Experience of menstruation with the use of reusable menstrual products: a qualitative study among menstruators in Israel

Abstract

Menstruation is an embodied experience that influences menstruators’ perceptions of the self and body. The stigma surrounding menstruation and its negative representation in popular culture has consequences for women’s sexual and reproductive health. In this study, semi-structured interviews were conducted with forty 18–50 year old participants who used reusable menstrual products to examine their experience of menstruation and how their use of these products shaped their self-body image. Data were analysed using thematic analysis. Participants commonly reported physical, medical and emotional improvement in menstrual experience and improved acceptance of the menstrual body alongside changes in feeling towards menstrual products and related issues. The participants described menstruation, menstrual blood, and the menstrual body more positively than before, reported a high comfort level with and in their bodies, and rejected common representations of menstruation. Findings suggest that using reusable menstrual products can contribute to body appreciation. Given these benefits, further research is needed to assess how knowledge of alternative menstrual products can stimulate positive views about the menstruating body and contribute to menstrual health.

Keywords:

• Menstruation
• menstrual health
• menstrual products
• qualitative
• Israel

Introduction

Menstruation is an integral part of women’s sexual and reproductive health and everyday life. Nonetheless, the topic is silenced in many cultures and societies and often accompanied by social stigma (Jackson and Falmagne 2013; Johnston-Robledo and Chrisler 2013; Kowalski and Chapple 2000; Schooler et al. 2005). Menstruators in Israel are exposed to media representation of menstruation, specifically advertisements for ‘feminine hygiene’ products, portraying menstruation as dirty and polluting (Bobel 2019). This is compounded by a widespread discourse of shame and concealment (Campbell, Freeman and Gannon 2021), which shapes menstruators’ attitudes towards their body and menstrual cycle (Chrisler et al. 1994). In Israel, some Jewish women follow Niddah laws, further reinforcing menstrual stigma (Tan, Haththotuwa and Fraser 2017). According to Niddah beliefs, menstruating women are considered impure, forbidden, and contaminating (Wasserfall 2015). More broadly, religious influence echoes throughout dominant menstrual discourse, contributing to mainstream negativity towards menstruation.

The negative representation of menstruation has various impacts on menstruators. Research shows that it affects to their wish to abolish the menstrual cycle (Johnston-Robledo et al. 2003), contributes to self-objectification (Johnston-Robledo et al. 2007), leads to self-body shaming (Jackson and Falmagne 2013), and influences negative body image (Calogero and Thompson 2010). Conversely, body appreciation has been linked to more positive attitudes towards menstruation (Chrisler et al. 2015). Since menstruators’ relationship to menstruation is closely connected to their general comfort with their body and body image (Kissling 2006), and menstruators’ general perception of menstruation correlates with their perception of reusable menstrual products (Grose and Grabe 2014), self-body image may also plausibly be connected with using reusable menstrual products. The use of these products involves intimate contact with one’s genitals, as well as increased contact with menstrual fluid, due to the products’ changing and cleaning requirements. This increased intimate contact may lead to more positive feelings towards menstruation and the body.

Menstrual cups, reusable pads and absorbent underwear are comfortable, healthy, environmentally friendly alternatives to single-use pads and tampons (Beksinska et al. 2015; Fourcassier et al. 2022; Lamont, Wagner and Incorvati 2019; van Eijk et al. 2019), which carry significant physical, environmental and financial costs (Peter and Abhitha 2021; Sommer et al. 2015). Tampons, for example, absorb not only the menses but also other vaginal secretions. In addition, the production process for disposables adds chemicals to the environment and produces enormous amounts of waste requiring many years to decompose (Stewart, Greer and Powell 2010). However, despite the advantages of reusable menstrual products, disposable products remain more popular (Lamont, Wagner and Incorvati 2019; van Eijk et al. 2019).

