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我們為什麼不能談論月經？
11:43來自不認真說事兒
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中英文稿
When I was a teen, I had terrible periods. I had crippling cramps, I leaked blood onto my clothes and onto my bed sheets, and I had period diarrhea. And I had to miss school one to two days a month, and I remember sitting on the couch with my heating pads, thinking, "What's up with this?" When I ate food, I didn't leak saliva from my salivary glands. When I went for a walk, I didn't leak join fluid from my knees, "joint fluid." Why was menstruation so different?
當我處於青春期的時候， 月經讓我深受折磨。我痛經很嚴重， 衣服和床單上總是 不小心沾上漏出的血， 我也會有經期腹瀉。因此在學校，我每個月 總要缺勤那麼一兩天， 我也記得抱著熱水袋 坐在沙發上的日子，心想：這怎麼回事？當我吃東西的時候， 口水可從不會從唾液腺漏出。當我走路的時候， 我的關節液也不會 從膝蓋處漏出「關節液」。為什麼月經那麼不一樣？
I wanted answers to these questions but there was no one for me to ask. My mother knew nothing about menstruation except that it was dirty and shameful and I shouldn't talk about it. I asked girlfriends and everybody spoke in euphemisms. And finally, when I got the courage to go to the doctor and talk about my heavy periods, I was told to eat liver.
我想要知道這些問題的答案， 但沒有人回答我。我的母親對月經一無所知， 除了「這是一個骯髒且羞恥的話題， 我不應該談論它。」 我問過我的女性朋友， 然而她們每個人說得都很委婉。最終，當我鼓起勇氣去看醫生 並談論我月經過多的問題時， 我被告知要多吃動物肝臟。
(Laughter)
（笑聲）
And when I went to the drug store to buy my menstrual products, my 48-pack of super maxi pads, back in the day when they were the size of a tissue box, each pad --
當我去藥店買經期用品， 48 包裝的超長加大衛生巾， 那時候每片衛生巾的大小 就宛如一個紙巾盒——
(Laughter)
（笑聲）
You know what I'm talking about. You have no idea how far absorbent technology has come.
你們知道我在說什麼—— 根本無法想像 吸收技術至今進步了多少。
(Laughter)
（笑聲）
I used to have to buy my menstrual products in the feminine hygiene aisle. And I remember standing there, thinking, "Well, why don't I buy toilet paper in the anal hygiene aisle?"
我曾經需要在女性衛生區的貨架上 尋找我要買的經期用品。我也記得我站在那裡，想著：為什麼我不用 在肛門衛生區的貨架上買手紙？
(Laughter)
（笑聲）
Like, what's up with that? Why can't we talk about periods? And it's not about the blood, as Freud would have you say, because if it were, there would be an ear, nose and throat surgeon up here right now, talking about the taboos of nose bleeds, right? And it's not even about periods, because otherwise, when we got rid of our toxic, shameful periods when we became menopausal, we'd be elevated to a higher social status.
究竟是為什麼呢？為什麼我們不能談論月經？正如弗洛伊德所說的那樣， 這和血液無關， 因為如果有關的話， 現在這裡就會有 一群耳鼻喉外科醫師 談論著流鼻血的禁忌，對吧？這甚至也和月經無關， 不然在我們擺脫 有害且令人羞恥的月經後， 也就是我們絕經後， 我們的社會地位會被抬高。
(Laughter)
（笑聲）
(Applause)
（掌聲）
It's just a patriarchal society is invested in oppressing women, and at different points in our lives, different things are used. And menstruation is used during what we in medicine call the reproductive years. It's been around since pretty much the beginning of time, many cultures thought that women could spoil crops or milk, or wilt flowers. And then when religion came along, purity myths only made that worse. And medicine wasn't any help. In the 1920s and '30s there was the idea that women elaborated something called a menotoxin. We could wilt flowers just by walking by.
這依舊只是一個 壓迫女性的男權社會， 在我們生活的不同階段， 會有不同的東西被用來壓迫我們。月經就是其中一個， 被用於我們在醫學上 稱之為生殖年齡的階段。在很早之前，其實已經就是這樣了。在很多文化中普遍認為 女性會破壞莊稼， 或是牛奶，或是使花朵凋零。後來隨著宗教信仰的出現， 聖潔的神話只是讓情況變得更糟了。醫學也沒什麼實際幫助。在 1920 年代至 30 年代， 有一種說法把女性描述為 某種叫月經毒素的東西。我們就算只是路過花朵旁， 也能使之凋零。
(Laughter)
（笑聲）
And that's what happens when there's no diversity, right. Because there was no woman to put her hand up and go, "Well, actually, that doesn't happen." And when you can't talk about what's happening to your body, how do you break these myths? Because you don't even need to be a doctor to say that periods aren't toxic. If they were, why would an embryo implant in a toxic swill? And if we all had this secret menotoxin, we could be laying waste to crops and spoiling milk.
