Gender affirming hygiene | Transgender, non-binary and gender diverse children

coloured background and title of post on 13. Gender affirming health care
girl and rainbow for support transgender child
photo of Felicity St John

This blog post is a part of the resource – Supporting Transgender, Non-binary and Gender diverse Children & Young People, created by Felicity St John and Felicity’s collaborator and fellow Master of Sexology student Lindsay SmithFelicity, during a placement with Sex Ed Rescue in 2024.

Felicity St John has a Master of Sexology (Professional) with Distinction and a Bachelor of Human Services – Child and Family Studies. She currently works for an NGO as a supervisor of four practitioners, coaching and case managing families facing complex challenges. Felicity also offers professional development and consultancy. Her professional interest areas are sex education, puberty, LGBTQI+ people, child development, transgender/non-binary/gender-diverse people, relationship coaching, family coaching, and parenting psychoeducation. Felicity has a passion for supporting people to step into their capacity. When she’s not working Felicity loves to laugh, play, be with loves ones, rock climb, SUP board, explore nature, read, write, hike, cycle, swim, and laze about like a cat. You can contact Felicity via email.

‘Because daily interactions with our bodies can be distressing, many transgender people end up neglecting our hygiene just to avoid dysphoria.’
– Kimberly Vered Shashoua

‘Explain to them what is happening. Don’t just say a period means you can get pregnant. Explain the cycle and the phases and the discharge. If they struggle with anatomically correct terminology, then find alternatives. Just because it makes them dysphoric doesn’t mean they don’t need to know what will occur.’
– Bodhi (28yo trans man, he/him)

I’m finding my kid’s used menstruation pads stashed under their bed and in other weird spots, like behind a pot plant in the toilet. What’s that about?

Gender identity aside, knowing what to do with menstruation products is a learned skill you have to pick up from somewhere. Periods are still a taboo in many families and cultures. Some kids, including cisgender ones, just don’t know how to use menstruation products or how to care for their bodies in the new ways it needs to be cared for. The cultural and/or family shame and secrecy around periods can also stop them from asking for help. Provide the scaffolding for your child to learn the skills they need. Please don’t wait for them to ask. You can build your confidence by having these discussions by learning from resources such as Sex Ed Rescue’s How to start explaining periods to your child (sexedrescue.com).

In puberty sessions with children with vulvas (and a caregiver), we demonstrate the whole process of using different period products, ideally before they need to use one. For example, with menstruation pads, we compare pads, demonstrate and practice unwrapping, applying different pads to an unworn demo pair of underwear, and disposing. This even includes a walk to the bin, how to dispose of things, and how to wash hands. We also learn how to use other menstrual products such as tampons, liners, menstrual underwear, and menstrual cups. We use diagrams so children understand where menstrual blood comes from, where urine comes from, where the vulva and vagina are, and where the anus is.

It’s good to have a bin in the bathroom your child uses. If you find used menstrual products in places you don’t want them, approach your child with warmth and calm, model with them how to dispose of the product, care for their body, and be explicit about what to do with bedding and clothing which may have menstrual blood on it. This probably won’t be a one-time lesson, so calm, parental warmth, and repetition may be needed. That’s okay. Skills are built in repetition.

For some transgender/non-binary/gender-diverse (TGD) people, menstruation can be something that reminds them of the gap between the body they were born with and their gender. This gap or mismatch is sometimes referred to as gender incongruence. This can lead to discomfort and distress due to the incongruence, which is referred to as experiencing gender dysphoria. Sometimes, the distress becomes so intense that it meets a clinical mental health diagnosis of gender dysphoria. For many transgender children, gender dysphoria can intensify when puberty changes, such as menstruation, occur. Not every TGD person finds menstruation to be a negative experience, though, so don’t make assumptions. 

Some of the tricky practical parts of menstruation as a trans person include:

  • Period products can be stereotypically gendered as feminine products.
  • In a public bathroom, period pads can be noisy to take off and may draw unwanted attention.
  • Boxer underwear used on their own doesn’t support menstruation pads well.
  • Toilets gendered male are unlikely to have menstruation sanitary bins.
  • Toilets gendered male often have a lot more urinals than stalls.
  • Storing menstrual products so the person is not outed and to reduce the risk of harassment and/or violence.
  • The ability to clean menstrual cups in public bathrooms which aren’t single stalls.

