Abstract
Many adolescents experience severe pain during menstruation, yet their attempts to receive medical attention to alleviate or manage this pain are often met with dismissal or disbelief. In light of these barriers to care, many adolescents turn to social media to share their experiences with menstruation and pain, as well as hear from other members of their community. In this study, we investigated how adolescents present their experiences with menstruation in vlogs (or “video blogs”). Using critical qualitative methods and a four-column analysis structure, we transcribed and thematically analyzed the audio and video content of 17 YouTube vlogs wherein adolescents described their experiences with menstrual pain. We found that stylistically, the vloggers modulated between a polished documentary style and an intimate storytime style of video production. We additionally found that vloggers spoke about their menstrual pain experiences from three perspectives: as a Patient managing and diagnosing physical symptoms, as a Self considering how the pain affects their life and ambitions, and as a Teacher educating their audience. Considering both the visual and audio data, we discuss how healthcare providers can use these findings to inform their approach to discussing menstrual pain with adolescents. We further discuss possible future directions for research into health story sharing on social media.
Introduction
Menstrual pain is common among adolescents who menstruate. Menstrual pain, or dysmenorrhea, is characterized by pain around the time of menstruation that can occur in the pelvis, abdomen, or back and headaches and may be accompanied by nausea, diarrhea, and vomiting (Harel, 2008; Osayande & Mehulic, 2014). Reports suggest that between 50% and 90% of adolescents who menstruate report experiencing pain with menstruation (Iacovides et al., 2015; Söderman et al., 2019), and over 40% describe this pain as moderate to severe in nature (Ortiz, 2009; Söderman et al., 2019). Despite the prevalence and severity of menstrual pain among adolescents, the condition has been largely overlooked in research (Berkley & McAllister, 2011) and poorly managed in clinical settings (McShane et al., 2018).
Researchers have examined the impact of menstruation across a number of cultural contexts, with evidence that religious (e.g., Baumann et al., 2021), cultural (Mukherjee et al., 2020), and income-related factors (e.g., Holmes et al., 2021) play a significant role on the attitudes toward menstruation and the interference that menstruation can play in one’s life. Research on dysmenorrhea, particularly research that focuses on issues in dysmenorrhea beyond prevalence rates, has most emerged from developed and high-income countries (Holmes et al., 2021). Among research from developed countries, menstrual pain is associated with significant interference in the day-to-day functioning of youth, and many adolescents’ symptoms are debilitating. It is not uncommon for adolescents who menstruate to regularly miss school, with up to two-thirds missing at least 1 day per cycle (Pitangui et al., 2013; Söderman et al., 2019). Individuals with menstrual pain report elevations in symptoms of depression and anxiety (Sahin et al., 2018) and describe their pain to impact their quality of life (González-Echevarría et al., 2018). Interference with social functioning has also been reported, with many adolescents reporting that they spend less time with friends when experiencing menstrual pain and that their menstrual pain interferes with extra-curricular activities (Banikarim et al., 2000). Menstrual pain also impacts long-term health outcomes as it has been associated with an increased risk of developing chronic pain conditions (Li et al., 2021).
Many adolescents are hesitant to seek help for their menstrual pain because they believe it is a normal occurrence during the menstrual cycle that must be endured (Wong, 2011). Those who do seek help report that their pain is dismissed or minimized (Holst et al., 2022). Moreover, it is not uncommon for adolescents to be told that their pain should improve by adulthood, despite evidence that a substantial portion of females continue to experience menstrual pain throughout their adult reproductive years (Fernandez et al., 2020; Weissman et al., 2004). As a result, many adolescents who menstruate live with ongoing pain for which they receive minimal support or treatment.
Given the barriers to receiving formal medical attention, many individuals, including adolescents, rely on social media communities for menstrual pain support and to help make meaning of their experiences. Social media platforms provide an accessible and private avenue for sharing health-related information (Chambers, 2018) or individual experiences with health conditions (De Nardi et al., 2020). The use of social media to navigate health-related experiences has been reported among adults with menstrual pain–associated conditions. For instance, among adult gynecological patients, those who report chronic pelvic pain are more likely than patients without pelvic pain to use social media platforms to understand and manage their condition (Piszczek et al., 2022). Females with endometriosis report having a positive attitude toward sharing information about their health on social media platforms and turn to social media to help understand their experiences (Sbaffi & King, 2020).
