Menstrual Hygiene Management

Tackling menstrual unawareness among

young girls
Dr Rupali
Menstruation is supposed to be invisible and silent.
Mahadik

Unspeakable
inconvenience
Dr Rupali
Mahadik

Menstruation

Bad omen

Blood + Pain =
{ Curse
Taboo
Danger
Impure
Dr Rupali
Mahadik

Menstrual Myths
Dr Rupali
Mahadik Beliefs, Myths and Taboos
Harmful restrictions

In some cultures, women and girls are told that

• During their menstrual cycle they should not bathe (or

they will become infertile)

• Touch a cow (or it will become infertile)

• Look in a mirror (or it will lose its brightness)

• Touch a plant (or it will die)

Young women chatting

about menstrual issues. 5
Source: UNICEF (2008)
Dr Rupali
 I do not wash/clean/take bath
Mahadik

 I do not play or have sports

 I cannot attend religious functions

 Not allowed to attend school

 Not allowed to cook

 cant eat certain foods

 I have to sleep separate from other

members
Dr Rupali
Mahadik

People Are Finally Talking About

The Thing Nobody Wants To
Talk About
Dr Rupali
Mahadik
◦ 52% of women worldwide are in reproductive age and most
of them thus are menstruating monthly.

◦ Still, the majority of them are not in conditions to take

care of their menstruation in a hygienic manner or are
impaired by it.
Dr Rupali
Mahadik

 Menstrual hygiene is an important issue that affects

healthy adolescent girls and pre-menopausal adult
women monthly.

 women have developed their own personal strategies to

cope with menstruation, depending on economic status,
the individual’s personal preferences, local traditions
and cultural beliefs and education status
Dr Rupali
Mahadik

 Often methods of management can be

unhygienic and inconvenient.

 43% and 88% of girls wash and reuse

cotton cloths rather than use disposable
pads.
Dr Rupali
Mahadik  However reusable material may not be
well sanitized because cleaning is often
done without soap and with unclean
water, and social taboos and restrictions
force drying indoors, away from sunlight
and open air.

 Poor MHM may increase a woman’s

susceptibility to reproductive tract
infections (RTI).
Dr Rupali
Mahadik  As a girl progresses from puberty into
womanhood, RTIs potentially triggered
by poor MHM could affect her
reproductive health.

 Studies have shown women with

Bacterial Vaginosis may be at higher
risk of adverse pregnancy outcomes like
preterm birth , acquisition of sexually
transmitted infections and development
of pelvic inflammatory disease (PID)
Dr Rupali
Mahadik

PUBERTY
Dr Rupali
Mahadik
Parents
hesitate to talk
about menstruation
Dr Rupali
Mahadik

Girls
Are unaware and
unprepared
on their first period
Dr Rupali
Mahadik

Why should a girl know about

menstrual hygiene and
management even before she
starts to menstruate?
Dr Rupali
Mahadik
 difficult to predict when and where your
daughter will experience her first
menstruation (menarche).

 Being in a situation in which you discover

blood coming out from the vagina for the
first time can be extremely confusing if she
is not prepared for it in advanced.

 prior knowledge about menstruation-

what is menstruation and how to deal with
it-can help her in dealing with such a
situation in a much better way.

 This will help her prevent embarrassment

and free from stress.
Dr Rupali Emotional changes that occur
Mahadik
during puberty
 1. Feeling overly sensitive
 During puberty, since your body
undergoes many changes, it is common to
feel uncomfortable about them and
become overly sensitive about your
physical appearance.
 feel irritated quite easily, lose your temper
or feel depressed.
 be aware of the changes in the behaviour
and talk about it with someone that you're
comfortable talking to.
Dr Rupali
Mahadik
Looking for an identity

 may try to figure out how you are different from others
and how you fit into the world. This may eventually lead
to some sort of a struggle to become more independent.
Dr Rupali
Mahadik
Feeling uncertain

 Puberty - transition phase,

 begin to wonder and think about new
and unfamiliar aspects of life such as
career, livelihood and marriage.
 Since, all of this is new and unfamiliar
when you start thinking along these
directions,
 may feel uncertain about the future.
Dr Rupali
Mahadik Peer pressure

 conversations with your friends will increase.

