Understanding Menstrual Knowledge, Attitudes, and Sociocultural Beliefs Among Adolescent Boys in Ghana: A Qualitative Study

Abstract

Background: Adolescent boys often lack adequate menstrual education, leaving them susceptible to harmful sociocultural influences and reinforcing discriminatory attitudes. The purpose for this study was to explore adolescent boys’ knowledge, sociocultural beliefs, and attitudes toward menstruation. Methods: A descriptive-phenomenological qualitative study was conducted, involving 25 in-depth interviews with adolescent boys enrolled in senior high school (eligibility age range 14–19 years; achieved sample aged 15–19 years) from five districts in Ghana’s Volta Region. Participants were purposively sampled to ensure diverse perspectives. Semi-structured interviews explored knowledge sources, sociocultural influences, and attitudes toward menstruation. Data were analyzed thematically using Braun and Clarke’s six-phase framework with the aid of MAXQDA software. Results: Adolescent boys’ knowledge of menstruation was fragmented, stemming from family, school, and internet sources. Mothers were frequently cited as key informants, but misconceptions about menstruation persisted. Sociocultural and religious beliefs reinforced menstruation-related taboos, such as restrictions on cooking and entering sacred spaces, shaping discriminatory attitudes. Reactions to menstrual leaks varied from empathy to teasing. Conclusions: The findings highlight the need for inclusive menstrual education targeting boys and their families. Educational programs should include biological, emotional, and social aspects of menstruation to help reduce myths and nurture empathy.

1. Introduction

Menstruation, a fundamental biological process in the lives of many women, remains shrouded in cultural taboos, myths, and misconceptions, often reinforcing gender inequality and perpetuating stigma [1,2]. In many societies, including Ghana, menstruation is not only considered a private matter but is also viewed as impure or shameful, a perception that has significant implications for both menstruating individuals and those around them [3,4,5]. This cultural framework can result in physical and emotional challenges for women and girls, while simultaneously shaping the attitudes and behaviors of those in society, particularly adolescent boys. Although menstruation is an inevitable biological process, boys often lack comprehensive education about it, which leads to gaps in knowledge and the reinforcement of negative attitudes [3,6].

Throughout this paper, the terms “stigma” and “discrimination” are used to capture related but distinct aspects of this phenomenon. Stigma refers to the negative attitudes and beliefs attached to menstruation and to menstruating individuals, whereas discrimination refers to the differential and often harmful treatment, such as exclusion, teasing, or restriction from social and religious spaces, that can result from these attitudes [7]. Both concepts are relevant here because participants’ accounts reflect both negative beliefs about menstruation and concrete instances of differential treatment of menstruating peers.

Perceptions of menstruation vary considerably across cultural, religious, and educational settings, and this variation motivates context-specific inquiry. In South Asia, adolescent boys in India have been shown to gain fragmented, incidental knowledge of menstruation due to pervasive silence and associations with impurity, rather than through structured education [3,8]. In East Africa, surveys of adolescent boys and girls in Tanzania similarly document widespread period-related teasing and stigma compounded by low baseline knowledge [9]. Studies among adolescents in Taiwan and South Africa likewise report that religious and cultural framing of menstruation as unclean or shameful strongly predicts boys’ discomfort and avoidance behaviors [10,11]. While the biological reality of menstruation is universal, its social meaning, and consequently boys’ attitudes toward it, is therefore substantially shaped by local cultural and religious systems, underscoring the value of context-specific research such as the present study.

Adolescence is a particularly important developmental window in which attitudes toward menstruation are formed. As boys pass through puberty alongside their female peers, they are increasingly exposed to menstruation-related experiences at home and school, yet they rarely receive formal instruction on the topic [3]. Evidence from India suggests that adolescent boys’ curiosity about menstruation peaks during this period but is often left unaddressed, leaving them to rely on informal, peer- or family-based sources that may transmit inaccurate or stigmatizing information [4,8]. This developmental stage therefore represents an important window for targeted educational intervention, before attitudes and misconceptions become entrenched into adulthood.

