home Featured, Reproductive Health Murdering Feminine Hygiene. Part One: Hormonal Birth Control

Murdering Feminine Hygiene. Part One: Hormonal Birth Control

Margaret Sanger: mother of planned parenthood, dreamed of a birth control pill decades before it existed.She was prosecuted for instructing women about contraception.

After some consideration, I’ve decided that I passionately hate feminine hygiene. I am referring both to the phrase as well as the practice itself.

Gross, you’re thinking, as if I’ve just admitted that I never wash myself.

On the contrary, I don’t think ‘feminine hygiene’ is simply about keeping clean. If it were, we wouldn’t need an entire industry dedicated to it.

As a phrase it is particularly one sided. We don’t use the equivalent “masculine hygiene”, but that doesn’t mean men don’t keep themselves clean. A Google search of the topic offers, among others: Ten Things She Secretly Notices about Your Hygiene, Essential Grooming Rules for Guys (“change your underwear” is actually an item on this list), Five Personal Hygiene Tips for Men, and one list of 10 Sexual Hygiene Tips for Better Sex. No results specifically use the phrase ‘masculine hygiene.’ It isn’t a thing.

From the above articles, one might infer that “masculine hygiene”, if it did exist, would include activities like: shaving, showering, wearing deodorant, clipping toenails, flossing & brushing, popping blackheads, and yes, changing undies.

Even in the article specific to sexual health I still don’t see the words ‘masculine hygiene’, though changing underwear is also there alongside shaving pubic hair, wearing condoms, keeping clean and communicating with your partner. No one is arguing with this list, it’s a good list. But it is not particularly gendered — I wouldn’t say this is the equivalent of ‘feminine hygiene’ for men. Rather, it is just sensible advice for all genders.

On the other hand, one of the first results I find from a Google search of ‘feminine hygiene’ is Feminine Hygiene Tips: How To Make Your Vagina Smell Good. I couldn’t bear to click on it. The point is that feminine hygiene is almost exclusively devoted to issues of the vagina, from necessities like menstrual products to the harmful like douches and powders and washes and waxes and razors and things you don’t want to think about.

Why is that? Why isn’t feminine hygiene broader? Why doesn’t it also include things like communicating with your partner? Why does it include things like washing down there but not things like washing one’s hair?

I want to attack these feminine hygiene items one at a time in order to make you feel a little cringe every time you hear that phrase, if you don’t already. I want to kill them. I want to cut them all up into little pieces and saute them until they are all black and charred and then I want to bury the ashes and never speak of feminine hygiene again.

But as I started into it I realised that the topic is so vast I couldn’t possibly murder it all at once. I needed to aim my vendetta against something more specific, or else write an epic history of vaginas. So where to begin?

Perhaps I should start with that most odious of feminine characteristics, that which has seen Nepalese girls banned to live in huts, the onset of which means a girl in some countries faces circumcision or enforced marriage in others, and which in a western culture might signify the beginning of that lifelong practice we refer to as feminine hygiene. Bleeding, yuck.

A few years ago there were some numbers thrown around about the cost of a period. In the UK, the estimate came to £18,450, in the US a similar estimate came to $18,171USD, and in New Zealand the estimate came to nearly $16kNZD. This is the amount spent by the average woman over a lifetime on all period related items including the obvious things like tampons and pads, but also including things like birth control, pain killers, new undies after a leak, and even chocolate for those cravings.

It appears that even the topic of menstruation and related detritus might be too much for a single assassination. And I have no desire to murder chocolate. I have no problem with chocolate. By all means, gorge yourself. It’s delicious and has a few health benefits. In any case, my beef is not with chocolate (though you can make beef with chocolate).

Let’s get to the heart of the matter then: birth control. This is the bulk of the expense on the cost of periods lists, making up $11,000 according to the US Huff Post article. This is where I should start my rampage. In part two perhaps I can move on to destroy tampons and pads and panty liners.

“Hey now,” I hear you protesting, “Birth control doesn’t count — it’s not a feminine hygiene product.”

That’s where you are wrong. If ‘feminine hygiene’ refers almost entirely to issues of the female reproductive organs, then what is more relevant than preventing reproduction?