The use of social media platforms among adolescents who experience menstrual pain has been considered to a much lesser degree, despite 85% of youth reporting using social media (Pew Research Centre, 2020). Youth with menstrual pain may have unique needs and experiences when it comes to menstrual pain, such as different developmental needs, different cycle characteristics, and different knowledge needs (Coast et al., 2019; Diaz et al., 2006; Houston et al., 2006).
Research Aims and Objectives
Although youth experiences of menstrual pain are underrepresented in the research, adolescents find a voice on social media, making such platforms a valuable source for researchers to examine adolescent menstrual pain management needs as distinct from those of adults. Our project aims to investigate how adolescents present their experiences with menstrual pain in vlogs. A portmanteau of “video” and “blogs,” vlogs are a genre of conversational videos wherein creators share how they think and feel (Sanchez-Cortes et al., 2015). Using qualitative methods involving iterations of interpretation and thematic analytical organization, we highlighted patterns across the vlogs and deeply explored what menstrual pain means to adolescent vloggers.
To achieve this aim, we searched YouTube for vlogs about menstrual pain posted by adolescents. We then transcribed these vlogs using a four-column analysis structure (Mohammed et al., 2023) to capture both visual and audio data. Finally, we analyzed the cumulative data using a critical qualitative approach.
A Multimodal Qualitative Approach
To analyze the YouTube vlogs, we applied a critical qualitative approach to data transcribed through a four-column structure designed for multimodal research. We found qualitative inquiry to be appropriate, as it can be used by researchers looking to “understand or explore meaning and the ways people make meaning” (Braun & Clarke, 2013, p. 35), making it a suitable tool to explore how adolescents make meaningful sense of menstrual pain within their communities. Further, a critical qualitative approach allowed us to focus our analysis on the representation of menstrual pain on social media (Braun & Clarke, 2013). The vlogging format is a canvas for audio and visual content that cumulatively construct representations of adolescent menstrual pain. Importantly, these representations are crafted by those experiencing the pain. Because representations utilize systems of meaning embedded in cultural hegemony, they have implications for perpetuating or challenging structures of power (Hall, 1997). Therefore, a critical qualitative approach is useful to focus on how the vlog representations of menstrual pain experiences relate to the vloggers’ sociocultural context, as well as the vlogs’ potential implications for viewers.
The YouTube 1 video-sharing platform is a particularly valuable resource for this investigation as it offers rich, naturalistic stories in a participatory setting. For decades, research has shown that the internet has been a medium for sharing stories about health and illness (Diaz et al., 2002). In the early 2000s, the internet provided an alternative to traditional in-person support group spaces, which worked especially well for people with stigmatized illnesses such as HIV/AIDS (Mohammed & Thombre, 2005) or urinary incontinence (Berger et al., 2005). Almost 20 years later, users can readily participate in online story-sharing communities through the vlog format. Vlogs provide naturalistic data, wherein the creator shares their stories intimately, as though speaking to a friend (Lange, 2009; Raun, 2018), instead of stories expressed to a researcher in a research setting. In these ways, the YouTube platform is well-suited for analysis of rich qualitative data.
However, the value of data on YouTube is not limited to the vlogger’s spoken words. Rather, the stories vloggers share are meaningfully represented using techniques beyond dialogue. Vloggers craft their words carefully and decide what they show the audience to depict their stories. To incorporate these multimodal elements of the vlogs in our qualitative analysis, we utilized a four-column transcription structure to translate visual and audio elements into qualitative data so that visuals can be analyzed alongside the dialogue (Mohammed et al., 2023). This transcription method enabled us to identify the qualities of the composite visual and audio pieces that constitute the total story being conveyed. We were thus able to gain more rigorous insight into the vlogs by considering the multiple avenues through which vloggers express meaning.
Methods
The study utilizes a four-column analysis structure based on Stuart Hall’s (1980/2009) theory of encoding and decoding. The structure facilitates the simultaneous deconstruction of audio and visual content, allowing the analyst to decode the meaning the creators encode into their productions (Mohammed et al., 2023). In this study, the structure enables researchers to gain insight to not only what adolescents say about their menstrual pain but how they meaningfully portray these experiences to an audience. 2
Sampling
Video and Vlogger Demographics.
Note. Although the data sources are publicly available, this table does not include links to the videos to protect the identity of the creators.
aA and B indicate different videos from the same vlogger.
bAs of November 2020.
