By Shay-Akil McLean
Last week Dr. Jennifer Gunter, a Canadian OB/GYN, tweeted “If men had periods pads would be free” in an attempt to highlight what she and many other women see as a disparity defining their lived experience as women: menstruation. Dr. Gunter’s tweet inspired Pediatrician Dr. Joannie Yeh to create the hashtag “#IfMenHadPeriods” that later trended on twitter sparking some important conversations that bring to light the role that Western medicine and medical practitioners have in perpetuating exclusionary ideologies that underlie health inequities impacting Transgender and Non-binary gender patients.
People engaging with the hashtag jumped at the chance to make similar cis-normative statements about menstruation and the period tax. Soon as tweets including critiques of their gender essentialism entered the conversation, they claimed that they had a clear superior argument – their reasoning being that they ‘accurately understand biology’. In order for us to understand the problem that lies within what many people see as a “common sense” issue we first have to understand what gender is and is not. According to Australian Sociologist Raewyn Connell, “common-sense knowledge of gender is by no means fixed. It is, rather, the rationale of the changing practices through which gender is ‘done’ or ‘accomplished’ in everyday life” (“Masculinities” 2005:6). Gender is the range of mental and behavioral characteristics pertaining to, and differentiating between and across, masculinity and femininity. Sex is a determination made through the application of socially agreed upon biological criteria for classifying persons as females or males. The criteria for classification can be genitalia at birth or chromosomal typing before birth, and they do not necessarily agree with one another (“Doing Gender” by West & Zimmerman, 1987:127). Nothing about the definition of gender is directly associated with genitalia or other measures of biological sex. The conflation of binary gender with binary biological sex is a colonial mechanism that does not match the diversity of gender or even the diversity of sex karyotypes in humans. Meaning that social norms surrounding binary gender and its conflation with sex and genitalia does not match gender diversity across humanity. Despite the conflation and notion of what is natural, people who do not fit the gender binary and/or the sex binary still exist. Binaried biological determinist categorizations do not match human practice meaning that they fail as guidelines for how we understand human social life with respect to gender and sex.
Vaginas and menstruation aren’t exclusive to women: not all women have vaginas and not all women who have vaginas menstruate. Not even all cis women menstruate. Non-binary and Transgender people exist and have genitalia and genitalia is not gender. And intersex people are also impacted by these forms of bio-determinism. Some intersex women menstruate, some do not. Some intersex men menstruate, some do not. Placement in a sex category is achieved through the application of the sex criteria, but in everyday life, categorization is established and sustained by the socially required displays of identity that proclaim one’s membership in one or ‘the other’ category. Sex and sex category can vary independently meaning that it’s possible to claim membership in a sex category even when the sex criteria are lacking. In other words, biological sex is not gender and also genitalia doesn’t solely define sex because sex also includes socially required displays.
So what does it mean when physicians make transphobic supposedly ‘feminist’ statements & claims?
Quite frankly it represents the reigning presence of transphobia in Western Medicine that has real consequences for Trans people who also have a right to healthcare but are not seen as fully human by medical professionals and staff. Physicians and medical institutions gate keep access to medical transition, crucial for those who need hormone replacement therapy as well as gender reassignment surgery. And for those who decide to not transition, they have a right to go to a physician’s office or hospital and be treated with structurally and socially competent care.
While many see nothing wrong with Dr. Gunter’s tweet nor the giant sweep of support she got from other social media users (which included other physicians), it points directly to a form of exclusion that erases the lived experiences of men who also need gynecological and obstetric care: Transmen. Such statements also exclude Transwomen who while not menstruating are women. Such statements that conflate gender with essentialist notions of biology also negatively impacts cis women who don’t menstruate and/or, cannot, or choose not to bear children.
This represents the number of ethical problems lying at the heart of medical practitioners making political statements about human experiences based on cis normative ideas of who gets to be human and how they have to be organized based on essentialist conflations between gender, genitalia, and biological sex.
The #IfMenHadPeriods hashtag is a reflection of the violence that Transgender people face in society and especially in medical institutions. There are real consequences for Transphobia amongst physicians and medical staff that lead to increased morbidity and mortality risk among Trans people. Approximately 30 percent of Transgender patients report delaying or not seeking care due to discrimination faced in a doctor’s office or hospital according to a research study by Jaffee et al. 2016. Research has also found that Transmen patients experience verbal harassment, physical assault, or denial of equal treatment in a doctor's office or hospital (Shires and Jaffee 2015).
Tanya Walker, a 53-year-old Black Transwoman activist and advocate was cornered at the hospital by staff and aggressively questioned about her genitalia when she was coughing up blood and suffering from lung cancer. A physician even refused to call Jay Kallio, a Transman patient to provide with him his diagnosis of aggressive breast cancer when he needed immediate treatment. I have had to travel almost three hours away just to get structurally and socially competent care. Doctor appointments always come with a lesson plan where I end up teaching the physician about my humanity as a Black Transman. Transphobic behavior from those working in medical institutions has detrimental impacts and pile onto other discriminatory practices in medical institutions such as racism resulting in health inequities. Most cases involving the discrimination that Trans people experience in medical institutions goes unreported and is under-researched. Though the U.S. Department of Health and Human Services state that Transgender people are protected by the Affordable Care Act (ACA), we still suffer from gross mistreatment when we interact with medical institutions.
While Dr. Gunter’s tweet appears to be harmless, its exclusionary and has detrimental impacts on Transmen who need and have a right to non-discriminatory care from their OB/GYN. Perpetuating the notion that gender is the same as genitalia in public spaces has detrimental consequences and highlights other problems: how those same physicians treat Transgender patients. Medical professionals have a responsibility to educate themselves instead of placing the burden of educating them on their patients. SOME MEN DO HAVE PERIODS. NOT ALL WOMEN HAVE PERIODS. That is a fact. Transmen are men. Transwomen are women. Dr. Gunter, Dr. Aquino, and Dr. Yeh and other medical professionals like them have a lot to learn because men do have periods and it doesn’t solve the problem of the period tax in a patriarchal society.