*Co esponding au ho : K. Indi ani
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion Liscense 4.0.
Knowledge, a i ude, and p ac ice on mens ual hygiene among adolescen gi ls in
Coimba o e: A c oss-sec ional s udy
Indi ani Kaliappan 1, * and P emagow i Balak ishnan 2
1 Depa men o Foods and Nu i ion, PSG College o A s and Science, Coimba o e, Tamil Nadu, India.
2 Depa men o Clinical Nu i ion and Die e ics, PSG College o A s and Sciences, Coimba o e, Tamil Nadu, India.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 21(01), 196-203
Publica ion his o y: Recei ed on 28 No embe 2024; e ised on 07 Janua y 2025; accep ed on 09 Janua y 2025
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.21.1.0012
Abs ac
Backg ound: Mens ua ion is a phenomenon speci ic o women. The Wo ld Heal h O ganisa ion s a es ha i is a
no mal biological occu ence ha is de ined by he u e ine passage o mucus and blood pe iodically. Many gi ls ha e a
ange o symp oms du ing hei mens ual cycle, including headaches, s omach c amps, i edness, mig aines, and acne.
Gi ls con inue o expe ience social and cul u al shame in ou socie y, which is exace ba ed by common misconcep ions
and belie s. India may be mo e suscep ible o imp ope mens ual managemen p ac ices due o a lack o adequa e
hygienic acili ies and limi ed access o eminine hygiene p oduc s.
Objec i es: This s udy aimed o in es iga e eenage school gi ls'(10-19 yea s) KAP o mens ua ion, and o ge hei
mens ual heal h- ela ed heal h-seeking beha io .
Me hodology: Using a semi-s uc u ed, p e es ed ques ionnai e, 1137 eenage schoolgi ls pa icipa ed in a c oss-
sec ional s udy conduc ed be ween Ma ch 2021 and July 2024 ega ding hei knowledge, p ac ices, and hygienic
me hods o managing p oblems ela ed o mens ua ion.
Resul s: Mos o hem lea ned abou mens ua ion and i s issues om mo he s (77.1%) and iends (15.9%). Nea ly
4.5% we e awa e o mens ual p oblems, and 41.9% and 42.9% we e awa e o unexcep ed mens ua ion, and he
physiological changes espec i ely. Acco ding o he in es iga ion o mens ual heal h managemen , 59.7% epo ed
psychological symp oms and 59.2% o mon hly absences om school. App oxima ely 34.8% exe cised o pe o med
yoga o educe pain, and 47.4% sough medical assis ance o mens ual heal h di icul ies. A ound 94.5% use
disposable pads and, 58.9% use h ee o ou napkins daily.
Conclusion: This s udy emphasizes he impo ance o p o iding comple e educa ion on mens ua ion, ep oduc i e
heal h be o e pube y, app op ia e mens ual hygiene managemen , and he nega i e consequences o a lack o
in o ma ion abou hygiene p ac ices among adolescen gi ls. Fu he mo e, h ough he p o ision o heal h ca ds o ack
and manage mens ual heal h and cleaning p ac ices, i is ad ised ha heal hca e p o essionals hold egula wo kshops
o aise awa eness among pa en s, educa o s, and young gi ls. This will inc ease hei a i udes and beha io s a ound
mens ual hygiene.
Keywo ds: Mens ual P oblems; Mens ual Hygienic Managemen ; Knowledge; Mens ua ion
1. In oduc ion
An indi idual who is no ye a eenage o an adul is said o be in adolescence. I is cha ac e ized by changes in an
indi idual's physical, psychological, and social ou look. The mos ob ious change in eenage gi ls is he commencemen
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o mens ua ion. I is a na u al biological p ocess ha in ol es he pe iodic elease o mucous issue and blood om he
u e us [WHO,2006]. Du ing hei mens ual cycle, many gi ls su e om a ange o symp oms, which include a igue,
mig aines, acne, ain ing, headaches, and c amping in he abdomen. I is signi ican o educa e adolescen gi ls abou
ypical symp oms. I has been no ed ha a ound 23% o Indian schoolgi ls d op ou a e pube y [Rose,2013].