Data Collection and Analysis
Two senior undergraduate research assistants completed transcription and quality assurance checks of the YouTube videos. The first author took the lead on analysis, in consultation with the second and third authors. She transcribed the vlogs using a four-column coding system with columns dedicated to (1) timestamps, (2) the setting, (3) the scene, and (4) the dialogue content of each video (Knowles, 2020; Mohammed et al., 2023). The setting and scene columns were used to record the visual content of the vlogs. The setting column recorded the visible objects and surroundings in the frame, including characteristics of the vlogger, while the scene column recorded the actions taking place in the frame (Knowles, 2020). All spoken content was transcribed in the dialogue column. The timestamp column allowed us to align the setting, scene, and spoken content.
The first author analyzed the setting and scene columns using compositional interpretation (Rose, 2016), while the dialogue was analyzed using thematic analysis (Braun & Clarke, 2006). Compositional interpretation as defined by Rose (2016) requires the analyst to look carefully at images “for ‘what they are’” (p. 57). By focusing on the composite parts of the work’s visual content and production decisions, analysis emphasizes “the affective and the nonrepresentational” (Rose, 2016, p. 58) elements, illuminating how they cumulatively impact the viewer’s understanding of the material. She specifically looked at the content of the frame, the spatial organization of the shot, the structure of the vlog, the mise-en-scène, the rhythm of cuts, shot distance, editing techniques, sounds, and expressive content. She then coded the transcriptions in context of the research question, collated the codes, and proceeded through several iterations of organizing and reorganizing the codes according to how they appeared together and their combined effect to convey the meaning of the video.
To identify the patterns throughout the spoken content, she thematically analyzed the dialogue column using Braun and Clarke’s (2006) phases. After reading through the transcripts, the first author inductively coded the dialogue according to relevance to the research question. Then, after jotting down initial thoughts on potential themes, and in consultation with the second and third authors, she coded the dialogue a second time and built a codebook to ensure all codes were discrete and held validity to the research question. After collating the codes, she organized them into distinct themes, and reviewed and refined the themes and their names, again consulting with the second and third authors, to ensure they remained specific to menstrual pain, before reporting the themes in writing. The themes presented are grounded in verbatim quotes from the vloggers that illustrate the themes and evidence our analysis.
Positionality of Analyst
Because we use an inductive approach to analysis, our interpretations are not structured around any existing theory. However, the analysis is produced by the analyst, who carries particular positionalities that inform the interpretive process. The transcripts were analyzed by the first author, who is a cisgender, able-bodied, Trinidadian-American woman. Throughout analysis, she kept reflexive memos to track her thoughts about the analysis structure and to mindfully recognize her reactions to the content of the transcripts. Through memoing, she articulated her resonance with many of the creators’ experiences of menstrual pain but further recognized that her experiences of reproductive care may be influenced by factors that diverge from the creators’ experiences, such as race, socioeconomic status, and country of residence. These reflections helped the analyst grasp how her interpretation was informed by her own experiences but avoid imposing such experiences onto the data.
Results of Analysis
The vlogs were analyzed in two distinct sections: Setting and Scene, and Dialogue. The setting and scene analysis produced two major intertwined styles of production: Documentary and Storytime. Analysis of the dialogue produced three themes outlining the perspectives from which the vloggers speak: Patient Stories, Self-stories, and Teacher Stories. Combined, the two sections of analysis illustrate how vloggers use YouTube to call attention to the often-overlooked complexities of their menstrual pain.
Setting and Scene
Through video editing, camera work, and scene presentation, vloggers use a mixture of techniques that create videos with both documentary and storytime styles. By weaving throughout these styles, the vloggers pull their private experience with menstrual pain into the public eye. The modulation from the detached, polished documentary style of video production to the more personal, conversational storytime style reflects the enigmatic location of menstrual pain as an intimate topic spotlighted on a highly visible public platform.
Documentary styles of production are used to illustrate the experience of menstrual pain in a broad or generalized sense. Scenes take place in public settings such as a store or school, or at home with a propped camera, showcasing discussion of periods as casual or mundane. The vloggers similarly present themselves using casual body language, such as sitting upright and talking with their hands, and casual attire, such as sweatshirts and jean jackets. Sixty-two percent of the videos included some form of video editing, including animations and effects, past footage or images spliced in, on-screen text, or background music. These effects were often used to help communicate information, such as the definition of endometriosis (Vlogger 13A) or using wipe transitions to split the content into easily digestible sections (Vlogger 8). These aspects come together to create the feel of a documentary in which the vlogger provides information about periods in the public sphere.