likely to be influenced by what you see around you in popular
media and the culture that is represented through them.
These events can lead to a gap between what is perceived as
appropriate by parents and friends.
Dr Rupali
Mahadik
Conflicting thoughts
 may feel stuck between how you were
as a child and how you wish to be as an
adult. For example, might want to be
more independent and at the same
time, might also look for support from
parents.
Dr Rupali
Mahadik Mood swings

 occur due to shifting levels of hormones

in the body and other changes taking
place during puberty.
Dr Rupali
Mahadik 7. Feeling conscious about self

the changes in their bodies such

as development of breasts and
widening of hips are more
noticeable. This may make them
feel more conscious about their
body in presence of their peers of
the same age group.
Dr Rupali
Mahadik Getting sexual feelings
 Puberty is also the phase after which you develop sexual
maturity. Sexual maturity is the stage of your life when
you can have children. One aspect of sexual maturity is
being curious about sex and also about bodies of people
that you are attracted to. With the onset of puberty, it is
normal for a boy or a girl to be sexually attracted to
people that they would want be more than 'just friends'
with.
 You may also feel sexually excited by normal everyday
activities such as reading a romantic novel or watching a
romantic scene on television. These feelings are normal
and there is nothing to feel guilty about. You may have
many questions about sex. It is a good idea to talk to a
mature adult (like your mother, doctor or a counselor)
with whom you're comfortable discussing sex. You should
get your questions answered and should stay informed on
safe sex.
Dr Rupali
Mahadik

Physical changes that occur during

puberty in girls
Dr Rupali
Mahadik

 Development of breasts

 Appearance of hair in the armpit

Dr Rupali
Mahadik  Widening of hips and appearance of
pubic hair

 Growth spurt
 During puberty girls experience a sharp growth in their height.
 This is known as growth spurt.
 By the time she is 16 years old,
 she attains about 98% of the final height
that she will eventually grow to.
Dr Rupali
Mahadik Onset of menstruation
 Menstruation is a process in which a sexually
mature girl's or a woman's body releases of a small
amount of blood and tissue through her vagina.
Menstruation is a normal process that every healthy
and sexually mature girl and woman undergo
generally once every month. First occurrence of
menstruation is called menarche.

 Generally menarche occurs

between the ages of 9 and 14 years and varies on an
individual basis.
Dr Rupali
Mahadik

Basic knowledge
about menstruation that every
girl must know
Dr Rupali
Mahadik

Menstrual phase begins on the first day

of menstruation and lasts till the 5th
day of the menstrual cycle. The
following events occur during this
phase:

•The uterus sheds its inner lining of soft

tissue and blood vessels which exits
the body from the vagina in the form of
menstrual fluid.
•Blood loss of 10 ml to 80 ml is
considered normal.
• experience abdominal cramps.
These cramps are caused by the
contraction of the uterine and the
abdominal muscles to expel the
menstrual fluid.
Dr Rupali
Mahadik
Dr Rupali
Mahadik
Dr Rupali
Mahadik
Dr Rupali
Mahadik
Menstruation
Taboo

Ovulation

Celebrated

Pregnancy
Dr Rupali
Mahadik

What should a girl do when she

gets her first menstruation?
Dr Rupali
Mahadik
Memories of first menstruation - whether good or
bad - are unforgettable.

However, if you don't know much about

menstruation, your first step should be to not panic
because menstruation is normal for every healthy
woman

When you get your first period, you should talk

about it with your parents or any other adult that
you can trust, such as an elder sister or a teacher.

They will support you and provide you with

necessary information and sanitary products to
manage your periods
Dr Rupali
Mahadik

How can a girl or a woman stay

prepared for her menstruation on a
regular basis?
Dr Rupali  The key to dealing with menstruation is to be prepared
Mahadik
for it. This involves predicting when you will have your
next period and then, making preparations for it in
advance.
 Four measures that you should keep in mind to be
prepared for your next period are as follows:

 Keeping track of your menstrual cycle

 Analysing the cervical mucus

 Keeping a sanitary pad or tampon handy

 Staying healthy and confident

Dr Rupali Keeping track of your menstrual
Mahadik
cycle

 The length of the menstrual cycle can be calculated

by counting the number of days between the first
day of your period and the first day of next period.

