At least 44 states currently require or request the asking of female high school athletes for information about their “menstrual period,” Outsports has found through a state-by-state examination of publicly available “preparticipation physical evaluation” forms, as they are commonly called.
The issue has recently come to the fore as Florida last week drew public scrutiny for the Florida High School Athletic Association including these questions on forms, with further concerns about where information was stored and who has access to it. People across the media and social media attacked the state for being “transphobic,” “a police state for women,” “trampling on women’s rights,” and a host of other critiques.
The state has asked these questions for about two decades, according to reports.
Outsports’ survey reveals the Sunshine State is only one of dozens of states to suggest or require asking these questions of female high school athletes before they can compete.
Outsports has reviewed the websites of the high school sports associations and Departments of Education of all 50 states. At least 88% of the states include some form of pre-participation medical evaluation that requests or requires asking female athletes about their “menstrual period,” or similar questions.
Of the other six states, at least four — Maine, Massachusetts, Mississippi and Vermont — have recently asked these questions statewide or had the questions included by cities, sections or schools. It was not clear if these questions were included in statewide athlete pre-participation forms in 2022.
It’s unclear if New Hampshire has ever suggested questions about menstrual cycle or genitalia.
From publicly available content, Outsports could find forms for only one state — Oklahoma — that do not seem to ask questions about menstrual periods in 2022. The state does include a supplemental “biological sex at birth affadavit.”
Among other states, Massachusetts does currently suggest an examination of “genitalia.” Other states also suggest genital examinations, some of them like Oklahoma and Michigan singling that out for “males only,” or like New York asking if male athletes “have only one testicle.”
As some people have suggested the questions in Florida are transphobic or anti-woman, or that the information could be used against trans athletes, states that publicly offer forms with these menstrual-period questions include Connecticut and California, which have some of the most trans-inclusive high school sports policies in the nation.
An example from Connecticut’s form — accessible directly from the Connecticut Interscholastic Athletic Conference website front page — includes a request for the inspection for “males only” of genitals and three questions for “females only”:
- Have you ever had a menstrual period?
- How old were you when you had your first menstrual period?
- How many periods have you had in the last 12 months?
California goes further in asking these and a fourth question:
- When was your most recent menstrual period?
Most of the states included these forms on their websites under tabs labeled “health,” “safety” and/or “sports medicine.”
Many of the states asked similar or identical questions to one another, as their forms are derived from — or copies of — the pre-participation evaluation form suggested and written by the American Academy of Pediatrics.
“The AAP has included these questions because medical providers who perform sports physicals recognize that they are important,” said Dr. Rebecca Carl from the Institute for Sports Medicine and an AAP representative. “It’s also important to note that we take the concerns about privacy seriously. The information is not designed to be shared with schools. That information is to document the information between the person performing the physical and the student-athlete and their family.”
The medical reason for these questions?
“Female athletes/athletes with uteri who are not having menstrual periods are at increased risk of stress fractures,” Carl said.
How this information is shared is part of the focus of the conversation. While the AAP suggests that these questions be asked by a physician and kept by a physician, school physicians can be the people conducting the survey and filling out the form. Various states’ forms are unclear if students should submit the entire form to the school; Even when they are clear, some students submit the entire form with these questions anyway.
States publishing these suggested or required forms determine state-by-state how the information can and should be shared.
“The only form any high school athletic association needs is clearance by a physician,” said Dr. Lisa L. Rapalyea at UC-Davis. “They don’t need all of this medical history.”
Micah Porter, an associate principal at Warren Tech in Lakewood, Colo., and a former high school athletic director, said these questions are not required to be turned into the schools, though some students do that anyway.
“In Colorado, there are clear policies pertaining to how the information collected from health questionnaires can be used by districts and schools for students,” Porter said. “This information is vital for informing athletic departments of any medical needs for the student-athlete. The information should always be kept confidential and never used beyond medical support.”
Rapalyea also questioned the validity of these questions in regards to Title IX.
National Center for Lesbian Rights legal director Shannon Minter, a longtime advocate for women and transgender athletes, said states or schools asking these questions is simply unnecessary to compete in high school sports.
“Our society is obsessed with controlling women’s bodies, starting even in adolescence,” Minter said. “Every female student in this country deserves privacy, dignity, and respect—whether that is about her body, her sexual orientation, or her transgender status. Florida should stop this practice immediately, and other states should do the same.”
High school state athletic associations are often kept at arms length from state elected officials, though elected officials can make state policy about how sports are governed in the state. Florida, for example, banned trans girls from the female sports category in 2021 when Gov. Ron Desantis signed the ban into law.
Of the 44 states that include these questions, there was no significant difference between how often Republican-led or Democratic-led states utilized them on their suggested or required forms.
Beyond high schools, the US Women’s National Team in soccer is reportedly required to share menstrual information with the team, as some believe managing that information in regards to practices and physical requirements can optimize athletic production. Good Morning America reported that the practice helped the team win the 2019 Women’s World Cup.
For many decades, female athletes have been at times pushed away from what was deemed physically strenuous athletic activity due to reproduction and other questions. Women were allowed to compete in marathons only in the last 60 years for these alleged reasons.
The latest revelation that these questions about menstrual cycles are being asked raises concerns for some about how we define the athletes who can compete in the female category of sports, and whether questions for “female only” or “male only” athletes like this drive away some athletes.