Opinion

  • Sociocultural Considerations in Implementing HPV Self-Sampling and Menstrual Blood Testing in Conservative Settings
    by Hasan Mahmud Reza
    HPV Self-Sampling and Menstrual Blood Testing in Conservative Settings

    HPV self-collection has repeatedly been associated with greater privacy, physical ease, and personal control, while minimizing discomfort and embarrassment linked to pelvic examinations. As a result, it has been shown to improve screening participation among women who are under-screened in low- and middle-income countries (LMICs) (1–3). More recently, research indicates that HPV detection using menstrual blood may offer a practical and non-invasive alternative, with performance in certain contexts approaching that of clinician-obtained cervical specimens (4). These strategies hold promise for extending screening access to women who encounter structural, logistical, or interpersonal obstacles to clinic-based services.

    Nevertheless, successful implementation in socially conservative and resource-limited environments demands sensitivity to prevailing cultural norms. In many LMICs—and within some traditional communities in high-income countries—sexual and reproductive health remains a delicate topic. Women may avoid screening because of embarrassment, anticipated stigma, or concerns about confidentiality (2,5). Cultural and religious values can also influence perceptions of acceptability, similar to their impact on HPV vaccine uptake during the ages when immunization is most beneficial (6).

    In certain settings, menstrual blood is viewed as ritually unclean, and longstanding beliefs or taboos may discourage women from providing menstrual samples for clinical use (5,7). Distrust may be compounded by misconceptions about how biological specimens are handled, limited understanding of HPV and cervical cancer prevention, and moral framing of HPV prevention as implicitly endorsing sexual behavior (2,6,7). Evidence from Muslim-majority and other conservative societies highlights how norms related to modesty, sexual propriety, and gender roles restrict open discussion of reproductive health (8). Such dynamics can suppress participation in cervical cancer screening under the banner of religious or cultural propriety, and may also hinder acceptance of menstrual blood–based testing despite its technical advantages.

    Unlike rapid diagnostic tools such as pregnancy tests or certain infectious disease assays, HPV self-tests do not yield immediate results. After collecting the sample, women must submit it to a laboratory or healthcare provider for analysis and, if results are positive, attend follow-up visits. In communities where maintaining privacy throughout this process is difficult, these additional steps may present barriers comparable to those associated with conventional facility-based screening.

    Overcoming these challenges will require culturally responsive educational initiatives, meaningful collaboration with community and religious leaders, and tailored communication strategies that frame screening as routine preventive care rather than a morally sensitive intervention. Without these supportive measures, innovations in specimen collection alone are unlikely to achieve equitable and sustained uptake in conservative LMIC contexts.

    1. BMJ Glob Health 2022;Z;e008815. doi: 10.1136/bmjgh-2018-001351.
    2. Bulletin of the World Health Organization. 2013;91:683-90. https://doi.org/10.2471/BLT.12.116020 
    3. Lancet Oncol. 2023;24:e204-16. doi: 10.1136/bmj.k4823.
    4. BMJ 2026;392:e084831. doi: 10.1136/bmj-2025-084831.
    5. BMC women’s health. 2022 Dec 2;22(1):486. DOI: 10.1186/s12905-022-02043-y
    6. Vaccines. 2021;15;9(10):1188. DOI: 10.3390/vaccines9101188
    7. BMC Womens Health. 2019 Aug 9;19(1):108. DOI: 10.1186/s12905-019-0809-z
    8. PloS one. 2017 Sep 5;12(9):e0183924. https://doi.org/10.1371/journal.pone.0183924

  • Concept and Definition to Third Science
    by Hasan Mahmud Reza

    Knowledge acquisition extends beyond formal training to include experience, reflection, observation, and collaborative brainstorming. When these organically developed insights are combined with structured scientific knowledge, they can generate innovative ideas to address complex and unresolved challenges. In this context, we propose an expanded interpretation of the Third Science that transcends traditional disciplinary boundaries and addresses the evolving demands of modern knowledge creation.

    Central to the Third Science is the cultivation of advanced competencies such as critical thinking, interdisciplinary reasoning, creativity, and problem-solving. These can be achieved through different non-institutional learning processes. Once completed, these attributes are leveraged to transform knowledge, technology, and skills to drive purposeful solutions and innovation at the intersections of science, technology, and medicine.

    Therefore, we define Third Science as the competence to empower individuals to process diverse ideas and address problems with intellectual rigor and scientific soundness, thereby finding solutions.