I is es ima ed ha 300 million women and gi ls will ha e mens ua ion in a single day demons a ing ha i is a no mal
occu ence. Mens ua ion is s ill augh wi h social and cul u al s igma o women, e en hough i 's such a equen
occu ence. The mos p e alen ones include being p ohibi ed om using he cooking a ea, pa icipa ing in daily asks
a ound he house, exe cising, and playing spo s, as well as being p ohibi ed om social ga he ings [Eijk,2015]. In
addi ion o he ules di e en amilies adhe e o, some ha e ce ain belie s. Fo ins ance, one such belie is ha i a
emale places b ooms icks o ce ain plan lea es a ound he du ing he mens ual cycle, e il will no be allowed o
en e he body [Pa il,2011]. A p e alen no ion is ha an adolescen gi l has o ake a ba h o cleanse he sel ollowing
he pe iod.
These my hs need o be add essed and dispelled as he e is no scien i ic o empi ical e idence o suppo hem, and
doing so will help o a oid socie al s igma agains women who mens ua e. A woman's ood, heal h, and cleanliness
mus all be p ope ly a ended o du ing he mens ual cycle. Adolescen emales a e an especially accoun able
demog aphic in India. E en while "coming o age" is gi en ce emonial emphasis, ela i ely li le in o ma ion ega ding
he eali y o mens ua ion is p o ided. Res ic ions a e used o con ey a lo o he in o ma ion. [Na ayan,2001]
Managing mens ua ion is linked o emb acing eminine cha ac e is ics om he momen o mena che and
implemen ing sani a y habi s. To help adolescen gi ls who a e anxious abou hei pe iods, all misconcep ions and
aboos ha include no ha ing a ba h, a oiding ho and cold meals, and no exe cising need o be dispelled because hey
a e unsuppo ed by science.
De eloping a habi o adhe ing o s ingen cleanliness measu es du ing mens ua ion is c ucial in a oiding
ep oduc i e sys em in ec ion. The lack o p ope wa e , sani a ion, and hygiene acili ies in schools causes eenage
emales in u al egions o s uggle wi h mens ua ion hygiene, pa icula ly when a ending school [Yada ,2017]. I has
been no ed equen ly ha many gi ls do no know he eason o sou ce o hei mon hly blood, no e en ha hey
mens ua e be o e hey mena che [Aga wal,2017]. To encou age a mo e posi i e a i ude owa ds mens ua ion, gi ls
should be well-in o med abou i om an ea ly age.
Nume ous esea ch has e ealed ha adolescen gi ls di e in hei knowledge, a i udes, and mens ual hygiene
p ac ices. These a e a ew conclusions d awn om hese su eys, as pe Bou ah's 2022 epo , a ound 96.51% o
emales a e conscious o hei mens ual cycle, and 83.72% know i 's a na u al phenomenon. A ound 42.94% o
adolescen s know ha imp ope mens ua ion hygiene migh esul in in ec ions a he ime. Acco ding o he
in es iga o , Belayneh, in 2019, o nea ly 791 adolescen gi ls who ook pa in his su ey,68.3% did no know much
abou mens ua ion. Schoolgi ls u ilize abso ben p oduc s in a ound 48.1% o cases, and 69.5% wash hei ex e nal
geni alia. In gene al, mens ual hygiene p ac ices we e inadequa e o 60.3% o gi ls. Inadequa e knowledge o menses
[OR = 1.48:95% CI (1.04, 2.1)], longe days o mens ual low [OR = 2.51:95% CI (1.66, 3.80)], and age unde 15 yea s
[OR = 1.71:95% CI (1.22, 2.39)] we e all signi ican ly co ela ed wi h poo mens ual hygiene p ac ices. Thus, his s udy
assessed eenage gi ls' knowledge, a i udes, and p ac ices ega ding mens ua ion.