這是在多樣化缺失時 會發生的事，對吧？因為那時沒有女性 舉起手，走上前並說 「你看，實際上，這並沒有發生。」 當你無法談論 你的身體正在發生什麼的時候， 你如何打破這些迷思？你甚至不需要成為一名醫生 來表明「月經不是有毒的」。如果月經是有毒的，為什麼胚胎 會紮根於這樣一個有毒的環境？如果我們所有女性 都攜有這種秘密毒素， 我們可能會毒害莊稼， 讓牛奶變質。
(Laughter)
（笑聲）
Why would we have not used our X-Women powers to get the vote sooner?
我們為什麼還沒用自己 X 女戰警的能力更快地獲得更多選票？
(Laughter)
（笑聲）
(Applause)
（掌聲）
Even now, when I tweet about period diarrhea, as one does,
甚至直至今日， 和別人一樣，當我發送關於 經期腹瀉的推文時，
(Laughter)
（笑聲）
I mention that it affects 28 percent of women. And every single time, someone approaches me and says, "I thought I was the only one." That's how effective that culture of shame is, that women can't even share their experiences.
我也會提及， 這影響著 28% 的女性。然而每一次， 都有人跑過來和我說， 「我以為我是唯一的一個。」 我們的羞恥文化就是那麼的有效， 以至於女性們 甚至無法分享她們的經歷。
So I began to think, "Well, what if everybody knew about periods like a gynecologist? Wouldn't that be great?" Then you would all know what I know, you'd know that menstruation is a pretty unique phenomenon among mammals. Most mammals have estrus. Humans, some primates, some bats, the elephant shrew and the spiny mouse menstruate. And with menstruation what happens is the brain triggers the ovary to start producing an egg. Estrogen is released and it starts to build up the lining of the uterus, cell upon cell, like bricks. And what happens if you build a brick wall too high without mortar? Well, it's unstable.
所以我開始思考， 「好吧，如果每個人都能 像婦科醫生一樣對月經有所了解 不是很棒嗎？」 之後你就會知道所有 我知道的東西， 你會知道月經 是哺乳動物中相當特別的現象。大多數哺乳動物有發情期。人，有些靈長類動物， 一些蝙蝠， 象鼩，還有非洲刺毛鼠 都有經期。這意味著在月經期間， 大腦會觸發卵巢 開始產生卵子。雌性激素也因此被釋放， 開始形成子宮內膜， 一層又一層地堆積卵子細胞， 宛如磚塊那樣。但如果你的磚牆建得太高 卻沒有足夠的水泥，會發生什麼？它會不太穩固。
So what happens when you ovulate? You release a hormone called progesterone, which is progestational, it gets the uterus ready. It acts like a mortar and it holds those bricks together. It also causes some changes to make the lining more hospitable for implantation. If there's no pregnancy, (Whoosh) lining comes out, there's bleeding from the blood vessels and that's the period. And I always find this point really interesting. Because with estrus, the final signaling to get the lining of the uterus ready actually comes from the embryo. But with menstruation, that choice comes from the ovary. It's as if choice is coded in to our reproductive tracts.
當你排卵的時候， 你體內會釋放 一種叫黃體酮的荷爾蒙， 這是一種孕激素， 讓你的子宮做好準備。它的作用就像水泥一樣， 把那些磚塊牢固地黏在一起。它也會改變子宮內膜的環境， 使之更適宜於受精卵的植入。如果沒有懷孕， （輕呼） 那層膜會被排出體內， 同時血管也會流血， 這也就是月經的形成。我總是覺得這個很有趣。因為在發情期， 讓子宮內膜做好 受孕準備的最終信號 實際上是來自胚胎。但對於月經， 是否來月經取決於卵巢。這個決策過程好像是被編碼在 我們的生殖系統中一樣。
(Cheering and applause)
（喝彩與掌聲）
OK, so now we know why the blood is there. And it's a pretty significant amount. It's 30 to 90 milliliters of blood, which is one to three ounces, and it can be more, and I know it seems like it's more a lot of the times. I know. So why do we have so much blood? And why doesn't it just stay there till the next cycle, right? Like, you didn't get pregnant, so why can't it hang around? Well imagine if each month it got thicker and thicker and thicker, right, like, imagine what tsunami period that would be.
