This article originally appeared on VICE US
Like vegans and people who do CrossFit, menstrual cup converts have earned a reputation for evangelizing—they gush endlessly about their beloved blood funnels, small silicone udders slipped inside the vagina to collect menstrual drip.
I can readily see the benefits of a long-lasting, reusable period product, but still, the specter of spillage long blocked me from hopping aboard the menstrual cup express: How in the ever-living heck do you extract a chalice of uterine gore from your undercarriage without dumping its contents all over your lap? Are menstrual cups the exclusive purview of people whose hands don’t shake wildly whenever they have to hold something that could create an obvious, inconvenient mess? What is this witchcraft?
I started using cups six months ago and I found few outlets for reliable information on these topics. Although menstrual cups have been around since the 1930s, they remain a niche product: 98 percent of US women use pads and tampons. This unsung status makes cups relatively mysterious items; indeed, one gynecology professor I contacted for this story copped to not knowing enough about them to offer insight. Still, those who make the switch tend to swear by their choice, as they will remind you at every available opportunity.
Here’s everything you’ve ever wanted to know about using menstrual cups.
People who use them seem obsessed. What are the benefits of menstrual cups?
Have you read the recent climate reports? Right, so, basically we have screwed ourselves almost beyond repair: Rather than trashing dozens of tampons (plus the plastic and paper in which they’re packaged) every month, it seems prudent to invest in a more sustainable option, one you can wash and reuse for about 10 years. That also makes them budget friendly: $25 to $40—or free plus the cost of shipping with this brand—buys you menstrual management for about a decade, which sounds especially reasonable compared to the thousands you might spend on disposable period products over the course of a lifetime.
I did not begin using menstrual cups out of curiosity or even a desire to diminish my environmental footprint, although I enjoy that element of the ordeal; I began using them after receiving samples for an article I wrote last spring, and stuck with them because—as a freelancer who subsists on unpredictable paychecks—I eagerly embrace opportunities to cut recurring costs from my budget.
You can also leave these bad boys in for 10 to 12 hours at a time, without soggy dangling strings or squishy diaper vibes, and without having to worry quite as much about what you’re putting inside your body: Most cups are made from silicone, a bacteria-resistant material that’s easy to clean.
What are the drawbacks?
When you insert and remove a menstrual cup, you stick your fingers inside your vaginal canal, and then you dump a palmful of sanguine mess into your toilet or shower. If your own bodily fluids gross you out, you may want to consider a different product. (Or, *clears throat* maybe this up-close-and-personal contact with your bits would help eliminate some of culturally instilled aversion to what is, for many, a natural biological function!)
Purchase the wrong size (see the next question), and you may spend a lot of money on a product you can’t return or regift. Menstrual cups can also cook up some very special smells, and, as mentioned, emptying them in public without streaking the bathroom in blood feels intimidating at first.
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What should I look for when shopping? Are there different types and sizes? Are they all reusable?
The majority of menstrual cups are reusable and look like tulips: Given the vagina’s shape, there aren’t many ways to reinvent this wheel. (See the sex question for firsthand perspective on the single-use Flex Fit Disk, and know that a very similar disposable product called the Softcup, recently rebranded as the Softdisc, also exists.)
To find your menstrual cup match, Jennifer Conti, a clinical assistant professor of obstetrics and gynecology at Stanford University, recommends asking your reproductive healthcare provider to check your vagina length the next time you’re in the stirrups. You can also try the cup-matching quiz on PutACupInIt.com, which factors in flow and birthing history. The quiz's guidelines for measuring vagina length are: Slide in a finger and feel for your cervix, a smooth, semi-firm, donut-like structure. If it takes your full pointer finger to reach your cervix, you have a long vagina; if you get to your middle knuckle, you’re average length; and any less than that means you have a short vagina. (But Conti notes that this self-test does depend on finger length, so it's not perfect.) A heavy flow or long vagina requires a size large cup; a short vagina likely needs a small. Conti says she typically tells people that the first cup is a bit of a trial-and-error process where you’re trying to find what fits and feels the best, and not to give up if the first cup doesn’t fit well or leaks.
How will I know that it's in properly? Is leaking possible?
“Leaking is possible if the cup is not inserted correctly, or if it overflows,” says Raquel Dardik, a clinical associate professor of obstetrics and gynecology at NYU Langone Health. You can have a medical professional show you how to put the cup in place, or you can peep the video below for an insertion lesson, but basically: Wash your hands, fold the cup by pressing one wall into the opposite with your pointer finger, slide the wedge inside your vaginal opening, push it in until things feel comfortable, and give the base a twist to make sure the cup flares open.
