High school athletic board removes questions about menstrual cycle from school forms

The Florida High School Athletics Association removed all questions about student athletes’ menstrual cycles from its physical examination form at an emergency meeting Thursday morning, making Florida one of the only states in the country that does not ask student athletes questions about their periods.

The FHSAA also revoked its requirement that students turn their entire forms in to schools.

Now, schools will retain only Page 4 of the form, which is where the medical professional signs off on a student athlete’s eligibility.

The two recommendations submitted by FHSAA Executive Director Craig Damon and approved by the FHSAA on Thursday come on the heels of intensifying calls from political leaders, doctors, teachers and parents for the association to remove the questions and keep the forms out of schools, arguing that they are an invasion of female athletes’ privacy.

But others argued that the questions are medically necessary for female athletes’ safety and removing the questions would only further stigmatize menstruation.

The original Pre-Participation Examination Evaluation form approved by the FHSAA asked when a student had their first menstrual period, the date of the most recent period, the length of the interval between the periods, how many they’ve had in the past year, and the longest interval between periods in the last year.

[ RELATED: Florida high school sports group rethinks menstrual cycle questions ]

The questions alone are not out of the ordinary; most state athletic associations have included some version of them on their physical examination forms for years. They are mandatory on the 2022-23 form recommended nationally by the American Academy of Pediatrics, adopted by many states.

In fact, not asking the questions at all would make Florida an outlier.

Information about a students’ menstrual cycle can help doctors determine if student athletes are healthy. Irregular or missed periods could be a sign of low energy availability, which could indicate an eating disorder, among other medical conditions.

However, the FHSAA required students give their entire physical examination form to their schools, against the recommendation of the American Academy of Pediatrics, which says that doing so could violate HIPAA laws.

“The history form and physical examination form have Health Insurance Portability and Accountability Act (HIPAA) protected information, and should not be retained by schools, only by the health care provider in the student athlete’s medical record,” a July letter from the AAP states.

The Florida chapter of the AAP released a statement Thursday afternoon praising the FHSAA’s decision.

“Pediatricians recognize that both schools and physicians must perform the due diligence necessary to ensure students can participate safely in school athletic programs,” FCAAP President Thresia B. Gambon said. “We also know that storing records of protected medical information outside the clinical setting poses privacy risks for students and families. Today’s decision by the FHSAA is a win for Florida’s student athletes.”

The privacy concerns began in October after a Palm Beach Post investigation found that the information about students’ menstrual cycles was stored digitally, a potential privacy concern that took on new meaning after Roe v. Wade was overturned.

At a January meeting to review the policy, the FHSAA Sports Medicine Committee recommended that the questions, originally optional in Florida, be made mandatory to align with the updated national guidelines, and that students continue to turn the entire form into their school. The Board of Directors adopted the recommendation.

But in the weeks following the January meeting, critics raised additional concerns that the policy targets transgender athletes, a sensitive topic in Florida, where Gov. Ron DeSantis has sought to limit the inclusion of transgender athletes in womens’ sports.

On Wednesday, Rep. Lois Frankel and Rep. Debbie Wasserman Schultz sent a letter to the FHSAA, signed by all members of the Florida Democratic Delegation, asking for the association to adopt the recommendations to remove the questions and keep pages 1-3 of the form out of schools.

“A student’s medical history is private, personal information that is between the student and their trusted health care provider,” the letter read. “School personnel have no need for this information, and sharing it with them could violate a student’s privacy. Menstrual history is particularly sensitive information, and it should remain between a student and their provider.”

At Thursday’s meeting, the FHSAA read aloud each of the 150 emailed public comments it had received, nearly all of which denounced the questions as a violation of privacy. Some threatened legal action. Others suggested that the questions are meant to discriminate against transgender athletes.

“The only reason is to weed out trans kids who might not have periods,” according to one emailed public comment read at Thursday’s meeting.

Another said the current policy is “sick and borders on perversion.”

The revised form also changed the wording of one of the questions in the student information section, which will now go only to medical providers, to ask for “sex assigned at birth” rather than “sex.” The form recommended by the American Academy of Pediatrics also asks for “sex assigned at birth,” but some people took issue with the FHSAA’s change online, including state Rep. Carlos Guillermo Smith, who suggested this was also a move against transgender athletes.

“It was always about stopping trans kids from playing sports,” Smith tweeted.

Members of the Sports Medicine Committee maintained that their decision has nothing to do with transgender athletes, despite “narratives in the news media,” in a written comment read at Thursday’s meeting.

They responded to a Tuesday letter sent by the Florida House Democratic Caucus demanding responses to questions about why the questions are scientifically necessary and why the schools need the forms.

The committee said that the questions are consistent with other high school athletic organizations, and serve as an important screening tool to prevent injuries and illness.

“Not including the questions would increase the risk for a female student athlete participating in high school sports,” the response read, citing conditions including anemia and disordered eating.

The committee also said that the physical examination is sometimes the only contact an adolescent has with their medical provider.

Following the public comments, most board members voiced agreement with the recommendation.

“I’ve never seen such a skewed response on an issue from people on all sides asking that we eliminate these questions,” said Doug Dodd, one of the board members, who supported the recommendation.

Multiple board members, including Dodd, said they had daughters in school athletics and felt uncomfortable with their own daughters answering the questions.

But Chris Patricca, one of only two women on the 16-member board, said that the comments and the recommendation to remove the questions seemed to come from societal stigma surrounding menstruation rather than the goal of protecting female athletes’ privacy.

“So many of the comments from the public today felt like they were almost from biblical times,” Patricca said. “Menstruation is a perfectly normal bodily function and thankfully shame around menstruation has decreased as our society has evolved.”

Board member Charlie Ward agreed, saying he didn’t see why the questions about menstruation should not go to athletes’ doctors.

In response, Board member Richard Finlayson inquired whether women are not already asked those questions at doctors’ appointments.

“This question is not always asked and having the question on the form ensures that the conversation takes place,” Patricca said.

The vote was split 14-2, with Patricca and Ward voting against.