In the Ghanaian context specifically, menstruation carries particular cultural weight. Among Akan-speaking communities, for example, menstruation is a verbal taboo discussed almost exclusively through euphemism, reflecting deep-seated associations between menstrual blood, pollution, and, paradoxically, fertility and power [12]. Comparable patterns of secrecy, selective celebration of menarche, and restriction have been documented among the Ewe-dominant communities of Ghana’s Volta Region, the setting of the present study, where parents, teachers, and adolescent girls describe both celebratory rites and restrictive taboos surrounding menstruation [13,14]. A companion quantitative study conducted among adolescent boys in the same five districts, drawing on a larger survey sample, found that knowledge significantly mediated and moderated the relationship between sociocultural beliefs and attitudes toward menstruation [15]. The present study was conducted as a qualitative follow-up to that survey, using a distinct, purposively sampled group of participants and an in-depth interview design, to unpack the sociocultural narratives and family, religious, and educational influences that a larger, primarily quantitative survey could not capture.

In Ghana, this gap is particularly evident, where adolescent boys receive limited education about menstruation [16]. Cultural norms and traditional gender roles often limit open discussions about menstruation, creating an environment where misinformation thrives [9,17]. Boys may view menstruation with discomfort, embarrassment, or even disdain, influenced by prevailing sociocultural beliefs and a lack of accurate knowledge. These attitudes are further entrenched by inadequate school curricula on sexual and reproductive health [10,18] and which fail to address menstruation comprehensively. As a result, boys may often continue negative attitudes, such as considering menstruation a “women’s problem” or associating it with impurity or shame [5,10]. This increases the stigma surrounding menstruation and also reduces the development of mutual respect and understanding between genders [11,19]. Furthermore, the lack of empathy towards menstruating girls limits boys’ engagement in productive conversations about reproductive health, further entrenching gender inequality [17].

Building on this quantitative evidence [15] and the broader literature reviewed above, the present qualitative study sought to explore, in adolescent boys’ own words, their knowledge of menstruation, the sociocultural and religious beliefs that shape their understanding, and their attitudes toward menstruating peers, across five districts of Ghana’s Volta Region. In doing so, the study extends existing Ghanaian and sub-Saharan African literature, which has focused predominantly on girls’ experiences or on quantitative associations among boys [5,9,15,16], by foregrounding boys’ own narratives and the specific mechanisms through which sociocultural beliefs about menstruation are transmitted and negotiated.

The purpose for this study was to explore adolescent boys’ knowledge, sociocultural beliefs, and attitudes towards menstruation among adolescent boys in high schools in Ghana leaning on the tenets of the Theory of Planned Behavior (TPB) [20]. The theory posits that behavior is determined by three core constructs: attitudes toward the behavior, subjective norms, and perceived behavioral control. In the context of this study, we assume that boys’ attitudes are shaped by their beliefs about menstruation as a biological and cultural phenomenon, often skewed by misinformation and stigma. For instance, many boys may associate menstruation with impurity or shame, which negatively impacts their interactions with menstruating peers [5,6,20]. These attitudes are thought to be reinforced by subjective norms, prevailing societal and cultural expectations, which discourage open discussions about menstruation and frame it as a “women’s issue” [9]. Additionally, perceived behavioral control, or the boys’ confidence in their ability to engage in supportive or constructive behaviors regarding menstruation, could be limited by inadequate education and exposure to accurate information [5,6]. These constructs directly informed specific items in the interview guide as participants were asked how comfortable they felt discussing menstruation and about their personal views on the topic (attitudes), the cultural, family, and religious factors influencing that comfort level (subjective norms), and how they would react if a female sitting partner experienced a menstrual leak (a proxy for perceived behavioral control in a supportive-response context). While thematic coding proceeded primarily inductively, consistent with Braun and Clarke’s approach [21], these TPB-informed items provided a deductive scaffold for part of the interview guide and initial coding frame, and the Section 4 revisits the findings in relation to these three constructs.

2. Materials and Methods

2.1. Study Design

For this study, descriptive-phenomenological research approach was used to explore the socio-cultural beliefs, knowledge, and attitudes of adolescent boys toward menstruation. The qualitative design was integral to understanding the experiences and perspectives of these boys, particularly their attitudes and beliefs shaped by cultural and educational influences. The study’s approach provided an in-depth analysis of the socio-cultural narratives, knowledge and attitudes of adolescent boys.

2.2. Study Area and Population

The research was conducted in five districts within the Volta Region of Ghana: Hohoe, Afadzato South, Kpando, Ho West, and Ho Municipal. These districts were selected due to their cultural diversity and relevance to the study’s objectives. The population included adolescent boys aged 14–19 years, enrolled in mixed-gender senior high schools within these districts. This demographic was considered pivotal in exploring attitudes toward menstruation, given their position as key influencers in shaping societal beliefs and their interactions with menstruating peers. One senior high school was purposively selected within each of the five districts (Schools A–E), so that the sample of five schools jointly reflected the ethnic and sociocultural diversity of the Volta Region while keeping data collection feasible within the study period.

