Journal of Adolescent Health 78 (2026) 302—307

[Link]

Original article

Unveiling Adolescent Boys’ Perceptions of Menstruation:

A Qualitative Study
Shruti Vashisht, Ph.D., M.D. a, *, Anuj Vashisht, M.D. b, Seema Sharma, M.D. c, and A. S. Kalra, M.S. d
a
Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
b
Department of Hospital Administration, Armed Forces Medical College, Pune, Maharashtra, India
c
Department of Public Health, Base Hospital, Guwahati, Assam, India
d
Department of Surgery and Commandant, Base Hospital, Guwahati, Assam, India

Article history: Received July 14, 2025; Accepted October 6, 2025

Keywords: Menstruation; Menstrual awareness; Menstrual taboos; Adolescent boys; Qualitative

A B S T R A C T
IMPLICATIONS AND
CONTRIBUTION
Purpose: Menstruation is a natural biological function and plays an important role in a healthy
reproductive life. However, it is often wrongly viewed as solely a women’s concern, even though
This study highlights
reproductive health is not gender-specific. This misconception persists largely because the topic is limited understanding
avoided during a crucial stage of education, leaving adolescents uninformed and lacking accurate and prevailing mis-
knowledge. In view of this, the present study aims to explore the perceptions of adolescent boys conceptions of adolescent
regarding menstruation in order to understand their point of view and current level of knowledge boys about menstruation,
on the subject. shaped by stigma and
Methods: This study used a qualitative, exploratory design involving focus group discussions silence. By exploring per-
with adolescent boys aged 13—17 years from urban schools in Guwahati. Data were collected ceptions boys, it un-
through audio-recorded sessions guided by topics on social perceptions, cultural influences, and derscores the need to
knowledge of menstruation. Transcripts were thematically analyzed to identify key patterns and involve them in menstrual
narratives until data saturation was reached. health education. The
Results: Seven focus group discussions (FGDs) involving 46 adolescent boys revealed several key findings contribute evi-
themes. Participants demonstrated limited and incomplete knowledge about menstruation, with dence for developing in-
older boys showing slightly better understanding. Many boys felt embarrassment and clusive, school-based
awkwardness discussing menstruation with peers and family due to social stigma. Reliable in- interventions to reduce
formation was often lacking, as parents and teachers tended to avoid or rush through the topic. stigma and promote
Cultural taboos and myths were commonly observed, reinforcing restrictive practices. Despite gender-equitable repro-
ductive health literacy.
experiencing teasing among peers, some boys expressed a strong desire to support menstruating
girls. They also favored comprehensive education on menstruation, with mixed opinions on
whether sessions should be co-educational or separated by gender to foster comfort and
openness.
Discussion: Adolescent boys have limited knowledge and face stigma around menstruation but
show a willingness to support their peers. Improving menstrual education with inclusive and
sensitive approaches can help break myths, reduce embarrassment, and foster understanding.
© 2025 Society for Adolescent Health and Medicine. All rights are reserved, including those for
text and data mining, AI training, and similar technologies.

Conflicts of interest: The authors have no conflicts of interest to disclose.

* Address correspondence to: Dr Shruti Vashisht, Ph.D., M.D., Department of
Community Medicine, Armed Forces Medical College, Sholapur Road, Pune
Menstruation remains a critical yet stigmatized aspect of
411040, India reproductive health education. Often framed solely as a
E-mail address: shrutigarg6251@[Link] (S. Vashisht).