Storytime styles, in contrast, lend the viewer insight into the more private aspects of the vlogger’s experience with pain. The storytime genre has been described as videos wherein the YouTuber sits in their home and speaks directly to the camera as if having a conversation with the viewer (Hegel et al., 2022). Here, this style is characterized by a handheld camera and a lack of video editing effects, contributing to a more raw and authentic feeling video that simulates a personal video call. Scenes take place in the home, especially private spaces such as the bedroom and bathroom, where the vlogger may be wearing a bathrobe or housecoat. The vloggers depict themselves laying down in an effort to cope with the pain and visuals of the pain expressing itself through the body. Body language such as clutching the abdomen and facial expressions such as grimacing showcase the vlogger’s discomfort. Cumulatively, these aspects of the video immerse the viewer into the vlogger’s intimate experience of the pain, as though she were a friend telling a personal story.
Vloggers use a combination of these styles throughout their videos, reflecting the public and private nature of their menstrual pain experiences. While recounting their experiences, vloggers describe their period pain occurring in both private and public spheres, from the bathroom, to school, back into a bedroom. The stigma around their menstrual pain shrouds their discussion of it with shame and pushes it into private settings, yet the pain has broader implications for their participation in the public sphere (as they explore in their dialogue). The production of the vlogs reflects this paradox through compositional techniques that modulate between personal video calls and fully produced documentaries.
Dialogue
Analysis of vlog dialogue content produced three themes: Patient Stories, with subthemes “Pain” and “What’s Happening”; Self-stories, with subthemes “Tolerating Menstrual Pain,” “Contextualizing the Pain,” and “Results of Disclosing the Pain”; and Teacher Stories. These themes describe the perspectives that the vloggers speak from. Each vlogger spoke from multiple perspectives, often within the same video.
Patient Stories
When speaking from the perspective of a patient, vloggers give voice to their body by describing how the period pain affects them physically. Within this dimension of their stories, vloggers articulate their menstruation experiences in medical terms, thus framing their experience in clinically legitimate language. Vloggers employ documentary styles of production to show how they manage pain in public spaces, such as a hospital (Vlogger 13A) or in school (Vlogger 14), whereas storytime styles were used when vloggers described the narrative unfolding of the diagnostic process. Descriptions of how period pains impact their body were divided into two subthemes: figuring out what is happening to the body and processes of dealing with the pain.
What’s Happening?
To make sense of their biological phenomena, vloggers describe the mechanics of their period and their efforts to understand better what is happening in their body. The explanation of period anatomy can take the form of a young woman confidently describing what a period is to a young girl (Vlogger 10). More often, however, the content is characterized by uncertainty from the young woman experiencing the period and the accompanying pain. Vloggers list the indicators of menstruation they experience as symptoms, using words like fatigue, cramps, nausea, migraines, cravings, mood swings, and bloating. These terms indicate a collection of occurrences that might make sense to a physician but do not describe the sensations to an audience member who might not know what something like “bloating” feels like. In context of the symptoms, some vloggers expressed uncertainty and struggled to know whether their pain was reason for concern. Trying to differentiate between her endometriosis and an ovarian cyst bursting, one vlogger expressed frustration, saying: It’s difficult to tell whether you’ve got an ovarian cyst that’s about to explode or whether it’s just the endo on your ovary playing up, you just can’t tell because the pain’s the same so I have no clue what to do. (Vlogger 13B)
Another vlogger struggled with an irregular cycle, stating, “I actually don’t know, my periods have been all over the place” (Vlogger 15). The vloggers typically did not frame receiving a diagnosis as a solution to their uncertainty. Vloggers mostly used online medical websites for at-home diagnostic efforts, but a few did seek a medical diagnosis, such as Vlogger 7: Well, I went to a doctor and ended up getting an ultrasound. With the ultrasound they couldn’t find anything—no cysts, but endometriosis was still like an underlying condition, that could be what I have and to this day I still don’t know. I still don’t know what I have.
From the vloggers’ stories, a diagnosis guaranteed neither relief from pain nor certainty.
