The realities of menstruation have always played an active role in the sex lives of men and women. Yet pervasive and long-established taboos and myths surrounding menstruation often inhibit open dialogue and perpetuate misinformation, even between long-time sex partners. A lack of education about the options, risks and benefits of sex during menstruation and a common discomfort discussing them have many sex partners abstaining or inhibiting their sexual activities. Partners politely let each other "out of" having sex during a woman's menstruation without ever really teasing out the facts from the fictions about sex in the red.

Taboos and Social Constructions

Despite the fact that nearly every woman experiences her menstrual cycle from approximately 12 years of age to 51 years of age, menstruation has a long history of negative associations in Western culture. Historically, religions and social norms couple menstruation with the stigmas of secrecy, shame and the unclean. Plagues, failed crops, and spoiled food have all been attributed at one time a woman menstruating.

While advances in sexual reproductive health have debunked many of these myths, the underlying associations continue to pervade societal norms. Advertisements promoting feminine hygiene products focus on clean, odorless protection, often disassociating their product with blood at all. The use of the word 'protection' alone implies that menstruation carries with it a danger - one defined as dirty and unsanitary.

According to a 2002 study of contemporary attitudes towards sex and menstruation in Sex Roles: A Journal of Research, many participants in the study found menstruation to be "dirty and disgusting." And while we may have left behind some of the ancient myths, including that sex with a menstruating woman could prove fatal to a man, the perception that it is a sexual practice to be avoided as shameful, messy or unsanitary persists.

Safely practiced and consensual vaginal, anal and oral sex during menstruation is normal and healthy, but should be coupled with awareness of potential risks and benefits.

Risks and Benefits

Unprotected sex, and unprotected cunnilingus (oral sex performed on a woman) during menstruation in particular, is associated with higher risk of transmission for blood-borne sexually transmitted infections (STI's) such as HIV. To help protect against transmission, use barrier protections such as condoms, dental dams or saran wrap.

Pregnancy is also a risk during menstruation, particularly when the menstrual cycle is brief. That pregnancy during menstrual sex is impossible is a commonly held misconception that may prevent sex partners from using contraception during menstrual sex. For sexually active women trying to avoid pregnancy, one or more forms of contraception should always be used during sex, even when they are menstruating.

A common aspect of menstruation that women and couples face in their sex lives is dysmenorrhea, painful menstrual cramping. Orgasm for a woman, achieved through any form of sex play, has been shown in some cases to help eliminate or reduce cramping by relaxing the uterine muscles, releasing endorphins and increasing a woman's pain threshold.

In a 2002 study released by Yale and Southern Connecticut State Universities, researchers discovered a possible connection between sex during menstruation and reduced risk for endometriosis. Endometriosis is a disease associated with menstruation in which tissue resembling the uterine lining collects in other parts of the body, and cannot be shed through normal menstruation.

Strategies for Sex During Menstruation

For couples not concerned with the presence of blood in their sex play, sex during menstruation need not be any different than sex at other times. The blood may in fact act as an additional lubricant, adding to the pleasure of both partners. If they want to avoid staining clothes or sheets, they may lay a towel down before they engage in sex, or consider having sex in a shower.

For couples engaging in sex during menstruation that wish to avoid exposure to menstrual blood, several other options exist.

Menstrual cups and diaphragms are used to catch blood within the vagina, and then be periodically emptied. The Keeper and the Diva Cup are reusable menstrual cups, made with medically safe gum rubber or medical grade silicone, which sit lower in the vagina and need only be emptied two or three times a day. Their primary advantage allows masturbation and cunnilingus without the presence of blood or tampon strings. The cups also stop exposure of menstrual blood to air, preventing it from decomposing and thereby minimizing the odor often associated with menstruation.

Tampons should generally not be worn during penetrative sex, as they may get lodged in the vagina, making them difficult to remove and creating a risk for infection.

As variations on oral contraception emerge, more and more options are also available for women to influence their own cycle, reducing, or virtually eliminating time spent menstruating.

Seasonale is a new form of extended cycle oral contraceptive that reduces cycles from 13 to 4 times a year. Hormone injection, more commonly known as Depo Provera, is another contraceptive method that can reduce menstrual cycles over time. Protracted use of hormone injection can cause infrequent menstrual cycles and after a year of use, may cause them to stop entirely. The hormone injections have other associated side effects such as headaches, nervousness, mood changes, bloating, hot flashes, decreased interest in sex, breast tenderness, acne, hair loss, and backache.

Communication

Menstruation, like any other reproductive or sexual function, happens to both sexual partners. While men do not menstruate, if they are having sex with women, their relationships and sex life include the realities of menstruation. Good communication can only bring partners closer through a better understanding of their bodies, physical and emotional responses, and sexual preferences. And it may even give partners an opportunity to vary their sex play techniques.