1054-139X/© 2025 Society for Adolescent Health and Medicine. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
[Link]
 S. Vashisht et al. / Journal of Adolescent Health 78 (2026) 302—307 303

"women’s issue," it is surrounded by widespread misinforma- Researcher description

tion and discomfort among male adolescents [1]. Adolescence is
a transitional period between childhood and adulthood, char- The lead researcher is a female public health professional
acterized by major physical, emotional, and psychological with a medical background (MBBS) and advanced qualifications
changes [2]. Avoiding sensitive reproductive health topics dur- in Public health and Epidemiology. Her academic and profes-
ing this period can lead to misconceptions, fear, and shame later sional training has provided extensive experience in adolescent
in life. While much of the research on sexual and reproductive health, gender-sensitive research, and the sociocultural de-
health focuses on girls, it is equally important to consider per- terminants of health behaviors. Additionally, her personal
spectives and roles of boys in shaping inclusive and informed experience as a mother of two daughters has contributed to a
health narratives. This highlights the need to explore boys’ heightened awareness of the gendered dimensions of menstrual
perceptions of menstruation, the sources of their knowledge, health and the gaps in male engagement with the topic. The
and the barriers that prevent open and meaningful discussions. researcher’s prior understanding of menstruation as both a
Sommer et al. emphasized that overcoming menstrual taboos biological and socially constructed phenomenon played a sig-
and silence requires educating not only those who experience nificant role in shaping the research process. Her professional
menstruation but also their parents and communities about this training in public health and epidemiology provided a struc-
natural physiological process [3]. Studies have indicated that tured approach to data collection and thematic analysis, while
boys often receive fragmented or superficial information about her awareness of the gendered stigmas surrounding menstrua-
menstruation, primarily through school lessons, social media, tion informed the sensitivity with which focus group discus-
and peer discussions, with minimal involvement from parents sions were designed and facilitated. Recognizing the potential
or family members [4]. In India, especially in school settings, for personal biases to influence interpretation, reflexive prac-
many adolescent girls continue to suffer due to a severe lack of tices were employed throughout the research process, including
reproductive health education, particularly regarding menstru- maintaining detailed field notes and engaging in ongoing critical
ation [5]. Tragically, there have been multiple reported cases self-reflection. This reflexivity helped to ensure that the analysis
where girls have taken their own lives after being humiliated by remained grounded in participants’ perspectives rather than
peers or teachers or were killed by male members of the being overly shaped by the researcher’s own experiences or
household for period-related accidents or misconceptions [6— assumptions.
8]. These incidences reflect how a lack of menstrual awareness
and empathy in schools can lead to fatal consequences.
Mahon et al. observed that in patriarchal societies, men, Participant recruitment and setting
despite being largely unaware of the physiology of menstrua-
tion, are often the primary decision-makers when it comes to Adolescent boys aged 13—17 years were recruited from local
providing infrastructure [4]. While patriarchy is unlikely to schools in Guwahati. These schools were selected based on their
change in the near future, these decision-makers can be proximity to the researcher’s organization and their represen-
encouraged to participate in open discussions that break men- tation of urban populations of varying socioeconomic back-
strual stigma and promote male allyship in menstrual health grounds to ensure inclusion of diverse viewpoints. Parental
initiatives [9]. Previous studies have shown that including boys consent and participant assent were obtained prior to data
in menstrual health management (MHM) education can greatly collection. Participants were purposively selected to capture
enhance their knowledge and attitudes. These studies also variation in age (within the adolescent range) and class level,
identified a significant gap in understanding among both gen- thereby enhancing the diversity of the data in terms of social
ders, emphasizing the urgent need for comprehensive and in- and educational exposure to menstruation-related discourse.
clusive menstrual education [10,11]. The boys present in the school on the day of the study and from
Although extensive research has explored experiences and whom both assent and parental consent were available were
challenges of girls related to menstruation, considerably less included in the study. The boys were divided into groups as per
attention has been given to perceptions of boys and under- their class, i.e., eighth, ninth, 11th of study. Tenth and 12th
standing of the topic [5,12,13]. This study aims to examine standard/grade/class boys were excluded due to their ongoing
adolescent boys’ views on menstruation, their sources of preboard examinations.
knowledge, encounters with menstrual stigma, and their will-
ingness to support menstruating peers. By adopting a qualitative
approach, the research seeks to uncover deeper insights into the Data collection
social and cultural factors that shape boys’ attitudes and to
provide recommendations for enhancing menstrual health ed- Focus group discussions (FGDs) were conducted to facilitate
ucation in coeducational settings. open conversations about menstruation. An FGD guide was
developed following a comprehensive literature review and
included questions on:

