Why can't we talk about periods? | Jen Gunter

譯者: Lilian Chiu 審譯者: Lo Hsien Huang

When I was a teen, I had terrible periods.

青少年時期，我的經期問題很嚴重。

I had crippling cramps,

我會有非常嚴重的痙攣，

I leaked blood onto my clothes and onto my bed sheets,

血會漏出來染到 我的衣服和床單上。

and I had period diarrhea.

我還有經期腹瀉。

And I had to miss school one to two days a month,

我每個月有一、兩天無法上學，

and I remember sitting on the couch with my heating pads, thinking,

我還記得我會抱著熱敷袋 坐在沙發上，想著：

"What's up with this?"

「這是怎麼搞的？」

When I ate food, I didn't leak saliva from my salivary glands.

我吃東西時，不會從 我的唾腺漏出唾液。

When I went for a walk,

我去散步時，

I didn't leak fluid from my knees, "joint fluid."

我不會從膝蓋流出「關節液」。

Why was menstruation so different?

為什麼月經這麼不同？

I wanted answers to these questions

我想要得到這些問題的答案，

but there was no one for me to ask.

但沒有人可以問。

My mother knew nothing about menstruation

我母親對月經一無所知，

except that it was dirty and shameful and I shouldn't talk about it.

只知道它很髒、很可恥， 認為我不應該談論它。

I asked girlfriends

我問過女性朋友，

and everybody spoke in euphemisms.

大家都說得很婉轉。

And finally, when I got the courage to go to the doctor

最後，等我鼓起勇氣去看醫生，

and talk about my heavy periods,

談論我嚴重的月經，

I was told to eat liver.

他告訴我要多吃肝。

(Laughter)

（笑聲）

And when I went to the drug store to buy my menstrual products,

我去藥妝店買我的月經產品，

my 48-pack of super maxi pads,

我的四十八片超級大衛生棉，

back in the day when they were the size of a tissue box, each pad --

在那時，它們的尺寸 和衛生紙盒一樣大，

每一片——（笑聲）

(Laughter)

You know what I'm talking about.

你們知道我在說什麼？ 你們不知道吸收技術進步了多少。

You have no idea how far absorbent technology has come.

(Laughter)

（笑聲）

I used to have to buy my menstrual products

我以前會到女性衛生用品區

in the feminine hygiene aisle.

去買我的月經產品。

And I remember standing there, thinking,

我記得，我會站在那裡想：

"Well, why don't I buy toilet paper in the anal hygiene aisle?"

「為什麼不是到肛門 衛生區去買捲筒衛生紙？

(Laughter)

（笑聲）

到底是怎麼搞的？

Like, what's up with that?

Why can't we talk about periods?

我們為什麼不能談論月經？

And it's not about the blood, as Freud would have you say,

重點不是血，雖然佛洛依德 可能會要你那麼說，

because if it were,

因為若真是這樣，

there would be an ear, nose and throat surgeon up here right now,

現在就會有個耳鼻喉科 醫生站在台上，

談論流鼻血的禁忌，對吧？

talking about the taboos of nose bleeds, right?

And it's not even about periods,

重點甚至不是月經，

because otherwise, when we got rid of our toxic, shameful periods

因為若是如此，當我們 擺脫了有毒、可恥的經期，

when we became menopausal,

當我們到了更年期，

we'd be elevated to a higher social status.

我們的社會地位就會提升。

(Laughter)

（笑聲）

(Applause)

（掌聲）

It's just a patriarchal society is invested in oppressing women,

這只是父系社會 在我們人生不同的時間點，

and at different points in our lives, different things are used.

利用不同的東西來壓迫女性。

And menstruation is used

在醫學上我們把育齡期稱為月經。

during what we in medicine call the reproductive years.

It's been around since pretty much the beginning of time,

大概從有史以來就是如此了，

many cultures thought that women could spoil crops

許多文化認為女性會讓作物

or milk, or wilt flowers.

或牛奶腐敗，或讓花凋謝。

And then when religion came along,

接著，當宗教出現，

purity myths only made that worse.

純潔迷思讓情況更糟糕。

And medicine wasn't any help.

而醫學幫不上忙。

In the 1920s and '30s

在 1920、1930 年代，

there was the idea that women elaborated something called a menotoxin.

有種想法是，女性會 合成所謂的經期毒物。

We could wilt flowers just by walking by.

我們只要走路經過 就能讓一朵花凋謝。

(Laughter)

（笑聲）

And that's what happens when there's no diversity, right.

沒有不同的觀點被提出時， 這種荒謬事就會發生。

因為沒有女性會舉手並說：

Because there was no woman to put her hand up and go,

「嗯，其實，並不是這樣。」

"Well, actually, that doesn't happen."