2. Ma e ials and Me hods
The cu en s udy was a c oss-sec ional in es iga ion ca ied ou among eenage emales en olled in schools om he
6 h o 12 h g ades, i s and second-yea nu sing college s uden s in he u ban a ea su ounding he Coimba o e dis ic
o Tamil Nadu. The esea ch was ca ied ou be ween Ma ch 2022 and July 2024. The esea ch comp ised 1137
adolescen gi ls be ween he ages o 10 and 19. Be o e he s udy began, ins i u ional e hics commi ee consen was
acqui ed om PSGIMSandR. The college's p incipal, school headmas e s, pa en s, and child en ga e hei consen . The
consen documen explained he p ocess and gua an eed hei con iden iali y. The inclusion c i e ia we e adolescen
gi ls aged 10 o 19 who had eached mena che and p o ided in o med consen om s uden s and hei pa en s. On he
o he hand, he exclusion c i e ia included hose who had no a ained mena che, we e younge han 10 o olde han
19 yea s o age, wi h any non-communicable diso de , and, no in e es ed in pa icipa ing in he s udy. The p e- es ed
ques ionnai e was used o collec in o ma ion abou hei knowledge o mens ua ion, p oblems ela ed o i , ypical
age, and hygiene p ac ices hey ollowed du ing he mens ual. Subsequen ly, a heal h educa ion session on mens ual
hygiene managemen was held, co e ing subjec s such as he ana omy and physiology o mens ua ion, he egula
mens ual cycle, and i egula i ies, dispelling my hs abou mens ua ion, and he p os and cons o mens ua ion,
common ma e ials we e displayed o awa e hem abou he mens ual cycle. Addi ionally, mens ual hygiene p ac ices
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we e men ioned by dis ibu ing pamphle s. Resul s o he da a analysis we e p esen ed in he o m o desc ip i e
s a is ics a e he da a we e impo ed in o Mic oso Excel and SPSS IBM e sion 20.
3. Resul s and Discussion
3.1. Knowledge o Mens ual P oblems among Adolescen Gi ls
Pa icipa ing in he s udy we e 1137 eenage gi ls om me opoli an se ings. They anged in age om 10 o 19 yea s,
wi h he a e age age o he pa icipan s being 13±2.036. Mos esponden s' mo he s we e housewi es, and hose who
wo ked as unskilled labo e s had less unde s anding o managing mens ua ion p oblems and hygiene.
Table 1 Knowledge o Mens ual P oblems among Adolescen Gi ls
Knowledge o Mens ual P oblems among Adolescen gi ls
Adolescen Gi ls
(10-19 yea s) N=1137
N
Pe cen (%)
Do you know mens ual heal h p oblems?
51
4.5
Do you know a which age mena che occu s?
292
25.7
Does mens ua ion s a suddenly wi h he o e low?
476
41.9
A e you awa e o physiological changes in he body?
488
42.9
Did you discuss mens ual heal h p oblems wi h o he s?
689
60.6
F om Table: 1 Only 4.5% o he 1137 esponden s knew in o ma ion abou mens ual di icul ies, bu 25.7% knew abou
mena che age o gi ls, 41.9% knew abou he o e low when mens ua ion comes unexpec edly, 42.9% o he gi ls
knew he knowledge on physiological changes ha happen om he age o 8 in he body, and 60.6% o hem discussed
hei mens ual heal h issues wi h o he s. Acco ding o Pu a (2017), oughly 82.9% o gi ls who did no each
mena che eplied wi h "don' know" when asked abou hei pe cep ions o mens ua ion. Acco ding o Ruby Kha oon
e al.'s s udy om 2023, he majo i y o he emales (52.8%) in his su ey a e be ween he ages o 17 and 19. The gi ls'
knowledge o mens ua ion be o e mena che was s a ed by 87.6% o hem. Abou 68.2% o he gi ls ag eed ha he
main cause o mens ua ion was physiological and un ela ed o any speci ic sickness, bu 41.6% o he gi ls we e
unawa e o which o gan was he sou ce o bleeding. A ound 42.6% o he gi ls eached mena che be ween he ages o
10 and 13. The majo i y o pa icipan s (60.80%) accu a ely esponded o he ques ion on he a e age leng h o a ypical
mens ual cycle. The gi ls' knowledge o he app op ia e mena che age was only 35.27 pe cen . Nea ly 65.50% o hem
knew ha , hey we e su e ing om ep oduc i e heal h p oblems.
