems and doubts with them. Otherwise, it may lead to complications. For example in surgery, we had a case a year back where a girl did not have a vaginal opening by development. We had to surgically create the vaginal opening for her to be able to menstruate properly. Girls should know about menstruation so that they can share their problems without hesitation,” said Dr Padmavathi.
Women who cannot take care of themselves need to be taken care of by their mothers. They are more prone to infections due to constant wetness and dirt, if their hygiene is not maintained. Dr Rajini added that “significant progress has been made in India by government and non-governmental actors with regard to menstrual health and hygiene management (MHHM). It has enhanced access to female-friendly/gender-appropriate sanitation facilities and the availability of menstrual products.
Certain groups have been overlooked thus far, including girls and women with disabilities, who face an exceptional burden on account of the intersections between gender and disability.”