Menstrual cup
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A menstrual cup is a type of cup or barrier worn inside the vagina during menstruation to collect menstrual fluid. Unlike more common methods, such as tampons and pads, the cup neither absorbs the flow nor catches it outside the body.
There are two main kinds of menstrual cup currently available for sale in countries like the USA, Canada and UK (or over the internet). The most common kind is a bell-shaped cup made of rubber (latex) or silicone. It is reusable and designed to last for about 10 years, with proper care. Brand names of this type of cup include The Keeper, The DivaCup, Lunette and The Mooncup. The second kind of menstrual cup is currently only manufactured by one company and is called Instead. It resembles the contraceptive diaphragm (although it is not a contraceptive device ) and is disposable, designed for one use only.
Menstrual cups are not commonly used; the vast majority of women in Western countries use disposable tampons or disposable sanitary napkins (also known as towels or pads). A number of different companies have attempted to promote the use of menstrual cups during the 20th century; many of these products were withdrawn when they failed to gain widespread popularity. There are currently a growing number of women who are looking for alternatives to brand-name tampons and disposable sanitary napkins (for health, ecological, economic or other reasons). Other popular alternatives to these products include: non-bleached (and often non-GM cotton) or organic tampons; washable cloth sanitary napkins; natural sponges; and menstrual cups.
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[edit] Usage
[edit] Preparation and insertion
Menstrual cups are worn inside the vagina, so the user must be comfortable with touching the vulva, vaginally inserting fingers, and coming into contact with menstrual blood. Prior to insertion, the user should wash her hands. A reusable cup should be clean from previous use, and both types need to be flattened and folded. The disposable cup is usually just prepared by flattening the rim against itself, but reusable cups are more flexible and a variety of forms (referred to among users by names such as "punch-down fold" and "7-fold") exist. The user may apply lubricant to ease insertion, though the presence of menstrual fluid in the vagina is usually sufficient.
The disposable cup is inserted into the vagina and pushed into place near the cervix and behind the pubic bone, where the internal structure of the body should keep it. The bell-shaped cup is inserted until the "body" and stem are completely inside, then held by the lower point or stem and turned; this opens the cup and creates a gentle seal between the rim and the inner vaginal walls. The reusable cup will situate itself and need not be placed as high as the cervix nor tucked into a specific spot.
The cup can be used at any time during the cycle, such as when practice is needed, when menstruation has not yet begun but is anticipated, or when other vaginal flow (such as cervical mucus) is heavy.
[edit] Removal, cleaning, and care
Removal should occur as needed, but the cup should never be left in longer than the manufacturer recommends (usually 12 hours) without the short break of removal. Bearing down with the muscles will help bring the cup within reach. The Instead design can be pulled out by a fingertip hooked into the rim. The lower part of the bell-shaped cup usually features "grips" or slightly raised ridges as well as a stem to assist removal. A disposable cup should be discarded and replaced, but the reusable cups need only be emptied, cleaned (preferably with hot water and gentle soap), and reinserted.
Menstrual cups require relatively less attention and maintenance by the user than more common methods. The reusable cups are designed to hold roughly 30 mL (1 ounce) of fluid, which is a third of the entire volume of blood lost in an average woman's period. Additionally, the maximum recommended time between removals is 12 hours, making it possible for most users to empty the cup only two or three times a day. This allows the user to complete the usual several consecutive hours of work, school, or sleep without interruption. However, the cup may leak unexpectedly when filled to capacity or moved from its position. When it cannot be avoided, tending to the cup in public restrooms is completely possible; it can be cleaned with a wet paper towel brought into the stall, or with a few sheets of toilet paper.
At the end of menstruation, the reusable cup should be well-cleaned and carefully stored. Since silicone versions can tolerate high temperatures, very hot water is a popular option: a few minutes of stovetop boiling or even a run through the dishwasher provide sufficient sterilization. However, hand-washing in mild soap and hot water is the only absolute necessity. After drying, the cup must be placed in storage that allows for air flow; for example, the DivaCup comes with its own drawstring cotton bag. When menstruation begins again, the cup should be inspected for any damage, then washed in warm water just before being used. Some discoloration can set in over time, though this does not affect the cup's performance. Proper care will prolong the life of the cup, allowing several years of use. The generally quoted lifespan is 10 years, though the FDA has not approved such a figure.