Methodology • Social perceptions and stigma (e.g., "How do boys in your

school talk about menstruation?")
To achieve the goal of understanding how adolescent boys • Cultural influences (e.g., "Have you seen any menstrual-
perceive and make meaning of menstruation, this study related traditions at home?")
employed an interpretive qualitative, exploratory research • Knowledge and understanding (e.g., "What do you know
design. Thematic analysis was used to identify key patterns in about menstruation? Where did you learn about it?")
participants’ responses. • Supportive attitudes and behaviors
304 S. Vashisht et al. / Journal of Adolescent Health 78 (2026) 302—307

Each FGD session comprised 6—7 participants, lasted 25— Table 1

30 minutes, and was audio-recorded with participant consent. Major themes identified regarding boys’ knowledge, attitudes, and experiences
related to menstruation
Discussions were held in a confidential setting to ensure that
participants felt comfortable expressing their views. FGDs were Theme Description

conducted until data saturation was reached. We conducted 1. Limited knowledge and Incomplete or incorrect biological
data collection and analysis simultaneously. We considered data understanding understanding; misconceptions common
among boys.
saturation reached when successive FGDs yielded no substan-
2. Embarrassment and Discomfort discussing menstruation with
tially new codes. All FGDs were audio-recorded. Transcription awkwardness peers or family; fear of judgment.
was carried out verbatim in the local language by the research 3. Narrow exposure to Superficial school instruction; lack of family
team members. The translations were carried out by bilingual reliable information involvement; limited accurate sources.
researcher (lead) familiar with both languages and the study 4. Myths and cultural taboos Observance of religious/cultural restrictions;
absence of clear explanations for
context (International English Language Testing System: 8.9 and
practices.
Hindi mother tongue). A second equally competent bilingual 5. Negative peer attitudes Teasing, casual jokes among boys; no major
researcher cross-checked the translations against the original reports of direct mockery of girls.
transcripts to ensure accuracy and consistency. These were then 6. Desire to provide support Expressions of empathy and willingness to
and break stereotypes assist menstruating peers and challenge
checked by the senior members.
taboos.
7. Educational approaches Call for accurate and early education; mixed
Data analysis and preferences views on co-education versus separate
sessions.
The qualitative data was analyzed using an inductive the-
matic analysis approach. For this approach, first the audio re-
cordings from the FGDs were transcribed verbatim. The entire
transcript served as the unit of analysis. The lead researcher and included the role of bacteria or enzymes and confusion about
the members, trained in qualitative research methods, inde- the biological cause of menstruation.
pendently conducted the coding and analysis. Transcripts were “It’s a monthly process, every month the vaginal wall thickens
cross-checked and coded by additional two team members and then to remove it enzymes or bacteria come into play…. And
other than the lead to ensure fidelity. The analysis focused on then in the form of blood it comes out through vagina”
identifying and uncovering participant’s perspectives and
meanings from the responses of participant. The data were open (Student, Class 8th)
coded manually. Coding categories were not predetermined; It was also observed that boys in higher classes, such as ninth
rather, they emerged organically from the data, allowing themes grade and above, demonstrated relatively better but still
to reflect the participants’ perspectives as authentically as incomplete knowledge.
possible. Then, similar codes were grouped into broader themes.
The themes were refined and clear, and descriptive names were “ Egg production in females…… if it doesn’t get fertilised then
given. No qualitative analysis software was used; all coding and bleeding starts. It’s a natural process where waste products are
theme development were conducted manually. removed from the body.”
(Student, Class 10th)
Ethical considerations

