Please enjoy the original writing, Christian travel journal, and photography by a hapa haole named Gail Rhea.

Original Writing & Photography

by Gail Rhea

 

 

 

THE NEWBIE'S GUIDE TO MENSTRUAL CUPS

 

For Women Only:

Have you ever wanted to be free of the monthly chore and expense of stocking up on feminine hygiene products? Have you ever wished for a better way than the pads and tampons most stores have to offer? Say, "Yes!" and read on.

I don't recall exactly where or how it happened, but at the beginning of March 2007, I ran across the term "menstrual cup" at some website not particularly related to women's concerns. Maybe it was about camping. Anyway, curious about what it might be and with Google being such a good friend, I did some research and found that it's a device that many women rave about for being the perfect solution to their monthly menses.

After more research, I decided to get one for myself and enthused about it, put this out on my Information Desk in case you haven't heard and would like to consider this option for yourself.

In brief, a menstrual cup is a reusable cup that a woman inserts to catch her menstrual flow that's extremely cost effective and a boon to female travelers and others who find the sanitary napkin/tampon experience to be lacking in convenience.

Although there is a learning curve that may be as brief as learning to use a tampon or as long as three or more cycles to really get the hang of it, it's well worth the time and effort even if you have to switch to another size or brand.

The major con against the menstrual cup is the Ickiness Factor. Yes, a woman needs to be comfortable with her body and with the idea of using a cup, but since it doesn't have to be inserted as far as a tampon and one comes into contact with no more blood than with tampons, the Ickiness Factor isn't that much unless a woman is so squeamish that she prefers having to deal with sanitary napkins/tampons. After all, blood and tissue provide a gentle, nurturing cocoon for a baby to grow until it's ready to enter the world. How can anything so good for a precious new baby possibly be bad? All that's needed to clean your fingers is the same as with using a tampon - soap and water and maybe a quick going-over with a nail brush. 

A secondary con is if your grip is impaired due to a condition such as Carpal Tunnel Syndrome or arthritis. Depending on the degree of impairment, you may not always be able to use a cup or may not be able to use one at all.

Pros for the menstrual cup:

* It eliminates having to find, buy, pack or store, and dispose of tampons and sanitary napkins.

* It eliminates major leakage and odor resulting in less mess and self-consciousness than with using tampons and napkins. A cup user experiences a neater menses overall. Since the leakage associated with a properly sealed cup is so minor it can be dealt with a panty liner if the cup is emptied before it fills, stained clothing and sheets are items of the past.

* The savings over time is money that can be put toward traveling and other expenditures far more appealing than disposable feminine hygiene products. Although the initial cost is high compared to a month's worth of disposables, if the expense is amortized over several months, it's free for the next 5-10 years, maybe longer depending on how well taken care of it is.

* For all except those having extremely heavy flows, it lengthens the amount of time between having to attend to their periods. For example, a heavy flow requiring a super plus tampon and pad for leaks to be changed every 1-2 hours compares to 3-4 hours using a cup. A typical light to medium flow with a cup can go up to the 12 hours in accordance with manufacturers' instructions.

* There's no risk of TSS.

* There's the ability to insert the day of expected menses, before the actual onset, and not get caught at an inconvenient time like when using tampons.

* Using one eliminates the discomfort/pain associated with removing a tampon while it's partially dry.

* Using one eliminates the drying, scratching result of tampons and preserves the naturally healthy vaginal environment.

* The cup is environmentally-friendly; reduces landfill waste.

* Using one may decrease/eliminate irritations, infections, and inflammations typically associated with napkins/tampons.

* Using one may decrease/eliminate cramps.


Basic steps including a few tips:

1. Wash hands with soap and water.

2. Rinse cup and fold until the opening is as narrow as a regular or super tampon.

3. Find a suitable position, insert, and release slowly to avoid a startling SPROING! effect when it opens. It doesn't have to be inserted all the way at this point, but it does need to be in far enough for the rim to open inside you. If necessary, turning the cup will help it open. If you use a Lunette which has a flat stem, it's better to insert or turn it so that the broad sides of the stem are easy to grasp. 

4. Make sure there's a seal by using a fingertip to check for dents in the base which are a sign of a bad opening and no seal. After it's okay, push the base then stem while doing Kegels until the base is inside. Press against a side of the base to break the seal a couple of times during this brief process because doing so helps keep the cup lower for removal later. A bit of another prod with a fingertip on the end of the stem and a few Kegels later, the stem is drawn up completely inside where it's supposed to be. 

The entire process is short and easy.

5. Forget about it for up to 12 hours later, until it's time for Step 6. You'll learn the proper time interval for you through experience.

