While there has been an increasing trend toward open and honest discussions around menstruation, it has become clear that the most marginalised voices are left out from the conversation. We are taught to conflate sex and gender from an early age, and our understanding of sexual and reproductive health is often shaped by the binary assumption of a person’s gender. The general consensus is that a menstruating body and a woman’s body are one-in-the-same – but that is far from the truth.

Not all women menstruate and not all people who menstruate are women.

When we view menstruation as a symbol of femininity and womanhood, we introduce a restricted notion of what it means to be human and risk erasing the lives of trans-men, non-binary and intersex individuals who, too, grapple with “that time of the month.”

I asked three trans-men about their experiences of menstruation in Pakistan. Inam*, Tahir* and Salman* have helped me understand how trans-menstruators manage their bodies and identities in a society that not only refuses to see them for who they are but also regularly marginalises them for their state of “otherness.”

When I first started writing this article, I could not help but think back to something Inam had said to me during his interview: “as long as people do not understand who transgender people are and that they exist in Pakistan, any awareness you generate won’t matter.”

This stuck with me. More often than not, we fail to fully understand the reality of those we seek to represent through our activism.

It made me realise that we can only rid the world of menstrual taboo if we recognise and embrace the experience of all those who menstruate. By abandoning old vocabularies and understanding trans terms, we can start to ensure that our discussion on menstruation is more inclusive, and as a result, more effective. 

Dismantling the sex/gender binary

The transgender community in Pakistan is subject to a great deal of ridicule and ostracism. People often use transphobic slurs to ‘joke’ about effeminacy or emasculate men, and they do so without any real understanding of sex, gender or trans terms.

For the purpose of this article, and to honour Inam’s request, I have broken down a few important concepts below.

Sex: Sex can be understood as a biological framework. It uses words such as male, female and intersex to describe the anatomically-distinct components and functions of the body.

Intersex: Intersex is a term for people who are born with any of several variations in sex characteristics, including chromosomes, gonads, sex hormones or genitals that do not fit the typical definition of male or female bodies.

Gender: Gender is an aspect of identity that is gradually acquired. It can refer to the social, political and economic roles and responsibilities we take on as men, women, trans or non-binary individuals.

Cisgender: Cisgender is a term for people whose gender identity and/or expression match the sex they were assigned at birth.

Trans or Transgender: Trans or transgender are umbrella terms for people whose gender identity and/or expression do not match the sex they were assigned at birth.

Trans-man: Trans-man is a term for individuals who are assigned female at birth, but who identify as male.

Trans-woman: Trans-woman is a term for individuals who are assigned male at birth, but who identify as female.

Non-binary: Non-binary is an umbrella term for people who may experience a gender identity that does not fit into traditional categories of male or female. It includes individuals who identify as agender, bigender, gender fluid, genderqueer, and various other genders.

Cultures of shame and silence

Menstruation is a taboo subject in Pakistan, hidden behind brown paper bags, monthly “stomach-aches” and over-the-counter ibuprofen.

When I asked Salman if he would openly talk about menstruation growing up, I found that his experience was, in certain ways, not very different from my own. Social attitudes toward menstruation – both at home and the school – were generally negative and conversations about it (if any) were awkward, uncomfortable and poorly retained.

“If an ad about pads came on the television, my family members would change the channel. I also remember how my family members would write the word ‘pads’ on a piece paper and tell my sisters or me to take it to a step-in store. We would be told not to open the bag that the shop wala uncle gave. It was always so confusing, jaisa kei pata nahi kya cheez hai (as if it is something dangerous/weird).”

Salman

While the cultures of shame and silence that are built around menstruation can be damaging for women, they are even more so for those who fall outside the sex/gender binary. Trans-men have to manage their bodies in a world that views menstruation as a marker of women’s difference from men, and many of them tend to avoid discussing their period to hide their trans status, preserve their masculine identity and/or avoid being misgendered.

 “I don’t talk to anyone about my period. I feel like when it comes to talking about periods, and that too trans periods, even educated people tend to act as if they are uneducated.”