Ethical approval was obtained from the institutional review Embarrassment and awkwardness
committee. Informed consent was also secured from the prin-
cipals of the participating schools. Participants’ anonymity and Participants reported feeling of discomfort and embarrassing
data confidentiality were maintained in accordance with the when discussing menstruation both with female peers and
ethical research guidelines. parents. Many boys feared being misunderstood or judged if
they display interest or empathy. They believe that girls might
Results interpret their open discussion as prying or insensitivity. In their
opinion, an open discussion on menstruation is not encouraged
Seven FGDs were conducted, involving 46 adolescent boys in the societies and communities.
aged 13—17 years. The boys who participated in the FGDs
“They (girls) keep it secretly, don’t tell or share …so we don’t
adequately represented a range of ages, socioeconomic status
ask, and it’s very awkward if we ask. The girls start judging us.
(lower middle to upper middle class), and educational levels,
Once, boys were discussing menstruation in class, and one girl
allowing for diverse perspectives. Thematic analysis yielded
overheard it and reacted, ‘What shameless people.’ So we are
seven major themes, each capturing distinct but interrelated
conscious and scared about discussing such things, what if they
aspects of boys’ knowledge, attitudes, and experiences related
slap us or something.”
to menstruation as elaborated below in Table 1.
(Student, Class 10th)
Limited knowledge and understanding of menstruation
Attempts to discuss menstruation with parents were often
met with avoidance or dismissal, indicating a broader discom-
It was revealed from the analysis of the transcriptions that
fort within families.
adolescent boys had incomplete biological understanding about
menstruation. Many boys admitted to having only partial or “Because whenever I have asked my family members, they
vague knowledge of the menstrual process. Key misconceptions simply ignore, don’t say anything.”
 S. Vashisht et al. / Journal of Adolescent Health 78 (2026) 302—307 305

(Student, Class 9th) hypothetical examples of helping girls obtain products or

providing emotional support.

Narrow exposure to reliable information “We will tell them that this is a natural process, will comfort
them, whatever they want during that time, we will get for
Educational materials (books, school lessons) and social them…”
media were cited as primary sources of knowledge, However, (Student, Class 9th)
boys felt that these sources provided only superficial knowl-
edge. Family members were rarely involved in menstrual edu- “ If needed can take them to the medical room, get help for them,
cation, and parental responses often discouraged curiosity with if they have problem running around, we can do those tasks for
remarks like “You are too young” or similar. them…”

“My mother said that don’t you anything better to ask…. You’ll (Student, Class 11th)
get to know when you grow up.”
(Student, Class 8th) Educational approaches and preferences

Despite being part of the school curriculum, teachers were The boys believed that complete and accurate information
often hesitant to discuss menstruation in depth and tended to should be provided on menstruation to both boys and girls,
avoid addressing more detailed questions. According to the especially before menarche. It will help reduce fear, stigma, and
boys, such topics are rushed over by the teachers and they are misconceptions.
asked to go through the topic at home themselves.
“They will be aware about the changes in the body, they will be
“Teachers also feel uncomfortable teaching such topics. They ask prepared and it will not come as a shock”
us to copy questions and answers from the board and do not
dwell into the topic.” (Student, Class 10th)