2.3. Sampling and Recruitment

Participants for this study were recruited from among adolescent boys who had previously completed a quantitative survey on knowledge, sociocultural beliefs and attitudes [15]. Access to schools was facilitated by the teacher responsible for school health, whose involvement was limited to arranging the initial meeting between the research team and students. The teacher had no role in consent procedures, data collection, or participant selection. Five in-depth interviews (IDIs) were conducted in each of the five schools (in the five districts), resulting in a total of 25 IDIs. A selection process was developed in attempt to ensure diversity in participants, and representation across various age groups, religious affiliations, and sociocultural contexts to capture a broad spectrum of perspectives. The sample size of five participants per school was predetermined based on the principle of thematic/data saturation established in comparable qualitative studies of adolescents’ menstrual health perspectives conducted by the study team in similar school-based settings in Ghana [13,14], and elsewhere [22,23], where a sample of this size and structure was found sufficient for no substantively new codes to emerge. A trained, independent research assistant explained the study and obtained written informed consent or child assent and legal guardian consent from each participant, prior to data collection. To minimize the risk of perceived coercion arising from school-based recruitment, students were informed that their decision to participate or decline would not be disclosed to school staff and would have no bearing on their academic standing.

2.4. Data Collection

Data were collected through semi-structured interviews using an interview guide specifically designed for the study. The guide was developed based on a review of relevant literature and aligned with the objective of the research. Open-ended questions explored participants’ understanding of menstruation, the influence of sociocultural and familial beliefs, and their attitudes toward menstruating peers. The interviews were conducted in private, secure spaces within the school premises to ensure participants’ comfort and confidentiality. All interviews were audio-recorded with the participants’ consent and supplemented with handwritten notes to capture contextual details. Prior to the interview, each participant completed a short background information sheet capturing sociodemographic characteristics (age, class/form, ethnic group, and course of study). The semi-structured interview guide combined TPB-informed items (e.g., “How comfortable do you feel discussing menstruation, and what are your personal views on the topic?”, with probes on whether comfort/views had changed over time and on the cultural, family, and religious factors influencing comfort level; and “What would be your reaction if your female sitting partner leaks during menstruation?”) with open-ended questions on knowledge sources and sociocultural beliefs. Eligible participants were adolescent boys aged 14–19 years, the typical age range for Ghanaian senior high school students, enrolled at one of the five participating schools and willing, with parental/guardian consent and personal assent, to discuss the topic. Boys who were unable to provide assent or whose guardians did not provide consent were excluded.

2.5. Data Analysis

Thematic analysis was used to analyze the data, following Braun and Clarke’s six-phase framework [21]. Interviews were transcribed verbatim and subjected to iterative coding to identify recurring patterns and themes. Themes were developed deductively, guided by the study’s objectives, and inductively, emerging organically from the data. This dual approach allowed for a comprehensive understanding of the participants’ perspectives. The analysis involved familiarization with the data, generating initial codes, identifying major themes and minor themes, and refining and synthesizing these into coherent narratives. MAXQDA version 2022.4 software facilitated the systematic organization and coding of the data. To enhance the validity of the findings, member checking was conducted by sharing preliminary interpretations with participants for feedback and confirmation. “Empathy” was operationalized qualitatively rather than measured on a scale. Responses were coded as reflecting empathy when participants described supportive, non-judgmental reactions (e.g., discreetly alerting a peer to a leak, offering to help her cover herself) to the interview probe on how they would react if their female sitting partner experienced a menstrual leak.

2.6. Researcher Reflexivity

The research team comprised public health researchers, several of whom have prior experience conducting menstrual health research with adolescents and communities in the Volta Region, including the companion quantitative study referenced above [15]. Interviewers were trained in qualitative interviewing techniques for sensitive topics and were, in most cases, adults external to participants’ peer groups and schools, which may have encouraged some participants to speak more openly than they might have with a familiar adult, while potentially limiting disclosure on the most sensitive experiences. The research team held regular debriefing sessions during data collection and analysis to reflect on interactions with participants, discuss emerging interpretations, and minimize the influence of the researchers’ own sociocultural and disciplinary backgrounds on data coding and interpretation. Reflexive notes taken during and after each interview were incorporated into the analytic memos used during coding.

