RESULTADOS Y DISCUSIÓN
5. Toma de decisiones:
The exact nature of the above associations is not entirely understood, however,
various religions, philosophical notions, anthropological, sociological and
psychological research findings all offer some insight Into the possible roots of
these psychological manifestations.
Historically, a lot of interest has focused on menstruation. For exam ple, Aristotle
(384-322 B.C.) believed that menstruation was the loss o f bad humours. Roman
scholar, Pliny II believed menstrual blood had malevolent properties and
described them in his Natural History:
C o n t a c t w i t h it ( m e n s t r u a l b l o o d ) t u r n s n e w w i n e s o u r , c r o p s t o u c h e d h> it b e c o m e b a r r e n , K r a f t s d i e , s e e d s i n g a r d e n s a r e d r i e d u p . t h e f r u i t o f t r e e s f a l l s o f f . t h e e d g e o f s t e e l a n d t h e g l e a m o f iv o r > a r e d u l l e d . b i \ e s o f b e e s d i e . e \ e n b r o n z e a n d i r o n a r e a t o n c e s e i z e d b y r u s t , a n d a h o r r i b l e s m e l l f i l l s t h e a i r ; t o t a s t e it d r i s e s d o g s m a d a n d i n f e c t s t h e i r b i l e s w i t h a n i n c u r a b l e p o i s o n . . . . K s e n t h a t v e r s t i n s c r e a t u r e t h e a n t is s a i d t o h e s e n s i t i v e t o it a n d t h r o w s a w a s g r a i n s o f c o r n t h a t t a s t e o f it a n d d o e s n o t t o u c h t h e m a g a i n .
Generally a negative connotation of the menstrual flow survives almost globally
and, in many societies it is considered polluting and perhaps dangerous (Brooks-
Gunn, 1985). It features in rituals, magic, myths and folklore.
Menstruation imposes restrictions on sexuality, food preparation, personal habits
and social activities (Brooks-Gunn, 1985). For example, in the Bible, in Leviticus,
the third book of Moses (1515 B.C.), menstruation is described as polluting.
Menstruation is also termed as a sickness, and having sex with a menstruating
woman is seen as a crime much like incest (cited in W illiams & Echols, 1994).
Some clergy believed that witch and devil worshippers used menstrual blood in
their magic ointments, but the most popular belief was tbat m enstruation was a
punishment inflicted on womankind because of E ve’s sin. For orthodox Jews,
Afterwards it is obligatory for her to cleanse herself hy taking a ritual hath
(M ikvah). The Koran, the holy hook o f Islam, calls the m enstruating woman a
"pollution." This notion of menstruation as polluting is held among Hindu
wom en, and as such, affects their social relations. When m enstruating they are
prohibited from preparing food; marriages are cancelled if future m other-in-laws
are menstruating; and menstruating widows are excluded from m ounting their
husband's funeral pyre (Dumont, 1979). Adult male Oriya Brahmans^ believe
that menstrual blood is poisonous, able to obliterate trees and plants, shrink
testicles, and pollute the environm ent (Shweder, 1985). Melanesian Ifaluk men
avoid social or sexual contact with menstruating women for fear o f death. They
also fear ‘if a drop of menstrual blood falls on them, they will lose their hair,
have a constant stomach-ache and will go insane’ (Paige & Paige, 1981). The
Rom gypsies - who originated from India som e 5,000 years ago, consider the
lower half of the female body as polluted. The genital-anal area of the body is
particularly shameful and all excretions from this area are highly polluting
(Sutherland, 1975) and once a women starts m enstruating her top and bottom
clothes are washed separately. During menstruation she sleeps alone facing a
wall - som etim es with her legs tied together.
M enstrual myths and taboos also persist among New Guinea society. For
exam ple, it is reported that a tribesman divorced his wife because she slept on his
blanket wbile menstruating. Convinced he could still be affected by ber evil
influence, later he killed her with an axe (Meggitt, 1964 cited in Delaney, Lupton
& Toth, 1988). Among some modern day M exican-Am ericans the belief exists
Menstruation, Menstrual Problems and Hysterectomy
18
that d uring m enstruation the chirrionera and the ajolote, lizard-like anim als, prey
on w om en sm elling o f m enstrual blood. Should an unsuspecting w om an urinate
outside, these creatures m ay enter the vagina and build a nest in the w om b,
resulting in the w om an giving birth to these beings, or the w om an m ay have her
insides eaten hy lizards, resulting in the w om an’s death (Snow & Johnson, 1977).
R esearchers (Snow & Johnson, 1977) claim that in som e cultures, w om en fear
m enstruation because they associate it w ith w itchcraft w hich can injure them
d uring this vulnerable time.
In w estern society, m enstruation also governs m any w om en ’s lives. For exam ple,
one quarter o f A m erican w om en reorganise their physical and social activities
because o f it and fifty per cent refrain from sexual intercourse (B rooks-G unn,
1985). D uring m enstruation, Jew ish and C atholic w om en are m ore likely to
practice sexual abstinence.