F om Figu e :1 A ound 77.1% ob ained hei knowledge abou mens ua ion om hei mo he , ollowed by iends
(19.8%), a sis e (15.9%), ela i es (13.5%), a school eache (12.3%), and no one (4.7%). App oxima ely 2.8% come
om gua dians, 2% om a he s, and 1.9% om o he s. In many s udies—mo he s we e he mos equen sou ces o
in o ma ion abou mens ua ion and i s p oblems [P ajapa i,2015]. Acco ding o Ade e al., (2013) o e 50% o he gi ls
ci ed hei mo he s as hei p ima y in o ma ion sou ce, wi h iends and amily coming in second, and 10% iden i ying
eache s and he media as o he sou ces. Abou 27.7% o eenage gi ls, acco ding o Belayneh, Z. (2019), lacked
knowledge abou mens ua ion and p ope hygiene p ac ices be o e mena che. Ou o 72.3% o schoolgi ls who had
in o ma ion abou mens ua ion be o e he s a o hei pe iods, 38.3% ci ed hei mo he as he p ima y sou ce, while
16.3% ob ained his in o ma ion om hei classma es.
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Figu e 1 The sou ce o Knowledge abou mens ua ion ob ained om (i yes)
Addi ionally, 6.4, 2.4, 7.6, and 1.3% o gi ls wi h in o ma ion ci ed ela i es, eache s, he media, and o he s
espec i ely as sou ces o in o ma ion on mens ual bleeding along wi h ways o p ope ly manage i .
3.2. A i ude o Mens ual P oblems among Adolescen Gi ls
Mens ual hygiene was he subjec o bo h good and nega i e sen imen s, acco ding o he s udy's indings. This can be
explained by he ac ha many o he young gi ls had ne e hea d o mens ua ion be o e when hey i s expe ienced
i and ha he gi ls had g own up in a se ing whe e mens ua ion is owned upon in u al places. Fo ins ance, hey
o bid gi ls om cooking o cleaning u ensils because hey hink ha mens ua ion makes hem di y. These indings
a e consis en wi h o he esea ch conduc ed in Nepal and Saudi A abia, which ound ha gi ls had un a o able
opinions on mens ual hygiene [Yada ,2018; Sha ma,2020].
Table 2 A i udes o Adolescen Gi ls abou Mens ual P oblems
A i udes o adolescen gi ls abou Mens ual P oblems
Adolescen Gi ls
(10-19 yea s) N=1137
N
Pe cen (%)
Do you ge any psychological symp oms du ing he mens ual cycle?
679
59.7
Do you hink psychological symp oms a ec he quali y o li e?
384
33.8
Do you hink he absence o mens ua ion causes any heal h issues?
673
59.2
Do you hink physical changes in mens ua ion a e ine i able and, hence accep able?
580
51
Do you obse e mens ual p oblems as a loss o eenage s?
548
48.2
F om Table 2, he s udy’s goal was o asce ain he a ge Pa icipan s' a i udes. The in es iga ion e ealed ha , o
abou 59.7% o psychological symp oms, 33.8% impac quali y o li e, 59.2% o mon hly absences esul in heal h
di icul ies, 51% can accep he physical changes associa ed wi h mens ua ion, and 48.2% iew mens ual oubles as
a sign o eenage loss. In a 2023 analysis, esea che Shah ound ha 17.1% (n = 64) o pa icipan s admi ed o no
exe cising, and almos 37.6% (n = 141) o esponden s said hey didn' wash hei bodies while hey we e mens ua ing.
A ound 29% (n = 104) o he gi ls men ioned hei sis e s, and 38.2% (n = 137) el com o able discussing o asking
hei mo he s o help on mens ua ion. Abou 67.3% (n = 202) epo ed eeling anxious and s essed du ing hei
mena che. To deal wi h his p oblem, he majo i y, o 68.3% (n = 205), s a ed ha hei iends, amily, sis e s, o o he s
should in o m hem be o ehand. Fu he mo e, almos 42.8% (n = 238) o esponden s said ha hei moms, sis e s,
iends, o ela i es should ell hem, and 91% (n = 273) ag eed ha gi ls should be in o med o hei i s cycle.