2.7. Ethical Considerations

Ethical approval for the study was granted by the University of Health and Allied Sciences Research Ethics Committee (UHAS-REC). Administrative permissions were obtained from the Ghana Education Service and the authorities of the participating schools. Participants were fully briefed on the study’s purpose, and informed consent was obtained. For minors, legal guardian consent was secured alongside the assent of the participants. Confidentiality was maintained through the anonymization of all data, and strict data management protocols were followed to ensure secure storage and restricted access to the research team.

3. Results

3.1. Sociodemographic Characteristics of Participants

Table 1. Sociodemographic characteristics of participants.

Participant	Age	Class	Ethnic Group	Course Studying
School A
001	17	Form 1	Ewe	Applied Technical
002	16	Form 1	Ewe	Home Economics
003	17	Form 1	Ewe	Applied Technical
004	19	Form 1	Ga	Visual Arts
005	19	Form 1	Ewe	Visual Arts
School B
001	19	Form 3	Akan	General Arts
002	18	Form 3	Ewe	General Arts
003	19	Form 3	Ewe	Business
004	18	Form 3	Akan	General Arts
005	18	Form 3	Ewe	Business
School C
001	16	Form 2	Ewe	General Arts
002	16	Form 1	Guan	Visual Arts
003	17	Form 2	Ewe	General Arts
004	18	Form 1	Ewe	Visual Arts
005	17	Form 1	Krobo	Building and Construction
School D
001	15	Form 2	Ewe	Home Economics
002	16	Form 2	Ewe	General Arts
003	19	Form 3	Ewe	General Arts
004	17	Form 2	Ga	General Arts
005	16	Form 2	Guan	General Science
School E
001	18	Form 2	Ewe	Visual Arts
002	17	Form 2	Ewe	Visual Arts
003	17	Form 2	Ewe	Visual Arts
004	17	Form 2	Akan	General Science
005	17	Form 2	Ewe	General Science

provides an overview of the sociodemographic characteristics of 25 participants selected from five senior high schools, with ages ranging from 15 to 19 years. Each school exhibits distinct age distributions, reflecting a diverse mix of student age groups. The students are enrolled in various class levels, including Forms 1, 2, and 3, which correspond to different stages of academic experience.

In terms of ethnicity, the Ewe group is the most represented, appearing across all schools, while smaller proportions of students from the Akan, Ga, Guan, and Krobo ethnic groups are also present. The participants pursued a range of academic and vocational courses, including Applied Technical, Home Economics, Visual Arts, General Arts, Business, General Science, and Building and Construction.

In summary, of the 25 participants, ages ranged from 15 to 19 years (15 years: n = 1, 4%; 16 years: n = 5, 20%; 17 years: n = 9, 36%; 18 years: n = 5, 20%; 19 years: n = 5, 20%). By class/form, 8 (32%) were in Form 1, 11 (44%) in Form 2, and 6 (24%) in Form 3. By ethnic group, 17 (68%) identified as Ewe, 3 (12%) as Akan, 2 (8%) as Ga, 2 (8%) as Guan, and 1 (4%) as Krobo. By course of study, 8 (32%) pursued General Arts, 7 (28%) Visual Arts, 3 (12%) General Science, 2 (8%) Applied Technical, 2 (8%) Home Economics, 2 (8%) Business, and 1 (4%) Building and Construction.

3.2. Thematic Results

The results (

Table 2. Thematic results.

Major Themes	Minor Themes
Knowledge of menstruation	Awareness of menstruation
	Understanding and misconceptions
	Premenstrual symptoms and experiences ✓ Pain and discomfort
Sociocultural and religious beliefs	Taboos and restrictions
	Community beliefs and practices
Attitudes toward menstruation	Comfort level discussing menstruation
	Engagement with menstruators ✓ Influence of family and society
	Reactions to menstrual leaks
	Participation in education programs ✓ Willingness vs. reluctance

) indicate adolescent boys’ knowledge, sociocultural beliefs, and attitudes toward menstruation.

3.2.1. Knowledge of Menstruation

Awareness of Menstruation

Adolescent boys obtained information about menstruation from various sources, such as family, school, peers, and the internet. This diversity in sources reflects the fragmented nature of how boys learn about menstruation, often incidentally or through secondary channels. For many, their awareness was shaped by family discussions, particularly involving mothers. Schools played a role as well for some participants, providing formal education that introduced the topic to them.