Many of the hormonal options are also commonly used for menstruation suppression, which is why it appears on the period bill. They are also marketed for other potential benefits such as acne reduction and moodiness. In practice then, hormonal birth control might be more relevant than a tampon to what we call feminine hygiene.

As a topic it is also extremely one sided and gendered. Women are largely responsible for birth control and the most severely affected when it goes wrong.

When I moved to New Zealand I discovered that a subsidised birth control pill was cheaper than buying tampons every month (it cost me $3 to fill a six month prescription plus $30 for a doctor’s visit to renew. A box of 10 regular tampons goes for around $7 and I went through more than 10, plus panty liners and pads sometimes).

For those who don’t know, the combined pill suppresses ovulation and menstruation, though a ‘period’ has been “helpfully” built into the pill’s instructions by suggesting users do not take the pill, or take a placebo, seven days every month. Doing so causes what is essentially a small withdrawal bleed but should not make one susceptible to pregnancy, unless of course, she misses an eighth day.

This has always annoyed me and from what I can glean, the need for a seven day break is not medically warranted. It is in place simply because that’s how it was designed and nobody bothered to question it. Some sources say it is so women are reassured they are not pregnant by having a withdrawal bleed, or that women would find the pill more acceptable if they had a period in the mix. (Um, did they actually ask any women?).

On the other hand, according to one source, “The lengthening of the pill free interval is one of the most common causes of pill failure and is often associated with a woman starting her new pill packet late.”

Most of my doctors have said I could skip it without worrying. Delightful news! I thought. I never had my period and It. Was. Great. It seemed to my 20 year old self that I had blasted the shit out of feminine hygiene in one fell swoop and I need not ever look back.

For nearly ten years I took the subsidised combined pill. In the last two or three years I started to have some problems on it – especially the terribly coined ‘breakthrough bleeding’, which refers to spotting or bleeding throughout the month despite the pill’s supposed ability to prevent bleeding altogether. One imagines the vagina as a wall that has had its fortress penetrated by an evil bloody enemy. Gross, possibly TMI, and oh so disheartening to see yet another surprise stain on a pair of $20 sexy lacy panties. Haha ok you caught me, I don’t wear fancy underwear. But still.

I did not get pregnant while I took the pill, so it was easy to justify continuing it. When the bleeding issues got worse, I started having the 7 day interval again, to no avail. I would bleed between no pill intervals and after sex. I wore panty liners every day. One gynecologist told me that my vagina looked ‘fragile’. It wasn’t the end of the world, just a little annoying to both me and my partner at the time, and obviously, part of the pill’s main appeal — being able to skip a period — was starting to fade.

I switched pills to a bigger dose option, no longer subsidised, called Yasmin, at the advice of my doctor.

“You’ll love it,” he said. “It makes you lose weight and your boobs bigger.”

I switched doctors too.

Six months in, with no change in bleeding issues, I started to do my own research. I’d relied on the pill so heavily in the last ten years but I’d never really bothered to understand it. It was just one of those things that had cemented itself into my life and I didn’t question it.

What I found about Yasmin freaked me out. The worst — overseas lawsuits due to links to stroke, gallbladder diseases and embolisms, plus possible links with the onslaught of seizures and epilepsy in users.

More recently, hormonal birth control, including the pill, has also been linked to depression.

In a comment on the research, Holly Grigg-Spall succinctly frames this issue:

“Considering that women are fertile just six days per menstrual cycle and men are fertile every single day, that the burden of avoiding unwanted pregnancy falls to us, regardless of the burden that might have on our health and wellbeing, is nothing short of sexism. After all, there are certainly effective alternatives to hormonal contraceptives –the copper coil, diaphragm, condoms and new technology that’s making it simple for women to practice the fertility awareness method, not to mention, of course, vasectomy and the promise of Vasalgel, a contraceptive injection for men.

Yet, we’re reminded with one medical professional’s response to this new research that “an unwanted pregnancy far outweighs all the other side effects that could occur from a contraceptive.” If that’s true, why bother researching the side-effects at all?”