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3.3. P ac ice o Mens ual Hygienic Managemen among Adolescen Gi ls
Va ious sexually ansmi ed diseases, u ina y ac in ec ions, and se e e ep oduc i e ac in ec ions migh esul
om unsani a y and inapp op ia e beha io s du ing his ime. I may also be a ac o in he de elopmen o se ious
illnesses like ce ical cance . The adi ion was o wash he clo h pieces and hen le hem d y in he sun in a quie
loca ion whe e no one could see hem, as many o he gi ls wan ed o do. One o he main causes o ep oduc i e ac
in ec ions in people who use clo h is how o en hey wash o euse he ab ic. Because o hei e oneous iews and
inco ec concep ions ega ding mens ua ion, he majo i y o he gi ls in ou s udy p ac iced a ious limi a ions.
Adolescen gi ls and hei amilies accep adi ional cus oms and supe s i ions because hey a e igno an . E e y
eenage emale adhe ed o se e al ules, such as no going o emples o going in o he ki chen. The p ac ice o
es ic ions including sleeping ou side he home, a oiding con ac wi h amily membe s, and being sepa a ed om he
amily du ing mon hly low was also disco e ed.
F om Table:3 Nea ly 47.4% o hem isi a doc o when mens ual heal h issues a ise, 43.9% consen o ecei ing
medical ca e, i necessa y, 81.4% p ac ice pe sonal hygiene, 34.8% engage in yoga o o he exe cise o elie e mens ual
pain, and 46.8% ea pa icula oods o elie e pain. Among 1137 pa icipan s using ma e ials du ing hei menses
nea ly 94.5% we e using disposable pads, he emaining 2.5% we e using old clo h, 1.4% using eusable pads, 0.5%
using new clo hes, and bo h (old and Disposable pads), 0.2% e-used clo h and 0.4% Bo h ( eusable and disposable
pads).
Table 3 P ac ices among Adolescen Gi ls ega ding Mens ual P oblems
P ac ice among adolescen gi ls abou mens ual p oblems
Adolescen Gi l’s
(10-19 yea s) N=1137
N
Pe cen (%)
Did you consul a gynecologis a he onse o a mens ual heal h p oblem?
539
47.4
Ha e you aken any medical ea men o mens ual p oblems?
499
43.9
A e you gi ing impo ance o pe sonal hygiene du ing he mens ual cycle?
926
81.4
A e you doing any exe cise o yoga o elie e he mens ual heal h p oblem?
396
34.8
A e you aking any special ood o ge id o pain?
532
46.8
P ac ice abou Mens ua ion
Ma e ials Used Du ing Menses
New Clo h
6
0.5
Old Clo h
28
2.5
Re-used Clo h
2
0.2
Reusable Pads
16
1.4
Disposable Pads
1075
94.5
Bo h (old and Disposable Pads)
6
0.5
Bo h ( eusable and disposable pads)
4
0.4
Disposal o Pads
Unw ap and dispose o in he open bin
61
5.4
Flush in la ine
48
4.2
Disca d i om he window
17
1.5
Bu n i
310
27.3
Don’ dispose by hemsel es
494
43.4
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Disposed by mo he s and o he s
643
56.6
Bu ied unde mud/disposed in he g ound
36
3.2
Th ow i in egula ash on he s ee
23
2
W ap wi h newspape and use a black co e p ope ly
482
42.4
Cleaning agen o Ex e nal Geni alia
Only wa e
605
53.2
Neem wa e
19
1.7
Tu me ic wa e
20
1.8
Wa e and Chemical
13
1.1
Gel
22
1.9
Soap
378
33.2
Figu e 2 Napkins use pe day among pa icipan s
F om Figu e: 2 Nea ly 58.9% o hem use 3 o 4 Napkins pe day, 29.1% o subjec s use 1 o 2 napkins pe day, and 12%
use >7 napkins. The cu en s udy e ealed he p ac ice o disposal me hods among he esponden s, app oxima ely
56.6 % o mo he s and o he s dispose o i on hei behal , 43.4 % don’ dispose o i by hemsel es, 42.4% p ope ly
w ap he ma e ial in he newspape and dispose o i in a dus bin co e ed in black, 27.3% bu n hem, 5.4 % dispose o
abso ben ma e ials unw apped and h own in open bins, 4.2 % lush in he la ine, 3.2 % being bu ied in he ea h o
disposed o in he g ound, 2% h ow i in egula ash in he s ee , and he emainde 1.5% disca d i om he window.