6. Wash hands with soap and water before removing the cup. Sit on the toilet, squat in the shower, or find another suitable position. Relaxing, gravity, and bearing down as if having a bowel movement will lower the stem and the bottom of the cup so you can grasp it. Don't bother trying to pull on the stem when it exits your body to remove the cup - you'll only experience suction because you need to break the seal before you can pull it out. When it's within reach, grasp the base of the cup - several cups have ridge lines at the base to aid your grip - and pinch the sides to break the seal. 

If you want to facilitate removal, you may insert a finger between the cup and vaginal wall to press the cup inwards to break the seal earlier.

After the seal is broken, you may gently pull the cup the rest of the way out. By keeping it pinched to make it narrow and withdrawing one end of the rim before the other, removal will be easier because you won't be trying to get the entire rim out all at once at its widest expansion. I recommend using a square of toilet tissue to grasp the cup's base, but you may use your bare fingers, if you want. The tissue eliminates any slipperiness that may exist due to natural secretions other than the menstrual flow which remains inside the cup so the cup won't be inclined to slip from your grasp and drop into the toilet or fall elsewhere, like on a white bath mat, when you pull it out like it might when you use bare fingers. If you remove it while sitting on the toilet, tipping the cup more will empty it directly into the bowl in a single motion.

Some women prefer other techniques such as folding the cup back into a C fold for removal. 

7. Wash, rinse, or wipe the cup, and reinsert. If any holes are clogged, they're easily cleared by filling the cup with water, pressing a palm over the top, inverting, and squeezing the cup to force the water out through the holes.

Some women perform Steps 1-4 and 6-7 while in the shower for convenience. Others, using public restrooms, employ different methods such as taking both a wet and a dry paper towel into the stall with them to wipe the cup before reinsertion.

8. At the end of menses, sterilize according to the manufacturer's directions. Usually, a silicone cup is to be sterilized by boiling in water for 2-5 minutes, but some women use a cleaner such as (rubbing) isopropyl alcohol. Frankly, isopropyl alcohol is a disinfectant, not a sterilizer but whatever you do, don't use hydrogen peroxide because it's not good for silicone. While some question the efficacy of this step since any contact afterwards compromises sterility, the purpose is more likely for the destruction of any infectious bacteria that might have been deposited onto the cup during menses.

9. Let the cup air dry, then store according to manufacturer's instructions, usually in the attractive drawstring bag provided. 


The Cups at the Top of My List (are made of medical grade silicone):

1. Lunette (silicone) - made in Finland (http://www.lunetteinfo.com - VAT is not charged for U.S. residents)

2. Mooncup UK (silicone) - made in the United Kingdom
(http://www.mooncup.co.uk), not available for delivery to U.S. addresses since January 2009 because Moon Cup US (below) trademarked the name in the U.S. for its copycat product.


While both products have excellent reputations, I chose the Lunette over the Mooncup UK because:

1. The difference in ease of insertion and removal isn't significant.

2. The Lunette is smoother, easier to clean.

3. The Lunette has larger holes making them easier to clean and easier to break the seal for removal.

4. The solid, flexible, flat stem with ridges compared to the hollow, stiffer, mostly smooth, cylindrical stem of the Mooncup UK makes it easier to grasp and less likely to poke and irritate because it bends and moves with you which is why some women end up cutting the stem off the Mooncup UK and others entirely. Also, a hollow stem is prone to getting dirty inside after the plug's gone, either from falling out or from the stem being cut, and is harder to clean.


The Cups at the Bottom of My List and Why:

1. DivaCup (silicone) - made in Canada, it's also available in some U.S. stores (http://www.divacup.com). Although the DivaCup is available in the U.S. and comes with a one-year full-money-back guarantee, I'm reluctant to recommend it because it has the highest number of reports about difficulty during the learning phase with insertion and sealing and with removal because the seal is the most difficult to break. The reports about difficulty with removing the DivaCup include PAIN because of difficulty breaking the seal and I'm not into pain. Among the silicone cups, the Mooncup UK has been around longer and those who switched from the DivaCup to the Mooncup UK are thrilled that they did. While I chose to sidestep the issue by buying a Lunette from the get-go, if you want, you can try the DivaCup, and if you like it, keep it. If you don't like it, you can return it under their guarantee, switch to another size if you want, or get your money back and buy another brand.

2. The Keeper (rubber/latex) - made in the U.S. (http://thekeeper.com). Although used by the women of Biosphere 2, I don't recommend The Keeper because it's made of rubber (latex). If one isn't already allergic to latex, it's possible for an intolerance to develop as it did for the first time in my entire life at my dentist's office in Honolulu for a routine cleaning in 2001. I firmly believe that the vagina is the last place to have an allergic reaction especially while a woman is on a trip and having her period.