[edit] Usage variations
Since each vagina is unique, the specifics of usage differ from person to person. Users of bell-shaped cups can usually choose from two sizes, one meant for nulliparous females under a certain age, and the other for those who have given birth and/or are older. A female who starts off with the smaller cup and then gives birth usually has to upgrade to the next size, a situation sometimes covered by return policies. In some cases, being a certain age or whether she has given birth vaginally have little to do with the cup size that is right for an individual.
After purchase and initial experimentation, the user may find that trimming part or all of the stem makes for more comfortable wearing, or that the stem is best left intact for ease of removal. Additionally, the user will determine which insertion fold works best for her personal needs.
Frequency and schedule of emptying varies according to the length and heaviness of her period, and in some cases, the user finds she needs a backup method (such as a pad or an extra pair of underwear) in case of leakage. Based on these variables, which can make cup usage a more involved process than that of more popular methods, most manufacturers offer a return policy that allows for several months of trial and experimentation (and returned cups are not resold).
| Bell-shaped cup | Diaphragm-style cup | Tampon |
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| The bell-shaped cup is worn low in the vagina. It may work its way higher during the day, which is perfectly natural, but it is not designed to be placed over the cervix. Every bell-shaped cup has a tab at the bottom to make it easier to remove. | Instead is inserted and worn in the same way as a contraceptive diaphragm. It sits over the cervix, and is kept in position by pressure from the pubic bone. To remove, hook a finger over the rim and pull it down past the pubic bone. | A tampon should be inserted up next to the cervix; this is the most comfortable position as it leaves plenty of room for the tampon to expand both widthwise and lengthwise as it absorbs the flow. A tampon has a string stitched through it which hangs clear of the body for ease of removal. |
[edit] Safety
With proper care, all kinds of menstrual cups are sanitary and statistically safer to use than tampons. They are regulated by the Food and Drug Administration (FDA) in the United States, and have been used by a number of women for decades. No reported cases of toxic shock syndrome have been attributed to the use of menstrual cups, nor have any other health risks. Note, however, that due to varying popularity, numbers of cases are not directly comparable between different products, and no option is guaranteed to be perfectly safe.
Since inserting and removing the cups requires inserting fingers into the vagina, it is best to wash one's hands with soap and hot water both before and after inserting or removing a menstrual cup, as one should when using other internal products (sponges, contraceptive diaphragms, etc.).
Reusable menstrual cups usually come with instructions on care and storage. If these are followed, they can be reused for many years. In general, they should only be washed with soap and water at the end of the woman's cycle before storage. While users may choose to rinse the cup after each disposal of menstrual fluid, it is not necessary to do so.
Cups made from silicone can be sterilized by placing them in boiling water for 5 minutes. This is especially useful for women prone to vaginal candidiasis; the cup may otherwise induce a new infection.
It is worth noting that although tampons (and increasingly sanitary napkins) usually come individually wrapped and are exposed to bleach, they are not sterile. This bleaching process adds dioxin, creating health concerns. Commercial sanitary products do not require bleaching for safety, and although this practice may create environmental and health problems, consumers generally prefer to buy ivory-white products[citation needed].
[edit] Comparisons with tampons and sanitary napkins
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Many of the following factors are subjective.
[edit] General
Advantages
- Like tampons, menstrual cups can be worn during sports such as swimming.
- Some women who use sanitary towels and menstrual cups report shorter and less painful periods than when they use tampons.
- Menstrual cups can be worn for as long as twelve hours at a time before emptying (the maximum time manufacturers usually recommend tampons and sanitary napkins be worn is eight hours).
- Menstrual cups do not dry or scratch the vaginal walls or leave fibers behind (as tampons may).