(Student, Class 9th) “Inform the boys too, otherwise they (boys) will not know what
is happening, and yes…when we grow up…we’ll be able to help
our wives.”
Myths and cultural taboos
(Student, Class 8th)
It was found that regarding the cultural taboos, boys affirmed Some boys in the FGD supported separate educational ses-
having observing restrictions at home. They encountered family sions for boys and girls. The common reasons cited by boys were
practices like prohibiting women from entering prayer rooms or that this would help both girls and boys feel safer and free to ask
kitchens during menstruation or avoiding certain foods. They questions without embarrassment. Boys felt that it might
rarely receive any clear explanations for these restrictions, and remove the discomfort of mixed-gender settings and enable
these practices were typically explained as tradition rather than more frank discussions in separate sessions.
fact.
“No…. both (girls and boys) will be uncomfortable no sir, it’s
“ They (women of the house) do not cook food, do not pray, do their (girls) personal issue… they might feel embarrassed taking
not go to temple. There is a taboo in the society related to this…. about private parts.”
Old mindset.”
(Student, Class 8th)
(Student, Class 10th)
On the other hand, some boys were in support for mixed
sessions, favoring co-educational sessions to normalize
Negative peer attitudes menstruation as a natural process. They argued that shared
sessions would break taboos and create collective understand-
Boys confirmed encountering casual teasing within male ing, thus reducing shame and secrecy.
peers, wherein a particular boy with a bad mood is teased by
“If we’ll study together, then we shall be able to understand a
friends with one-liners like “You must be on your periods.” Boys
girl’s perspective, we’ll also feel comfortable and will be able to
are conscious of jokes made by male peers among themselves.
share experiences openly.”
Although teasing sometimes occurs, they reported not wit-
nessing direct mockery of girls for staining or menstruation- (Student, Class 11th)
related issues.
“I have heard a few boys talking behind the backs, laughing, Discussion
making fun…like…why are you having mood swings…are you
on periods?” The study was conducted with an aim to get insights into
(Student, Class 8th) perceptions of menstruation of adolescent boys. The results and
findings of the study highlight gaps in knowledge, societal
stigma, and emerging supportive attitudes among boys.
Desire to provide support and break stereotypes A key finding of this study was that boys lacked compre-
hensive knowledge about menstruation, often acquiring frag-
Despite gaps in knowledge, many boys express a genuine mented information from school, social media, or peers. At
willingness to support menstruating peers. They shared times, teachers and counsellors themselves, constrained by
306 S. Vashisht et al. / Journal of Adolescent Health 78 (2026) 302—307