3. Moon Cup (silicone) - made in the U.S. by the same company that makes The Keeper (http://www.mooncupsandkeepers.com). I don't recommend the Moon Cup (USA) that came out in the fall of 2006 because I suspect the company of trying to cash in on the popularity of the Mooncup UK; naming their silicone version so similarly to the earlier product is too obvious for me to ignore. I don't like supporting chicanery especially when I know about and was able to get the original product just as easily (in 2007 when I was shopping for a menstrual cup). 

4
. Another option is the disposable, diaphragm-styled INSTEAD® Softcup® (polyethylene) (http://www.softcup.com). There's an increased Ickiness Factor, higher cost over time, reports of leakage and difficulty inserting and removing. As far as I'm concerned, its being disposable puts it into the same category as the typical disposable feminine hygiene products with similar problems for female travelers.


The following are provided for your consideration.

Cup comparisons (text & photos):
http://community.livejournal.com/menstrual_cups/648061.html 

http://www.labyrinth.net.au/~obsidian/clothpads/Cups.html - discusses more cups than I have here


Folding techniques (text & photos):
http://community.livejournal.com/menstrual_cups/453392.html
 


H
elp with Insertion:
http://community.livejournal.com/menstrual_cups/tag/insertion
 


H
elp with Removal:
http://community.livejournal.com/menstrual_cups/tag/removal
 


More information and tips:
http://www.livejournal.com/tools/memories.bml?user=menstrual_cups 

http://menstrualcups.org

http://www.answers.com/topic/menstrual-cup.


There are other forums and discussion groups on this topic such as on Yahoo. Google is your friend if you want to research this more before trying one out for yourself.

One issue I want to address before concluding this page is that there are websites taking an FDA response to a petition out of context. Misinterpreting the words, "physiologically plausible" to mean that the FDA noted the association between the association of endometriosis with the use of menstrual cups to support their desire to have manufacturer's change the labeling on the packaging of menstrual cups, they purport that the FDA recognizes a likely increased risk of endometriosis associated with menstrual cups that manufacturers are deliberately concealing from buyers and are liable by not providing appropriate warning labels even while admitting that the cause of the disease is unknown. 

In fact, the FDA's response states (Bold emphasis added):

"While we agree that endometriosis is an important women's health issue, FDA does not believe that there are sufficient grounds to 'withdraw the approval' of these devices, as you request.

We agree with the assertion in your petition that it is physiologically plausible that use (and misuse) of the menstrual cup might increase the risk of endometriosis by creating an obstruction to the flow of menstrual effluent (blood and cells) out of the uterus, re-directing menstrual effluent into the peritoneal cavity via the fallopian tubes (retrograde menstruation). However, you have not submitted and we have not identified sufficient evidence to show this is more than theoretical.

...Only one report suggests a possible association between a menstrual cup and endometriosis (and adenomyosis). This is the same report you cite in your Citizen Petition.

...This single case report does not constitute an adequate basis for FDA to issue an order to stop distribution of this product or withdraw approval. Additional information might warrant a review of menstrual cup labeling to determine whether menstrual cup wear time should be re-examined. However, in the absence of results from a well-designed clinical study, it would be inappropriate to make any statements about whether menstrual cups (or other menstrual fluid collecting devices) increase the risk of either endometriosis or adenomyosis."

As you can see, the FDA response points out that the petition is based on only one case report that suggests a possible connection and that's not enough to constitute a scientific fact. (See the FDA's entire letter at http://www.mum.org/fdacups2.htm which also has a link to the petition to which it's responding.) 

Since DivaCup, Instead, The Keeper, Moon Cup (USA) all claim receiving FDA approval (and for DivaCup, Health Canada as well), somebody's not on the up-and-up and since "physiologically plausible" was taken out of context in a spurious attempt to persuade the public that the FDA supports their position, I'm thinking it's the opponents who are being deceptive, not the manufacturers, especially since the cause of endometriosis is not known and has been found in parts of the body other than the reproductive organs. At any rate, don't wear a cup for more than 12 hours without removing and reinserting it in accordance with manufacturer's directions. 


Because a menstrual cup is lightweight and takes up such little space that it's okay to pack one "just in case," I believe the Lunette or Mooncup UK will be a welcome addition to your home and packing list as the alternative to the disposable feminine hygiene products typically sold in stores. Who wants to pack all that stuff for a trip or have one's plans disrupted to hunt down suitable products while in a strange town or foreign country that may not have similar products or the variety that the U.S. has, anyway?

 

 

 

 

 

 

 

 

 

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