Sex Ed Programs Leave Behind Teens With Endometriosis

I'm an adult, but I'm still playing catch-up with my sex education. Now that I am learning about reproductive health, I can look back on my teenage years with new knowledge. I can see how my heavy and painful periods were not normal. And I wonder if I could have been more proactive about my health if my high school sex education courses taught me about endometriosis.

The current state of sex education

Sex education in the United States gets a failing grade. As of the summer of this year, at least 6 states do not mandate sex education be taught in public schools. A vast minority of schools include disability and chronic illness in their sex education curriculum.¹

So what do public school sex ed programs teach? Many sex ed programs aim to prevent teen pregnancy. Thirty-seven states require that sex educators teach abstinence.

As a teen, I remember how my sex ed teacher equated sexual health with abstinence. The teacher passed around printed images of patients' genitalia with rashes, bumps, or skin discoloration. "Take a good look," I remember the teacher urging us. She continued, "Do these bodies look healthy to you? STIs can impact anyone who has sex. The only way you can 100 percent avoid getting one of these conditions is by staying abstinent."²

Perpetuating medical stigma and misinformation

My abstinent-only education implied that STIs were a moral failing: A natural consequence (or, perhaps, a punishment) for 'irresponsible,' premarital sex. However, these lessons also perpetuated medical stigma and misinformation. As I learned about the potential symptoms of STIs (late or spotty periods, cramps, and heavy bleeding), I was confused when I started to experience many of these same complications. But I was a virgin, and my sex ed had taught me that abstinence would protect my reproductive health.

Atop this abstinence approach, many programs also discount young people's pain. Many medical studies indicate that doctors tend to underestimate women and trans patients with vaginas when those patients report feeling like they are in pain. For example, women tend to receive less pain medication than men even when they both have similar symptoms.³

Swallowing our pain

From a young age, many of us are taught to swallow our pain like a horse pill. A 2019 study showed that as many as 14 percent of menstruating people had to take time off work or school because of their painful or heavy periods. But coworkers or teachers may shrug off these complaints as being excuses to avoid work or 'overly dramatic' bids for attention.⁴

Sex education programs may feed into these biases. One day, I stayed after class to ask my sex ed teacher a question: "My friend says she has really heavy periods. Sometimes, her blood is really red, and sometimes it looks brown. She feels horrible pain. She told me that she has never had sex. Is there anything that she should worry about?" My biological mother wasn't in my life, so I did not have another trusted female figure I could ask. The teacher glanced at me over her glasses and said, "Well, has your friend 'experimented' with any boys? Pregnancy can cause discomfort. Otherwise, she probably shouldn't worry."

I remained abstinent through high school, but my menstrual complications continued. But I shrugged off these early warning signs for endometriosis, and I assumed that everyone else just lived with the same issues. A decade later, my endometriosis had progressed and caused irreparable damage to my body.

How endometriosis-friendly sex education can save lives

When students do not learn about menstrual health, they may not recognize when they are experiencing symptoms of endometriosis or other reproductive conditions. While endometriosis has no cure, comprehensive sex education programs may facilitate earlier diagnosis and better health outcomes for young people.

Most people with endometriosis take around 10 years to be diagnosed. In this time, endometriosis pain and scarring can worsen. Because endometriosis is a chronic illness, proactive treatment is vital to preventing further inflammation. In other words, scar tissue can be removed, but it cannot be reversed. However, when young people can be diagnosed early, they can avoid this tissue damage in the first place.

What might an endometriosis-friendly sex ed program look like?

1. Redefining ableist or moralist ideas of 'reproductive health

Like me, too many students learn only about reproductive complications from STIs or pregnancy. These lessons can create a false binary: 'healthy' = abstinent; 'unhealthy' = promiscuous. So when a young person experiences worrying menstrual health symptoms, they may keep silent about their pain. They may worry about being judged, or they may think that their pain is normal.

2. Including diverse reproductive health conditions

Around 1 in 10 women is diagnosed with endometriosis. Many other people experience cysts, irregular periods, PCOS, or other medical concerns. An inclusive sex education program could educate students about these different conditions and their potential symptoms.

3. Having candid discussions of pain and side effects

Pain is subjective, and it can be difficult to quantify or tangibly describe 'normal' menstrual discomfort. However, inclusive sex educators can describe different types of pain and what bodily processes cause these sensations.

For example, mild-to-moderate abdominal cramps may be a usual side-effect of periods since prostaglandins trigger the uterus to contract. These hormonal changes and muscular contractions can also cause mild digestive changes (AKA 'period poops').

However, sex educators should emphasize that not all period symptoms are the same. If a person is routinely experiencing severe cramps or nausea that prevent them from coming to school or going to work, or if that person experiences lingering burning or aching pains that radiate through their abdomen and their back or legs, they may need to consult with a doctor.

4. Demystifying blood

Menstruating people may feel like their blood is taboo. I was taught to carefully fold up my tampon or pad in layers of tissue paper before disposing of it in the trash can - not just for sanitary purposes, but to physically hide away the evidence of my bleeding. Many people hide their clean tampons or pads in a sleeve or a purse when they go to the bathroom to prevent other people from even knowing that they're on their period.

Because of this period stigma, it can be difficult for young people to have an accurate gauge for their bleeding. An endo-friendly sex ed program could show students liquid measurements for how much blood, on average, a person can expect to lose during their period. When teens know these healthy ranges for menstrual bleeding, they can recognize when their heavy bleeding may be a cause for concern.

5. Pointing out community resources

Awareness is the first vital step to learning about endometriosis. However, what should students do when they recognize that they might have menstrual abnormalities? Sex educators can encourage students to go to a doctor. After all, any person who suspects they might have a health issue should seek prompt medical care from a qualified professional.

Sex educators can perform an important service by connecting students and families to community resources. For example, an endo-friendly sex ed program might distribute flyers about low-cost health clinics.

In the fight against endometriosis, early diagnosis and intervention is key. Countless young people struggle with pain for years before they realize that their symptoms might point to a more serious, underlying illness. Inclusive sex education programs can help turn the tide.