TGD children/young people can be supported around menstruation by:

  • The SOC 8 recommends supporting prepubertal children by openly talking to them in an age-appropriate way about how bodies change at puberty. 
  • Learning about menstruation to increase your confidence in discussing it with your child.
  • Watching videos by TGD people with lived experiences of menstruation and how they have managed. 
  • Using gender-neutral language about menstruation. Such as “some people’s bodies menstruate”, “people who menstruate”, “menstruation is something some bodies do”, and “people with vulvas”.
  • Ask your child what language they prefer to use for their body parts. For example, the use of front hole may be a preferred term for vagina for some transgender people.
  • Learn about safer ways to suppress menstruation. This may include seeking support gender-affirming care from a doctor. Some explore using oral contraceptive pills (progestins) to suppress menstruation. This may be more immediately accessible for young people than waiting for access to a gender clinic to commence.
  • Because puberty blockers commenced at the appropriate stage in puberty followed later by hormonal affirmation, can mean a transgender child/young person may never experience a period, it makes sense that they may seek to access puberty blockers. Caregivers can support children to access gender-affirming care if this is available to them.
  • Exploring which menstrual products your child/young person feels more comfortable with. For example, boyshort menstruation underwear. It’s different for different people. For example, some young people may experience intense gender dysphoria around inserting products, while others may prefer a menstrual cup due to it not being noisy in a toilet.
  • Your child/young person may want to use a period tracking app to feel a bit more in control around knowing when their period may be coming. One gender-inclusive tracking app is Clue.
  • Look at storage, which conceals the menstruation products in a bag.
  • If your family/culture have public rites of passage that equate the onset of menstruation with becoming a woman, explore with your child/young person what this means to them and what they may want to have happen in this instance.
  • Advocate for single-stall bathrooms with an internal sink and sanitary bins.
  • Advocate for trans inclusive puberty education and resources in your child’s school.
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Resources

Some shops which sell gender affirming menstruation-related products

  • Modi Bodi – period underwear – https://www.modibodi.co.uk/collections/all-gender
  • Spectrum Outfitter – Boxers which are made for sanitary pads https://spectrumoutfitters.co.uk/collections/boxers-and-packers/products/3-in-1-spectrum-boxers
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References

  • Having periods as a guy by Jamie Raines (Jammidodger) 2018.
  • Menstruation by Trans Hub 2021.
  • My Period and Me: A Trans Guy’s Guide to Menstruation by Wiley Reading 2014.
  • Personal Hygiene Challenges for Nonbinary People by Jennifer O’Mann 2021
  • Queer Periods: Attitudes Toward and Experiences with Menstruation in the Masculine of Centre and Transgender Community by Chrisler et al., 2016.
  • Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 by Coleman et al., 2022.
  • Supporting Parents Raising Children Who May be Transgender/Non-binary/Gender-diverse – Questionnaire for Trans Adults by Felicity St.John 2024.
  • Supporting Transgender Patients with Their Personal Hygiene by Layton et al., 2023.
  • Talking about periods beyond gender by Jan Bell 2017.
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My kid is a bit smelly and doesn’t want to shower. When I try to get them to shower we just end up fighting. It’s creating distance between us. Help me find a better way.

This challenge is not limited to families with transgender/non-binary/gender-diverse (TGD) children, but there are different considerations.

Some children/young people, including cisgender ones, may feel self-conscious about how their bodies are changing. Children, including cisgender ones, whose bodies change earlier than their peers may be more self-conscious about the changes. 

During puberty, people start to sweat more. Body odour can become quite strong due to bacteria on the skin, particularly if a child/young person isn’t washing themselves.  