The s udy e ealed he epo abou cleaning agen s on ex e nal geni alia a ound 53.2% used only wa e , 33.2% used
soap, 1.9 % used gel, 1.8% used u me ic wa e , 1.7% used neem wa e , and 1.1% used chemicals (an i-sep ic) o wash
hei ex e nal geni alia.
In esea ch conduc ed by Maji S, he majo i y o pa icipan s used sani a y pads, and one- hi d o hem eused hei old
clo hes [Maji,2016]. In con as o he esul s o ou s udy, which showed a la ge numbe o gi ls using solely sani a y
pads (73.6%), Dabade KJ e al. ound ha only 52.3% o gi ls in u al Gulba ga used sani a y napkins [Dabade,2017].
The majo i y o he eenage gi ls in ou esea ch disposed o hei mens ual was e p oduc s in bins, a p ac ice
p e iously seen in he s udy o u al school-going gi ls by Chauhan P e al. [Chauhan,2019]. Con a y o ou s udy's
indings, Dabade KJ e al (2017). disco e ed ha abou 75% o he gi ls egula ly cleaned hei in ima e a eas wi h soap
and wa e . In 2019, 218 emales, o 79.9% o he o al, op ed o w ap hei pads and dispose o hem in closed con aine s,
acco ding o Pa el's epo on disposal me hods. Mens ual pads may be disposed o in h ee di e en ways: nea ly
6 (2.2%) gi ls lushed hem down he oile , se en (2.6%) gi ls w apped and h ew hem in open bins, and o y-one
(15%) gi ls chose o bu n. Acco ding o he indings o he di e en hygiene me hods used, 130 gi ls (47.6%) and 140
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gi ls (51.3%) espec i ely cleaned hei p i a e a eas wi h soap and wa e and plain wa e . A o al o 244 emales, o
89.4%, epo ed aking a daily showe .
4. Conclusion
This s udy ound ha despi e ad ancemen s in mens ual heal h and cleanliness, he e is s ill a lack o knowledge on
mens ua ion, p oblems, and p ac ices. E en hough mens ua ion is a no mal occu ence, many homes ne e heless
p ac ice unscien i ic limi a ions a ound i . This esea ch emphasizes he need o educa e adolescen gi ls abou
mens ua ion and ep oduc ion be o e hey each pube y. Mens ua ion- ained counselo s mus be employed in e e y
school o ensu e ha gi ls a e educa ed abou he mens ual cycle and i s signi icance. The p esen s udy also showed
ha mos o he gi ls lea ned abou menses om hei mo he s be o e hey eached mena che, which highligh s he
signi icance o mo he s in laying he g oundwo k o u u e gene a ions mens ual heal h and he need o pa en
counseling p og ams. Encou aging ou ine medical isi s and p o iding medical heal h ca ds is necessa y o ensu e ha
mens ual p oblems and hygiene a e adhe ed o.
Compliance wi h e hical s anda ds
Acknowledgmen s
We a e app ecia i e o he adolescen gi ls' en husias ic in ol emen in he s udy as well as he headmas e , p incipal,
and s a o hei coope a ion.
Disclosu e o con lic o in e es
The e is no con lic o in e es in his manusc ip .
S a emen o e hical app o al
The e is a subjec in ol emen in his manusc ip . The ins i u ional e hics commi ee consen was acqui ed om
PSGIMSand R, ( e .no- PSG/IHEC/2022/App /FB/013).
S a emen o in o med consen
Owing o he c oss-sec ional design o his s udy. Pa en s and s uden s p o ided w i en, in o med consen , and
con iden iali y was gua an eed.
Re e ences
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