Pain, infections, toxic shock: 14 important questions about menstrual cups
We have written more than once about menstrual caps: made a review of the most popular bowls, tried them all edited, talked about caps with technological elements - for example, a tracker or an applicator. But for many women, the question remains open - what gives the bowl, besides convenience, economy and environmental friendliness? Manufacturers claim that the transition from pads and tampons to bowls will improve health, reduce monthly pain and get rid of the risk of TSS (toxic shock syndrome). We understand whether this is true, together with the obstetrician-gynecologist, candidate of medical sciences and blog author Tatyana Rumyantseva.
How does toxic shock syndrome occur?
Toxic shock syndrome, or TSS, is a rare but very dangerous adverse effect of using tampons. It develops due to the fact that in the "nutrient medium", consisting of menstrual blood and components of the tampon, bacteria begin to multiply - Staphylococcus aureus. They secrete a toxin called TSST-1 (toxic shock syndrome toxin-1, toxic shock syndrome toxin 1) - it causes a life-threatening disorder at which the temperature rises, pressure drops and organs fail.
In the 1980s, when tampons with high absorbency entered the US market, doctors began to notice a rapid increase in cases of TSS — one out of 7,000 women came across it. It became clear that taking a tampon in the vagina for too long was not a good idea. After that, manufacturers of hygiene products stopped producing superabsorbing tampons, limited the maximum period of use to eight hours (with the recommendation to change as often as possible), and the situation returned to normal.
Today, TSS develops in only one of two million women. Nevertheless, because of this - even if it is a very low risk - many people are afraid to use tampons, especially at night, or they are afraid that they will forget to change a tampon in time. That is why in 2002 a new solution appeared in the UK - the reusable silicone menstrual cup Mooncup (later renamed MCUK). Following the British, other manufacturers began to produce drips, and soon the bowls flooded the market.
Is it true that with the risk of TSS there is no?
One of the bonuses of the menstrual cup, which is actively used in marketing, is that it can be changed once every twelve hours, that is, only twice a day. At the same time, as many manufacturers write, there is no risk of TSS - and it was believed that this is the case, until 2015, when TSS was registered after using the menstrual cup. It developed in a woman of thirty-seven years old who, ten days before that, started using DivaCup capa. She kept the necessary hygiene, took out the bowl in time and washed the bowl, but at one of the first introductions she scratched the vaginal wall. Doctors felt that a large accumulation of blood with oxygen and carbon dioxide, as well as damage to the mucous membrane, could trigger the growth of Staphylococcus aureus and the release of dangerous toxins.
Scientists decided to test how staphylococcus grows in various hygiene products, namely in eleven types of tampons and four menstrual cups. It turned out that S. aureus multiplied in the caps even faster, apparently due to the access of air, which is provided by the design of the bowl. According to the results of the study, new recommendations emerged: to follow more or less the same precautions as when using tampons, that is, empty and clean the bowl at least once every eight hours. Fortunately, warnings about the risk of TSS appeared on the websites of some manufacturers - in particular, the pioneer MCUK: now they offer to change the bowl not two, but at least three times a day.
Tatyana Rumyantseva explains that the bacteria probably do not care where to breed - in the blood that is in the cup or inside the tampon. Menstruation itself is already a factor that provokes a violation of microflora. Today it is known that bowls do not increase the frequency of detection of Staphylococcus aureus in the vagina, and the materials from which they are made do not interact with toxins and do not enhance their action. However, one case of toxic shock syndrome has been described - and therefore one cannot be 100% sure that there is no risk. The gynecologist adds that if there are fears and doubts, you can simply empty the mouthpiece more often.
Can the cup get stuck and do I need to run to the doctor if it remained in the vagina for more than twelve hours?
The cups are designed so that it is enough to press on the surface - and it becomes easy to remove. If the cervix rose a little higher and the cup went a little further, then you should not worry. First, take your time and relax. Then try to tighter: gradually the mouthpiece drops and you can grab it by the tail or lower part.
As for the one-time long stay: according to Tatyana Rumyantseva, she has not encountered any problems in literature or in practice. In addition, with prolonged use, the bowl may overflow, and then, even if it is “stuck”, it will be even easier to get it.
Should soap be used every time rinsing the bowl?
The manufacturers' instructions are diverging here: someone writes that it is necessary to rinse the mouthpiece under running water, others advise using mild soap, and still others recommend cleaning the bowls only with means for intimate hygiene. The doctor explains that if soap is on hand (normal or for intimate hygiene), it is better to use it, but if there is no detergent, then running water is enough. It is very important to thoroughly wash off the traces of any soap from the bowl - if it gets onto the vaginal mucosa, it can disrupt the pH and damage the vaginal microflora.
Why sterilize the cup before and after menstruation?