Some kids, including cisgender ones, may not know how to take care of their bodies in the new ways that are needed during puberty. For example, don’t assume your child knows what you mean by “take a shower”. Some kids think a shower means standing or sitting under the shower stream and letting the water run over them. They don’t realise it includes using products or cleaning under their armpits, for example. Sometimes, we need to break the processes of caring for our bodies down into their smaller parts. Think about what parts of the getting clean process there are. Sometimes, a checklist in the bathroom can be helpful.

For some TGD people, showering a body that is starting to look more and more like the sex they were assigned at birth and not their gender can lead to discomfort and distress. This is called gender dysphoria. Sometimes, the distress becomes so intense that it meets a clinical mental health diagnosis of gender dysphoria. Not all TGD people experience gender dysphoria.

Gender dysphoria can intensify when puberty changes occur, such as the penis growing in size, breasts/chests developing, hips widening, wet dreams, unanticipated erections and menstruation.

Limiting showering/bathing may be a way a TGD person avoids additional experiences of gender dysphoria. 

I’ve also worked with some trans boys who felt affirmed in their gender when they didn’t wash, as they equated stronger body odour with masculinity.

Rather than getting caught up in a power struggle, which may leave your child feeling unsupported and disconnected from you, invite them in to explore the barriers and come up with solutions together. Power struggles tend to result in us digging in our heels and getting more rigid. They can stop us from seeing the way forward.

There can be many barriers for a young trans person to get clean. There are also many ways to get clean. Be flexible and think outside the box. 

Some of the ways TGD children/young people can be supported around getting clean include: 

  • There are many ways a person can keep themselves clean. It doesn’t have to be a shower, and cleaning doesn’t have to take place in a bathroom. People can use washers, wipes, buckets, cups, and hoses. 
  • Seeing oneself in a mirror may cause some trans young people to distress or discomfort. Does your family really need a mirror in the bathroom? Can a cover be available to easily put on? Can you cover the mirror with affirmations instead? Can you fog up the mirror?
  • Hygiene products are often highly gendered as feminine or masculine. Ensure there is access to gender-affirming products that match your child’s gender. For example, stereotypically masculine body wash and deodorant for a trans-masc person. There are also products such as shampoos, which are more gender neutral in appearance and fragrance.
  • Having a big bubble bath.
  • Using towels that affirms gender. 
  • Talk to your young person about using baggy clothing to cover them when changing.
  • A person may want to keep some clothing on while getting clean. Such as underwear, binders, boxers, or a tank top.
  • Shorten the time it takes to get clean. For example, using a 2 in 1 shampoo and conditioner.
  • Use dry shampoo.
  • Wash hair in the sink. You could even do this for your child and make it a recurring ritual that connects you. 
  • Some people opt to get clean with their eyes closed.
  • Some people change the lighting so that there is low light or darkness.
  • Having a towel right next to the shower can help. 
  • Make sure your children have enough clothing that aligns with their gender so that changing into clean clothes is more likely.
  • Using music, meditations, or mantras.
  • Having a shaver or other hair removal options available for children who find removing body hair from specific body parts gender affirming. Ensure they know how to remove their hair safely.
  • Not pressuring your child to shave their legs or armpits if they were assigned female at birth.
  • Using a bathing sponge which is thick.
  • Exploring what times of the day or week, your child thinks getting clean is more workable for them. 
  • Doing something your child finds enjoyable straight afterwards. 
  • Having access to other ways to feel affirmed in their gender. Such as clothing, hairstyles, accessing gender-affirming medical care, and using pronouns. 
  • Let your child known they are not alone, and other people experience this as well.

If your child does use a binder and is prepared to take it off during the getting clean process, this can be a good time for them to check the condition of their skin under the binder.

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Resources

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References

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Felicity St John holds a Master of Sexology (Professional) with Distinction and a Bachelor of Human Services – Child and Family Studies. She supervises a team in an NGO, coaching and supporting families with complex needs, and offers professional development and consultancy. Her interests include sex education, puberty, LGBTQI+ inclusion, child development, and family coaching. Outside work, Felicity enjoys time with loved ones, outdoor adventures, and creative pursuits.
You can find Felicity at LinkedIn - https://www.linkedin.com/in/felicity-st-john-726365256/