 If you have access to a computer or a smart phone,

then you can use a variety of software and
applications to keep track of your menstrual cycle.
In the beginning you may experience irregular
periods and it might take several months for your
periods to become regular.
Dr Rupali
Mahadik Analysing the cervical mucus
 Cervical mucus is secreted by the cervix.
To take a sample of the cervical mucus, you should
insert clean fingers in the vagina and check the colour
and texture of the mucus on them.

 Just before and after menstruation the cervical mucus

decreases in quantity, looks white in colour and
feels sticky.
 Around the time of ovulation the mucus increases in
quantity, looks transparent and feels slippery like
raw egg white.
 Thus before menstruation, a thick, white and sticky
cervical mucus will indicate high probability of the
start of your period in a few days.
Dr Rupali
Mahadik Keeping a sanitary pad or a tampon
handy
 impossible to predict the exact time and the
situation when your period may begin.
good idea to keep a sanitary pad or a tampon handy
at least when you are expecting your period in a
few days.
Tampons and even the slim sized napkins are small
enough to easily fit in a purse.

 In case you also experience abdominal cramps

during menstruation, you might also like to keep a
few, over the counter, pain relievers handy.

 These measures will ensure that your period does

not come in the way of your daily routine.
Dr Rupali
Mahadik Staying healthy and confident

 Leading a healthy and stress free life can

keep your the menstrual cycle regular and
uniform.
On the other hand, a stressful and
unhealthy lifestyle can disrupt your
menstrual .

 A balanced diet consisting of adequate

amounts of essential nutrients and feeling
confident is essential for your physical and
mental well being
Dr Rupali
Mahadik

Promoting good practices for

Menstrual Hygiene Management
Dr Rupali
Mahadik
1. Managing menstrual flow

2. Maintaining proper hygiene

and cleanliness.

3. Eating a balanced diet to

provide the body essential
nutrients.

4. Maintaining an active lifestyle

while avoiding stress and
tension.
Dr Rupali
Mahadik

How to Capture the BLOOD

What is menstrual
management?
Dr Rupali
Mahadik

 When girls begin to menstruate,

they need to take a few steps to
deal with their menstrual flow
and to maintain general hygiene.
Dr Rupali
Mahadik
FLOW MANAGEMENT
Dr Rupali
Mahadik

What are the different ways to

manage menstrual flow?
Dr Rupali
Mahadik  During menstruation the menstrual fluid needs to be
absorbed and disposed off in the right manner.
This can be done using any of the following products:

1. Disposable sanitary pad

2. Reusable cloth pad

3. Tampon

4. Menstrual cup
Dr Rupali
Mahadik
What is a sanitary pad?
Dr Rupali
Mahadik
 Sanitary pad / sanitary napkin / menstrual pad,
is a thin pad made of absorbent material that absorbs
the menstrual fluid during menstruation.

 most sanitary pads are disposable and are meant for

single use only.

 Reusable sanitary pads are mostly cloth pads that can

be washed, dried and reused over a number of times.

 Sanitary pads come in different shapes

and sizes, with different capacity to absorb for days of
heavy and light menstrual bleeding.
Dr Rupali
Mahadik How to use a sanitary pad?
 Sanitary pad is worn between the vulva and the
underwear.

 In most cases pads have adhesives that stick to the

panties, while others have wings that wrap under the
panties to keep the pad in place.

 Sanitary pads are generally changed after every 4 to 8

hours to avoid it from getting over soaked.
Dr Rupali Precautions while using a sanitary
Mahadik
pad:
 Sanitary pads cannot be used during swimming.
Never enter a pool while you are using a pad.
 In case you feel some itching around the thighs or
vagina, never scratch the area while wearing a pad.
It can rub against your skin and cause rashes.
 Don’t wear a panty with loose elastic. Good elastic
secures the pad and the panty in place.
 When planning to wear a tight trouser or boy
shorts, tampons are a better choice as they are not
at all visible through the garment. However, if you
are not comfortable using tampon, you can go for
an ultra-thin sanitary pad as it is less visible. You
can also team up your tight fitting trousers or short
with long t-shirts
Dr Rupali
Mahadik  Cleaning reusable sanitary pad
If you are using a reusable sanitary pad, then
after each use, it should be soaked in cold and
mildly salty water.
If you use hot water, then it can cause the
blood to set in and leave a permanent stain.
After soaking, it should be properly washed
and dried in the sun. Sun rays are natural
sterilizers that kill germs and bacteria.
Dr Rupali
Mahadik What is a tampon?

