Menstrual cup

A menstrual cup is a type of cup or barrier worn by a woman inside her vagina during menstruation to prevent the flow of blood from soiling her clothes. Unlike tampons, which are also worn internally during menstruation, the menstrual cup does not absorb the blood. Blood is contained within the cup until the woman goes to the toilet, removes the cup, and pours the contents into the lavatory.

There are two main kinds of menstrual cup currently available to buy 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. Examples of this type of cup are The Keeper, The DivaCup and The Mooncup. The other 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 to be used once only.

Menstrual cups are not widely used; the vast majority of women in Western countries use disposable cotton tampons or disposable sanitary napkins (UK: towels). A number of different companies have tried to sell menstrual cups during the 20th century; many of these products were withdrawn because they failed to gain widespread popularity. There are however a growing number of women who are looking for alternatives to brand-name tampons and disposable sanitary napkins (for health, ecological, economic or practical reasons). The main alternatives to these products are: ecologically friendly, non-bleached (and often non-GM cotton) tampons; washable sanitary napkins; natural sponges; and menstrual cups.

Usage

Menstrual cups are worn inside the vagina. They are not porous, absorbent or fibrous, so the cup will not scratch or dry the vaginal walls, disrupt the vagina's natural self-cleaning ability, become difficult to remove if worn during the lightest part of a woman's period or leave fibers behind. Nor have they been linked to toxic shock syndrome. All of the above are problems associated with using tampons. Menstrual cups should also help to prevent problems caused by wearing sanitary napkins: outbreaks of vaginal candidiasis (due to the warm, damp environment a sanitary napkin provides); and outbreaks of cystitis (which occur when feces on the napkin transfer E. coli to the urethra or vagina). Menstrual cups and can be worn at any time of the month; you can practice inserting and removing one when you are not menstruating, and you can insert it in anticipation of your period beginning to avoid being "caught out" while away from home.

They also require changing (or emptying) less frequently than tampons and sanitary napkins. The cups are designed to hold 1 ounce (30ml) of fluid, which is a third of the entire volume of blood lost in an average woman's period. They can be left in for up to 12 hours before emptying, so it should be possible for most women to empty the cup only two or three times a day; in this way they may avoid having to change or empty it in a public bathroom even if they work full time.

The two different kinds of cups are worn in different positions in the vagina. A diagram of the proper position for a tampon is also included for comparison.

diagram with labels]]

Bell-shaped cup	Diaphragm-style cup	Tampon
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 widthways and lengthways as it absorbs the flow. A tampon has a string stitched through it which hangs clear of the body for ease of removal.

Insertion and virginity

Inserting menstrual cups will take some practice, especially if the woman is not already used to using tampons, or is a virgin. For further details on how to insert the different kinds of cups, see below.

Menstrual cups (like tampons) can be used by virgins even from a girl's very first period. The more familiar a woman or girl is with her vagina, the easier using internal products will be. A good way for a girl to do this is to look at diagrams and descriptions of female genitalia and reproductive organs, and to become comfortable with her own body, perhaps using a hand-mirror.

Some (but not all) women are born with a hymen, a thin layer of skin over or around the vaginal entrance (it is perforated to allow menstrual blood out). If the hymen has not already been torn or stretched through exercise or sexual activity, it will be necessary to do so when you insert a menstrual cup for the first time. This may be a little painful, but it is only necessary to do this once. If a woman, for religious, moral, or cultural reasons, does not want to interfere with her hymen (if she has one) then neither tampons or menstrual cups are likely to be appropriate. By the modern definition of virginity, a heterosexual woman is a virgin until she has penetrative vaginal sex with a man.

If the vagina is dry, it may be difficult to insert a menstrual cup. Try dampening the cup with water. If this is not sufficient, try using a small amount of a lubricant that is suitable both for internal use and the material of the cup (i.e. do not use Vaseline, try a kind of lubricant which is suitable for use with condoms instead). The lubricant should be applied to the entrance to the vagina, rather than the cup itself. If too much is used, it may interfere with the ability of the cup to form a seal with the vaginal walls, which is necessary to avoid leaks.

All women who are trying a menstrual cup for the first time should remember to relax and take their time. It is not important to get it right first time, especially if you are practicing before your period, rather than during.

Are they sanitary?

Yes, with proper care, both kinds of menstrual cups are sanitary.

Since inserting and removing the cups requires that a woman pushes her fingers into her vagina, she must wash her hands with soap and hot water both before and after inserting or removing a menstrual cup. This is true of any internal product (tampons, sponges, contraceptive diaphragm, etc).