“My mother told me about menstruation when my sister started hers”

(19yo, SchD P003)

“The first time was in JHS. That was when I learned about it”

(16yo, SchC P001)

“At Google. It tells me it’s the monthly flow of blood from the vagina of a woman”

(17yo SchD P001)

Understanding and Misconceptions

Adolescent boys’ understanding of menstruation varied, with some demonstrating accurate knowledge of its biological basis and others displaying significant misconceptions. Those with a clearer understanding described menstruation as a regular biological process involving the discharge of blood due to unfertilized eggs.

“The periodic discharge of blood from the female reproductive organ”

(17yo, SchE P005)

“In my understanding, what happens in the woman’s body is that, while growing, if the ovaries or the ovary not, like get any sperm to fertilize the eggs, then it breaks down into a menstrual flow”

(17yo, SchC P003)

However, some misconceptions were seen, ranging from exaggerated beliefs about its frequency to myths regarding its relationship with pregnancy. For instance, one participant said:

“Some of them too, like, if their own comes every week. Some of them, too, [every] three days, yes”

(18yo SchA P004)

“If a woman is on her menstruation, and she has an affair with a guy, it will cause a pregnancy”

(19yo SchB P001)

“They feel to have sex during menstruation”

(17yo SchB P005)

While some of these happenings are possible, they are rare.

Premenstrual Symptoms and Experiences

Participants displayed awareness of the physical and emotional challenges that menstruating individuals face, often acknowledging common symptoms such as abdominal pain, headaches, and difficulty in mobility. This awareness suggests that boys recognize menstruation as a potentially disruptive experience for girls.

“During menstruation some women find it very difficult to walk and others find it very difficult to sit. They feel headaches and other painful symptoms”

(17yo, SchD P001)

“They have abdomen pains when their menstruation is beginning”

(16yo, SchC P001)

To distinguish objectively correct, partially correct, and inaccurate beliefs from cultural/religious beliefs that are not empirical knowledge claims,

Table 3. Correct, inaccurate, and cultural/religious beliefs about menstruation reported by participants, with likely source of influence.

Statement (Paraphrased)	Classification	Likely Source of Influence
Menstruation is the periodic discharge of blood from the female reproductive organ, occurring when an egg is not fertilized.	Accurate	School/Internet
Menstruation can occur as often as every few days or every week.	Inaccurate (exaggerated frequency)	Peers/informal family talk
Sexual intercourse during menstruation will cause pregnancy.	Inaccurate (overgeneralized)	Family/peers
Women want to have sex while menstruating.	Inaccurate (overgeneralized stereotype)	Peers
A girl’s first menstruation signals readiness for marriage/pregnancy; rituals (e.g., a boiled egg) mark this transition.	Cultural/religious belief (not a knowledge claim)	Family/community custom
Menstruating girls/women should not cook or enter sacred spaces (e.g., shrines, the altar).	Cultural/religious belief (taboo)	Family/religion

summarizes representative statements from participants alongside their classification and their likely source of influence, as reported by participants themselves.

3.2.2. Sociocultural and Religious Beliefs

Taboos and Restrictions

Adolescent boys frequently mentioned sociocultural and religious restrictions imposed on menstruating individuals, reflecting entrenched beliefs associating menstruation with impurity. These restrictions, such as prohibiting cooking or entering sacred spaces, reinforce stigma and can shape boys’ attitudes towards menstruation.

“When you are menstruating, you don’t have to cook for your husband”

(17yo, SchC P005)

“They are not to enter specific places, like the shrine, and maybe some of the palaces”

(19yo, SchB P001)

Additionally, religious restrictions were evident, with one participant stating,

“In my church, if you menstruate, if you are a lady and you menstruate, you don’t go to the alter or the pulpit to dress or to clean up that place [because] yeah, they said God is a clean spirit. He’s clean so they don’t want an unclean person to clean His… let’s say like, His dwelling place in the church”

(16yo, SchC P002)

Meanwhile there are traces of deeply ingrained convictions, with adolescent boys justifying these beliefs with familial or religious teachings.

“Me, as for the church aspect, I see that, it’s in the Bible that, cleanliness is next to Godliness so maybe if you are not clean, and you are cleaning up the alter or the pulpit, you are not holy or clean to do that in his presence”

(16yo SchC P002)

Community Beliefs and Practices

Rituals and customs tied to menstruation were described by boys, illustrating how first menstruation is often seen as a marker of maturity or readiness for marriage. Such practices underline the symbolic importance of menstruation in defining a girl’s role in society, though they also perpetuate gendered expectations.

