About the Author
Read an Excerpt
Sex Hormones and Menstrual Suppression in Brazil
By Emilia Sanabria
Duke University PressCopyright © 2016 Duke University Press
All rights reserved.
MANAGING THE INSIDE, OUT
MENSTRUAL BLOOD AND BODILY DYS-APPEARANCE
Menstruation is, in many ways, a banal and unexceptional experience shared by women worldwide. Given that cultural attitudes toward menstruation vary widely, shaping individual women's feelings about the experience in innumerable ways, it is difficult to speak about menstruation per se. Because it is often understood to be, along with pregnancy and childbirth, a defining aspect of womanhood, much of the academic attention it has received pertains to the symbolic role it plays in gender hierarchies (Godelier 1982; Gregor and Tuzin 2001; Héritier 1996; Lewis 1988; Reeves Sanday 1981). In this literature the meanings of menstruation tend to be presented in binary terms as either negative (such as in the case of so-called menstrual pollution beliefs) or positive or in a manner that, in the end, dissociates menstrual symbolism from the physiological process of menstruation. Such analyses tell us relatively little about how women actually experience menstruation.
Drawing on extensive interviews carried out with over sixty women of different social backgrounds in Salvador, I show how menstruation can be at once eagerly anticipated and detested, painful and yet welcome, or considered mucky and nevertheless cleansing. It is precisely these ambiguous aspects of menstruation that I aim to foreground in this chapter. Regardless of whether the women I encountered spoke positively or not of their periods, their experiences of the menstrual cycle reveal that menstruating is often perceived as unsettling a state of normal embodiment. Narratives of menstruation reveal that the experience of cyclicity — however common — is taken as a somewhat exceptional bodily state. Women regularly speak of the emotional and physical changes associated with the menstrual cycle as disrupting their normal sense of self and their usual relationship to their body. Although women spend more time not menstruating than they do menstruating, menstruation is by no means a rare occurrence (as childbirth or serious illness may be). My aim in this chapter is to explore how menstruation can be seen as both a habitual and an exceptional phenomenon. Narratives of menstruation, which posit the body as changeable and at times out of one's control, allow an alternative image of embodiment to emerge. They produce a foil of sorts and are an occasion for the formalization of what — against the posited abnormality of the menstruating body — is taken as normal embodiment. In this chapter I examine the multiple, contradictory, and ambivalent ideas that surround menstrual blood and suggest that concerns regarding menstrual blood serve to manage and delimit bodily orifices. The interviews I conducted with women regarding their experiences of menstruation reveal a surprising degree of bodily awareness and attention to the subtle intricacies of the changes that take place within their bodies. These narratives show that many women have appropriated and given meaning to the myriad symptoms attributed to the hormonal fluctuations of the cycle. While they come to know their bodies in particular ways, this knowledge at times leads them to experience their body as if it were something other than "them." The things that their bodies do are narrated as things that happen to them and that they struggle to reconcile to their selves. In this sense, visceral signals can intercede in the normal relation a person has established with her body, transforming her subjective experience. What implications might this have for the notion of bodily plasticity? My concern here is with the dynamic interplay operating between the body's interiority and its exterior. In the first section of this chapter I examine this relationship through an analysis of how the body's interior processes are made amenable to conscious control. In the second I explore how the management of menstrual blood and the hygienic practices that surround it highlight concerns with policing and, I argue, producing the boundary between the inside and outside of bodies.
Menstruation and Bodily Dys-Appearance
In narrating the physical and emotional fluctuations they underwent throughout their menstrual cycles, some of the women I encountered explicitly voiced incertitude concerning the status of what they called their eu (me). Such narratives reveal how women attempt to deal with what we might call disjunctions of the self, that is, how they deal with the angry, depressed, or nervosa part of themselves that cyclically emerges as a result of hormonal fluctuations. What is striking is the way in which one aspect of the self or bodily experience is taken to be "me" (eu) and others excluded. This has an important social dimension, in that certain aspects of experience are largely excluded, repressed, or otherwise marked as inappropriate by social rules.