 Tampon is a mass of absorbent material that is used

to absorb the menstrual fluid during menstruation.
 Tampon is worn inside the vagina, where it absorbs
the menstrual fluid right after it is released from the
uterus.
 Tampons have different absorbing capacities .
 A tampon should not be left inside the vagina for
more than 6 hours because prolonged use of a
tampon can cause a rare but potentially fatal illness
called Toxic Shock Syndrome (TSS).
Dr Rupali
Mahadik  With clean hands hold the base of the
tampon between the index finger and the
thumb.

 Insert the tampon into the vagina.

 Push the tampon inside, gently, with the
middle finger while leaving the string
hanging out of the vagina.

 Remove the finger while leaving the string of

the tampon hanging out of the vagina, to be
used later during the removal process.

 A tampon should not be left inside the vagina

for more than 6 hours because leaving a
tampon inside for a prolonged time can
cause a rare but potentially fatal illness
called Toxic Shock Syndrome (TSS). After
use, tampon is pulled out by the string of the
tampon which is left hanging out of the
vagina.
Dr Rupali
Mahadik Why is it necessary to dispose off
sanitary napkins?

 If they are left in the open, they are a

sore sight

 May lead to transmission of infections

like Hepatitis B and hepatitis

 Will attract flies and insects

Dr Rupali How to dispose a used sanitary pad
Mahadik
or a tampon?
 Sanitary pad or tampon
should never be flushed down
the toilet because it may clog
the drainage system and lead
to flooding of the toilet.
 Disposing of non-
biodegradable sanitary pads
in pit latrines leads to quick
filling and thus shortened
service of the pit.
 disposed products may get
contaminated with germs and
emit a foul smell.
Dr Rupali
Mahadik  After use, a disposable
sanitary pad or a tampon
should be wrapped in a news
paper or waste paper and put
in a garbage bin.
 keep the garbage bin covered
 to prevent the foul smell
from spreading in your house
and secondly,
 the contents of the garbage
bin should be disposed of
promptly to prevent spread
of diseases by flies and other
insects that gather around
these garbage bins.
 Disposal of napkins …..

We use sanitary napkins for our convenience and dispose them off
randomly in the bin, or in the toilet sparing little thought to what
happens after…..
 Our rag pickers have to handle badly wrapped or
unwrapped napkins or

the plumber is caught in embarrassing situation when

drainage gets choked.
Dr Rupali
Mahadik What is a menstrual cup and how
to use it?
 Menstrual cup is a bell shaped
container made of soft rubber
or silicone that is used to
collect menstrual fluid.

 A menstrual cup is used by

inserting it into the vagina and
leaving it there.

 If properly inserted, the rim of

the cup forms a seal with the
walls of the vagina to prevent
leakage.
Dr Rupali
Mahadik  Menstrual cup should be changed after every
12 hours.

 To pull it out of the vagina, the stem at the base

of the cup needs to be held tightly between the
thumb and the index finger and pulled out.

 After disposing off the menstrual fluid, the cup

can be rinsed with water and reused. Once your
period is over, the cup can be reused for the
next cycle after cleaning the cup with boiled
water and drying it.
Dr Rupali
Mahadik Lack of facilities and sanitary
products
... Can push many girls out of school.
Relationship between menstrual hygiene
and school drop-out of girls from the
higher forms due to lack of facilities,
affordable sanitary products, fear of
bloodstains and more.
Dr Rupali
Mahadik

school drop-out of girls

Dr Rupali
Mahadik
Dr Rupali
Mahadik
r Rupali
ahadik
Dr Rupali
Mahadik
Dr Rupali
Mahadik
Dr Rupali
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Dr Rupali
Mahadik

Hygiene
 What are general hygiene measures
necessary during menstruation?
Dr Rupali
Mahadik

 Take a bath or shower at least once a

day.