The reusable menstrual cups come with instructions on the proper method of cleaning them each time they are emptied and in between periods. If these are followed, the cups are perfectly safe to reuse for many years, and will not develop an odor. In general, they should be washed with soap and water each time they are emptied. If this is not possible, they may be rinsed in clean water, wiped with dry or damp toilet paper, or even rinsed in the woman's urine (urine is sterile as it leaves the body), and then washed properly at the next available opportunity. Some women have had the idea of rinsing their menstrual cups by holding them in the toilet as it flushes: this is completely unsanitary; if there is no wash basin or other source of clean water in the toilet cubicle, simply wipe the cup with dry toilet paper instead.

Cups made from silicone can be sterilized by placing them in boiling water for 5 minutes. Women who are prone to vaginal candidiasis may find this especially useful as the cup may reinfect them if it is only washed in soap and water.

It is worth nothing that although tampons (and increasingly sanitary napkins) may come individually wrapped, they are not sterilized; they are just bleached white.

Comparisons with tampons and sanitary napkins

Bell-shaped cup

Advantages

• they do not dry or scratch the vaginal walls or leave fibers behind (as tampons may)
• they do not interfere with the vagina's self-cleaning ability (as tampons do)
• they will not cause cystitis by transferring E-coli from the anus to the urethra or vagina (as sanitary napkins may)
• they will not cause the warm, damp conditions which candidiasis flourishes in (as sanitary napkins do)
• they have never been linked to toxic shock syndrome
• some women who use sanitary towels and menstrual cups report shorter and less painful periods than when they use tampons
• unlike tampons, they can be inserted at any time of the month (useful for practising) and can be inserted when a woman is expecting her period rather than having to wait for it to begin

• one reusable cup costs about the same as six-months' worth of tampons and sanitary napkins, but lasts for about 10 years
• 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
• they require little room in luggage even when packing for a trip lasting many months

• they cause none of the waste of disposable products (compare applicator tampons: a box, individual wrappers, the tampons each with a disposable applicator made of cardboard or plastic, multiply by 10 years)
• the manufacturing process may also be less harmful to the environment (no bleaches needed for example)
• as there is no waste to dispose of, other than the menstrual blood itself, they are ideal for using in situations (like hiking, etc) when a woman would otherwise have to bury her used menstrual products, or carry them with her for the duration of her journey

• women who think they may have unnaturally heavy periods can use menstrual cups as an accurate way to measure how much blood they lose each month

• like tampons, they can be worn during sports such as swimming
• they 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)

Disadvantages

• like tampons, they are worn internally which is something some women are not be comfortable with doing
• they require that the hymen (if present) is broken or stretched
• removal as well as insertion may take some practice, and will be messy if the wrong technique is used
• they are slightly wider than super-absorbency tampons, and so may be more difficult to insert at first

• they will leak unless correctly inserted
• they may be pushed slightly out of position (and leak unless repositioned) by an orgasm, a full bladder, a full rectum, or by defecating
• the cup is partly held in position by the muscles in the vagina, these may need to be strengthened if the cup has a tendency to slip too low
• like tampons, they must be removed before sexual intercourse

• they may have to be purchased online, as they are not as easy to find as tampons and sanitary napkins are in the western world
• they require a higher initial investment than tampons and sanitary towels (although many manufacturers offer a money back guarantee)
• they require some care (washing and correct storage) while tampons and sanitary napkins can simply be disposed with after use

Diaphragm-style cup

Advantages

• they do not dry or scratch the vaginal walls or leave fibers behind (as tampons may)
• they do not interfere with the vagina's self-cleaning ability (as tampons do)
• they will not cause cystitis by transferring E-coli from the anus to the urethra or vagina (as sanitary napkins may)
• they will not cause the warm, damp conditions which candidiasis flourishes in (as sanitary napkins do)
• they have never been linked to toxic shock syndrome
• some women who use sanitary towels and menstrual cups report shorter and less painful periods than when they use tampons
• unlike tampons, they can be inserted at any time of the month (useful for practising) and can be inserted when a woman is expecting her period rather than having to wait for it to begin

• like tampons, they can be worn during sports such as swimming
• they 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)

• unlike tampons, they can be worn during sexual intercourse (but they are not a contraceptive devise)

Disadvantages

• they cause more non-biodegradable waste than tampons or sanitary towels
• they can never be disposed with by flushing down the toilet, unlike tampons

• like tampons, they are worn internally which is something some women are not be comfortable with doing
• they require that the hymen (if present) is broken or stretched
• removal as well as insertion may take some practice, and will be messy if the wrong technique is used

• they are less common and easily available than tampons and sanitary napkins, but they must be bought just as frequently

Insertion, removal and cleaning

Bell-shaped cups

This style of cup is sold in two sizes, one designed for women who have never given birth, the other for older women, or just for women who have given birth (through the vagina) depending on the brand. The difference in size is slight (the larger cups are about 1/8th inch or 3mm wider in diameter) but it is important to choose the correct size for the most comfortable fit.