Stroke, Epilepsy, Depression. These are serious side effects, but to mention them one seems to risk falling into the politically undesirable camp of the anti-abortion extremists and people who hate women. Yet anybody who has experienced depression either in themselves or through a close friend or relative knows what should seem sort of obvious: depression is life threatening. A pulmonary embolism is life threatening. A stroke is life threatening. If those are not serious enough side effects for you, then I hope you’ll go jump off a bridge.

I quit taking the pill altogether and I don’t plan to go back. It did the job of preventing pregnancy, and I’m still alive and in pretty good health, no embolisms, epilepsy, or strokes to speak of, so it seems I would be remiss in making any kind of complaint.

When I went off the pill, I had no idea what to expect. The pill masks one’s cycle, so for someone who had used it since she was a teenager, it meant I could not possibly have any idea what my adult cycle might be like. Apparently, mine was “abnormal”, but as far as I can tell, no one has a “normal” 28 day cycle every single month. Still, I wished as I neared the end of my 20s that I knew a little bit more about myself.

Hormonal changes are very real and they affect everything. Grumpy PMS is a thing, and a big fat fuck you to anybody who has the gall to mention it while it’s happening. It’s also not the only thing: there’s a best time of the month to give a speech and an appropriate time to grab a book and some chocolate (hint: more often than not). Sure, these aren’t life changing discoveries, but they are mind changing, and they are helpful.

I don’t have anybody else to blame but myself for not understanding my cycle to begin with, hormonal changes and all, but I do believe that our culture’s reliance on the pill has diminished the importance of education when it comes to reproductive health.

The pill has been so well marketed that it is almost just accepted as rote. The entire contraception industry, including condoms, diaphragms and other options, is expected to hit $33 billion by 2023 (source – globalnewswire.com). The birth control pill is the most popular option, making up 28% of this industry in the United States (source – cdc).

Writing for the American Journal of Public Health, Elizabeth Siegel Watkins notes the changes to the birth control since the invention in the 1960s. Despite its popularity and profitability, the technology behind hormonal birth control has hardly changed. The only advancements have been ‘tweaks’ to the amounts of estrogen and progesterone. Watkins writes, “In the world of contraception, scientific and technological innovation has been moribund for decades.” Instead of improving the technology or broadening the options, pharmaceuticals have focused on marketing the pill for it’s ‘lifestyle’ benefits.

Most of my friends used it for almost as long as me, or much much longer. It seemed so entwined with the belief in empowerment that previous generations had earned us that we could not oppose it. For a moment I hesitated to write this because even to highlight the pill’s downfalls might suggest to some readers that I am of the somewhat spiteful and untrue belief that the pill has not been an essential part of empowering women. Or that it did not do what I wanted it to do in the first place.

This difficulty in discussing the drawbacks to hormonal birth control is ironically similar to the history of taboo that prevailed over any discussion about birth control before the pill was even invented. Under the Comstock Laws Margaret Sanger was prosecuted and jailed for running a clinic and distributing “obscene” material — pamphlets about birth control.

Forms of those restrictions are still alive and well today. Just consider the Global Gag Rule: here is a striking example of a western country prohibiting any discussion about abortion options in the countries that depend on USAID funding. Abortion is not the same as birth control, but as Sarah Boseley rightly points out in an article on the Guardian, the consequences of limiting the conversation between a doctor and patient are much further reaching than simply ending abortion. Indeed, for many of the women who are affected by the gag order, having the birth control options that I’ve been privileged with might save their lives.

The point of this is not to get rid of hormonal birth control. But let’s be practical: it’s a drug with side effects. Despite a proliferation of brands and options for women, we have not seen much improvement in technology. In addition, as Grigg-Spall points out, we need more options for men. This issue affects women disproportionately and costs us more, but it is not only about women. Birth control should not have anything at all to do with feminine hygiene, as if it were simply our problem to bear. Even if a woman still wants to use it to keep her period at bay, birth control should never be thought of as a ‘lifestyle’ choice or a cosmetic choice. It’s not a lifestyle or a luxury: it’s a basic human right.

One of the best things, maybe the second best thing, about quitting the pill was that my partner and I had to start communicating more often about what other kinds of birth control we can use. It became an issue that we shared, rather than a burden that I suffered almost by default. Couple’s hygiene.

The first best thing about quitting the pill is now we have a son.

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