Tahir

 “I feel like if I talk about menstruation, people get confused. I guess they tend to think of me as a man, so they can’t seem to understand why or how I could be interested in a “woman’s problem”.

Salman

For Salman, the need to hide his period to (a) conform to social ‘etiquette’ and (b) preserve his masculinity also prevented him from exploring alternative menstrual hygiene products. “So, you know how when you’re at the grocery store, and sometimes you decide to try a new shampoo? With menstrual products, I can’t take the risk. For many trans-men who menstruate, the products we’ve been using since forever have to do, even if there are better products in the market. There’s just this fear, you know? What if something goes wrong? What if there’s a stain on our clothes? What if somebody can tell what I’m wearing?” he exclaims.

This is why talking about menstruation, with regard to all those who experience it, is so important—the exchange of ideas and knowledge can help clear menstrual myths and misconceptions that have been around for hundreds of years, and empower individuals to lead safe and healthy lives.

Gender dysphoria

Salman and Inam spoke about their experience with gender dysphoria at certain points in their lives. They remembered feeling uncomfortable with their assigned sex and identifying with a more masculine gender identity. “I had a feeling I was trans since I was very young. I mean, I dressed differently, I had a ‘boy-ish’ haircut, and when I’d see boys reciting naats on TV, I’d try to follow them. Nobody really said anything to me at school, but I’d feel uncomfortable wearing a girl’s uniform,” shared Salman.

Their distress was worsened during the days they had their period, as it reminded them of the fact that their bodies did not align with their gender identity. “In terms of the impact my period had on my masculinity, well, it was something that was a part of my body, and there wasn’t really anything I could do about it at the time. It was difficult to stomach, and even though I hid how I felt, my period did affect me a lot psychologically. I mean, I was forced to deal with a part of my body that I didn’t want,” Inam highlighted.

“Growing up, people used to tell me about how they would experience a lot of pain and cramping during their period. I mean, it happened to me too, but I used to try to hide it from everyone. I didn’t want people to know that it happens to me too.”

Salman

It appeared that much of their anxiety and inability to talk about their trauma was rooted in the association of menstruation with cisgender women. “The biggest problem that transmen face is that they are not comfortable with their body, and the changes they experience aren’t something they like. Talking from personal experience, I used to hide the changes my body was going through and never discussed them with my friends. I didn’t want to accept that I was a girl,” Inam explained.

“I started to feel like I was sick…like I had some mental disorder. Growing up, I had seen trans women, and I knew that people like that do exist. But to identify myself as a boy or a man? I felt as if I was the only person in the world who felt like this, and if I ever told anyone—I mean, you know how it is, log kya kahein gai?” said Salman.

If we start to see menstruation for what it is—a bodily process that affects some but not others—rather than a “women’s issue”, we can help lessen the gender dysphoria trans-men and people with non-binary gender identities feel during their period.

Menstrual management

While I was talking to them about the measures they took to keep their period a secret, Salman and Tahir mentioned how difficult it can be to manage menstruation in public. “I try to go out less during my periods. If I do go out, I keep pads on me and only go to places where there are restrooms. I even go as far as to take old newspapers or plastic bags with me so that I can dispose off my pad correctly. But even then, I always hesitate to use public bathrooms—what if they don’t have dustbins? How will I change my pad? As someone who values cleanliness and personal hygiene, this thought really disturbs me,” said Tahir.

“Generally, I avoid using public bathrooms, even if it’s at somebody’s house. But when you have your period you can’t exactly control that; you have to check your pad every few hours to determine whether or not you should change it. So, whenever I’m on my period, it’s like, ab kya karein? (what to do now?),” exclaimed Salman.

Their disdain toward using public bathrooms did not just stem from how inconvenient these bathroom trips tended to be. For trans-men, the public bathroom often becomes a gendered space and brings up a fear of ridicule, violence and/or conflict. “Girls usually have a purse they can hide a pad in and take to the bathroom. But I don’t have a purse. I only have the office briefcase I keep my pads in. When I want to use the bathroom, I first need to figure out how to get a pad from my briefcase into my pocket without anyone noticing,” added Salman. 