The limited visibility of reusable menstrual products in mainstream advertisements and their absence from mainstream supermarkets limit consumers’ awareness and knowledge of them, which may explain low usage rates. Nor are reusable menstrual products currently mentioned in educational materials for girls reaching menarche in Israel. The general lack of menstrual education also reflects inadequate knowledge about the menstrual cycle among national ministers, policymakers, and sexual and reproductive health practitioners in Israel (Ministry of Economy and Industry 2017; Schwartz 2022). This is strongly tied to prevalent menstrual stigma and shame, which affects women’s menstrual experience and determine which menstrual products they choose.

Although reusable menstrual products are not commonly used, research suggests that satisfaction with them may increase with use (Milne and Barnack-Tavlaris 2019) and that their users are satisfied with them, while non-users are often willing to try them (Beksinska et al. 2015). Neither self-objectification nor body shame have been found to be directly related to attitudes towards and willingness to use reusable menstrual products (Lamont, Wagner and Incorvati 2019). Given the potentially significant impact of a particular menstrual product on menstrual experiences, a review of available products for menstruators, programme developers and policymakers would be invaluable. In parallel, disseminating comprehensive knowledge about the menstrual cycle could stimulate positive views of the menstruating body. Thus, it is essential to analyse the menstrual experiences and self-body image of reusable menstrual product users.

Research on menstrual experience using reusable menstrual products has thus far focused on use and acceptability rather than their impact on the user’s bodily and personal narratives (Beksinska et al. 2015; Gharacheh et al. 2021; Hennegan 2019; Medina-Perucha et al. 2022; Pokhrel et al. 2021; van Eijk et al. 2019). While studies of use and acceptability are valuable and may provide practical insights, they do not capture the users’ total experience. Studying users’ narratives can provide a more comprehensive understanding of that experience. In addition, qualitative studies of long-term reusable menstrual products users are rare and most research to date has been conducted via questionnaires, which cannot capture complex, nuanced information about users’ experiences. Interviews offer a more flexible, in-depth approach, providing a deeper understanding of participants’ experiences.

No qualitative data is available regarding reusable menstrual products users in Israel. In this study, we interviewed menstruators in Israel to close this research gap and understand their menstrual experiences. We aimed to understand potential connections between reusable menstrual product use and body image, body appreciation and general comfort with the body. The many potential advantages of these products, including their ability to promote a positive attitude towards the body, reduced consumption and benefit to the environment, make researching this issue essential. Specifically, considering how Niddah laws reinforce menstrual stigma, it is essential to examine Israeli menstruators’ own narratives and whether reusable menstrual product use can affect the self-body image. This research may promote positive discourse in Israel about menstruation by addressing barriers contributing to the shame narrative and promoting change in the mainstream’s current negative approach to menstruation.

Method

Since a qualitative descriptive methodology would likely facilitate a deeper understanding of participants’ menstrual experiences. 40 semi-structured interviews were conducted between September and November 2020.

Participants and recruitment

Since much discourse regarding reusable menstrual products occurs online, participants were recruited through social media, mainly via Facebook groups and WhatsApp, Instagram, and forums.

¹

All the groups and pages examined are operated by private individuals aiming to bring together reusable menstrual products users or people interested in a more ecological lifestyle. Within these platforms, the researchers created a post to solicit individuals for participation in an interview study about menstruation and experiences with reusable menstrual products. Since the study’s purpose was to evaluate long-term users’ experiences, eligible participants were defined as being aged 18 or older, and having used reusable menstrual products for more than a year.

Of the 290 individuals who volunteered to participate, a purposive sample of 40 individuals, aged 18–50 (mean = 34.3 years), was selected based on the research criteria and resource constraints. This sample size was considered adequate to achieve the desired diversity and comprehensively understand participants’ experiences. Age groups were represented according to their percentages within the total number of registrations. To understand the experiences of as wide-ranging a sample as possible, participants with diverse characteristics (socioeconomic backgrounds, country of origin, racial/ethnic origin, cultural background, and gender identity) were selected. Minority ethnicities, religions and countries of origin were intentionally oversampled. Additionally, during the interviews, participants reported a range of socioeconomic and educational backgrounds, employment histories, relationship statuses, parenthood statuses, political views, religions, identifications with feminism, and specific products used (menstrual cups, reusable pads, and absorbent underwear). Table 1 shows the sample’s demographic characteristics.