- Menstrual cups do not interfere with the vagina's self-cleaning ability (as tampons do).
- Menstrual cups have never been linked to toxic shock syndrome (see above).
- As long as the area and hands are kept clean, menstrual cups do not cause cystitis by transferring E. coli from the anus to the urethra or vagina (as sanitary napkins may).
- Menstrual cups will not cause the warm, damp conditions around the vulva in which candidiasis or other bacterial growth can flourish (as sanitary napkins do).
- Unlike tampons, menstrual cups can be inserted at any time of the month (useful for practicing) and can be inserted when a woman is expecting her period rather than having to wait for it to begin.
- Menstrual cups have never contained harmful substances such as dioxin, bleach or other chemicals used in the manufacture of commercial tampons.
Disadvantages
- Like tampons, menstrual cups are worn internally, something with which some women are not comfortable.
- Removal as well as insertion may take some practice, and can be messy if the inappropriate technique is used.
- Requires access to soap and running water for washing hands before and after removal and insertion.
[edit] Bell-shaped cups
Advantages
- They pose little or no risk of toxic shock syndrome.
- They catch fluid rather than absorb it, leaving the vagina's naturally moist environment intact.
- As there is no waste to dispose of other than the menstrual blood itself, they are ideal for using in situations (eg. hiking or camping) when a woman would otherwise have to bury her used menstrual products, or carry them with her for the duration of her journey.
- One reusable cup costs about the same as six-months' worth of tampons and sanitary napkins, but lasts for about 10 years, preventing the disposal of hundreds of conventional menstrual products.
- Since the cup only needs replacing once every 10 years, it is useful for women living or travelling in countries where tampons and sanitary napkins are hard to find or expensive.
- The cup's manufacturing process may be less harmful to the environment; it is not subjected to the bleaching process and uses no wood pulp, for example.
- Much less waste is created versus disposable products. For example, compare them to applicator tampons, which require a box, individual wrappers, and cardboard or plastic applicators.
- They require little room in luggage even when packing for a trip lasting many months.
- They allow a woman to closely track how heavy her flow is, by visual inspection of the contents of the cup.
Disadvantages
- Like tampons, they need to be removed before any penetrative intercourse.
- They may not work for all women because of variations in body shape from person to person.
- The cup may slip too low if muscles in the vagina are too weak.
- They may be pushed slightly out of position, and therefore leak, by an orgasm, a full bladder, a full rectum, or by defecating.
- They may have to be purchased online, as cups are not as easy to find in the West as commercial tampons and sanitary napkins.
- They require a higher initial investment than commercial/organic tampons and sanitary napkins; however, the long-term savings are considerable. Moreover, many manufacturers, such as The Keeper and The DivaCup, offer a money back guarantee.
- They require some care (washing and correct storage, for example), while commercial/organic tampons and sanitary napkins can simply be disposed of after use.
- They may leak if not correctly inserted.
[edit] Diaphragm-style cups
Advantages
- Unlike tampons, they can be worn during sexual intercourse (though menstrual cups are not a contraceptive device; also, contraceptive diaphragms may be used as re-usable menstrual cups)
Disadvantages
- They cause more non-biodegradable waste than tampons or sanitary napkins.
- They can be costly (although can be reused a few times).
- Environmental issues are a concern due to waste and materials used.
- Like tampons and sanitary napkins, they have to be disposed of correctly in an appropriate receptacle for waste.
- They can be more difficult to insert correctly than the bell-shaped cups.
- They can be messier and more difficult to remove than the bell-shaped cups.
[edit] Insertion, removal and cleaning
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[edit] Hymen Concerns
Inserting menstrual cups can take some practice, especially if the woman is not already used to using tampons or has not had penetrative sex. Menstrual cups can be used from the beginning of one's first menstrual cycle, regardless of whether or not the woman has had penetrative sex or not. Insertion is easier upon repeated usage and familiarity with the vaginal area. Relaxation and practice prior to a menstruation cycle is encouraged.