“If a girl menstruates, it means she is ready for pregnancy”

(17yo, SchE P005)

“They put a boiled egg in your mouth so that you are not going to mash the egg then swallow it. They will now know that you are now a matured girl before they give you to a man to marry.”

(17yo, SchC P003)

3.2.3. Attitudes Towards Menstruation

Comfort in Discussing Menstruation

The level of comfort boys felt discussing menstruation varied, often depending on the context and participants in the conversation. Some boys expressed a willingness to discuss the topic openly, particularly in all-male settings, while others felt discomfort, especially in mixed-gender interactions.

“To discuss menstruation. I feel normal. I don’t think it’s something strange to talk about”

(17yo, SchE P004)

“Talking about this topic with a lady is uncomfortable, I don’t like to do that”

(17yo, SchE P005)

“As for guys de3, if we meet, we can discuss it but with a guy and a woman, it will be very difficult”

(19yo SchB P001)

Engagement with Menstruators

Some participants displayed aversion to menstruation-related items, such as sanitary pads, as one participant admitted,

“Because I don’t like seeing sanitary pad, I don’t even like touching the pads. Even sleeping with someone, like my sisters, if they are menstruating, I distance myself from them. I don’t get some like, in the room, where I will sleep, I will change my position from them.”

(16yo, SchC P002)

These attitudes are highlighted by the adolescent boys’ views on menstruation. These were captured by some participants as

“For we boys de3 we don’t experience some so is their own problem.”

(18yo, SchE P001)

“Some of the ladies don’t take good care of themselves such as, not putting pads [wearing pads] well [which makes them leak and have fowl smells].”

(19yo, SchB P001)

Meanwhile adolescent boys justify their actions with leanings from either family or their religion.

Family teachings played a role in shaping boys’ beliefs about menstruation, with many citing parental influences as the source of their knowledge. However, this may reinforce existing taboos and restrictions rather than fostering open-mindedness.

“Because earlier on my mother talked about it before, so me I take like a normal thing”

(18yo, SchE P001)

“Because my father told me if a girl is menstruating, like she’s not supposed to cook. So that thing is in my mind”

(17yo, SchA P001)

Reactions to Menstrual Leaks

Adolescent boys’ responses to menstrual leaks varied. While some reacted sensitively, quietly alerting the individual to avoid embarrassment, others noted instances of teasing, highlighting a lack of empathy and the influence of societal stigma.

“I will just prompt her… so she should find a way to cover herself and go and clean up”

(17yo, SchE P004)

“I don’t want to see [menstrual] blood. Like aah”

(18yo, SchE P001)

Also, while others noted the prevalence of teasing, participants reported not participating in any of it. One recounted,

“A girl stained her dress and they [other students] were laughing at her but our teacher punished them”

(17yo, SchE P004)

Meanwhile, adolescent boys believe that other girls are perpetrators of period teasing as well.

“See [even] the females, some laugh at their friends because, when they are menstruating, it sometimes pour [leak] on the desks, so they used to laugh at them but as for me, I’m going to show them not to do that while a friend is menstruating. If they see that flow [blood] on the desk, I must make sure they tell the person to go and clean herself then do justice to whatever is on the desk”

(17yo, SchC P003)

Participation in Education Programs

Many boys expressed enthusiasm about participating in educational programs, recognizing the importance of understanding menstruation to support peers and family members. However, others viewed such programs as irrelevant to their lives, reflecting societal norms that frame menstruation as a “female issue”.

“Like, we want to learn it, so that, the girls that don’t know how to count [track] their menstruation, we can also help them to know it”

(18yo, SchC P004)

“I don’t think I will need it.”

(17yo, SchE P004)

4. Discussion

The findings of this study present an understanding of adolescent boys’ knowledge, and attitudes towards menstruation, which are shaped by various sociocultural, family, and some educational influences. The sources of knowledge on menstruation among these boys were multiple: family, school, and the internet. An informal multi-source approach to learning about menstruation reflects an understanding, where boys often learn incidentally or through second-hand information. For example, many adolescent boys discussed that the first information about menstruation came from within the family—mostly from their mothers. This is corroborated by other studies suggesting that mothers tend to be the major source of information about menstruation for boys and girls [8,24]. While participants in this study exhibited low levels of or misunderstood menstruation, simply because of informal teachings—which mostly are culture-rooted, it could be appreciated that parents play an important role in shaping adolescent boys’ perceptions toward menstrual health. In any case, not so many parents, especially in contexts such as where this study was conducted, freely discuss menstruation with adolescent boys [16]. This centrality of mothers as informants contrasts somewhat with findings from other settings, where sisters or female peers, rather than mothers specifically, have been reported as adolescent boys’ primary informal source of menstruation-related information. For instance, in Tanzania, by comparison, boys and girls alike frequently cite friends and classmates as an information source alongside family [9]. This suggests that while family remains the dominant informal channel across contexts, the specific family member or peer relied upon may vary, which has implications for who educational interventions should target as information intermediaries.