These cups are about 1.5 inches (3.8cm) 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. Wash the cup and your 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). Sit on the toilet, squat or stand in a comfortable position. 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 you can 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 (aiming for the small of the back, to give you an idea of the orientation of the vagina). To insure 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 your 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 that tab is uncomfortable. It may work its way higher in the vagina during the day; this is perfectly natural. If you are not confident that you have positioned it properly, it is a good idea to wear sanitary napkins as well until you have perfected the technique.

Since these cups sit so 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 you will see from the 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 you need to relieve yourself while wearing the cup, do so rather than waiting until later. The muscles involved in defecating are also capable of disturbing the cup slightly. You should check that the cup is still properly positioned after defecation, especially if you were constipated or had to strain (but first, wash your hands!).

The cup is held in position by the seal formed with the walls of the vagina, and from pressure from the muscles in the vagina. If the cup seems to slip down check that you are inserting it correctly and forming a seal. If this is not the problem then you might need to improve the strength of the vaginal muscles through exercises like Kegels.

The seal that hold the cup in place and prevents leaks may make the cup painful to remove if you use 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 you cannot reach the tab when you reach into your vagina do not panic! Try squatting (to shorten the vagina) and push the cup down with your internal muscles. Then 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 lavatory. If you have no access to soap and clean water to wash the cup, then wiping it with dampened or dry toilet paper will be enough, but you should wash it properly at the next opportunity. Ideally, the cup should be washed with hot water and soap each time it is emptied. The cups made from silicone can be sterilised between periods in boiling water, but this would damage the rubber of the latex cups. See the manufacturer's instructions for more details. The cup should not smell. If it does develop an odor, this can be dealt with by soaking it in vinegar at the end of your period, or storing it in bicarbonate of soda between periods. Menstrual cups, when used properly, are perfectly sanitary.

Diaphragm-style cups

Instead has a diameter of approximately 3 inches (7.5cm). 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, you should first wash your hands with soap and hot water. Choose somewhere you feel relaxed and will not be disturbed. Sit on the toilet, squat, or stand in any position you find comfortable. Take an Instead cup out of its wrapper. Squeeze it into a slim shape, spread your labia and locate the entrance to your vagina with one hand, and gently insert the cup into your vagina with the other. Remember that the vagina is tilted backwards, so it might help to image you are aiming for the small of your back. Instead will spring open when you release it. Then push it up your vagina, until you can hook it in position over the pubic bone (this is where it may help to be squatting, as it shortens the vagina). Last of all, wash your hands again.

Instead can be left in place for several hours. If you are not confident that you have positioned it properly, it is a good idea to wear sanitary napkins as well until you have perfected 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, you have to reach up into your vagina (so remember to wash your hands before you begin) and use a finger to unhook it from behind the pubic bone. Remember that it will be full of blood, so to avoid messy spills, try to keep it as upright as possible. It is a good idea to practice this at home the first few times, rather than doing it in a public toilet. Once you have successfully removed Instead, tip the contents into the lavatory, wrap the cup in tissue and dispose of it in the trashcan or bin provided for sanitary waste. If one is not available, you must wrap it well and take it away with you. Do not flush Instead down the toilet; it will cause a major blockage in the plumbing. If necessary, insert another Instead cup, then wash your hands.

Related articles

• menstrual cycle, endometrium
• vagina, uterus, cervix, vulva
• Kegel exercises
• tampons, sanitary napkins (UK: towels), sponge
• latex, silicone, cotton
• hygiene, toxic shock syndrome, candidiasis, cystitis, E. coli
• sanitation, toilet, bidet, toilet paper
• pollution, environmental movement, ecology movement
• birth control

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
• Go Ask Alice! - The Ins and Outs of Menstrual Cups
• Official company websites:
  • The DivaCup
  • The Keeper or a more detailed site
  • Instead
  • The Mooncup