As a female doctor actively following feminist hashtags on social media, the number of period positivity posts I come across as I scroll absent-mindedly is heartening, especially when it comes to posts that talk about using a menstrual cup. Having tried it a few months ago myself, I totally identify with all the ‘cupverted’ ladies out there. No doubt there is a learning curve involved to get the hang of the process; seeing a cup the first time and imagining using it can be daunting. The first try can knock the breath out of you if you are not relaxed enough (I faced that the first two times before I became an expert). But once you learn to skillfully fold the cup and tuck it in, there is really no stopping you as you forget that you are on your period and go about your day. What’s not to love about this ecofriendly investment?
But before you take to the streets to chant slogans encouraging other menstruators to ‘cupvert’, it might be time to take a step back and analyse if it is truly the best choice for everyone?
The foremost medical reason to not use the menstrual cup is in the post-delivery state. In the management of bleeding after medical abortions, too, patients are advised to not use menstrual cups (and tampons); in fact, any menstrual product which is used internally is a no-no. The vaginal tissue is weak at this time, the cervix is dilated, the wound from placental attachment is raw. All these are more than enough to be breeding ground for serious bacterial infections. Stick to sanitary napkins or cloth pads during these vulnerable times.
The second medical indication for women who should be wary of using menstrual cups is recurring urinary tract infections (UTI). A friend told me she wasn’t able to proceed with using cups because she was prone to urine infections and she had a bad flare-up after going the cup way. I spoke to menstruation educator Rajasi Kulkarni about this and she affirmed that she too had heard complaints from women that UTI episodes had gone up after using internal menstrual products such as cups.
Minor trauma to the urinary tract during the insertion of the cup could be one of the reasons for the UTI flare-up. The pressure on the urinary tract from the cup placed in the vagina can lead to a little urine retention, which can be another reason for the infection. In addition, even if you are not susceptible to UTIs, unclean hands and an unclean cup can lead to infection, so watch out.
Some women really wish to go down the cup route for the eco-friendliness and comfort factor, but cannot due to allergy to latex. For such users, my advice is to check the details of the manufacturing material. Essentially: Silicone good, rubber bad.
If you are scared to insert something up your vagina that looks so big when placed on your hand, then just remember a baby’s head is way bigger than that itsy cup (and less flexible). Besides, the cup is folded on itself before insertion and does not have to enter whole. So, take a deep breath, relax your vaginal muscles and insert with the cup slightly tilted facing towards your spine.
Yet, there are many women who cannot handle internal menstrual products and complain of extreme pain. If you suffer from abnormal vaginal tightness, which bars penetrative intercourse, then you should steer clear of menstrual cups. This condition of tightly contracted vaginal muscles is known as vaginismus and precludes pain-free sex as well as gynaecological procedures and even cup insertion. Work with your doctor to reduce this tightness with the help of progressive dilatation. If you are suffering from endometriosis and that is the cause for your pain, then surgery may be the answer for you. But until that is taken care of, go for pads.
Even if you have none of the medical conditions I have spoken about, there still are some barriers to using pads. If you decide to use cups on your travel and have only public toilets at your disposal, then cups might be a little difficult to use in a bathroom stall without washbasin access. In such scenarios, go for bottled water to thoroughly wash your cup after each use and remove the residue.
If you feel cups are high-maintenance and feel you might slack off with the sterilization and storage, then think again before investing in a cup. Not air drying the cup after sterilization can cause it to go moldy, as menstruation educator Rajasi tells me she has observed in some menstruators. It needs a certain degree of commitment to safeguard yourself from infections owing to poor cup management.
On the other end of the spectrum are ladies who over-clean. Women using antiseptics after every cup emptying are putting themselves at risk of vaginal irritation and infection. The vagina is like a self-cleansing oven and needs little to no maintenance. The cup needs to be washed with plain water between uses and sterilized in boiling water between periods. Soap or antiseptic residue are irritants to the vaginal canal, so beware of overcleaning.
And then again, there are products being manufactured as cup cleansers. If not washed off properly they can lead to irritation. Also, they are unnecessary and expensive! As long as there is running water in your tap, let there be nothing stopping you from reaching out for this little cup of freedom.
Dr Farah Adam Mukadam is a family physician based in Bengaluru and the author of Newborns and New Moms. She is also a women's health educator working through her Instagram channel @dr.farah_momstein.