Table 1. Characteristics of study participants.

	N = 40
Age
18–24	6
25–29	11
30–34	12
35–40	8
41–45	2
46–50	1
Reusable menstrual products used
Menstrual cup	15
Reusable pads	3
Absorbent underwear	1
Reusable pads + absorbent underwear	1
Menstrual cup + reusable pads	13
Menstrual cup + absorbent underwear	5
Menstrual cup + reusable pads + absorbent underwear	2
Education
High school education	1
Current undergraduate student	8
Bachelor’s degree	18
Master’s degree	12
Doctorate	1
Place of birth
Israel	33
USA	2
Colombia	1
Romania	1
France	1
Argentina	1
Russia	1
Religion
Jewish	38
Christian	1
Muslim	1
Relationship status
Single	10
In a relationship	16
Married	13
Divorced	1
Parenthood status
Parent	16
Non-parent	24
Identification with feminism
Feminist	32
Non-feminist	3
Unspecified	5

Data collection

Semi-structured individual interviews were conducted online using Zoom due to COVID-19 restrictions. The interviews lasted from one to two hours and, with participants’ verbal consent, were audio-recorded and transcribed. All participants were interviewed by one of the authors (A.K.). Interviews were conducted in Hebrew. Identifying data were removed and each participant was assigned a pseudonym to ensure anonymity. The discussion was guided by a series of open-ended questions on predetermined themes in the relevant literature. Participants responded to 35 questions about their menstrual history, menstrual experiences and practices (e.g. ‘What do you think about menstruation and the menstrual cycle?’), experience of menstrual product use (e.g. ‘Why did you decide to switch to reusable products?’), feelings regarding their bodies (e.g. ‘How do you feel about your current appearance and body?’), and related ecological behaviours. These questions served to trigger unscripted dialogues on related topics. Follow-up questions, clarifications and probes were free-flowing and conversational. The study and interview protocol were approved by Haifa University Humanities Institutional Review Board (approval number 459/20).

Data analysis

All interviews were transcribed verbatim by a professional transcriptionist, translated into English by the authors, and validated by a professional translator. The English translations were then re-read by the interviewer to determine their accuracy. A random sample of five translated interviews was translated back into Hebrew by a different professional translator to ensure consistency between the results in both languages. The quotes appearing in this paper are verbatim.

Thematic analysis was used to analyse the data. This process, chosen to capture a breadth of experiences (Braun and Clarke 2012), involved reading and re-reading each transcript, identifying emergent themes, searching for connections between these themes, and comparing them across interviews. Each transcript was analysed and coded. After all transcript analyses were complete, the tables of themes that had been drawn up for each transcript were compared to identify shared themes.

Findings

Three major themes were identifiable in Israeli menstruators’ reports of their experience using reusable menstrual products: (a) improvement in menstrual experience; (b) acceptance of the menstrual body; and (c) changes in feelings towards and because of the products. The following descriptions show that some participants’ responses fitted multiple themes.

Improved menstrual experience

Interviewees reported improvements in three key aspects of menstrual experience since using reusable menstrual products: physical, medical, and emotional. Many participants reported physical improvements, including shorter menses, greater comfort, and better smell, colour, and sensation. For example, Tamar (25, Menstrual Cup, Israeli) noted changes in the vulva:

My vulva was always dry, probably from the tampons. It felt like the blood was brown, and now it’s red. I guess that is absorbed in the tampons, and I never saw the blood. Menstruation shortened from a week to four or five days, and now my vulva isn’t dry anymore.