And when you can't talk about what's happening to your body,

如果你無法談論 你的身體發生什麼狀況，

how do you break these myths?

你該如何打破這些迷思？

Because you don't even need to be a doctor

因為你就算不是醫生 也知道月經不是有毒的。

to say that periods aren't toxic.

If they were, why would an embryo implant in a toxic swill?

如果有毒，為什麼胚胎 會被放在有毒液體當中？

And if we all had this secret menotoxin,

如果我們都有這種神秘的經期毒物，

we could be laying waste to crops and spoiling milk.

我們可能就會毀壞 作物、讓牛奶腐敗。

(Laughter)

（笑聲）

Why would we have not used our X-Women powers to get the vote sooner?

我們為什麼沒有早點用這種 X 女戰警能力來取得投票權？

(Laughter)

（笑聲）

(Applause)

（掌聲）

Even now,

就連現在，

when I tweet about period diarrhea,

當我在推特上談論經期腹瀉，

as one does,

一如往常，

(Laughter)

（笑聲）

I mention that it affects 28 percent of women.

我提到有 28% 的女性 會受到經期腹瀉影響。

And every single time, someone approaches me and says,

然後每次都會有人來找我，說：

"I thought I was the only one."

「我以為只有我會這樣。」

That's how effective that culture of shame is,

這就顯示出羞恥文化的影響力，

that women can't even share their experiences.

讓女性無法分享她們的經驗。

So I began to think,

所以，我開始想：

"Well, what if everybody knew about periods like a gynecologist?

「如果人人都像婦科醫生 一樣懂經期，會如何？

Wouldn't that be great?"

那不是很棒嗎？」

Then you would all know what I know,

那你們就會知道我知道的一切，

you'd know that menstruation

你們會知道月經在哺乳類 動物中是極獨特的現象。

is a pretty unique phenomenon among mammals.

Most mammals have estrus.

大部分的哺乳有動情期。

Humans, some primates,

人類和一些靈長類動物、

some bats,

一些蝙蝠、

the elephant shrew and the spiny mouse menstruate.

象鼩以及非洲刺毛鼠會有月經。

And with menstruation what happens is the brain triggers the ovary

月經的發生是因為大腦觸發卵巢

to start producing an egg.

開始製造卵子。

Estrogen is released

會釋放雌激素，

and it starts to build up the lining of the uterus,

雌激素會開始形成子宮的內膜，

cell upon cell, like bricks.

一個細胞一個細胞 堆疊，像磗塊一樣。

And what happens if you build a brick wall too high without mortar?

磗塊堆太高又沒有 用灰漿砌合，會怎麼樣？

Well, it's unstable.

它就不穩固。

So what happens when you ovulate?

所以排卵時會怎樣？

You release a hormone called progesterone,

你會釋出一種荷爾蒙，黃體激素，

which is progestational, it gets the uterus ready.

目的是在懷孕前讓子宮準備好。

It acts like a mortar and it holds those bricks together.

它的功能就像灰漿， 能把磗塊固定在一起。

It also causes some changes

它也會造成一些改變，

to make the lining more hospitable for implantation.

讓內膜更適合著床。

If there's no pregnancy,

如果沒有懷孕，

(Whoosh)

（咻）

lining comes out,

內膜就會出來，

there's bleeding from the blood vessels and that's the period.

而血管就會發生流血，造成月經。

And I always find this point really interesting.

我總覺得這一點很有趣。

Because with estrus,

因為，就動情期來說，

the final signaling to get the lining of the uterus ready

要把子宮內膜準備好的最後訊號

actually comes from the embryo.

是來自胚胎。

But with menstruation,

但就月經來說，

that choice comes from the ovary.

那個選擇權來自卵巢。

It's as if choice is coded in to our reproductive tracts.

就彷彿這個選擇權本來 就在我們的生殖道裡面。

(Cheering and applause)

（歡呼聲和掌聲）

OK, so now we know why the blood is there.

現在我們知道為什麼會有血。

And it's a pretty significant amount.

而且出血量相當大。

約有三十到九十毫升的血，

It's 30 to 90 milliliters of blood,

which is one to three ounces,

等同於一到三盎司，

and it can be more,

有可能更多，

and I know it seems like it's more a lot of the times.

我知道通常似乎都更多。

I know.

我知道。

So why do we have so much blood?

所以，為什麼我們有這麼多血？

And why doesn't it just stay there till the next cycle, right?

為什麼它不留在那裡， 等下一次週期？

Like, you didn't get pregnant, so why can't it hang around?

你若沒懷孕，為什麼它不能待著？

Well imagine if each month it got thicker and thicker and thicker, right,

想像一下，如果每個月 它會變得越來越厚，

like, imagine what tsunami period that would be.