Snow & Johnson (1977) testing ideas about intercourse to w om en in a M ichigan
public clinic found that 62 percent o f the w om en thought that intercourse during
m enstruation w ould increase the m enstrual flow , cause haem orrhaging, infections
and uterine cancer (M atlin, 1987).
E vidently there is a w ealth o f published m aterial on the negative aspects o f
m enstruation, but infrequent regard for the positive aspects o f it. Som e studies,
how ever, have redressed the balance. D rellich & B ieber (1958), for exam ple,
found that the m ajority o f the hysterectom y patients they investigated had
positive feelings tow ards m enstruation and regretted the loss o f this im portant
instrum ental for the conservation o f health and w ell-being. In som e societies
(e.g. Som ali) it represents power. ‘Since m ilitary pow er and political pow er
depend on the continual expansion o f the num bers o f m ales in the clans, strong
fraternal interest groups place an overw helm ing value on fecu n d ity’ (Paige &
P aige, 1981). Cessation o f m enstruation not only signifies loss o f fertility, but a
disruption to a w om an ’s w hole sense o f w om anhood and bodily equilibrium and
loss o f power. In 1983 the W orld H ealth O rganisation (WHO) studied attitudes
tow ards m enstruation in all socioeconom ic classes in Egypt, India, Indonesia,
Jam aica, M exico, Pakistan, Philippines, R epublic o f K orea, the United K ingdom ,
and latter day Yugoslovia. The research focused on patterns o f m enstrual
attitudes by collecting data on birth control practices, since it has been
universally established by population and health w orkers that disturbances in the
m enstrual cycle often affect the way a woman selects and uses birth control
(Snowden & C hristian, 1983 cited in D elaney, Lupton & Toth, 1988). They
found that despite the physical and em otional problem s w om en suffer during
m enstruation, and negative cultural taboos regarding this m onthly event, som e
w om en saw it as a positive event. This was apparent in parts o f India where
religion, caste and notions o f pollution induce m any w om en to avoid chores at
this tim e. The m ajority o f these Indian women would not voluntarily subm it to
induced am enorrhea, such as m ight result from the pill.
C learly throughout history m enstruation has been described as having negative
properties, and, as a result, beliefs and attitudes tow ards it m ay adversely affect
w om en ’s body im age and perception o f disease causation (Snow et al, 1977).
T herefore, m edical practitioners m ight want to focus m ore on the psychological
Menstruatioriy Menstrual Problems and Hysterectomy
20
theories o f the nature of the female body and tem peram ent em phasized the
weakness and unstable emotions created by hormonal imbalances, and to the
nineteenth-century physician, the womb and ovaries were the most significant
organs in a w om an’s body (Owen, 1993).
Disorders of Menstruation:
Menorrhagia and Dysmenorrhoea
‘ N o m a n , ( w h o is b u t n e v e r s o l i t t l e v e r s e d i n s u c h m a t t e r s ) i s i g n o r a n t , w h a t g r i e v o u s Symptômes, t h e R i s i n g , B e a r i n g d o w n , a n d P e r v e r s i o n , a n d C o n v u l s i o n o f t h e Womb d o e x c i t e : w h a t h o r r i d e x t r a v a g a n c i e s o f t h e m i n d e , w h a t P h r e n s i e s , M e l a n c h o l y D i s t e m p t e r s , a n d O u t r a g i o u s n e s s , t h e praetem atural Diseases o f t h e W o m b d o i n d u c e , a s i f t h e a f f e c t e d P e r s o n s w e r e i n c h a n t e d : a s a l s o h o w m a n y d i f f i c u l t Diseases, t h e d e p r a v e d e f f l u x i o n o f t h e T e r m s , o r t h e u s e o f Venus m u c h i n t e r m i t t e d , a n d l o n g d e s i r e d d o f o m e n t . ’H a r v e y ( 1 6 5 3 )
Twentieth century medical and psychological journals have am assed much
material on the pathophysiology of menstrual disorders, though progress in
understanding the psychological aspects involved, appears to be limited and
controversial.
Several studies have shown that there is a recognized association between
em otional illness and gynaecological symptomatology (Stott, Teague & W alker,
1983). This has been demonstrated in the UK (e.g. Bryne, 1984; Ballinger, 1977)
and Australia (W orsley, Walters & Wood, 1977) who used the General Health
Questionnaire [GHQ] (Goldberg, 1972) to detect such morbidity. It has
prompted such comments as: ‘of all the medical specialities, there is perhaps none
so closely allied to psychiatry as gynaecology’ (Rogers, 1950).
Ballinger (1977) reported that women attending gynaecology outpatient clinics
population (cited in lies and Gath, 1989). Sainsbury (1960) com pared patients
w ith dysm enorrhoea, m enorrhagia, irregular m enstruation, asthm a, psoriasis,
acne vulgaris) to patients with other com plaints: appendicitis, cholecystitis,
fractures, hernia, injuries, varicose veins - w here the psychological factor w as not
usually considered im portant - to see w hether there w ere any differences on
personality factors. He found high levels o f neuroticism am ong gynaecological
patients.