This User-Friendly Menstrual Cup Is What Happens When Design Is Inclusive

There are lots of conversations about the lack of diversity in science and tech these days. Along with them, people constantly ask, "So what? Why does it matter?" There are many ways to answer that question, but perhaps the easiest is this: because a homogenous team produces homogenous products for a very heterogeneous world.

This is Design Bias, a Motherboard column in which writer Rose Eveleth explores the products, research programs, and conclusions made not because any designer or scientist or engineer sets out to discriminate, but because the "normal" user always looks exactly the same. The result is a world that's biased by design. -the Editor

The whole thing started with Jane Adame cursing to herself in the bathroom. “It has a very unglamorous origin,” said Adame. “Just standing in the bathroom swearing and injuring myself.”

Adame was trying to remove a menstrual cup—a small reusable cup to catch blood—and it wasn’t going well. A menstrual cup sits inside the vaginal canal, and if it’s properly sized it should snugly hug the wall of the vagina. But that means in order to get the cup out, users have to be able to get their hand up into their vagina, deftly pinch the cup, and slowly pull it out, all without spilling the contents. Adame has Ehlers-Danlos syndrome, a connective-tissue disorder that often makes people's joints unstable. When trying to take out the used cup requires a fair amount of both wrist flexibility and hand strength, Adame risks dislocating her joints. Not exactly something you ever want, but especially when you’re trying to remove a container of blood from your body without spilling.

Here at Design Bias, a lot of what I do is tell you about how badly things are designed. For this installment of the column, I’d like to show what’s possible when previously excluded voices are included in the design process. Because that’s exactly what Adame, and the cup she invented, represent.

The big sticking point Adame identified for menstrual cups, and one that many people (disabled or not) share is that removal can be tricky and takes a while to get the hang of. To solve this problem, Adame teamed up with her friend and medical device designer Andy Miller to try and figure out how to improve the menstrual cup design. Together, they fiddled and prototyped and messed around with all kinds of different designs, trying to figure out how to make the cups easier to use.

That’s tricky no matter who you are—the biggest barrier to menstrual cups for people is often this learning curve. So Adame homed in on trying to figure out a way to make removal easier. And thus, the Keela cup was born.

Adame, who recently turned 30, isn’t your typical startup cofounder. She was a hairdresser and worked in customer service for years. But when her cup kept failing her, she had to imagine that there was a better way. Couldn’t someone invent a better one? Immediately she thought of Miller, a former client, someone she’s known for 10 years. “I would cut his hair and we would chat about design ideas, and his voice popped into my head,” Adame told me. “He would always say ‘if there’s ever a little plastic thing you want to make just let me know!’”

And suddenly, she did have an idea for a little plastic thing.

Most menstrual cups currently on the market require that pinch of your fingers to grab and fold. The Keela cup, instead, works kind of like a tampon. Pull the silicone “string” at the bottom, and the cup comes out. The string is connected to the top of the cup, and it essentially provides the folding action that normally you’d have to use your finger to perform.

Throughout the design process, Adame and Miller were constantly asking interested friends and volunteers for feedback. At one point, someone commented about the stem itself. In the prototype, the stem has a little rubber ball at the bottom, but that can be hard to grab onto for some people. So Adame and Miller decided to try a loop instead, which is what the cup now features.

“We realized it was a really important addition and it really went along with our philosophy of inclusion,” Adame said. “It definitely turned out for the better.”

Keela started with a Kickstarter in January, raising $55,808. The duo initially thought they would produce a limited run of the cups with that money, but just a few weeks ago Keela was acquired by FLEX, a company that makes disposable, flexible stand-alone menstrual discs that collect the blood. While menstrual cups are reusable, menstrual discs are meant to be used just once. Now, Keela will be known as the FLEX Cup and will be sold paired with the FLEX disc as a “discovery kit,” with the goal of helping new users understand how these products work. “The idea with the kit is to empower the buyer to try new things and decide what works best for them,” Adame told me.

The acquisition makes sense, because Keela isn’t a cup designed only for disabled users. It’s also great for anybody new to cups, who hasn’t yet gotten a handle on the art of insertion and removal. Lauren Schulte, the founder and CEO of FLEX, says the company was looking to add a menstrual cup to its product line. “We’ve been working on a cup of our own for years because we think they’re a great eco-friendly option,” Schulte told Forbes. “Cups offer the same 12-hour wear as our discs, but they are reusable, whereas FLEX discs are single use.” But the company struggled with the same obstacle that pushed Adame to create Keela: “During the design process,” Schulte explained, “we couldn’t solve the fundamental issue of difficult removal.”

When she saw the Keela Kickstarter, she realized Adame had already solved the problem.

I often talk about the need to invite a diverse group to the table, so that you can avoid the kinds of biased and exclusive products and policies that lead to, say, pregnant researchers often getting no lab safety guidance and mammogram machines that can make you “feel like you’re from another planet” when you’re disabled. The Keela cup is just one example of what’s possible when a diverse set of designers are involved in creating products. Without her disability, Adame might have never set off down this path. But Keela also shows that it’s not as simple as just hiring a more diverse team. You have to be ready to change your workflow to let them succeed.

As Adame told me, the biggest barriers to creating Keela haven’t been on the technical side, or even the funding side. Instead, she said the biggest challenges have been “managing and dealing with my disability while running an unpredictable, demanding startup.”

Startup culture is notoriously fast paced and unforgiving. And that’s a system that privileges people who are able to operate under those conditions. “There are always pressures with timelines and I think a lot of folks living with disabilities might have to operate on different timelines,” Adame added. Due to her disability, she said that there would be weeks that she simply couldn’t work on the project, something that would be untenable at a more traditional startup. “Adding disabled people, bringing them to the table, it may look different from the workflow than with an able-bodied person,” Adame said.

Miller, who’s worked on other startup projects in the past, said that this might mean changing the time table. “It’s not the traditional ‘have X done in the next two hours, and Y done in the next three hours,’” he told me. “You want to look at things in longer time periods or chunks, and in terms of outcomes not timelines.”

In the recent acquisition, both Adame and Miller were hired on at FLEX. “The company has made great accommodations for me so I have stability and I can take care of my body,” Adame said. Changing your system and timeline to be more inclusive isn’t just about adding diversity. It will make your product better. “It’s totally worth it,” Adame added, “since we tend to have to innovate our way through the world that’s not made for us anyway. We have a lot to contribute.”

Miller agrees. “It’s absolutely worth it,” he said. “Jane is Keela and has built something really amazing. And it’s her unique voice that has carried the whole project.”