想像那是什麼樣的海嘯級月經。

(Laughter)

（笑聲）

We can't reabsorb it, because it's too much.

我們不能重新吸收它， 因為太多了。

And it's too much because we need a thick uterine lining

會這麼多是因為， 有個非常明確的理由，

for a very specific reason.

讓我們需要夠厚的子宮內膜。

Pregnancy exerts a significant biological toll on our bodies.

懷孕會對身體造成重大的損害。

There is maternal mortality,

有孕產婦死亡，

there is the toll of breastfeeding

餵母乳也有代價，

and there is the toll of raising a child until it is independent.

將孩子養育到能夠獨立也有代價。

And evolution --

而演化——

(Laughter)

（笑聲）

That goes on longer for some of us than others.

對我們某些人來說， 養育孩子那段時間特別長。

(Laughter)

（笑聲）

But evolution knows about risk-benefit ratio.

但是演化懂得風險利益比。

And so evolution wants to maximize the chance of a beneficial outcome.

所以演化會想要將產生 有益結果的可能性提到最高。

And how do you maximize the chance of a beneficial outcome?

要如何把產生有益結果的 可能性提到最高？

You try to get the highest quality embryos.

那就是想辦法得到 最高品質的胚胎。

And how do you get the highest quality embryos?

要如何得到最高品質的胚胎？

You make them work for it.

要讓它們自己去努力。

You give them an obstacle course.

要提供它們障礙訓練場。

So over the millennia that we have evolved,

在我們演化的數千年間，

it's been a little bit like an arms race in the uterus,

情況有點像是子宮中的軍備競賽，

the lining getting thicker and thicker and thicker,

內膜變得越來越厚，越來越厚，

and the embryo getting more invasive

胚胎則變得更有侵略性，

until we reach this détente

一直到最終緩和下來， 形成我們現今的子宮內膜。

with the lining of the uterus that we have.

So we have this thick uterine lining

我們有很厚的子宮內膜，

and now it's got to come out,

而它必須要離開身體，

and how do you stop bleeding?

要如何防止流血？

Well, you stop a nose bleed by pinching it,

停止流鼻血的方式是捏住鼻子，

if you cut your leg, you put pressure on it.

如果割傷了腿，則是在腿上加壓。

We stop bleeding with pressure.

我們用壓力來止血。

When we menstruate,

月經來時，

the lining of the uterus releases substances

子宮內膜會釋放物質，

that are made into chemicals called prostaglandins

形成化學物，包括前列腺素

and other inflammatory mediators.

以及其他發炎介質。

And they make the uterus cramp down,

它們會讓子宮夾緊，

they make it squeeze on those blood vessels

讓子宮去擠壓那些血管，

to stop the bleeding.

以阻止流血。

They might also change blood flow to the uterus

它們也可能改變 流入子宮的血流量，

and also cause inflammation and that makes pain worse.

那也會造成發炎， 產生更大的疼痛。

And so you say, "OK, how much pressure is generated?"

你會問：「產生的壓力有多少？」

And from studies where some incredible women

在一些研究中， 有些很了不起的女性

have volunteered to have pressure catheters

自願讓子宮內壓力導管 插入她們的子宮中，

put in their uterus

that they wear their whole menstrual cycle --

直到整個月經週期過程結束——

God bless them, because we wouldn't have this knowledge without,

上帝保祐她們，因為她們 我們才得到這些知識，

and it's very important knowledge,

這些是非常重要的知識，

because the pressure that's generated in the uterus

因為，在月經期間子宮產生的壓力

during menstruation

is 120 millimeters of mercury.

是一百二十毫米汞柱。

"Well what's that," you say.

你會問：「那是多少？」

Well, it's the amount of pressure that's generated

那等同是你在分娩的第二階段

during the second stage of labor when you're pushing.

用力把孩子推出時所產生的壓力。

(Audience gasps)

（觀眾驚訝聲）是的。

Right.

Which, for those of you who haven't had an unmedicated delivery,

如果你沒有自然生產的經驗，

that's what it's like when the blood pressure cuff

用血壓計的壓脈帶來比喻，

is not quite as tight as it was at the beginning,

就是沒有像一開始 那麼緊，但仍然蠻緊，

but it's still pretty tight,

且你希望它快結束。

and you wish it would stop.

So that kind of makes it different, right?

那變得有些不一樣了吧？

If you start thinking about the pain of menstruation,

如果你開始思考經痛，

we wouldn't say if someone needed to miss school

如果有人在分娩的第二階段 用力推出孩子時，

because they were in the second stage of labor and pushing,

必須要向學校請假， 我們不會說她們軟弱。

we wouldn't call them weak.

我們會說「喔，我的天， 你撐這麼久」對吧？

We'd be like, "Oh my God, you made it that far," right?

