I have run enough marathons that seeing people poop their pants in the last miles of the race is no big deal. I also know women who have purposely peed themselves during a marathon to save a few precious minutes because those Boston qualifying times are tight and porta potty lines are long. As both a runner and gynecologist, I thought I had seen it all, but even I was surprised when I read about Kiran Ghandi running the 2015 London marathon while freely menstruating. Her high profile period brought attention to the “free bleeding” movement and has since inspired other women to also “let it flow.”

The ideology behind the free bleeding movement is that menstruation is a natural process that women shouldn’t be ashamed of. Why should women live in fear of spotting through their clothes, why should girls who can’t afford pad or tampons have to miss school due to their cycles? Proponents of free bleeding also point out the environmental burden of tampons and pads. Additionally, some women find that tampons make their menstrual cramping worse, and pads are bulky and uncomfortable. These are all valid points, but is free bleeding the best solution?

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While free bleeding may help you feel less inhibited, medically, it is not the best option for handling menstruation. Any blood that gets left behind on public surfaces has to be treated as potentially infectious. Several viruses, including hepatitis, can live in dried blood for up to 4 days. Any area where you were free bleeding in public would need to be disinfected. Also, you might find yourself invited to a lot less dinner parties after the first time you sit on a friend’s white couch while you are menstruating.

It is true that women often experience less cramping with free bleeding and create less waste material by not using tampons; but there are other options that can more hygienically accomplish these goals. Using a reusable menstrual cup (such as diva cup) is environmentally friendly. Another, newer option is the Flex disposable menstrual disc which is designed to sit higher in the vagina than a menstrual cup to reduce leaking and cramping. It is smaller than a tampon and can safely be worn for 12 hours. Perhaps the best option for those wanting the free bleeding experience without the biohazard mess is Thinx period underwear. These are underwear that contain built-in pads that absorb moisture and odor. They are machine washable and environmentally friendly, but may not be sturdy enough for heavy flow days.

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I am a feminist. I believe “vagina” shouldn’t be a dirty word and women shouldn’t be marginalized because they menstruate, but I also believe in being a conscientious human who doesn’t leave biohazardous waste in my wake. Periods are normal, but we also have technology that can keep us from being rude and messy.

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