Today’s Directive by Governor Youngkin to the Board of Health on School Bathrooms is Right: School Bathrooms are a Serious and Growing Health Issue

The debate over school bathrooms has taken center stage in Virginia’s campaign for Governor. More than a political flashpoint, however, school restrooms are a little-understood source of profound anxiety, embarrassment, and even physical illness that directly undermines student learning. Today, Governor Youngkin issued a directive to the Virginia Board of Health to promulgate regulations addressing this serious health concern by protecting sex specific spaces. 

The widespread but often invisible health issue students face is known as “bathroom anxiety.” It is a legitimate psychological challenge that affects a significant portion of the student body. Now, as progressive policies seek to redefine bathroom and locker rooms spaces, the fears of many students are being overlooked. Hopefully, Governor Youngkin’s directive will change that! 

Bathroom Anxiety is a Documented Health Issue

It is easy to dismiss restroom anxiety and avoidance as trivial. Psychology tells a different story. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes conditions like paruresis (“shy bladder syndrome”) and parcopresis (“shy bowel syndrome”) as legitimate Social Anxiety Disorders. The symptoms can be debilitating, disrupting a student’s academic performance and social integration. I’ve seen this firsthand; as a Principal, I watched a student on track to be valedictorian nearly fail out of school because her crippling bathroom anxiety led to chronic absenteeism.

This is not a niche problem. Three-quarters of U.S. school nurses report their students have significant bladder and bowel issues linked to school bathroom policies. A study of nearly 20,000 Danish schoolchildren found that one in four actively avoided school toilets. In Scotland, over 63% of secondary students admitted to complete bathroom avoidance.

The reasons are consistent: students report bathrooms are dirty, lack privacy, and feel unsafe. The notoriously poor design of most school facilities, with wide gaps in stall doors and flimsy locks, amplifies feelings of vulnerability.

In response, students engage in physically harmful coping mechanisms, primarily “holding it” for hours and intentionally dehydrating themselves. The medical consequences are increased risk of urinary tract infections, chronic constipation, and dehydration. Even mild dehydration can reduce a student’s memory and concentration by as much as 10%. It’s no surprise, then, that 84% of school nurses state that restroom-related health problems directly undermine learning, leading to constant nurse visits and lost class time.

A Magnified Burden for Girls and a Collision of Rights

While anxiety affects both sexes, adolescent girls bear a disproportionate burden. Studies show girls report higher rates of “holding” behaviors, which correlates with more urinary health complaints and school absences. The onset of menstruation adds another layer of intense anxiety. When a bathroom offers no real privacy and lacks proper sanitary provisions, it becomes a place of potential humiliation, leading many girls to miss class or stay home entirely.

This is where the current political debate becomes so damaging. Policies that open female bathrooms to students of the opposite biological sex collide directly with these well-documented anxieties. A UK-based study found that girls in schools with gender-neutral bathrooms reported heightened discomfort, were more likely to avoid the facilities while menstruating, and felt less safe.

The argument is not that transgender students are necessarily a threat. The issue is the fundamental violation of a deeply ingrained need for privacy, cleanliness and safety that is particularly acute for adolescent girls. The presence of a biological male can amplify the very fears — of being seen, heard, or judged — that already keep girls from focusing in their classrooms.

Yet, in a rush to “affirm” the identity of one group, school districts in Loudoun, Fairfax, and elsewhere have dismissed the legitimate psychological, safety, and privacy needs of another, much larger group, the well-researched clinical needs of students with bathroom anxiety.

A Practical Path Forward for Virginia

The solution isn’t found in forcing all students into uncomfortable gender-open bathrooms. Instead, Virginia’s Board of Health, as directed by Governor Youngkin, should issue regulations addressing bathroom anxiety by outlines the health risks, particularly for girls, of opening bathrooms and locker rooms to the opposite biological sex and giving common sense guidance for moving forward.

A simple regulation could require a “privacy for all” approach that keeps existing sex specific bathrooms but mandate that they are retrofitted with full-length stall doors and partitions. This change alone would alleviate most bathroom anxiety. Next, regulations could require schools to designate or build a few single-user, unisex restrooms to provide a private option for any student who needs it – whether they are transgender, have clinical bathroom anxiety, are disabled, or simply want increased privacy. Finally, the regulations should require that schools ensure every bathroom is clean, well-stocked, and has working stall locks. This common-sense framework respects privacy, acknowledges biology, and provides a compassionate alternative for all students.

Governor Youngkin is wise to seek regulations from the Virginians Board of Health to provide clarity on this issue. Will the candidates for governor support this medically necessary directive or continue to push policies that make the widespread crisis of student bathroom anxiety worse?

Anyone who has worked in a school knows that a student worried about the restroom is a student who isn’t learning. We must do better. Kudos to the Governor for taking action!

Derrick Max is the President & CEO of the Thomas Jefferson Institute for Public Policy and may be reached at dmax@thomasjeffersoninst.org..