embarrassment or hesitation, do not provide accurate or role in normalizing menstruation and reducing stigma [15]. This
adequate information. This aligns with previous studies indi- proactive overview indicates a readiness to challenge social
cating that menstrual education remains largely female- norms if proper guidance is provided [13].
focused, leaving boys with surface-level understanding and The divergence in opinions on educational approaches
lingering misconceptions [14]. The reluctance of parents and observed in our study highlights a key area for intervention.
teachers to discuss menstruation further reinforces these While some boys preferred separate sessions, believing they
knowledge gaps, reflecting broader societal discomfort around would feel more comfortable asking questions, others favored
the topic [15]. At the interpersonal level, peers, family, and mixed sessions as a way to normalize menstruation as a shared
siblings play a crucial role in shaping menstrual perceptions, responsibility. These dual perspectives on separate versus
often perpetuating misinformation and stigma [16,17]. In our mixed education underscore the need for teaching strategies
study, boys’ understanding of menstruation was particularly that balance comfort levels of students with the broader goal of
hindered by minimal, surface-level explanations at school [18] reducing stigma. Developing and introducing age-appropriate,
and a lack of meaningful support from parents. This gap in interactive learning materials that address the biological, so-
guidance often led to confusion and reliance on peers or the cial, and emotional aspects of menstruation for both teachers
internet for information, which can further reinforce mis- and students can help reduce embarrassment and promote
conceptions and stigma. To address this, it is imperative to refine more open, informed discussions. Male role models and influ-
teacher training programs that equip educators with the skills encers can advocate for breaking menstrual stigma and
and confidence to discuss menstruation openly and sensitively. fostering positive discourse. A powerful example of male
The study also revealed that menstruation is often perceived engagement in menstruation awareness is the story of Aru-
by boys as an awkward or embarrassing topic, which prevents nachalam Muruganantham, an Indian social entrepreneur who
open dialog. Many expressed fear of being judged or misun- developed low-cost sanitary pads after witnessing his wife’s
derstood if they asked questions about menstrual health. This struggles with menstrual hygiene [22]. This underscores the
discomfort is further reinforced in family settings, where importance of involving men and boys in menstruation-related
nonverbal cues around menstruation are observed but not conversations and breaking the culture of silence surrounding it.
openly addressed. Such silence reflects the influence of tradi- The key strengths of this study lie in its use of FGDs with
tional gender roles in patriarchal societies, which continue to adolescent boys, a group which is rarely included in
limit open conversations about reproductive health between menstruation-related research. The purposive sampling
boys and other family members [19,20,21] Further presence of ensured representation across age groups and educational levels
casual peer teasing such as jokes about mood swings or periods and the thematic analysis, grounded in participants’ own words,
illustrates how stigma is trivialized rather than directly con- and supported methodological rigor and transparency. Howev-
fronted, making it more difficult to normalize discussions. er, certain limitations must be acknowledged. The study was
Introducing the discussion on real-life scenarios and case limited to a specific geographical and cultural setting, which
studies about menstruation can make discussions relatable and may influence the nature of attitudes expressed and the
engaging for boys. Open and nonjudgmental discussions in the particular taboos reported. Given the inherent limitation of
classrooms can make boys more comfortable. Another approach FGDs; the social desirability bias may have creeped in. The
can be the introduction of anonymous question boxes to allow presence of a female moderator could have potentially inhibited
students to inquire about menstruation without fear of open disclosure among participants, although efforts were
embarrassment. made to create a safe and nonjudgmental space. Transferability
At the community level, cultural and religious taboos should be assessed based on contextual similarities and not
continue to influence how boys perceive menstruation. Partici- assumed as generalizable to all adolescent populations.
pants frequently mentioned ritual restrictions such as prohib-
iting menstruating women from entering temples which reflect Conclusions
broader societal norms echoed in other studies [19—21]. Boys’
exposure to these cultural and familial taboos, including re- This study highlights the importance of engaging adolescent
strictions on prayer, cooking, and household activities, further boys in menstrual health education to bridge knowledge gaps,
reinforced their understanding of menstruation as something challenge stigma, and foster supportive attitudes. By addressing
impure or shameful. These practices were often observed but cultural taboos, educational limitations, and peer-influenced
rarely explained, leading to the unquestioned internalization of perceptions, comprehensive interventions can empower boys
such norms. This is consistent with earlier studies showing that to become allies in menstrual health discussions, ultimately
menstrual myths are passed down through generations, contributing to a more informed and empathetic society. Future
contributing to ongoing misinformation and stigma [3]. The lack research should explore interventions that effectively engage
of open discussion within families and communities further boys in menstrual literacy, including the impact of co-
entrenches these beliefs, overshadowing factual knowledge. To educational versus gender-segregated formats.
address this, schools could implement orientation programs and
provide parental guidance materials that directly confront cul- Acknowledgments
tural myths with scientifically accurate information.
Despite prevailing stigma, many boys expressed a willing- During the preparation of this work, the authors used
ness to support menstruating peers, challenging traditional ChatGPT in order to improve the flow of the language. After
gendered silences. Participants acknowledged the need for more using this tool/service, the authors reviewed and edited the
open discussions to reduce stigma and prevent misinformation. content as needed and take full responsibility for the content of
These findings align with emerging research suggesting that the publication. We would also like to acknowledge Dr. Chetan
when boys receive accurate education, they can play a crucial and Dr. Niranjan for their help and support.
 S. Vashisht et al. / Journal of Adolescent Health 78 (2026) 302—307 307

Supplementary Data [10] Khan R, Sarker S, Sultana F, et al. Engaging boys in menstrual hygiene
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of rural and urban school students’ menstruation-related questions in
Bangladesh. IJERPH 2022;19:10140.
[12] Vashisht A, Pathak R, Agarwalla R, et al. School absenteeism during
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