 Use clean undergarments and

change them regularly.

 Change pads or tampons regularly.

 Wash the genital area with plain water
Dr Rupali
Mahadik (no soap) after each use of toilet and even
after urination.

 Keep the area between the legs dry,

otherwise you may experience chafing.

 It is very important to remember that

vagina has its own self cleaning mechanism
and an external cleaning agent like
deodorant or soap should not be used
inside it.
Dr Rupali
Mahadik

Do girls and women have special

nutritional requirements during
their years of menstruation?
  Nutrition and period problems
Dr Rupali
Mahadik

 Studies have shown many nutrients are closely linked with

periods.
 Women with premenstrual syndrome usually have low levels
of calcium, chromium, copper and magnesium.
Supplementation of nutrients like calcium, magnesium, zinc,
vitamin B6, vitamin D and vitamin E have been shown to
reduce symptoms related to premenstrual syndrome.
 A balanced diet is essential for proper growth, development
and functioning of the body and this remains true even
during the years of menstruation. A balanced diet containing
lots of fresh fruits and vegetables should be taken.
Dr Rupali
Mahadik

What are menstrual myths and

how do they affect a girl or a
woman?
  Menstruation was a mystery before
Dr Rupali science could explain it.
Mahadik So, a lot of different ideas and beliefs
were created to explain periods in
ancient societies and cultures.
Many such ideas and beliefs have been
proven wrong by Science, but they are
still followed in current societies.
We call these ideas menstrual myths.
Dr Rupali  These myths tend to suggest that
Mahadik menstruation is a disease or a curse and it
leads up to beliefs like a woman's body is
polluted when she is experiencing periods.

 Such beliefs cause discrimination against

women and at times, can lower your self-
esteem and opportunities for growth.

 We find this situation to be a problem for a

society in general because women are the
'better half' of every society.
Dr Rupali
Mahadik
A menstruating woman is impure,
dirty, sick or even cursed.
Dr Rupali  None of these beliefs are correct. Periods are natural and
Mahadik normal for women.

 Menstrual fluid is just a harmless mixture of blood and

tissue that was not used by your body to nourish a baby in
the Womb.

 a reason to stop women, who are having their periods,

from taking part in various social events. This happens
especially in the case of religious events
Dr Rupali Menstruating woman should not
Mahadik
take bath.
  This myth may have begun during the times when people used to
Dr Rupali take a bath in the open,
Mahadik
for example, in natural water bodies such as lakes, rivers etc.

 But, now we generally take a bath or a shower in a private

bathroom.

 Hence, there is no reason to follow this myth.

 Rather, it is a good idea to take a bath or a shower daily for a

hygienic and clean body.
Dr Rupali Menstruation leads to heavy blood
Mahadik
loss leading to anaemia.
 Menstruation in healthy women does
not cause iron deficiency anaemia.
Blood loss during a period in healthy
women is not more than 80ml (around
3 table spoons).

 In case, the blood loss is more than

80ml, you should consult your doctor
immediately
Dr Rupali
Mahadik

Hygiene of private parts

Dr Rupali
Mahadik Hygiene of private parts is a serious
matter and it must be given
the same time and consideration
that we give to the hygiene of the rest of
our bodies.

It is an issue that every woman– must take

seriously because it can have implications
on one’s overall health.
  Biological Irritants
Commonly, biologic fluids such as urine and feces cause
Dr Rupali
Mahadik irritation of the vulvar skin. Rarely, some women will be
allergic to latex or semen.

 Chemical Irritants
The majority of chemicals that produce hypersensitivity of
the vulvar skin are cosmetic or therapeutic agents,
including vaginal contraceptives, lubricants, sprays,
perfumes, douches, fabric dyes, fabric softeners, synthetic
fibers, bleaches, soaps, chlorine, dyes in toilet tissues, and
local anesthetic creams.
External chemicals that trigger the irritation process must
be avoided.
 Signs & Symptoms
Dr Rupali
Mahadik

Acute contact dermatitis results in red,

edematous, inflamed skin. Acute contact
dermatitis results
The skin may become weeping and eczematous.
The common symptoms of contact dermatitis
include superficial vulvar tenderness, burning
and pruritis.
Dr Rupali
Mahadik
Is there a ‘right way’ to clean the
genitals?