Boys’ attitudes toward menstruation, ranging from matter-of-fact acceptance to discomfort or embarrassment, were shaped by the accuracy (or inaccuracy) of their underlying beliefs, as summarized in Table 3. Subjective norms were evident in participants’ own accounts of family and religious expectations discouraging open discussion of menstruation and, in several cases, explicitly justifying restrictive practices. Perceived behavioral control was reflected in the variation in how confidently boys described they would respond to a menstruating peer in distress, from confident, supportive action to uncertainty or avoidance. Because the analysis itself was inductive rather than deductively structured around TPB, these observations should be read as a post hoc organizing lens on the findings rather than as a formal test of the theory’s propositions.

Although some participants in this study cited the internet as their source of knowledge on menstruation, most of them could not explain beyond their understanding of the menstrual cycle, which in some cases were described wrongly. Promising in the use of this source is the desire of adolescent boys to learn about menstruation but an unguided use of this approach may not provide much to improving on boys’ knowledge. The most important source indicated by some participants is school, where participants are taught about menstruation in structured lessons. However, this approach was seldomly indicated by participants. The dominance of the informal, possibly culture-driven teachings about menstruation, as reported by many participants may strongly explain the gaps discussed below.

This fragmented pattern of information-seeking can usefully be framed through the lens of health literacy, which is the ability to access, understand, and use health-related information to make sound decisions. Evidence from adult populations shows that low health literacy is independently associated with poorer health outcomes, including higher hospital re-admissions and mortality [25], underscoring that how information is accessed and processed, and not only whether it is available, matters for health-related behavior. Applied to the present findings, boys’ unguided use of internet searches and reliance on incidental family conversations suggest a knowledge and broader health-literacy gap. Participants generally lacked a reliable, structured process for evaluating and acting on menstruation-related information, regardless of source. This suggests that interventions should build boys’ capacity to critically appraise informal and digital information, rather than simply supplying more facts.

While some boys clearly understood the biological processes of menstruation, Others wrongly associated blood flow to pregnancy. Although this phenomenon could rarely happen—where women with a far shorter or longer than 28 days cycle are fertile during the time of menstrual flow [26,27], the case of these participants was a clear misconception as they seem to imply this in all cases. This adds to several other misconceptions reported in the literature, and emphasizes the need for structured and accurate menstrual education [5,28]. Table 3 places this and other examples side by side with participants’ objectively accurate statements (for instance, their correct, if basic, description of menstruation as the periodic discharge of blood following an unfertilized egg) and with beliefs that are better understood as cultural or religious rather than factual claims, such as marking a girl’s first period with a boiled-egg ritual. Distinguishing these three categories matters practically, correcting factual misconceptions (such as the pregnancy-risk belief) calls for accurate biological instruction, whereas cultural and religious beliefs about menstruation call for a more dialogic, respectful engagement with families and religious leaders rather than a simple correction of “wrong” knowledge.

It is important to highlight that adolescent boys had some good knowledge of premenstrual symptoms and challenges faced by menstruating individuals, often referring to it as a disrupting experience for girls. They further linked menstruation to common symptoms like abdominal pain and headache, and indicated ways showed empathy toward menstruating girls in their circles. Most often, though, the description of this understanding stays quite superficial and does not reveal their understanding of possible emotional and psychological consequences due to menstruation, hence may not be very useful at providing the needed support for these menstruating girls. This finding argues that for a holistic health for the adolescent girl, adolescent boys must be critically considered in menstrual health education to provide them with comprehensive knowledge on menstrual health issues, supporting similar stance in other jurisdictions [28,29].