Dealing with Pain
Vloggers dedicated much of their content to describing their dysmenorrhea. They document the changes in intensity of pain as the period progresses, as one vlogger notes that she “was fine and then all of a sudden it was like excru- excruciating excruciating pain” (Vlogger 4), while another forebodingly stated “as of right now it’s not too painful but I’m not counting on that staying” (Vlogger 11B). To further emphasize the intensity of the pain, vloggers described how the body reacts to it, citing effects such as an inability to fall asleep, lack of mobility, fatigue, vomiting, losing consciousness, shaking, and crying. Vloggers attributed these phenomena to the intensity of their period pain: “My period cramps they were so bad I could not get out of bed my legs were trembling” (Vlogger 7). To manage this pain, vloggers described and demonstrated using a variety of methods ranging from medical interventions including medication, heating pads, birth control regimens, and a TENS machine, to do-it-yourself solutions, including homeopathic remedies, changing their diet, watching TV to distract from the pain, laying down and resting, and light exercise. However, vloggers expressed disappointment when their strategies failed to alleviate their pain: “I ended up sitting in the shower for a little while just so that the hot water could go on my stomach—didn’t help at all” (Vlogger 4). Notably, failed pain relief attempts resulted from both medical interventions and do-it-yourself methods.
Self-Stories
To reflexively process their pain, vloggers used self-stories to describe how their chronic experiences with menstrual pain meaningfully impacted their lives. These self-stories illustrated how they molded their lives around their menstrual pain, as well as the motivations behind these decisions including their attitudes and coping strategies. The act of storytelling also seemed to create space for vloggers to process what menstrual pain means to them. Regarding self-stories, although some vloggers used documentary production styles for the re-enactment of their experiences (Vlogger 8), vloggers relied more heavily on the storytime styles to narrativize and evaluate their experiences of menstrual pain. Vloggers described their lives across three subthemes: Tolerating Menstrual Pain, Contextualizing the Pain, and Results of Disclosing the Pain.
Tolerating Menstrual Pain
In addition to how period pains impact their bodies, vloggers explained their efforts to continue living their lives, despite the pain. The vloggers expressed their intentions to tolerate menstrual pain, stating their desire to “push past it” (Vlogger 4) and resigning themselves: “[I’ll] just deal with it” (Vlogger 15) and “I’ve come to accept it” (Vlogger 7). Some vloggers attributed this attitude to their exasperation after many failed attempts to relieve the pain, noting that they’ve “tried everything and nothing would work” (Vlogger 2), or to their realization that there is no cure for their pain after being diagnosed with endometriosis. Other vloggers adopted this attitude from more general messaging in the zeitgeist, noticing that “basically anyone I know is like ‘oh yeah just get over it’” (Vlogger 7). This messaging was also reflected in the expectation placed on the vloggers to fulfill obligations to school, work, or peers despite their period pain. One vlogger’s pain kept her from spending time with her family: It was so bad and I was trying so hard to like push past it because I had plans the next day with my family that came down from [US State] um and I was trying so hard to just like “alright I can be fine maybe it’s all in my head” the pain and I can just push past it so I was trying really hard. (Vlogger 4)
Vloggers regretted the interruptions pain had on their lives when they were unable to tolerate it, saying that they had to miss out on social plans, parts of their daily routine, attending school, and getting work done. One vlogger further expressed concern for her career prospects, worrying that she “can’t have a job like this because no one’s gonna tolerate you know ‘oh sorry I can’t come in twice two days a month’” (Vlogger 4). As a result of these environmental pressures, vloggers decide their best course of action is to endure their pain.
Contextualizing the Pain
The vlog provided a processing space for many vloggers to consider how their pain compares and contrasts with other young women as well as how it fits into the broader scheme of their lives. Vloggers drew similarities between their pain and that of other young women. These young women were either people they knew personally, as one vlogger states, “my sister and I had the exact same we have you know the same symptoms” (Vlogger 4), or a more general statement about women having the same experiences, as another vlogger supposes, “I’m sure a lot of people with endo do relate” (Vlogger 13B). At the same time, vloggers contrasted their pain with that of other young women. One vlogger recognized the need for medical help after realizing that “maybe my symptoms aren’t quite right—all my friends did not experience the same thing that I did” (Vlogger 13A). By comparing and contrasting their pain to other young women, vloggers used information about others’ experiences of pain to determine whether their own pain is acceptable and natural, or if it requires medical intervention. This reflexive practice was apparent in several vlogs. One vlogger explicitly described the purpose of the vlog as a processing space, characterizing the video as “kind of for both you and me so I can look back and see what happened” (Vlogger 11A). Although most vloggers did not define the vlog as a processing space so directly, many expressed mixed feelings about their period pain, such as Vlogger 1, who summarized her discussion of her period saying, “it’s honestly just a bunch of emotions all together.” By sharing their experiences through video content, vloggers have the space to discuss any conflicting feelings about dealing with period pain.