Menstrual suppression

Many people wonder why some trans-men don’t use hormonal management to stop or reduce their period. Out of the three people I interviewed, Inam was the only one who had transitioned medically. Intrigued, I asked them about their attitudes toward menstrual suppression and found that their reality was much more complex. Not all trans-men want to take period blockers or testosterone.

“No, I’ve never taken any medication to stop my period. I decided against it when I researched more on their side effects. Even now, when I talk to trans-men who have had their uteruses removed, they tell me about their experience with weight gain and other health problems. I guess, for me at least, my period has just become a part of my life. I don’t feel the need to hide it or stop it as much anymore… it’s better to learn to manage it and move forward,” said Salman.

Even if they do, everyone cannot access them. Salman explained how difficult it can be to purchase oral contraceptive pills when you live with your family: “When I got my period in eighth grade, I searched for some things on the home computer and found medicines that could stop my period. But then I thought, ‘even if I find them, how will I go to a medical store and buy them. What will people there think?’ I would go to school in a van, and I couldn’t make them stop at a store. If I went out otherwise, I would go with my dad. If I went to the area medical store, the shopkeepers would know me. When it comes to buying a medication like that, there’s the fear that your family might find out.”

In Pakistan, the knowledge and use of any contraceptive method are particularly low due to negative social perceptions and religious concerns, among other things. Not only do we rarely talk about it, but its use is limited to married women who are trying to avoid pregnancy. Getting caught purchasing oral contraceptive pills as an unmarried teenager, then, has the potential to cause quite the commotion.

Then versus now

During their interviews, I asked each of them if they thought their attitude toward and experience with menstruation had changed over time. Tahir and Salman both felt that they had grown fairly comfortable in their own skin as they reached adulthood. Salman further commented: “Things are the same, but I’ve gotten used to them now. I understand things, I’ve settled down, and my life feels like it’s in motion… it doesn’t feel so difficult anymore. Before, when my body was just starting to change, and I was not independent, it was harder to process how I felt.”

They did, however, lament over the lack of menstrual positivity in Pakistan. The progress they had made in coming to terms with their bodies and identities was in spite of, not because of, the system they found themselves in.

What can we do?

A conversation on trans periods is long overdue. Toward the end of each interview, I asked them how we could make the menstrual movement more inclusive in Pakistan. All three of them agreed that knowledge and information for all would be a step in the right direction.

“Every house has people who menstruate. If we have open and honest discussions, then we can surely increase awareness. I think the most important thing is that we need to have this conversation in a co-educational environment—boys need to be part of the discussion.”

Inam

“I mean, from a very young age we’re taught that we’re Muslims—we need to offer prayers five times a day, fast, give zakat—you know, basic things. So, if we can talk about these ‘basic things,’ why can’t we learn about people and what happens to them?” asked Salman.

There is a need to create a social landscape that is accepting of both menstruation and trans and non-binary gender identities. Salman felt that the best way to do this would be through a bottom-up approach: “I mean we can suggest separate bathrooms, stores and medical facilities for trans individuals, but what all can we separate? Some people from our community feel that this further marginalises us. But then again, if you don’t do these things, we continue to face the issues I mentioned before. It’s a tough dilemma to resolve, so I think our first step should be to normalise these things from the get-go—we need to change the curriculum and make room for more inclusive conversations. I mean, come on yaar, periods are a normal part of life, and we need to treat it as such.”

We are more than our bodies; we have hearts and minds that should not be defined by misconstrued views on sex and gender. From branding and advertising different “feminine hygiene products” to exclusively referring to people who menstruate as “women,” we need to revisit our preconceived notions of gender conformity to make a strong case for menstrual equity. Blood has no gender, so why do we insist on setting boundaries and creating further barriers to menstrual comfort?

*Names have been changed to maintain anonymity