Many other participants also mentioned shorter menses. For instance, Ruth (36, Menstrual Cup + Reusable Pad, Israeli) said, ‘It lasted for days, and it got shorter when I used a menstrual cup regularly. I felt that it helped contain menstruation, and it’s not spread to more days than it’s supposed to.’

When asked about physical changes from switching to reusable menstrual products, many participants described these as positive. Some said adjusting to the products took several cycles, but most reported good experiences immediately. Inbal (28, Menstrual Cup + Reusable Pad, US citizen) described the physical changes she experienced:

It’s much more pleasant and comfortable, I have fewer period pains; with the regular pads, I had a lot of blood, and the flow felt heavy all the time. It’s like they are putting something in it that makes you use it more, and it makes your body discharge more. I finally feel that I’m not disgusting all day.

Menstruation-related medical issues include premenstrual syndrome (Eisenlohr-Moul 2019; Hartlage, Breaux and Yonkers 2014), endometriosis (Evans et al. 2022), uterine fibroids (Hoffman et al. 2020), and other gynaecological conditions. Participants described improvements in several menstruation-related medical issues, including premenstrual syndrome, dysmenorrhea, pain, migraines, itching, urinary tract infections, yeast infections, and psoriasis. Sara (25, Menstrual Cup, Israeli) said: ‘I remember it was excruciating, but five years ago, when I started using other products, the pain was reduced significantly.’ Rey (31, Menstrual Cup + Reusable Pad, Israeli) saw improvement in her headaches: ‘Since I’ve been using reusable, I have fewer period pains and fewer migraines.’ Smadar (31, Reusable Pad, Israeli) connected her pain and premenstrual syndrome to tampon use: ‘I found out around age 20 that I suffer from premenstrual syndrome. I had cramps and terrible abdominal pains, and then I realised that the pain went away when I took the tampon out.’ Medical issues also provided a solid motivation for testing other products, as Nerya (27, Menstrual Cup + Absorbent Underwear, Israeli) noted:

My first interest was in the menstrual cup, and it started from a medical perspective. I developed psoriasis, and I was treated with medication. I didn’t make any diagnosis; I just realised that I’m sensitive to these products, and then I moved to a menstrual cup. I remember that from the first use, it just stopped itching, and it was terrific. Within six months, even the psoriasis was cured.

All participants mentioned positive emotional changes regarding their menstruation and cycle from using reusable menstrual products. Asked about previous menses, participants mentioned shame, trauma, hiding the blood, concealing the products, and silence. These feelings shifted to excitement, anticipation, maturity and positivity following their adoption of the products. Nadya (30, Menstrual Cup + Absorbent Underwear, Russian) described her feeling when using the products and the changes she experienced:

The periods felt better. I was less stressed that I might get dirty. If I wasn’t home, it wasn’t comfortable, and suddenly there’s another option, and it released a lot from me. You don’t need to worry about changing pads all the time, and I think it released patterns that seemed the most natural and legitimate in the world.

Bodily changes influenced mental states, too, many participants reported. They described viewing their body and menstruation more positively, which generated greater comfort and confidence. As Amal (26, Menstrual Cup + Reusable Pad, Arab-Israeli) said, ‘I started enjoying my period.’ Oxana (32, Menstrual Cup, Romanian) even described anticipation and joy:

I had a challenging relationship with my menses; I suffered a lot. I had an experience of destruction, a time of the month when everything was ruined, and somehow when I started working with the blood, I started looking forward to these days. I celebrate these days. I talk about it. It used to be a burden, and today it is full of connection and self-love.

Acceptance of the menstrual body

Participants reported that using reusable menstrual products led to increased positivity towards not just menstruation but their entire body, their menstrual blood, and even their sexuality. Accepting their menstrual body, they reported, affected their entire body and body image. Or (30, Menstrual Cup + Reusable Pad, Israeli) talked about accepting her menstruation as a whole-body image transition:

Once I started using it, I started loving the menses, and once you love your menses, you realise it is a part of you and your body, and you don’t need to be disgusted by it or your discharges. It’s a part of me; it’s who I am. It helped me accept myself consciously. I’m not accepting one hundred per cent of myself—nobody does, but I think that it’s process the menstrual cup had something to do with; it has a significant part in this process.