Many women are born with a hymen, a thin layer of skin over or around the vaginal entrance, which is naturally perforated to allow menstrual blood to leak. If the hymen has not already been torn (which can occur during horseback riding, sports, vaginal intercourse or insertion of foreign objects), she may not be able to insert the cup.
If the vagina is dry, insertion may be difficult; this can be alleviated by dampening the cup with water or lubricant. Oil or petroleum-based products such as Vaseline will degrade latex cups; a water-based lubricant such as K-Y Jelly is preferred. The lubricant should be applied to the entrance of the vagina, rather than the cup itself. Too much may interfere with the ability of the cup to form a seal with the vaginal walls, causing leaks.
[edit] Bell-shaped cups
The different brands of bell-shaped cups all vary slightly in their design and size. The most significant difference is between The Keeper, which is made of latex rubber, and The DivaCup and The Mooncup which are both made of medical grade silicone. Women with an allergy or sensitivity to latex should obviously not use The Keeper. Another difference is that The Keeper comes with a very long tab allowing you to customize it for a higher or lower placement. If the tab length creates any discomfort it can be trimmed, as recommended by the manufacturer.
Depending on the brand, this style of cup is sold in two sizes, one designed for women who have never given birth, the other for women who have given birth (through the vagina). The difference in size is slight (the larger cups are about 1/8th inch or 3 mm wider in diameter) but it is important to choose the correct size for the most comfortable fit.
These cups are about 1.5 inches (3.8 cm) in diameter, and up to 2 inches long (from the rim to the base, not including the tab). To insert one into the vagina, it is squeezed and rolled up to make the slimmest shape possible. It should not be much wider than a super-absorbency tampon, so women who are accustomed to inserting tampons should not find this too difficult.
To insert a cup for the first time, a woman should choose a time and place where she will not be disturbed and will be able to relax. Remember that since menstrual cups are not absorbent they can be inserted at any time in the menstrual cycle, which is ideal for women who wish to practice before using it for the first time during their period. They should start by washing the cup and their hands with water and soap suitable for the cup (the latex cup needs to be treated more carefully in this respect in order to preserve the rubber for as many years as possible). Suitable positions can be siting on the toilet, squatting or standing comfortably. Fold the cup in on itself, as in the diagram, until it is as slim as possible. Hold on to it with a finger and thumb as low down the cup as possible while keeping it rolled up. With the other hand, part the labia, find the entrance to the vagina, and guide the cup up and backwards. Remember that the vagina is tilted backwards, so it might help to imagine aiming for the small of the back. To ensure that the cup unfurls correctly (so the entire rim is making contact with the vaginal walls), gently rotate the cup by twisting the tab. To check that it has fully opened, slide a finger up next to the cup and feel all the way around it. The cup should be seated low in the vagina, but not so low that the tab is uncomfortable. It may work its way higher in the vagina during the day; this is perfectly natural. If a woman is not confident that she has positioned it properly, she can wear sanitary napkins in addition to the cup, until she has perfected the technique.
Since these cups sit low in the vagina, it is not possible to have vaginal sex with one inserted. There is no reason why a woman cannot have an orgasm while wearing a cup; however, it would be wise to check that the cup is still correctly positioned after orgasm. As can be seen in the diagram of a menstrual cup in the vagina shown above, both the bladder and rectum are close to the part of the vagina the cup should sit in. It is possible for a full bladder or rectum to push against the cup and shift it out of its proper position; if a woman needs to relieve herself while wearing the cup, she should do so rather than waiting until later. The muscles involved in defecating are also capable of disturbing the cup somewhat. She should check that the cup is still properly positioned after defecation, especially if she was constipated or had to strain (remembering to wash her hands first).
The cup is held in position by the seal formed with the walls of the vagina, and by pressure from the muscles in the vagina. If the cup seems to slip down, check that it was inserted correctly and that it is forming a seal. If this is not the problem then the user might need to improve the strength of her pubococcygeus muscle through exercises such as Kegels.