None of the women I interviewed was currently using a chart to monitor her cycle, although a few women had done so at one time. However, bodily cues marking different stages of the menstrual cycle were widely reported. Lana, a young woman working as a sales assistant in a clothing store in the popular neighborhood of Piedade, explained in an interview that she did not count the days of her cycle, but always knew when her menstruation was coming as "she" signaled her arrival clearly: "For me, the signal that she is coming is that my breasts are swollen, I get a secretion in my underwear, and a distinctive smell, a bit acidic, you know?" Pricilla, a forty-four-year-old orthodontist and mother of two, uses hormonal implants to suppress her menstrual cycle because she found menstrual cycling challenging:
My cycle is well defined. I feel ovulation. The difference between the phases is very clear: until ovulation is one phase, I'm arisca [horny], and then I feel the day of ovulation. After I ovulate, the "fire" lessens, and then there is another peak just before menstruation. But I feel a lot of alteration. That's why I use the [menstrual suppressive] implant now. The transtornos [disruptions] of premenstrual tension were just too much. It gave me a lot of nervosismo, I would become a "[tyrannosaurus] rex," it disturbed [things] at home, at work, I was very irritable, impatient, I had pains in my body, I was tired, and then on top of that I would menstruate. It was horrible.
It is interesting to note that the positively valued changes associated with ovulation are expressed in the present tense in Pricilla's narrative, despite the fact that she no longer ovulated at the time of the interview. If anything, this reveals the extent to which, notwithstanding the pharmacological intervention adopted, the baseline state for the female body is to be marked by cyclicity. Aside from being marked by monthly cyclical phases, menstruation changes through the different phases of a woman's life, from menarche to menopause. Many women speak of being "very regular" while giving details of substantial variations in cycle length at different moments in their lives. "Sometimes my cycle can be 32, 35 days with long heavy periods, but at the moment it comes every 25 or 26 days and stays only 3 or 4 days," explains Gabriela, a doctoral student I interviewed. Tatiana, a communication analyst for a state administration, clearly identified distinct phases in her life throughout which her menstrual cycle had evolved. She describes herself as "conscious" of her body, a fact that derives from her "addiction" to yoga — as she qualified it — and her ecumenical spirituality, which draws as much from Candomblé as it does from New Age practices.
Well, the thing is, there are phases in which your menstruation changes. During adolescence, on the first day it would start with a little stain, and then it would come more strongly, proper blood, you know. I didn't pay much attention to it then; I didn't have any symptoms. After, when I was 15–16, I started getting really bad period cramps when my menstruation came down. It would come down all at once and stop very rapidly. Then it got more regular, because it used to drag on for 10 days, starting and ending with that stain. I didn't use to count the days, I only started counting when I took the pill. The pill made it regular, my period became more controlled. Then I stopped the pill, about 2 years ago, and I started to feel when she would arrive, to feel the premenstrual tension. I stopped the pill because it interfered in my sexual desire, and I didn't like it, it gave me the sensation that it wasn't good for me. Now she [menstruation] is in a new phase, I observe myself more. I get irritated. Now my menstruation has come to be like this: I get a cramp the first day, and a headache and pain in my lower back, during the bleeding. I feel symptoms of irritation two days before. That makes me think: "Ah! It's my menstruation! I'm not such a pain."
Detailed analyses of the many transformations occurring throughout the menstrual cycle are common, often centering on the premenstruum. Such narratives tend to present the premenstrual self in ambivalent terms, as other. Here, Tatiana expresses relief when her menstrual blood arrives, allowing her to reinterpret previous ill-humor and to differentiate between the hormonally altered being to which women often allude and her true self. My question in what follows concerns how certain bodily experiences come to be read as self, whereas others are marked as abnormal or other. How are we to understand the fact that menstruation, a common, repetitive corporeal experience in the lives of many women, nevertheless comes to be marked as an exceptional or abnormal bodily state?