Shir (27, Menstrual Cup + Reusable Pad, Israeli), describing accepting her body after moving to reusable menstrual products, said she felt ‘delighted’ and ‘in top physical shape’:

Regarding body image, I think once you start to follow your period and the different symptoms and use reusable products, you begin to understand the inner system, reflecting how the body looks on the outside. If I struggled about how my things look, now I realise that my pelvis is supposed to support a baby, I think my body is sexier now. Understanding my body helped me be more compassionate about it.

Many participants reported that regardless of their initial motivation, they continued using reusable menstrual products because they felt doing so created a new and different connection with their bodies. Gabriella (39, Menstrual Cup + Reusable Pad, Colombian) reported:

I realised a lot about myself, knowing it’s my body, my blood, it’s normal, it’s all right, it’s like you know from all the experience of self-love and acceptance. I realised it was perfectly normal and addressed it positively, so I had no problem with the bleeding experience.

Switching to reusable menstrual products made the participants more engaged with their menstrual blood. They noted that while using a cup or pad, direct contact with their menstrual blood accelerated changes in their perception of it. They described various positive aspects of the experience: pleasure, acceptance, interest, curiosity, absence of fear, and a positive surprise. Maayan (34, Menstrual Cup + Reusable Pad, Israeli) talked about the surprise of seeing the actual amount and how this influenced her:

I remember being amazed by the amount of blood, and I was sure I bled much more. I was even more shocked by the cup: ‘This is it? How does that make sense?’ I remember asking a friend, a female gynaecologist, if it was normal. I finally discovered how much I bleed, something I had no indication of before.

All the participants described their encounters with their blood in a positive manner. Vered (30, Menstrual Cup, Israeli) said: ‘There’s something raw about it. I see it and feel it: Wow, what a woman I am, what a beauty, the wonder of creation.’ Alma (28, Menstrual Cup, Israeli) said: ‘I don’t know how it’s going to sound, but I enjoy seeing my blood close-up and examining it and attributing it to something that is a part of me, that is mine. I started seeing my blood as something beautiful. I’m not disgusted by myself anymore.’ Neomi (37, Menstrual Cup, US citizen) talked about the colour: ‘It was enjoyable for me, suddenly seeing the real colour of my blood, identifying changes in the flow, the connections. With the cup, getting to the toilet, emptying it to the toilet bowl, and seeing the blood is much more fun.’

Some interviewees identified connections between accepting their menstrual body and their sexuality. Menstruators of all ages are taught by society and social norms to distance themselves from their genitals, body and sexuality (Crann et al. 2017). Liat (35, Menstrual Cup, Israeli) said: ‘The female genitals are perceived in our society as something dirty and disgusting, and generally, the perception is that the female genitals, femininity and sexuality are not spoken about.’ Because of this perception, many participants reported receiving disgusted comments from friends and contacts after sharing that they used reusable menstrual products. Hila (33, Menstrual Cup, Israeli) said:

I think the perception of menstruation and the female body is very out of date and misogynistic, and I often get disgusted comments regarding the cup. It’s like, ‘Why do you need to deal with discharge if you can use disposable?’ But I don’t see it like that, I don’t see it as disgusting, and I see it as part of life.

Many participants advocated for a greater understanding of the menstrual cycle to better understand fertility, the vulva, and sexual life. Nofar (24, Menstrual Cup, Israeli) explained: ‘I think using the products is connected to the ability to handle our body, get to know it. It requires familiarity with the vulva and the vagina.’ Understanding the female genitals and menstrual blood as normal opens up comprehension about more than just the reproductive body. Menstruation is part of the menstrual cycle and sexual life, and sexual life is part of menstruation. As Sapir (23, Menstrual Cup + Absorbent Underwear, Israeli) testified: ‘I don’t mind having sex during menstruation. It doesn’t bother me or my boyfriend. It’s my body, and I believe I don’t need to be ashamed of it.’