好了，所以我們現在了解了 為什麼會出血， 而且還是相對大量的血， 30 - 90 毫升的血量， 約為 1 - 3 盎司， 還可能更多。我知道很多時候實際看起來更多。我知道。所以我們為什麼排出那麼多血？為什麼這些東西不呆在原地 等著下一個生理周期，對吧？如果你沒有懷孕，為什麼那些東西 不可以在我們體內隨意逗留？那麼，想像每個月那層膜 都變厚一點，再厚一點—— 想像一下那種血崩 會是什麼感覺。
(Laughter)
（笑聲）
We can't reabsorb it, because it's too much. And it's too much because we need a thick uterine lining for a very specific reason. Pregnancy exerts a significant biological toll on our bodies. There is maternal mortality, there is the toll of breastfeeding and there is the toll of raising a child until it is independent. And evolution --
我們無法重新吸收那些東西， 因為量太大了。量大是因為 我們對厚子宮內膜的需求 是出於一個非常特定的原因。懷孕對我們的身體 會造成一個巨大的生物傷害。這包括產婦死亡， 母乳餵養的傷亡， 撫養孩子直至他們成年 其中獲得的傷害， 還有進化——
(Laughter)
（笑聲）
That goes on longer for some of us than others.
對於我們有的人 持續時間還更長。
(Laughter)
（笑聲）
But evolution knows about risk-benefit ratio. And so evolution wants to maximize the chance of a beneficial outcome. And how do you maximize the chance of a beneficial outcome? You try to get the highest quality embryos. And how do you get the highest quality embryos? You make them work for it. You give them an obstacle course. So over the millennia that we have evolved, it's been a little bit like an arms race in the uterus, the lining getting thicker and thicker and thicker, and the embryo getting more invasive until we reach this détente with the lining of the uterus that we have.
但進化是基於風險效益比率的。進化的目的是最大化 有益結果出現的可能性。那你怎麼最大化這一可能性呢？你嘗試保留最高質量的那個胚胎。那你如何嘗試保留 最高質量的胚胎呢？你讓它們為此奮鬥。你給它們一個需要通過的障礙。所以經過上千年的進化， 子宮內的競爭 宛如一場軍備競賽， 內膜變得越來越厚， 胚胎也更具侵入性， 直至與子宮內膜的關係 達到一個緩和狀態。
So we have this thick uterine lining and now it's got to come out, and how do you stop bleeding? Well, you stop a nose bleed by pinching it, if you cut your leg, you put pressure on it. We stop bleeding with pressure. When we menstruate, the lining of the uterus releases substances that are made into chemicals called prostaglandins and other inflammatory mediators. And they make the uterus cramp down, they make it squeeze on those blood vessels to stop the bleeding. They might also change blood flow to the uterus and also cause inflammation and that makes pain worse.
所以我們有了 這層厚厚的子宮內膜， 它現在需要被排出體外， 但是你是如何停止流血的？通常流鼻血的話， 你會捏住鼻子止血， 如果你劃到腿了， 你會加壓止血。壓力能夠幫助止血。當我們來月經的時候， 子宮內膜會釋放一種物質， 它能夠生成一種 名為前列腺素的化學物質 以及其它炎症介質。它們會造成子宮向下筋攣， 使子宮對血管造成壓力 從而起到止血作用。它們也可能會讓血流向子宮， 同時引發炎症，並加劇疼痛感。
And so you say, "OK, how much pressure is generated?" And from studies where some incredible women have volunteered to have pressure catheters put in their uterus that they wear their whole menstrual cycle -- God bless them, because we wouldn't have this knowledge without, and it's very important knowledge, because the pressure that's generated in the uterus during menstruation is 120 millimeters of mercury. "Well what's that," you say. Well, it's the amount of pressure that's generated during the second stage of labor when you're pushing.
你會說：「好吧， 這裡產生的壓力有多大？」 一些超讚的女性曾志願 在她們的子宮內植入壓力導管， 讓學者們進行研究， 她們在整個月經周期 都帶著那個導管—— 感謝她們，因為沒有她們， 我們不會了解這個知識， 而這是一個很重要的知識。因為在月經期間 子宮內產生的壓力 為 120 毫米汞柱。你會問：「這代表什麼？」 這相當於你分娩第二階段用力時 所產生的壓力。
(Audience gasps)
（觀眾倒吸冷氣）
Right. Which, for those of you who haven't had an unmedicated delivery, that's what it's like when the blood pressure cuff is not quite as tight as it was at the beginning, but it's still pretty tight, and you wish it would stop. So that kind of makes it different, right? If you start thinking about the pain of menstruation, we wouldn't say if someone needed to miss school because they were in the second stage of labor and pushing, we wouldn't call them weak. We'd be like, "Oh my God, you made it that far," right?
沒錯。對於在座沒有進行過 非藥物分娩的人， 這就好比你戴著的血壓袖套 不像一開始那樣緊， 但依舊蠻緊， 而且你希望它會停止的 那種感覺。這情況就變得很不一樣了，對吧？如果你開始回想經期疼痛， 我們不會說—— 倘若一個人在學校曠課， 是因為她們處於分娩第二階段， 並且用力在生孩子， 我們不會說她們是弱者， 而會說，「我的天 ， 你竟然做到了！」對吧？
(Laughter)
（笑聲）
And we wouldn't deny pain control to women who have typical pain of labor, right? So it's important for us to call this pain "typical" instead of "normal," because when we say it's normal, it's easier to dismiss. As opposed to saying it's typical, and we should address it.