Results of Disclosing the Pain
When vloggers decided that they need help to deal with their pain, they made the pain visible to trusted people in their lives, with mixed results. Recounting their first period, most vloggers reported hiding their pain, like Vlogger 1, who “didn’t feel the need to kind of tell anybody because I felt like I could just do it on my own.” However, after the pain reached a point where they needed relief, vloggers were willing to disclose that they had period pains, like Vlogger 2, who recounted “I was like honestly I don’t care who’s in the room I’m just gonna tell them.” Initially, most vloggers sought help from trusted family members, particularly mothers and sisters, although some were willing to reach out to neighbors and energy healers as well, and in some cases physicians were sought later on. Vloggers readily showed and recounted the support they received from their friends and family. This support included cheering up the vlogger while she’s in pain, helping her take care of herself, assisting with her pain management methods, and making accommodations for her pain. One vlogger’s mother even acted as a literal support: So she went and got my co-codamol and she got my apple juice that she’d bought me earlier on in the morning I think, and I managed to take this pill. But then I felt really, really sick and the problem was I had to lie on my back, [so] she was on her knees behind me and I was just kind of lying against her knees and holding- squeezing her hand like, I’m screaming through this pain. (Vlogger 11A)
However, vloggers were not always met with support or help after disclosing their pain. When seeking medical help, some vloggers noted their claims of pain were dismissed by physicians, declaring that “my doctors aren’t taking me seriously enough” (Vlogger 4). Although her doctor’s birth control recommendation limited the frequency of her pain, Vlogger 13A felt it did not attend to the cause of her pain or potential complications from the pain: I went to the doctor and I said to them you know like “I’m in agony” so the doctors recommended that I go onto birth control and they said “you can control your periods this way by only having like three periods a year—it’s tricycling” so that I wasn’t going through agony all the time, but they still just condensed that down to being just heavy periods so it was never like a label. They just sort of shoved me off, so I didn’t come back to the doctors.
In light of these interactions with health providers, many vloggers with similar experiences recommended seeking pain management help from a trusted family member.
Teacher Stories
In context of the menstrual pain experiences they share, vloggers teach their audience how to deal with their own pain and avoid the negative impacts of the pain on their lives. To this end, vloggers act as teachers by sharing the truth of their experience and directing viewers to information and behaviors that may help them as well. While vloggers utilize a storytime style to emphasize the importance of normalizing the discussion of period pain (Vlogger 4), teacher positions rely more on documentary styles to convey information, such as including on-screen definitions (Vlogger 13A) and showing helpful period products (Vlogger 12). Some vloggers directly stated their intentions to “help somebody” (Vlogger 4) or to “start raising awareness of this disorder […] so that maybe there could be a cure one day” (Vlogger 13A).
Although most vloggers showed less explicit intentionality behind their information sharing, their content nonetheless conveyed specific messaging about period pain. Often, vloggers shared a message of comfort by affirming to their viewer that period pains were normal and nothing to be worried about. For example, Vlogger 7 opened a vlog stating she wanted to “let you guys know that you’re not alone” in experiencing painful periods, and Vlogger 2 closed her vlog by asserting that “every woman goes through this.” Vloggers also sent a message that despite the taboo nature of period discussions, viewers needed to understand the reality of period pains. Before talking about their periods, many vloggers signaled that they were going to break a taboo by saying something along the lines of “sorry this is gross but this is what happened” (Vlogger 11A), to indicate that the viewer may not find the conversation pleasant but it needs to happen anyway. For example, one vlogger further justified her discussion of period pain as necessary resistance to the taboo: Yeah like this is so open and this is so honest, but I feel like if anyone’s gonna talk about it then it’s gonna be me who has it, and I don’t really care about being—you know, letting out the taboos at this point because there are so many women that have never heard of this condition and it’s so so common. (Vlogger 13A)
This emphasis on the necessity of period discussion was bolstered by vloggers’ intention to communicate only to people with periods, such as declaring “no boys allowed” (Vlogger 1) at the beginning of the video.