Changes in feelings towards and because of the products

Participants reported that using reusable menstrual products positively changed their feelings towards menstrual products. New positive feelings included cleanliness, shamelessness, safety and fearlessness. Some participants mentioned that using reusable menstrual products made them feel cleaner during menstruation. Gabriella (39, Menstrual Cup + Reusable Pad, Colombian) described the transitions she has experienced with the products:

I feel that cleaning is essential for me, it’s important to me, and I’m very sensitive to smells. Before the cup, I felt unpleasant, like it smelled all the time, and using the cup made me feel cleaner. It’s much more comfortable for me. Menstruating was a burden, and now it doesn’t bother me anymore, I even like it in a way.

Many others also mentioned the feeling of cleanliness. Amal (26, Menstrual Cup + Reusable Pad, Arab-Israeli) said, ‘Menstruation became an experience of cleansing.’ When asked about that, she elaborated, ‘I saw that it’s comfortable, sterile and clean. My body has felt cleaner since I started using the cup. Today I understand that menstruation isn’t gross and not that bad, and I even feel proud of it.’ Maayan (34, Menstrual Cup + Reusable Pad, Israeli) mentioned that after switching to reusable menstrual products, she started feeling cleaner around menstrual blood:

I remember thinking it was a bit disgusting, the blood, and what would happen if I touched it. But that thought went through my head very quickly. Today it’s not as awful as tampons. I pour the cup out into the sink, and it’s much cleaner for me, more aesthetically pleasing, and much more comfortable.

Discourses of shame and concealment are prominent in advertising for disposable menstrual products, portraying menstruation as embarrassing (Campbell, Freeman, and Gannon 2021). In broader modern discourse, the emotion most imputed to menstruators about menstruation is shame (Burrows and Johnson 2005). However, interviewees reported having stopped feeling shame and started feeling proud of their menstruation after moving to reusable menstrual products. Lital (25, Absorbent Underwear, Israeli) addressed the double standard about concealing menstruation:

Society perceives that menstruation is dirty and must be hidden constantly. The message is, ‘Quit about the pain; it’s only a period, what are you complaining about?’ and you can’t complain about it because everybody has it. Using reusable menstrual products distances us from that perception and helps us connect with menstruation. It forces you to see and touch the blood, stop hiding it and feeling shameful regarding it, and the more we deal with it, the less taboo it will be.

Participants also noted feeling safer during their periods after switching to reusable menstrual products, a message often emphasised in advertisements for disposable menstrual products (Erchull 2013), and participants often used these same terms when describing reusable products. Rey (31, Menstrual Cup + Reusable Pad, Israeli) testified: ‘I transformed. I won’t say I enjoy it, but I’m not anxious about it anymore. I know what will happen, how to handle it, and feel safe.’

Many participants reported that they also stopped experiencing fear about menstruation after switching to reusable menstrual products. Liat (35, Menstrual Cup, Israeli) said: ‘I don’t live in fear anymore. I don’t let things dictate to me what I’m doing. Everything I feel good with, I’ll do it.’ Ruth (36, Menstrual Cup + Reusable Pad, Israeli) elaborated on the fear she used to feel while using disposable menstrual products, in contrast with the safety she feels using reusable ones:

When I started using the cup, I was at school almost every day for many hours. And I remember it was so comfortable. You can put it inside and not feel it for many hours, without worrying about leaking and changing all the time. I didn’t have the security with it initially, but after a couple of times, when I saw it working, I started to gain more confidence with the cup, and that feeling liberated me.