The philosopher Drew Leder (1990) proposes a model to account for the disjunction between the lived body and the self. Leder proposes that Cartesian dualism is in part grounded in bodily experience, a fact that, he argues, accounts for the tenaciousness of mind–body distinctions within and beyond Western culture. He argues that the general mode of embodiment is one in which the body is absent. In the everyday, interactive experience of the body — which he refers to as "ecstatic" corporeality — the body disappears as it is turned onto the world. Ecstatic corporeality is contrasted in his model to bodily dys-appearance, the process where, in injury or illness, the body is foregrounded in our experience. When the body dys-appears, the otherwise taken- for-granted body is drawn "out of self concealment," emerging as "an alien presence" (76). He distinguishes between surface and depth disappearance, arguing that the inner or viscous body is even more elusive than the surface, ecstatic body. A viscus, he argues, cannot be "summoned for personal use, turned ecstatically onto the world" (5), as a surface organ may be: "I cannot act from my inner organs in the way I do from my surface musculature. Though I can lift my arm without any problem, I cannot in the same way choose to secrete a little more bile or accelerate my digestion. The 'magical' sway I have over my own body that Merleau-Ponty describes thus refers primarily to the body surface. The depths involve an even deeper sorcery extending beyond my domain" (48).
Citing Ricoeur's reflections on the voluntary and the involuntary and the fact that "life functions in me, without me" (Leder 1990, 46), Leder proposes that it follows that the subject ("I," in his text) experiences this disappearing visceral body as other, as an object. Can Leder's approach be drawn on to explain why the women I encountered often spoke of the body during or before menstruation as different from their self? The notion of dys-appearance is useful here because it highlights the tension that exists between what is taken as normal embodiment (an absence of the visceral body from experience) and the eruption of the visceral in everyday experience. In Bahia, this question was given a specific social dimension in the discourses promoted through popular media or medical consultations where the descontrolada (uncontrolled) self was presented as posing a threat not only to the self, but also to social harmony. Many women narrated their sense of frustration at not being able to express their irritation or sadness in public, in a context where strong emotions are viewed with suspicion and substantial collective effort is invested in the maintenance of a sentiment of alegria (joy) in the face of adversity. Leder's model can be read as a particular theorization of the mind–body relation, which, while grounded in a specific Eurocentric, male, and biomedical epistemology, provides some interesting elements with which to reflect on Bahian women's relationships to their bodies. Although the women I interviewed often expressed that they did not really think about the internal workings of the body, they gave detailed exegeses of their bodily changes. This begs the question: Which bodily processes or organs are "present" in women's everyday experience and which recede from perception and awareness?
Wombs, Hormones, and Blood: An Ethnophysiology of Menstruation
In her classic study of reproduction, Emily Martin (2001) attends to the question of the relationship between the "self" and the body. She argues that the central image that women use in the interviews she collected is one in which the self is separate from the body. She breaks this down into a series of positions that reveal, she argues, "a fragmentation and alienation in women's general conceptions of body and self" (89). The "fragmentation" between self and body that emerges from her data ranges from the idea that the body is something the self has to adjust to or cope with, that the body needs to be controlled by the self, or that physiological processes such as menstruation are things that happen to the self rather than actions that the self does. This idea resonates widely with the interview materials I collected in Bahia and with the problem that many women raised concerning the disruption menstrual cycle changes (most notably perhaps the hormonal shifts associated with the premenstruum) are felt to have for their normal selves.