（笑聲）

(Laughter)

And we wouldn't deny pain control

我們不會拒絕提供疼痛控制

to women who have typical pain of labor, right?

給典型分娩陣痛的女子吧？

So it's important for us to call this pain "typical" instead of "normal,"

所以，重要的是要把這種疼痛 稱為「典型」而非「正常」，

because when we say it's normal, it's easier to dismiss.

因為如果說它是正常的， 很容易就會忽略它。

As opposed to saying it's typical, and we should address it.

相對的，我們說它是典型的， 我們就應該去處理它。

And we do have some ways to address menstrual pain.

我們確實有些辦法可以處理經痛。

One way is with something called a TENS unit,

一種方式是經皮神經電刺激，

which you can wear under your clothes

你可以把貼片放在衣服裡面，

and it sends an electrical impulse to the nerves and muscles

貼片會把電脈衝送往神經和肌肉，

and no one really knows how it works,

沒人知道它怎麼運作，

but we think it might be the gate theory of pain,

但我們認為它可能是 痛覺的門控理論，

which is counterirritation.

也就是反刺激。

It's the same reason why, if you hurt yourself, you rub it.

你傷到自己時會去揉痛處 也是同樣的道理。

Vibration travels faster to your brain than pain does.

電脈衝傳導到大腦的 速度比痛覺更快。

We also have medications

我們也可以用藥物，

called nonsteroidal anti-inflammatory medications.

非類固醇消炎藥。

And what they do is they block the release of prostaglandins.

這種藥的功能是 阻止前列腺素釋放。

They can reduce menstrual pain for 80 percent of women.

八成的女性可以 用這種藥物減輕經痛。

They also reduce the volume of blood by 30 to 40 percent

同時也可以把血量減少三到四成，

and they can help with period diarrhea.

對經期腹瀉也有幫助。

And we also have hormonal contraception,

另外還有激素類避孕藥可以用，

which gives us a thinner lining of the uterus,

這種藥會讓子宮內膜變得較薄，

so there's less prostaglandins produced

產生出的前列腺素就會較少，

and with less blood, there's less need for cramping.

當血變少，就比較不需要夾緊。

Now, if those treatments fail you --

如果上述治療方法 對你都不管用——

and it's important to use that word choice,

注意這裡的用字很重要，

because we never fail the treatment,

因為治療無效的原因並非 出於我們自身的問題。

the treatment fails us.

是治療方法對我們不管用。

If that treatment fails you,

如果治療方法對你不管用，

you could be amongst the people

那你可能是屬於那種

who have a resistance to nonsteroidal anti-inflammatories.

對非類固醇消炎藥 有抗藥性的人。

We don't quite understand,

我們不是很了解，

but there are some complex mechanisms

但對於為什麼那些藥物 對某些女性就是沒有用，

why those medications just don't work for some women.

背後有些複雜的機制。

It's also possible that you could have

也有可能你的經痛

another reason for painful periods.

原因不一樣。

You could have a condition called endometriosis,

你可能有所謂的 子宮內膜組織異位，

where the lining of the uterus is growing in the pelvic cavity,

子宮的內膜在骨盆腔中生長，

causing inflammation and scar tissue and adhesions.

造成發炎、疤痕組織，以及沾黏。

And there may be other mechanisms we don't quite understand yet,

可能也有其他我們 還不甚了解的機制，

because it's a possibility that pain thresholds could be different

因為非常複雜的生物機制可能

due to very complex biological mechanisms.

會造成不同的疼痛門檻。

But we're only going to find that out by talking about it.

但只有把這些問題拿出來談 才有可能找出答案。

It shouldn't be an act of feminism

了解你的身體如何運作

to know how your body works.

不應該是女權主義的行為。

It shouldn't --

不應該——

(Applause)

（掌聲）

It shouldn't be an act of feminism

當你受苦時尋求協助

不應該是女權主義的行為。

to ask for help when you're suffering.

The era of menstrual taboos is over.

月經被視為禁忌的時代已經過去了。

(Cheers and applause)

（歡呼聲和掌聲）

The only curse here

這裡唯一的詛咒，

is the ability to convince half the population

就是有能力去說服 一半的人，讓他們認為

that the very biological machinery that perpetuates the species,

讓物種能夠永遠存在、

讓我們能擁有現在 這一切的生物構造

that gives everything that we have,

is somehow dirty or toxic.

是骯髒或有毒的。

And I'm not going to stand for it.

而我不會容忍這種事。

(Applause)

（掌聲）

And the way we break that curse?

要用什麼打破詛咒？

It's knowledge.

知識。

Thank you.

謝謝。

(Cheers and applause)

（歡呼聲和掌聲）