Using reusable menstrual products caused participants to pay different attention to their menses. Mor (24, Menstrual Cap + Absorbent Underwear, Israeli) reported that attention to her menstruation also helped her ‘pay more attention to nutrition, feelings, different phases of the menstrual cycle, and mood.’ She said, ‘I don’t know how to explain it, but I’m more aware of myself now.’ This increased attention was accompanied by positive emotions and feelings, as Oxana (32, Menstrual Cap, Romanian) noted:

Today, I perceive it as something wonderful and positive. I’m happy every month when I get my period. I know when it happens that my body is functioning. It connects me to the cycle of nature and gives me a perspective on life. Things are changing, and nothing stays the same. It’s a beautiful process. I’m pleased about it.

Discussion

The results of this study offer insight into menstruators’ experience using reusable menstrual products during menstruation. In examining the findings, we noted that participants used positive language when talking about their menstrual experience, often sharing descriptions of understanding, acceptance and positivity. The themes identified show that using reusable menstrual products may affect menstruators positively and significantly, including in unexpected ways. Findings highlight the importance of a qualitative approach to improving menstruators’ ability to make decisions about their bodies and sexual and reproductive health, including during menstruation.

Study participants reported positive bodily experiences using reusable menstrual products, stating that the products gave them comfort and confidence, in contrast to the norms regarding menstruation prevalent in society and among menstruators. Positive experiences with reusable menstrual products are valuable because of the social stigma that surrounds menstruation. Positive menstrual experiences support the idea that when stigma is lessened, and the body not marked as abject, negative feelings and emotions towards menstruation are reduced (Fahs 2020).

Another aspect of participants’ positive menstrual experiences was greater acceptance of menstrual blood. Reusable menstrual products users had a strong connection with their menses, which seemed to engender positive emotions, regardless of previous experience. They knew what ‘normal’ bleeding looks like, which reduced the fear and anxiety around it. Unlike disposable menstrual product users who often overestimated the amount of menstrual blood (Fahs and Swank 2021), reusable menstrual product users seemed to evaluate the quantity more accurately. In making these statements, we are not implying that all menstruators must embrace their cycle, but rather that menstruation can also evoke non-negative emotions, which can coexist with the negative menstruation-related feelings caused by infertility, pain or related health issues, highlighting the complex nature of menstrual experience.

Participants mentioned that reusable menstrual products stimulated conceptual changes by opening them up to new bodily experiences. They reported feeling more positive towards menstruation and their body more generally, alongside a greater appreciation for the menstrual body. This supports the findings of Chrisler et al. (2015) that menstruators who appreciate and respect their bodies are more likely to express well-being and pride about menstruation, and less likely to associate menstruation with embarrassment or annoyance. In this study, participants described experiencing comfort in their bodies and indicated an understanding that the menstrual cycle affects fertility, the vulva, and sexual life; that the female genitals are ordinary; and that menstrual blood is normal. This understanding helped them view menstruation as an essential part of the menstrual cycle and their sexual lives.

Participants identified several positive emotional changes after using reusable menstrual products, such as feeling safe, proud and clean. The primary message in advertisements for disposable menstrual products is an assurance that disposable products will instil those feelings; however, the evidence from our study indicates that reusable menstrual products can also engender these feelings. Participants adopted advertisements’ messages but referred to that discourse from a position of resistance. Since most messages about menstruation highlight its negative impacts (Johnston-Robledo and Chrisler 2013), it is essential to offer messages that can contribute to positive thinking about and attitudes towards menstruation (Chrisler et al. 1994), encouraging consumers to explore alternative menstrual products.

This research suggests that understanding the menstrual experiences of menstruators has significant implications for sexual and reproductive health education. Including greater reference to menstruation, the menstrual cycle, and reusable menstrual products in educational and health programmes can stimulate positive views of the menstruating body, sexuality and their interrelationship. Field experiments indicate that providing informed choices will minimise the cost to the environment and their implications for menstruators’ health (Mahajan 2019).

Strengths and limitations

This study illustrates the value of qualitative research methods, enabling participants to freely share their experiences on subjects that may be hard to express using closed-ended survey questions. With no prior interviews on the menstrual experiences of reusable menstrual products users in Israel, we employed a research methodology that allowed participants to share their narratives and facilitated the collection of complex, multidimensional data. This study also contributes to the qualitative literature on reusable menstrual products, differentiating itself from previous research that has mainly focused on short-term use and acceptance by centring on menstruator longer-term narratives.