Vloggers additionally shared information that viewers could practically apply to their own lives. For example, vloggers enabled viewers to identify period pain in their own bodies by relating the vlog stories to their own pain sensations. They described the physical sensations of period pain in illustrative (as opposed to medical) terms, such as “feels like a fat man sitting on my uterus” (Vlogger 8) and “so sharp like a stabbing pain” (Vlogger 11A), thus voicing the body in terms that could be understood by someone with similar pains. Vloggers additionally pointed viewers toward a grapevine of information sharing, suggesting that they retrieve additional information about managing period pain from “life hack videos” (Vlogger 1), vlogs from other YouTubers (Vlogger 2), or from peers (Vlogger 11B). By providing directions to more information, vloggers facilitated the knowledge transmission process for viewers.
Discussion
Our results indicate that adolescents are using social media to engage in educational, emotional, and medical discussions about their menstrual pain. By transcribing and coding visual content alongside the speech, we analyzed the themes vloggers discussed as well as the meaningful composition of the videos to lend insight to how they contextualized menstrual pain. Analysis of the video settings and scenes found that vloggers weave throughout “storytime” (Hegel et al., 2022) and documentary styles to pull a taboo and private topic into the more public sphere of information sharing and knowledge transmission. The storytelling style that mimics a one-on-one conversation grounds the intimate subject matter in a popular genre, while vloggers additionally use more public settings, editing techniques, and audio–video effects to create educational content and transmit knowledge that goes beyond the scope of their personal experience. Combined, these styles create tonally complex videos that reflect the complexity of period pain in the vloggers’ lives, a private struggle with social implications. This paradoxically public and private content requires the vloggers to position themselves as three different kinds of speakers: as a Patient managing and diagnosing physical symptoms, as a Self considering how the pain affects their life and ambitions, and as a Teacher educating their audience. By moving through all three positions, the vloggers can make space for discussion of this taboo topic and situate their personal experiences within larger issues of barriers to reproductive care.
These results resonate with existing literature on the challenges of seeking medical attention for menstrual pain. For example, the pain dismissal that many vloggers faced reflected several studies which found that one in ten young adults reported having their pain dismissed, which often resulted in damage to the relationship with the person who dismissed them, anger, and feelings of isolation (Defenderfer et al., 2018). Further research on pain dismissal has found that young female adults were significantly more likely to report pain dismissal from their physicians (Igler et al., 2017) and that parents were able to identify (and respond negatively toward) dismissive language used by medical providers (Igler et al., 2020). In one study of women with PCOS diagnoses, participants similarly reported their early symptoms being dismissed by doctors during adolescence, having negative experiences trying to get a diagnosis, and eventually turning to self-education and advocacy (Soucie et al., 2020). Women’s challenges in receiving healthcare transcends international boundaries, as women living with chronic pain in Sweden reported feeling abandoned by healthcare professionals (Arman et al., 2020), like the feelings expressed by the vloggers. Further, the vloggers’ experiences of dysmenorrhea resonated with previous findings that menstrual pain varied among women and across time, had a negative effect on their daily lives, and was not seen as a legitimate health issue, and that treatment for pain varied in effectiveness (Chen et al., 2018). The study also supports some of the previously identified barriers to seeking healthcare for dysmenorrhea, including the assumption that symptoms are normal, considering symptoms to be tolerable, and thinking providers would not offer help (Chen et al., 2017). However, while previous research has shown that women may feel too embarrassed or afraid to seek care (Chen et al., 2017), the vloggers in this study have described the ways they advocate for themselves in medical settings despite feelings of frustration with pain dismissal, and go as far as encouraging others to seek help and establish their own support systems to help pain management.
This reclamation of the body in health stories is not new but still has implications for the sharing of reproductive health knowledge on social media. Frank (1997) similarly described how illness stories can be subsumed under a medical diagnostic identity and how the process of giving voice to the body is a reflexive personal practice molded by social convention. Notably, he described how personal stories can challenge generalized medical descriptions of illness by creating new narrative possibilities for the ill person (Frank, 1997), much like the vloggers moving between patient stories and self-stories as if to acknowledge the significance of a medical diagnosis while also relocating menstrual pain into the personal context where it is taken seriously.