A lot to clean, right?

Not really
 Caring for Your Vulva
Dr Rupali
Mahadik
 The vulva does not need special care.

 But there are a few things you can do to stay

comfortable and prevent infections:

1. Cleaning the labia and vulva every day to prevent an

accumulation of smegma is important.
2. Women must also keep the anal opening clean so that
bacterial infections do not spread to the urinary
opening and the vagina
 The vagina?
Dr Rupali
Mahadik
 The vagina itself is self cleaning and you should leave it
alone unless instructed by your healthcare provider to
douche; the rest can be easily maintained following the
tips below.

 Never use hot water on the genitals so as to avoid over-

drying and chafing irritations. You can take your shower
as hot as you wish but turn the water to warm when
rinsing the genitals.
 Vaginal Douching
Dr Rupali
Mahadik

 Vaginal douching is the process of inserting a device into

the vagina for the purpose of flushing liquids inside.

 Vaginal douching has been subject to debate in scientific

journals for decades.

 Prospective studies are needed to determine whether

douching is a causal factor for infection (or disease) or is a
rather common behavior among women who are at risk for
these conditions.

 Hence, vaginal douching is not advisable to use for the

purpose of feminine hygiene.
 Intimate Feminine Hygiene
Dr Rupali
Mahadik
 External Wash
The mainstay of cleaning this area is to chose a mild
detergent that has a physiological pH of 4.2-5.6 .

 Soaps
Bar soap is the mostly used female hygiene product
in many countries. Bar soap is usually alkaline or
neutral, with a pH between 7 and 10, different from
vulvar skin which is somehow of acidic pH.

Alkaline pH may promote dryness, decreased acidity

of the vulvar skin and can contribute to vulvitis
 Liquid soaps & Cleansing Solutions

Dr Rupali
Mahadik
 Several intimate liquid soaps are products based
on lactic acid, because lactic acid is a natural
component of the skin

The main attribute of liquid soaps is to be able to
maintain the pH closer to the ideal pH, for the
development and maintenance of skin cells.

Lactic acid based cleansing solutions for female
genitalia are only recommended for external use
and not for vaginal douching.
 . Tissues & Wipes

Dr Rupali  Tissues and wipes products are relatively recent

Mahadik additions to the consumer market.
The formulations of these products vary, but consist
mainly of water with mild surfactant, preservatives,
antimicrobials, and fragrance. Some brands include
skin treatment agents, such as lotions with vitamin E
or aloe.

 Talcum Powder
Some women apply talcum powder either directly to
the vulva or indirectly through application to
menstrual pads, diaphragms or condoms for odor
control.
Modern products marketed specifically for feminine
hygiene use have replaced talcum powder with
cornstarch or baking soda.
 Clothing
Dr Rupali
Mahadik

 Clothing is one of the important factors in prevention of vulvovaginits.

 Bacteria and yeast thrive in moist or damp places. Therefore, clothing that
increases local heat and moisture such as nylon underwear and tight-fitting
garments including leotards, tights, rubber pants, skintight jeans, nylon
underclothing and tight-fitting diapers can contribute to vaginal infections
and prepubertal vulvovaginitis .

Cotton underwear is preferable to synthetic materials because cotton is
very breathable, and allows air to circulate around the external genitalia.
Aeration helps to keep microorganisms from building up and also helps
maintain sound skin around the vaginal area.

 In order to prevent vaginal infections, it is important to change damp

clothes, specially for those women that sweat easily or exercise often.
  A healthy reproductive system makes the miracle of life possible.
Dr Rupali  Taking good care of your reproductive health is important because
Mahadik
problems with this system can make it hard or impossible for you to
become pregnant.
 Reproductive health problems also can be harmful to your overall
health and emotional well-being and can make it hard to enjoy a
sexual relationship.

 Fortunately, many reproductive health problems can be prevented or

corrected if you take good care of your body and see your doctor for
regular checkups and screenings.
Dr Rupali
Mahadik

STAY HEALTHY