A cup half full!

"Why don't you use a menstrual cup?" my Mom, with her blatantly blunt way of hitting the nail in the head once asked me. That was the day when I actually introspected- yes, why don't I?

I had known all about the cup since a long time- I'd first come across it when I was researching endometrial stem cells a few years ago... I knew its benefits, and I did, in theory, support the fact that it was an ecologically viable alternative to minimise the biomedical waste sanitary napkins generate... I had encouraged a few patients who'd asked me my opinion on it to go ahead and use it too.. Yet I didn't use it myself! Why was that?

There was only one answer to this question- a question I had conveniently disregarded till now!

Just like most Indian women, I was uncomfortable handling my own genitals when I was on my period!

Yes, that's right! I, a gynaecologist, whose life literally revolves around the female genitalia, felt squeamish in putting in a menstrual cup!

The day I confronted this fear, I realised how ridiculous it was!

And now, having used the cup myself, and having realized how great it is, I'd really like to spread the word among women who've been similarly shying away from it so far!

This blog aims at addressing all the questions a new cup user may have in her mind.

What is a menstrual cup?

A menstrual cup is a flexible container made of medical grade silicone, which is so designed to fit inside the vagina and collect the shed endometrial tissue during a woman's period. It fits in place snugly and creates a tight vacuum seal when used the right way.

Why the cup?

As gynaecologists, we often advise women to change their sanitary pads once in every 4- 6 hours to avoid infections. Considering the fact that an average woman may bleed for 4- 5 days each month, the math suggests that each woman generates at least 18- 20 used pads per cycle. If we calculate the number of women in their reproductive age even in our city, leave aside the entire country, we'd be amazed at the amount of non- biodegradable waste we're generating! With the question of waste disposal looming large over us, we really need to rethink a few habits- just like we did when the government enforced the plastic ban. It sure was heart- wrenching to throw away the branded 'good' plastic bags we all had hoarded (like typical middle class Maharashtrian women!!!) But on retrospection, it was indeed a wise move, since we now are in the habit of carrying our own cloth bags wherever we go.

Similarly, a menstrual cup, if used in the right way, can last you a lifetime! Imagine the amount of non-degradable waste we'd be avoiding!

Is it uncomfortable or painful to have the cup inside you?

Not at all! Once properly inserted, you can hardly even feel it!

The vaginal mucosa is pain- insensitive. The only discomfort new users may experience may be in inserting and removing it till you get used to it.

While inserting it, one usually has to fold it and push it inside using the index finger and thumb. Once inside, it pops open and creates a tight vacuum seal between the walls of the vagina, thus avoiding leakage. It has a knob-like attachment at its lower end, which one can pull on while removing it. The trick during removal is to break the vacuum seal- press one end with your finger so the air entering in will loosen the cup and allow it to be pulled out easily.

Will the cup leak?

If inserted the right way, it won't.

There are three reasons a cup might leak-

1. It hasn't been inserted in the right way, i.e. the vacuum seal isn't tight.

2. It has filled completely and is overflowing.

3. It's not intact, that is, is torn from somewhere.

How often do I need to empty it?

That would depend entirely on your cycle and flow. It might take you 3- 4 cycles of using the cup to get the hang of how long it takes for your cup to fill up. On your heavier days, you might need to do it once in 4- 6 hours, however, on the lighter days, even once in 8- 12 hours should do. Till you get used to them, you can use pads too, as a backup.

Cups may be available in different sizes, and their capacity varies accordingly. As a rough guide, young women below 30 years, women who haven't borne children and delivered them normally, and women with a lesser BMI can do with a small sized cup. Heavier women above 30 years who've had previous normal deliveries should opt for the larger sizes. You can consult your gynaecologist for a check up to gauge your cup size too.

How do I clean the cup?

While on your period, all you need to do is empty the cup, rinse it with clean water and put it back in!

However, once you finish your cycle, it is recommended that you immerse it in boiling water for 8- 10 minutes, dry it completely and store it in a cotton pouch away from direct sunlight, moisture or heat. 

What are the side effects of the cup?

There are practically none!

There are a few rare case reports in literature about toxic shock syndrome, however the incidence is much lesser than that with tampons.

Cups are more comfortable with regards to avoiding napkin rashes one might experience with sanitary pads.

The only probable minor injuries one might have is if one is not careful enough during insertion. However, with practice, that too is a piece of cake! Ensure that your hands are clean and your nails are well- trimmed to minimise injuries and infections.

What do I do if I'm unable to remove the cup?

Sometimes, a novice may experience difficulty in removing the cup. Reach in with your index finger, locate the knob at the bottom and pull on it so the cup lowers enough for you to break the vacuum seal.

If you're unable to do that, straining or squatting, or putting one leg on a higher level than the other may help.

If you still experience any difficulty, do seek help from your gynaecologist.

Will having a cup stink?

Absolutely not!

The reason menstrual blood emits its peculiar odor is because when collected on a pad, it gets exposed to oxygen in the atmosphere and disintegrates. A menstrual cup prevents oxidation of the menstrual blood, by the vacuum seal it creates, and thus prevents odor.

However, if you are experiencing any smell or discharge, you need to consult your doctor- it may be an infection!

Can unmarried women also use the menstrual cup?

Virginity is a very sensitive topic, especially in our country. With the recent welcome move by the Maharashtra Government criminalising virginity tests, one may assume that the society is gradually opening its mind to women empowerment.

Women who are not accustomed to sexual intercourse may find it even more difficult, and even painful to use the menstrual cup for the first time. Use of a cup by a virgin would lead to rupture of the hymen. With practice and repeated use, it'd become easier and if the woman is comfortable in using the cup, she can very well go ahead with it.

The writer is a young, dynamic and easily approachable Obstetrician, Gynaecologist and Infertility specialist practicing in Pune.