Some of the research decisions in this study may have influenced the results. Our sample primarily consisted of Jewish participants, with insufficient representation of Arab menstruators due to the low number of non-Jewish volunteers. Future studies should seek to include a more diverse range of participants to better represent the wider population. Furthermore, due to COVID-19 restrictions at the time of the study, interviews were conducted online. This provided benefits such as the interviews being at home and able to speaking relatively freely but eye contact was limited as were other forms of non-verbal behaviours (James and Busher 2016; Oliffe et al. 2021). Future research could consider the value of in-person interviews. It is important to note that online recruitment may also have caused biases in the age, income, and education level of the participants (Rife et al. 2016). Despite these limitations, we achieved a diverse set of responses and a sufficient sample size for our study.

Finally, this study focused on menstruators in Israel. Conducting similar studies in different contexts would enhance results and assess cultural specificity. The study primarily included cisgender women, with only one nonbinary participant. Gender-nonbinary and transgender individuals may have distinct menstruation experiences, with secrecy and menstrual suppression perhaps being more important for them (Chrisler et al. 2016; Lane et al. 2022). While this study did not focus on experiences among diverse gender identities, further research should consider how menstruation or reusable menstrual products experiences differ by gender identity and explore the implications of these differences.

Future directions

Regarding future directions, there exists a notable gap in understanding feelings towards reusable menstrual products and potential differences compared to disposable products. Exploring this area through interviews with disposable product users could provide insights into how knowledge of an alternative menstrual product may foster positive attitudes (Beksinska et al. 2015; Grose and Grabe 2014; Milne and Barnack-Tavlaris 2019). Additionally, conducting further research with a comparison group, such as Israeli menstruators temporarily using reusable menstrual products, could clarify the impact and role of these products in shaping positive menstruation experiences (Tu, Lo and Lai 2021). Furthermore, investigating various reusable menstrual products for potential differences in their influence on users is important. Conducting more research among Israeli menstruators could promote positive discourse regarding menstruation, address cultural barriers perpetuating shame, and promote change. Finally, the study’s findings may be valuable to scholars seeking positive views of the female body and provide gynaecologists with new perspectives when identifying and treating patients’ health issues. Ultimately, acknowledging the positive menstruation experiences highlighted in this study should prompt policymakers, educators, feminist activists, and health professionals to consider their implications for challenging prevailing negative narratives.

Conclusions

Findings from this study shed light on the menstrual experiences of reusable menstrual products users, contributing to new knowledge about menstruation stigma, body appreciation, and the positive aspects of menstruation. In this study, the predominantly feminist reusable menstrual products users experienced menstruation, the menstrual body, and menstrual blood positively, suggesting a connection between reusable menstrual products and body appreciation. These users also rejected menstrual stigma, subverting its typical representation as dirty and shameful. Together, these findings suggest that reusable menstrual products can enhance and normalise menstrual experiences, contributing to the sexual and reproductive health and well-being of menstruators. They also highlight the importance of comprehensive education about the diversity of menstrual experience, which should be integrated into future menstrual health programmes so as to alert menstruators to the full range of product choices available to them.

Acknowledgements

We thank the participants in this study for sharing their lived experiences, and we express our appreciation to the anonymous reviewers for their valuable suggestions and insightful comments.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Sara Cohen Shabot received financial support from the Israel Science Foundation for a project entitled: Birthing is a Feminist Issue: Towards a Feminist-Philosophical Understanding of Obstetric Violence (Grant No. 328/19).

Notes

1 Anat Shynerman Facebook Group, accessed August 30, 2023, https://www.facebook.com/groups/1441403086161481, Rony Bruell Forum, accessed August 30, 2023, https://www.green-rb.com/women