Manufacturers warn that the cap needs to be sterilized every cycle - to do this, boil it for three to five minutes. This should be done both before the first use and after the end of the month. Before menstruation, sterilization helps to eliminate bacteria that have fallen on the mouthpiece from the air during storage, and after menstruation removes microorganisms that have fallen onto the cup from the vagina, preventing them from lingering on its walls and multiplying. So for maximum security, it is worth listening to the manufacturers and boiling the bowl twice in each cycle.
Does using a bowl increase the frequency of infections?
Studies involving women who used caps during menstruation showed that they do not affect the vaginal microflora and the results of urinalysis. So, switching from tampons or pads to the cup does not increase the risk of thrush, cystitis or other urinary infections. However, if you already have some violation of the flora at the time of the beginning of your period - for example, candidiasis - it is not recommended to use the cup until the end of treatment.
Does the bowl harm women with endometriosis, dysplasia or ectopia (sometimes called "cervical erosion")?
The same studies say that the caps do not affect the condition of the epithelium of the vagina and cervix - and therefore can not harm them. "None of the recommendations on dysplasia or endometriosis have any restrictions on the hygiene products used. And what we call“ erosion ”most often turns out to be an ectopia of the cervix - this condition occurs in 40% of women in Russia, is a variant of the norm and no treatment requires, "- says Tatiana Rumyantseva. Nevertheless, manufacturers advise to consult a doctor about the transition to the bowl, if you have some kind of gynecological disease.
Is there a risk of mechanical irritation from the cup?
Of course, this is possible. For example, you can scratch the vaginal wall when inserting the cup (so do not forget to file your nails). For some, the walls of the tray, the protrusions on it or the bezel can cause discomfort - then it is worthwhile to introduce it with the help of a water-based lubricant. The gynecologist explains that with the first few uses, until the woman has learned to deal with the thicket, the discomfort is normal, but if the vagina is injured when the cup is inserted every time, then you need to think about switching to another brand of cups or changing the hygiene product altogether. After the first attempts to insert a bowl, women usually feel more discomfort than when using tampons, but then they get used to it and the discomfort disappears. In general, 91% of women who tried the bowl no longer want to give it up and recommend it to their friends.
Should women use Kapa with weakened pelvic floor muscles and uterus prolapse?
Usually such problems arise in women after childbirth - and then for convenience, you can choose a larger bowl. If there is a strong prolapse of the uterus, it is better to ask the gynecologist whether to use the cup. “I haven’t met any studies on the effect of the cups on the tone of the muscles of the pelvic floor, and even in theory I cannot imagine the mechanism by which deterioration would occur due to the tray. However, I admit discomfort from using the bowls with marked omission,” says Tatyana Rumyantsev.
Are bowls compatible with intrauterine contraceptives?
Many manufacturers write in the instructions: women who have an intrauterine device, it is better not to use the bowl. So they are reinsured - what if you accidentally pull out the contraceptive system along with a mouth guard? It is possible to exhale with relief: a study involving almost a thousand women showed that the risk of loss of the intrauterine device among users of bowls does not exceed that of those who choose tampons or pads.
Is it possible to use the bowl for those who did not have penetrating sex?
As in the case of tampons, the presence of a vaginal crown is not a reason to refuse menstrual cups. It is only necessary to choose a smaller size and focus on your feelings. If you have pronounced discomfort with the introduction of the bowl (even with lubricant), then you probably should wait a little.
Will menstrual flow make menstruation more painful?
Not. Even on the contrary, it can bring relief to some: those who use bowls have spasms less often than those who choose gaskets.
Are bowls suitable for women with a womb?
Most often, yes. It may be necessary to insure the gasket for the first time, until it is possible to “grope” the optimal position of the bowl. If you have a uterus bend, you want to use a mouth guard, but it doesn’t work out for you - consult a gynecologist for advice.
Can I have penetrating vaginal sex when a bowl is inserted?
With most bowls, this is technically impossible. However, special caps have already appeared - for example, disposable Flex and reusable Ziggy Cup - in which you can have sex. In any case, penetrating sex during menstruation after using the bowl will be more comfortable than after a tampon: the latter absorb everything that comes handy, including natural vaginal discharge, which makes up about 35% of the filled tampon. With the cup you can not be afraid of excessive dryness of the vagina and comfortably have sex immediately after its extraction.
Rumyantsev reminds that bowls intended for sex are not a method of contraception. And although menstruation is not the most favorable period for conception, the risk of pregnancy is still there. If you do not plan a child, use contraceptives; If the bowl has projections or a sharp tip, remember that they can damage the condom. And do not forget to warn your partner about the presence of the bowl to avoid unnecessary injuries.
Photo: oxanakhov - stock.adobe.com, Monki