我們不會否認 那些承受典型分娩陣痛女性的 忍痛能力，對吧？用「典型」，而非「正常」 來形容這種疼痛很重要， 因為當我們說這很正常， 這說明疼痛很容易消失。然而說這很典型， 代表我們需要解決它。
And we do have some ways to address menstrual pain. One way is with something called a TENS unit, which you can wear under your clothes and it sends an electrical impulse to the nerves and muscles and no one really knows how it works, but we think it might be the gate theory of pain, which is counterirritation. It's the same reason why, if you hurt yourself, you rub it. Vibration travels faster to your brain than pain does.
我們確實有一些解決痛經的辦法。一個方法就是使用 經皮神經電刺激（TENS）止痛儀， 你可以把它貼在衣服裡， 它能將電流送往神經和肌肉， 並且沒人真正知道其中的原理， 但我們認為這個技術可能是 基於閘門理論， 即反刺激。同樣這也是為什麼如果 你傷到了自己，你會搓揉疼痛處。振動，相比疼痛， 能夠更快地被神經傳導至大腦。
We also have medications called nonsteroidal anti-inflammatory medications. And what they do is they block the release of prostaglandins. They can reduce menstrual pain for 80 percent of women. They also reduce the volume of blood by 30 to 40 percent and they can help with period diarrhea. And we also have hormonal contraception, which gives us a thinner lining of the uterus, so there's less prostaglandins produced and with less blood, there's less need for cramping.
我們也有藥物方法， 實用非甾體抗炎藥物（NSAID）。它們的主要作用是 抑制前列腺素的合成。該藥物可為 80% 的女性 緩解痛經， 也可以減少 30% - 40% 的出血量， 同時緩解經期腹瀉情況。我們也有荷爾蒙避孕藥， 讓我們的子宮內膜變薄， 從而減少前列腺素的生成， 並緩解出血情況， 同時對痙攣的需求也變小。
Now, if those treatments fail you -- and it's important to use that word choice, because we never fail the treatment, the treatment fails us. If that treatment fails you, you could be amongst the people who have a resistance to nonsteroidal anti-inflammatories. We don't quite understand, but there are some complex mechanisms why those medications just don't work for some women. It's also possible that you could have another reason for painful periods. You could have a condition called endometriosis, where the lining of the uterus is growing in the pelvic cavity, causing inflammation and scar tissue and adhesions. And there may be other mechanisms we don't quite understand yet, because it's a possibility that pain thresholds could be different due to very complex biological mechanisms. But we're only going to find that out by taking about it.
如果這些治療方法 對你都沒用—— 這裡的措辭很重要， 因為我們從不會讓治療失敗， 而是治療對我們沒用。如果那些治療方法「辜負」了你， 你可能屬於 對 NSAID 具有抗藥性的一批人。我們尚未完全理解， 為什麼這些藥物 就是對某些女性無效用， 這其中包含著一些很複雜的機制。也可能是因為， 導致你經期疼痛的原因 與上述情況都不同。也可能是因為你 患有子宮內膜異位症， 即，子宮內膜生成於盆腔中 進而引起炎症， 疤痕組織以及黏附現象。或許其中還有我們 尚未了解的機制存在， 因為這會牽涉到 非常複雜的生物學機制， 疼痛閾值也可能會隨之不同。但我們只有通過不斷談論它， 才能發現更多。
It shouldn't be an act of feminism to know how your body works. It shouldn't --
了解你的身體如何運作 不應該是一種女權主義的行為。這不應該——
(Applause)
（掌聲）
It shouldn't be an act of feminism to ask for help when you're suffering. The era of menstrual taboos is over.
在你身受月經折磨時尋求幫助， 這不應該是一種女權主義的行為。月經作為一種話題禁忌的時代 已經結束了。
(Cheers and applause)
（喝彩與掌聲）
The only curse here is the ability to convince half the population that the very biological machinery that perpetuates the species, that gives everything that we have, is somehow dirty or toxic. And I'm not going to stand for it.
這裡唯一的魔咒 就是說服一半的人口， 那個讓各個物種得以 在歷史長河延續生命， 給予我們所擁有的一切的生物系統， 是骯髒的、有毒的。我不會去支持這個觀點。
(Applause)
（掌聲）
And the way we break that curse? It's knowledge.
如何打破這一魔咒？用知識。
Thank you.
謝謝。
(Cheers and applause)
（喝彩與掌聲）
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