Sociocultural and religious beliefs contribute significantly to forming boys’ attitudes toward menstruation. Most adolescent boys, in this study, reported cultural beliefs that associate menstruation with impurity, leading to restrictions in activities such as cooking or entering sacred spaces. These findings are consistent with the existing literature that depicts how sociocultural norms and religious beliefs can perpetuate stigma and discrimination toward menstruators [13,14,30]. This becomes very important, as it does not only affect boys’ views on menstruation but also reinforces gender dynamics within their communities. The persistence of such taboos, including restrictions mirrored in the wider linguistic avoidance of the topic of menstruation documented among Akan speakers in Ghana [12], highlights the deep cultural and religious weight attached to menstruation and its impact on gender dynamics in these communities; addressing boys’ attitudes in isolation from these family and religious structures is therefore unlikely to be sufficient.

On attitudes towards menstruation, the study reveals an interesting narrative. While some boys showed an openness to engage in open discussions on menstruation, they expressed awkwardness when the discussion involved both sexes. This awkwardness may be a reflection of the societal imprints of the gendered norms surrounding the appropriateness of topics each sex can discuss. Previous studies have also found that social attitudes toward menstruation can create barriers to open communication, leading to misconceptions and continued stigmatization [31]. The finding implies that adolescent boys might be forced to conform to societal norms although they may want to act differently towards menstruation. This points to some complexities in the attitudes of adolescent boys towards menstruation. This discomfort suggests that societal stigma and gendered norms, more so than a simple lack of interest, may underlie much of boys’ reluctance to engage in mixed-sex discussions about menstruation.

The reactions of the boys to menstrual stain further exemplify the complexities in their attitudes toward menstruation. While some boys were sensitive, hence keeping quiet to avoid embarrassing the menstruators, others commented on the occurrence of teasing, which portrays a lack of empathy. Clearly, the importance of addressing social dynamics in relation to menstruation as a means to reduce stigma and increase supportive behaviors from peers is necessary and same is well discussed in the literature [5,32].

One strong finding from the study is that many adolescent boys in this study were willing to participate in educational programs about menstruation, describing such as an opportunity to help their female friends and family members who menstruate. This indicates adolescent boys will embrace the opportunity to improve their knowledge about menstruation, which consequentially reduces the effect of negative sociocultural beliefs on their attitude towards menstruation as reported in a past study [15].

Taken together, these findings support a dual understanding of adolescent boys’ role in menstrual health. Participants were, at times, part of the problem, echoing taboos, teasing menstruating peers, and holding inaccurate beliefs, but they also displayed empathy, curiosity, and, as noted above, willingness to learn. Rather than positioning boys solely as a source of stigma to be corrected, these findings suggest that many boys are open to being engaged as active, informed allies in menstrual health, provided that education addresses biological facts, the sociocultural and religious narratives, and the health-literacy skills, that currently shape their attitudes.

5. Strengths and Limitations

The study focuses on adolescent boys, a group often left out in discussions around menstrual health, hence addresses a significant gap in extant literature and thereby contributes to the development of better gender-sensitive educational strategies.

The reliance of the study on self-report data however raises concerns about the potential for social desirability bias, where participants may tend to underreport stigmatizing beliefs or behaviors. Another limitation is that, while this research provides important data on knowledge, sociocultural beliefs and attitudes, it does not examine the lasting effects of these factors on peer interactions or societal attitudes, which would have required a longitudinal study design. While the Theory of Planned Behavior guided the framing of specific interview questions, the analysis itself followed an inductive thematic approach; TPB therefore functioned as a sensitizing framework rather than a fully deductive analytic structure, and the Discussion’s mapping of findings onto TPB constructs should be read accordingly. As only one school per district was sampled, findings may have not fully captured within-district variation (e.g., across school types or urban/peri-urban settings), which limits generalizability beyond the five participating schools. Finally, terms such as “many”, “some”, and “most” used throughout the Results and Discussion reflect the relative, rather than precisely quantified, frequency of codes across the 25 interviews, consistent with qualitative reporting conventions, and should not be read as statistical estimates.

6. Conclusions

The findings of this study indicate that adolescent boys have inadequate knowledge about menstruation. Also, sociocultural beliefs that frame menstruation as a woman’s issue and limit open discussion about it persisted. Family influences, especially those stemming from mothers, are pivotal in shaping boys’ understanding, thus parent-focused interventions are needed to encourage accurate and empathetic messaging. While some boys exhibited discriminatory attitudes often due to cultural and religious beliefs, some indicated the willingness to educate themselves to enable them better support their female counterparts. Therefore, well-designed educational programs focused on the different comfort levels of boys can greatly reduce stigma, promote supportive behaviors, and change societal attitudes toward menstruation.