PutACupInIt co-founders Kim Rosas and Amanda Hearn say to avoid leaks, you should run a clean finger around the outside of your situated cup. “If you feel the cervix outside of the cup, you’ll want to reinsert it.” For the first few cycles, it’s smart to wear a panty liner for extra protection.
How do I remove it without spilling it everywhere?
This has been a learning experience, but I am pleased to report that at no time have I emerged from the bathroom looking like I’ve just performed a ritual slaughter. To remove the little monster, you must spread your legs wide enough to comfortably stick a hand in your hoo-ha. This probably means pulling your bottoms down past the splash zone.
“Creating a crime scene is a common worry, but removal isn’t messy,” Rosas and Hearn emphasize, but take heart: “Past the initial learning curve, it is highly unlikely that you’ll get anything on you. While over the toilet, or in the shower, pinch the base of the cup ... and pull down slowly. [The cup] pretty much stays level with the toilet, so once [it’s] out, just tilt over to empty.”
How the hell am I supposed to clean it in a public bathroom?
The ten- to 12-hour wear window lowers the odds of public emptying, but one wants to be prepared. “Just remove the cup, dump [its] contents, and either reinsert without cleaning or wipe the rim with a bit of toilet paper,” Rosas and Hearn say.
Here’s what I like to do: Grab a paper towel or two on my way into the stall, which I then place on my bare thigh or the top of the toilet paper dispenser. After pulling out the cup and dumping its contents into the toilet, I place the cup, point up, on the paper towel and wrap it up as if folding a dumpling. Then, cup covered, I wipe down the sides without getting blood on my hands. Once the surface has been cleared of mess, I pop that shit back in and worry about a deep clean once I’ve reached a safe space.
How do I deep clean it once my period's over? Where should I store it?
Most cups come with storage cases: Before you pack yours away, though, you need to clean it. Slip your cup inside a whisk and submerge it in a pot of boiling water (the whisk prevents the cup from sticking to the pot) for as many minutes as the packaging instructs (Rosas and Hearn suggest two minutes, my cup’s manufacturer says eight to ten), et voila, she’s sanitized. If using your kitchenware to clean period products makes you (or your roommate) squeamish, you could buy a steam bag, sterilizing tablets, or a microwave steam pot, but boiling kills the gross things dead, so why waste the money?
I don't have to worry about toxic shock syndrome (TSS), right?
Wrong. “Anything inserted in the vagina [presents] the possibility of TSS,” Dardik cautions. “However, with cleaning and replacing as indicated, the risk is very low.”
TSS results from a very specific toxin burped out by very specific bacteria. Vagina-havers whose vaginal flora includes a strain of Staphylococcus aureus bacteria may produce that particular bacterial toxin, *if* they leave menstrual products in long enough, *and* their bodies fail to fight off the invader. Very few people check both boxes, though: The Centers for Disease Control and Prevention tallied just 323 TSS cases in 2016, of which tampon use constituted just one cause—surgery, childbirth, and open wounds are more likely culprits.
Still, one recent study found that cups—especially large ones—were more likely to retain toxin traces after rinsing than were the tampons tested. Worried? Maybe buy two cups, so you can boil between insertions, not just between periods.
How long does it last? When do I need to replace it?
If you fastidiously clean and store your cup, it can last up to 10 years, according to Rosas and Hearn, but: “If they tear, crack, become slippery or slimy, the silicone has deteriorated, then the cup should be replaced.” Dardick agrees. “The cup is medical grade,” she notes, but when “it starts to look worn or leak, then it’s time for a new one.”
Can I buy it with my FSA or HSA account?
No, you cannot pay for menstrual products with flexible spending accounts (FSAs), health savings accounts (HSAs), or health reimbursement accounts (HRAs). But there’s a bill in Congress that would fix this sexist problem.
If I have a really heavy flow can I still use one? Do I just need to empty it more often?
As a person who weathers typhoon-like periods (thanks, copper IUD), I will personally confirm that aggressive bleeders can use menstrual cups successfully: Just empty yours more frequently than recommended, Dardik suggests, maybe every two to three hours. In early days of usage, to gauge the point at which my cup overfloweth, I checked it as often as I would change a tampon. Menstrual cups are surprisingly accommodating, though—large models usually hold 25 to 30 mL of fluid, which is plenty of space for people with typical flows to last 12 hours.
I have an IUD. Will a cup suction it out?
Calm yourself, though, because Conti has never seen that scenario play out—your strings would have to be long indeed to trail down the side of the cup. Nonetheless, she advised that the IUD-equipped among you “go slow; if you feel any discomfort or tugging higher up in your pelvis, stop and try pulling on a different part of the cup; [and] when in doubt, consult your women's health provider.” Pinch the base as you pull to break the suction-cup seal, especially if you have an IUD—better safe than sorry.