The seal that holds the cup in place and prevents leaks may make the cup painful to remove if using the wrong technique. Most cups have pin-sized holes under the rim to make it easier to break the seal. If simply tugging on the tab is not sufficient, then slip one finger up the side of the cup and break the seal that way. If the woman cannot reach the tab when she reaches into her vagina there is no need to panic! She can try squatting (to shorten the vagina) and pushing the cup down with her internal muscles. Grasp the bottom of the cup and pull it gently to remove, remembering to keep it as upright as possible to avoid spilling the contents.
This type of cup is reusable. First, tip the contents into the toilet. If there is no access to soap and clean water to wash the cup, then wiping it with dampened or dry toilet paper will be enough, but it should be properly washed at the next opportunity. Ideally, the cup should be washed with hot water and soap each time that it is emptied. The cups made from silicone can be sterilised between periods in boiling water, but this should not be done with the latex style cup; boiling will damage it. See the manufacturer's instructions for more details. The cup should not smell. If it does develop an odor, this can be remedied by soaking it in vinegar after each period, or storing it in baking soda between periods. Menstrual cups, when used properly, are perfectly sanitary (see also safety, above).
[edit] Diaphragm-style cups
Instead has a diameter of approximately 3 inches (7.5 cm). It has a sprung outer ring, so that it can be squeezed into a slim shape for ease of insertion. It springs back into its correct form once it is inside the vagina.
To insert an Instead cup, first the woman should wash her hands with soap and hot water. She should choose somewhere she feels relaxed and will not be disturbed. Then she should sit on the toilet, squat, or stand in any position she finds comfortable. Next, she should take the Instead cup out of its wrapper, squeeze it into a slim shape, spread her labia and locate the entrance to her vagina with one hand, and gently insert the cup into her vagina with the other. Remember that the vagina is tilted backwards, so it might help to imagine aiming for the small of the back. Instead will spring open when released. Then the woman should push it up her vagina, until she can hook it in position over the pubic bone (this is where it may help to squat, as it shortens the vagina). Finally, she should wash her hands again.
Instead can be left in place for several hours. If a woman is not confident that she has positioned it properly, she can wear sanitary napkins in addition to the cup until perfecting the technique.
Since Instead is positioned high in the vagina, it should be possible to have vaginal sexual intercourse with it in place. But, although it looks like a contraceptive diaphragm, Instead is not a contraceptive device and should not be used as such.
To remove Instead, a woman has to reach up into her vagina (remembering to wash her hands before she begins) and use a finger to unhook it from behind the pubic bone. Remembering that it will be full of blood, she should try to keep it as upright as possible, to avoid a spill. It is a good idea to practice this at home the first few times, rather than doing it in a public toilet. Once she has successfully removed Instead, she should tip the contents into the toilet, wrap the cup in tissue and dispose of it in the trashcan or bin provided for sanitary waste. If one is not available, she must wrap it well and take it away with her. (It is important not to flush Instead down the toilet; it will cause a major blockage in the plumbing.) If necessary, she should insert another Instead cup, then wash her hands.
A small percentage of women will be unable to properly insert and use Instead due to the shape or size of their vaginal tracts; however, because the vagina is shaped by elastic (flexible) tissue, this problem is fairly uncommon.
[edit] See also
- menstrual cycle, endometrium
- Kegel exercises
- tampons, sanitary napkins (UK: towels), sponge
- hygiene, toxic shock syndrome, candidiasis, cystitis, E. coli
- pollution, environmental movement, ecology movement
[edit] External links
- The History of Menstrual Cups from the Museum of Menstruation and Women's Health - including many photographs of menstrual cups available today, and those from earlier in the 20th century, and comments from women who have worn them
- Tampaction - the Tampaction campaign of the Student Environmental Action Coalition
- Go Ask Alice! - The Ins and Outs of Menstrual Cups
- Menstruation Products: A Compare-And-Contrast - explaining how to use tampons, pads, and menstrual cups
- A wiki FAQ page about menstrual cups
- Livejournal menstrual_cups community
- MoonKeeperDivas Yahoo! group
- Instructions on several ways to fold a menstrual cup before insertion, with pictures