The functions of the in-person storytelling that Frank (1997) identified were replicated on the internet some years later. Researchers noticed the emerging practice of health knowledge transmission online (Diaz et al., 2002), and studies have shown that the internet is an especially valuable health information resource for those with stigmatized conditions (Berger et al., 2005; Mohammed & Thombre, 2005). With the ubiquity of social media online, health knowledge transmission has become more fluid through the vlog genre and storytime format. The confessional function of storytime videos (Torjesen, 2021) enables the discussion of sensitive topics, such as intimate partner violence (Hegel et al., 2022), and disclosure of sexual assault (Riggs & Rasmussen, 2021). Further, the vlog genre provides a space to process negative experiences and counteract feelings of isolation by creating a communal space for affirmation (Berryman & Kavka, 2018) and identity reclamation (Andrews, 2020). With the effects of stigma minimized, social media videos offer an ideal space for adolescents to share their stories of menstrual pain management, process experiences of pain dismissal, and educate other adolescents about reproductive health based on their own experiences.
Recommendations
The results of this study highlight how adolescent women in the United States and United Kingdom are using online platforms to collectively reclaim their menstrual pain in the face of medical dismissal and inaccessible reproductive care. These findings can inform how healthcare providers discuss issues of menstrual pain and reproductive care with adolescent women. The vloggers describe being positioned as patients by figures of medical authority and position themselves as patients in turn. However, outside of their patient stories, they additionally use Self-stories to attend to the consequences of their pain on their everyday lives and how it impairs their ability to participate in their social world. Therefore, healthcare providers may need to discuss menstrual pain as a serious interference in the lives and identities of adolescent women. Such discussions may involve collaboratively developing a plan of pain management strategies with the adolescent that balance the intensity of the pain and stigma of the condition with the needs of the adolescent to continue participating in life activities.
Further, adolescents recognize this pain as a social phenomenon. Their pain is not simply isolated to their own body but a common (and even normal) occurrence for other menstruating people. They are thus compelled to share their experience for the benefit of others through Teacher stories. Healthcare providers can therefore ask adolescents what they already know about pain management strategies to begin discussions about the adolescents’ attitudes toward various types of pain management and clarify which types are available to them. While online information can seem authoritative in a documentary-style format, misinformation can spread quickly over the internet, and open conversations with adolescents about their preconceptions of menstrual pain can combat any misinformation. The guidance of the healthcare professional can thus provide a safe setting for adolescents to exercise control over their body and reproductive care. In a cultural context wherein many menstrual pain experiences are readily accessible to adolescents via social media, healthcare providers can facilitate positive reproductive care experiences by collaboratively attending to adolescents’ personhood through pain management.
Limitations and Future Directions
Our study has provided insights to the YouTube conversations about dysmenorrhea and the complex ways adolescents present their experiences with menstrual pain. Using a four-column analysis structure (FoCAS; Mohammed et al., 2023), we captured meaningful data from both the vloggers’ speech and the way they visually composed the videos. However, our study contains several limitations.
First, our sample characteristics are limited. For example, we only looked at vlogs from English speakers in the United States and United Kingdom. Contextual factors that influence adolescent access to healthcare and reproductive healthcare are varied across these countries. Future research can provide more focused insights to how adolescents describe their experiences with menstrual pain in different countries and how those experiences are influenced by national and regional healthcare policies. Additionally, research on menstrual pain experiences from creators who do not speak English may illuminate how such experiences are informed by different cultural considerations. Our sample also does not represent transgender or non-binary menstruating people. Gender non-conforming adolescents may not feel safe or comfortable openly discussing their gender identity on social media. Although this poses a difficulty for researchers, such experiences are important to the overall picture of reproductive healthcare. We also did not establish criteria to code for indicators of socioeconomic status; therefore, limitations of socioeconomic status in accessing healthcare are not accounted for in this analysis. These limitations point toward the many future directions for research to investigate experiences of menstrual pain for differently positioned adolescents.
Second, some aspects of the topic were not captured by our analysis and design. For example, our analysis did not explore how these conversations online construct networks of information sharing, nor how audiences engage with these videos. Future research can speak to the reach and relative engagement of the videos by analyzing comments, likes, dislikes, and shares on videos to see how information is being received, used, and interpreted by viewers. The study also lacked participation from the vloggers. Further studies on this topic may incorporate primary data collection or follow-up interviews with the vloggers for more focused narratives, an opportunity to validate the analysis through member checking, and a wide array of additional insights to adolescent menstrual pain experiences.
Footnotes
Acknowledgments
The authors would like to thank Sarah Bjornson and Laura Knowles for their assistance with this project.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