Are there reports of people struggling to take them out or them getting stuck?
The internet furnishes endless examples of any horror story you ask it to tell, and there exist myriad tales of menstrual cups lodging themselves inside their hosts and refusing to budge until someone gets the medical-grade grips. Still, you needn’t worry too much about stuck cups, Dardik says.
“The cup can’t go anywhere but the vagina since it is like a cul-de-sac, so there should be no issue with the cup being in the wrong place,” she emphasizes. If your cup seems stuck, pinch the sides to break the seal that keeps the device vacuumed in place. If you still can’t fish it out, contact a gynecologist or reproductive health specialist, Dardik advises.
What if I have baby carrot fingers and can't reach?
Look for long-stemmed cups: You can always trim the stem (the pointy part), but having a solid stretch of material to pull will help you remove the device. If your cup still winds up too high for you to grab it, don’t panic. “The vagina is a flexible, muscular organ,” Dardik notes. “If you put a leg up on a stool before trying to reach, the vaginal canal changes shape some,” making it easier for you to snare the cup.
Rosas and Hearn agree that relaxation is key: “Tensing up will tighten up the vaginal muscles, holding onto the cup and making it harder to remove. Try squatting and bearing down,” i.e., “pushing like you’re pooping,” or trying to birth the device. That should scoot the cup toward your fingers enough for you to pinch its base and pull it out.
Seriously, I can have sex while wearing it?
Yes, if you buy the right one: You probably won’t enjoy penetrative sex with a small cone sitting inside your vagina, but a few companies have hacked that design flaw.
Before I undertook my own journalistic experiment to answer precisely this question, I consulted Conti, who said she knew of no risks associated with my plan (provided I didn’t use a cone shape), but advised me to consider laying out a towel lest the movements jounce my cup out of place. In the end, both products I tried proved successful: I recommend either Intimina’s reusable Ziggy cup—a relatively shallow, reusable silicone disk that fits around the cervix like a diaphragm—or the Flex Fit Disk, a disposable model of similar design that I find actually feels better, and less obtrusive, than Ziggy.
Given the next-door-neighbor status of the anal and vaginal canals, it seems possible that back-door action could jolt a cup out of position. Conti could neither confirm nor deny: “Unfortunately, science is not ready for this question,” she tells mel, explaining that no one has studied the effect of anal sex on menstrual cup placement. Still, she added, “Even if it did increase the risk of dislodging the cup, that shouldn't prevent sex—just put a towel down.”
Can I use a cup if I have fibroids? Vaginismus? Endometriosis?
Maybe, but first things first: Uterine fibroids are non-cancerous growths that appear on the walls of the uterus, and they typically result in longer, heavier periods and sometimes pelvic pain. Vaginismus is characterized by spasming or contracting muscles around the vagina upon penetration, which can make sex and tampon use prohibitively painful. Endometriosis causes uterine tissue to grow outside the uterus, resulting in preternaturally painful periods and penetrative sex.
Cup users with fibroids may just have to empty the devices more frequently to accommodate an especially heavy flow. But if you have a disorder that makes it difficult or uncomfortable to insert something into your vagina, Dardik says, cups won’t be your best solution. You can probably gauge how it would feel to wear a cup by experimenting with a tampon: If an expanding cotton wad hurts, a cup will, too.
What do I do about my menstrual cup smell?
“Most users report no odor associated with using a menstrual cup as long as it’s worn no longer than the 12-hour maximum,” Rosas and Hearn allege, however I am here to rebut that theory. One cup I use (the Ziggy, FYI) generates a stubborn stench even after short stretches, and while that does not surprise me—recall, we are talking about a standing pool of blood, itself a stinky substance, left to marinate for half a day in a warm, wet environment—it does offend me. And a quick internet search suggests that I am not alone. Indeed, when I start typing “menstrual cup” into Google, she attempts to finish my query with the autofill “smells like death.” So yes, cup odor is a thing.
“Cups can be boiled after the cycle is complete for sanitizing, or there are Milton sterilizing tablets you can use to soak the cup for extra cleaning,” Rosas and Hearn recommend. Cup-maker Lunette proposes taking your regular boil two steps further: Soak your cup in rubbing alcohol, lemon juice, or a half-vinegar, half-water solution for an hour before sticking that sucker in boiling water for an extra-long, 20-minute purge bath. Whenever possible, rinse it (or wipe it down with cup wipes) between emptying and reinserting, and don’t leave the dang thing in so long next time!
This article originally appeared on VICE US.