Learning to Manage Feminine Hygiene Needs

Question: I have a daughter with autism who is showing signs of puberty. I want her to continue to be as independent as possible and to be prepared for all aspects of her own feminine hygiene, but don’t know where to begin with teaching her how to care for her menses. What is the best way that we can practice these skills before her menstrual cycle begins?

Answered by
Allison Parker, MA, BCBA

Autism and Feminine Hygiene Needs Puberty can be an anxious time for any parent, and feminine hygiene is a seldom discussed topic; therefore, your question is an incredibly important one. As behavior analysts and practitioners, we recognize that any skills related to hygiene that we teach girls with autism will equip them to have access to a higher level of independence, privacy, and dignity. We hope the following recommendations provide some guidance on helping your daughter become independent and confident with these skills.

Talking about Feminine Hygiene

As with any skill you teach children and adolescents, it is important to use plain language and to avoid abstract terms as much as possible. It is also important to become comfortable with all of the terms involved in feminine hygiene, such as period, pad, blood, etc. As uncomfortable as it may seem at first, speaking about these things becomes a normal part of the teaching process over time. Due to the fact that taking care of your period is a sensitive and private event, you may consider beginning by explaining to your daughter what it is and why you need to go over essential hygienic practices. Work a few basic facts into a conversation, or visual aid if you feel it will be helpful to your daughter’s acceptance of the teaching program. Explanations may include a basic outline such as, “as we get older, our bodies change, and one day you will get your period. When you get your period, there will be blood in your underwear when you go to the bathroom. We are going to practice how to clean it up and take care of your period.” Because of the range in communication ability and level of understanding among individuals with autism, and accounting for family, cultural, and personal preferences on this topic, the advice here will need to be tailored to match your daughter’s specific skillset.

Materials

Hygiene productsAs a caretaker, you will decide what products to use to teach your daughter to protect her garments from menstrual blood. Published research and clinical experience will limit my recommendations to the use of various pads, but other products available on the market include tampons, menstrual cups, and menstrual underwear. If you don’t plan to use the same type or brand of your product on a permanent basis, then you will want to teach your daughter with a few different types in order to expose her to the different features and options these products offer. For example, have a few types and brands of pads available to use such as panty liners, thicker pads, and pads with and without wings. It is best to train your daughter to use a range of products and brands from the beginning to avoid potential issues should a specific product be unavailable or be discontinued by the manufacturer.
Purse and clean underwearIf your daughter does not carry a bag such as a purse or backpack with her, it is a good idea to begin teaching this skill right away. She will need a place to keep hygiene products and a change of underwear. She may also need to learn to keep track of her purse and keep it with her during trips to the bathroom. Make sure that hygiene products and a clean pair of underwear are always available in the purse, especially before each teaching opportunity.
Trashcan and hamperMake sure a trashcan is easily accessible in the bathroom. Because most public restrooms have a waste disposal bin inside of the stall, it may be helpful to teach with a small trashcan next to the toilet. It may also be helpful to make a clothing hamper or basket available nearby the bathroom you’re teaching in. Consider what you will want your daughter to do with soiled underwear in most conditions. It may be helpful to teach her to keep them in a plastic bag or to throw them away if a hamper is not available.
Fake bloodFinally, if you are teaching your daughter before her menstrual cycle begins, you will need to simulate this experience using fake blood. Be sure to use items that are safe for contact with genitals, and consult with your gynecologist to ensure that ingredients will not cause infection or irritation. A realistic and safe option may include a mixture of canned beats, prune juice, and water. Keep in mind that these foods are natural dyes and may stain surfaces and linens.

Teaching

There are a few different scenarios your daughter may encounter during her menses, so it is recommended that you teach for each of these scenarios. Recommended teaching conditions include what to do when:

The underwear is soiled with blood
Only the pad is soiled
Both the pad and the underwear are soiled, and
Nothing is soiled (both underwear and pad are free from blood).
Before approaching the bathroom to teach each scenario, place the corresponding items (including fake blood) on your daughter in another room so that the practice closely simulates a natural situation in which she goes to the bathroom to care for her menses.

Since these skills are complex and include many steps, it is important to break them down into smaller units. Create a detailed list of steps, otherwise known as a “task analysis”, involved for responding to each teaching condition. A board certified behavior analyst can assist you with creating a task analysis based on the steps you want to teach, determining how to assist your daughter to complete each step (these are usually called response prompts), and teach you how to correct any errors she may make. Methods can be adapted from the study developed by Veazey, Valentino, Low, McElroy, and LeBlanc (2016). A sample task analysis is provided below for reference.

For example, you may want to wait a few seconds before each step to allow your daughter to complete it independently. If she does not move on to the next step, use assistance to prompt the correct response. If she completes the step incorrectly or goes to the wrong step, you should walk her through the correct step, and then allow her the opportunity to complete it herself. In a task analysis, each step serves as a reminder for what comes next, so it is important that your daughter experiences each step in the correct order. Provide specific praise such as “great job get ting the clean pad from your purse” and preferred items for steps done correctly, especially those that are done independently. Remember to identify items that can be provided in the bathroom and will not interfere with the process, such as tokens or stickers that can be traded in for a favorite activity.

Task analysis for soiled pad

1. Walks into the bathroom
2. Pulls down underwear and sits on toilet
3. Removes soiled pad from underwear
4. Wraps toilet paper all the way around pad at least once
5. Disposes of pad in trashcan
6. Wipes vaginal area with toilet paper until clean to remove possible residual blood and drops paper in toilet
7. Removes sanitary napkin from purse
8. Opens clean sanitary napkin
9. Disposes of outer covering in trashcan
10. Removes covers from adhesive areas of sanitary napkin
11. Disposes of covers from adhesive areas in trashcan
12. Fastens sticky side of napkin lengthwise in underwear and presses into place
13. Wraps wings of sanitary napkin around underside of underwear and presses into place (if applicable)
14. Pulls up underwear
15. Pulls up and fixes outer clothing
16. Flushes toilet
17. Holds soiled underwear by the waist band and puts into laundry basket
18. Washes hands

Additional Considerations

Always keep in mind the teaching techniques that work best for your daughter. You may need to use visual aids or change instructions and prompts as necessary. You may find that you need to specifically teach these steps in school and in the community, so I suggest teaching in a variety of bathrooms from the beginning. You may also need to gradually remove yourself from the bathroom in order to teach independence with these steps. Gradually fade out your praise and proximity. Check to see if steps were done independently by making sure the clean pad is placed correctly, items are placed in the trashcan and hamper, and clothes are fastened correctly.

We applaud you for considering this important skill for your daughter, and hope these steps will assist in her self-care as she transitions into a young woman.

Reference:

Veazey, S. E., Valentino, A. L., Low, A. L., McElroy, A. M., & LeBlanc, L. A. (2016). Teaching feminine hygiene skills to young females with autism spectrum disorder and intellectual disability. Behavior Analysis in Practice, 9(2), 184-189. DIO: 10.1007/s40617-015- 0065-0

Citation for this article:

Parker, A. (2017). Clinical corner: Learning to manage feminine hygiene need. Science in Autism Treatment, 14(4), 17-19.

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