The fragmentation that Martin describes finds its origin in the metaphors used in medical practice to depict the body, which present the uterus as separate from the self or describe physiological processes as autonomic and involuntary. Yet such representations are not always evenly shared across expert and lay knowledges of the body. One indication of the kinds of discrepancies that may emerge between these is the linguistic resources available to describe menstruation, which reveal that in speech, at least, menstruation or the behavior of the uterus is not considered to be entirely autonomic. In English, the body is referred to in the third-person neuter, whereas in Portuguese — where nouns have a gender — the body or the uterus is referred to as "he" or "she." Menstruation is spoken of in a way that grants "her" substantial agency. She can be late, come by surprise, or decide not to come when she is expected. She can be heavy, or pleasant, or predictable, and her particular qualities, such as odor, viscosity, taint, and flow, are often described using vivid terms. Linguistically this construes a rather different situation from the language of "it happens to you" that Martin (2001) reports. Although women also report the inevitability of menstruation, the verb to menstruate is commonly conjugated. In popular discourse, menstruation is thereby spoken of in active terms such as menstruei (I menstruated) or quando menstruou (when I menstruate), allowing the construction of a more active relationship to menstruating in lay parlance than in expert usages. Despite living in a heavily medicalized context, within which biomedical notions of reproduction circulate widely, the central metaphors women use to speak of menstruating reveal ideas that medical professionals strive to "demystify" (to borrow a term they often use) in clinical interactions.
Although Brazilian and U.S. health provision services are marked by similar disparities in access to health, the manner in which class processes are played out in and around medical expertise is markedly different in Salvador than in the situation Martin described. Women of all classes, I found, hold less to medical metaphors than Martin's North American informants do when narrating their cycles. Martin reports that the language of failed production and menstrual blood as waste material is prominent among North American women. Her middle-class informants associate the menstrual flow with the demise of the "egg" in the sequence of events recounted by the classical reproductive account Martin so carefully deconstructs. Martin's middle-class informants, like those I encountered in Salvador, showed some discomfort when they were not able to fully recollect the details of the process. Though their memories were often complemented by comments indicating they were not sure about what was going on "inside," she notes that "in spite of their hesitations, all of them managed to get out some version of the failed production view" (Martin 2001, 106). She concludes that middle-class women have two irreconcilable versions of menstruation. The first concerns "what [it] feels like, looks like, smells like, what the immediate experience of being a 'menstruator' is like," (107) and the second consisted in some version of the biomedical explanatory model of menstruation. She proposes that this situation is reversed among black and white working-class women, who recounted menstruation essentially by reference to the experience of bleeding (108). Martin concludes that working-class women do not summon medical metaphors of menstruation as failed production despite a clear indication of knowing these because, unlike middle-class women, they "resist" them as they "have less to gain from productive labor in the society" (110). Although I also noted substantial class differences, I would not analyze these in terms of resistance/domination to authoritative medical representations. If anything, low-income women tend to strive to perform a degree of medical competence in order not to appear as ignorant, thereby embracing rather than rejecting medical knowledge.
Excerpted from Plastic Bodies by Emilia Sanabria. Copyright © 2016 Duke University Press. Excerpted by permission of Duke University Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of ContentsAcknowledgments ix
Introduction. Plastic Bodies 1
1. Managing the Inside, Out: Menstrual Blood and Bodily Dys-Appearance 43
2. Is Menstruation Natural? Contemporary Rationales of Menstrual Management 71
3. Sexing Hormones 105
4. Hormonal Biopolitics: From Population Control to Self-Control 129
5. Sex Hormones: Making Drugs, Forging Efficacies 159
Conclusion. Limits That Do Not Foreclose 187
What People are Saying About This
"Read this book and you’ll never think about hormones the same way again. Emilia Sanabria takes us into the Brave New World of Brazilian gynecology, where experimental contraceptives (sometimes containing testosterone) are taken to suppress menstruation, improve body shape, 'give fire,' or manage relationships. Plastic Bodies is a fascinating account of how hormones came to have multiple forms and uses in Brazil. A beautifully written ethnography, it is also an intimate portrait of women’s experiences of these pharmaceuticals."
"This book belongs to a new generation of ethnographies that are reinventing our conceptions of gender, health, embodiment, and medicine. In her lucid exposition of hormonal practices in Bahia, Emilia Sanabria both introduces us to a new form of biological control and challenges existing models of self, agency, and matter. By meticulously charting the relative biologies of her informants, she persuasively argues that their plastic bodies are also ours."