Menstural Cup: An Unexplored Women’s Hygiene Product

Though available as one of the hygiene products in market since mid 20th century, menstrual cup remained a stranger among women, often being neglected and rejected for the fear and unawareness of the method of usage [1]. The merits of these cups are many when compared to that of the conventional menstrual hygiene products, still it remains unexplored both in scientific research platform as well as in the layman knowledge (Figure 1).


Introduction
Menstrual cup is a female hygiene product which is flexible and bell shaped made of medical grade silicon, worn inside the vagina to collect the menstrual blood.
Though available as one of the hygiene products in market since mid 20 th century, menstrual cup remained a stranger among women, often being neglected and rejected for the fear and unawareness of the method of usage [1].The merits of these cups are many when compared to that of the conventional menstrual hygiene products, still it remains unexplored both in scientific research platform as well as in the layman knowledge (Figure 1).
Made of medical grade silicon, menstrual cup is highly safe and easy to use.When inserted into the vagina, it collects the menstrual blood.The collected fluid can be disposed and cup reused after washing.A single cup can be reused for up to 10 years depending on the manufacturer.
Even though it is superior to all the conventional hygiene products available in the market, it still remains in the shadow [2]; unawareness, market strategies, moral taboo and fear of the unknown contributing to this current situation.

Method of Usage Insertion of the cup
1) The cup should be sterilized before and after each cycle.This can be achieved by boiling it in water for 7 to 10 mins.Through the sterilization process the infection rate can be kept at a minimum and the flora of vigina [3] is preserved.
2) Once sterilized it can be inserted into the vaginal by folding it into a "punched down" position, c-fold position or a 's'-fold position to decrease the circumference of the cup thus allowing an easy passage into the vaginal canal (Figure 2a).It is found comfortable to be in a upright sitting position with legs abducted or one led flexed at 90 degrees both at hip and knee and supported by a raised platform.The labia minora can be separated with fingers while inserting the cup.Lubrication may be used to make the insertion easier (Figure 2b). 3) Once inside the vagina, rotate the cup 360 degree while slowly moving towards the cervix of uterus.A knowledge of the position of cervix [4] by feel will be helpful in directing the movement of the cup and make sure that the cup does not deviate past the cervix .This is important as a proper position of menstrual cup is must to avoid any leakage.4) A "pop" voice will come as and when the cup gets released from the fold and seals itself to the cervix.

Removal of the cup
1) It is recommended that the cup be removed and emptied once in 6-12 hrs depending on the flow.The cup which comes in different size has an average capacity of 24 ml, which is higher than the average total menstrual blood during a single cycle.
2) Removal of cup can be done in the same position as inserting.Holding the tail of the cup, gently pinch the rear end of the cup releasing the cup from the cervix opening.Slowly retract the cup and take it out of the vagina [5].
3) Dispose the contents, wash the cup and re-insert (Figure 3).
4) The cup should be sterilised, dried and stored in a cotton bag before using it for the next cycle.

Size of the cup
Different sizes of menstrual cups are available in market.
Small: Usually used for adolescent females who are sexually inactive.
Medium: Usually used for adult females who have not given birth.
Large: Usually used for females who have given birth.
Extra-large: Usually used for females who have given multiple vaginal birth (Figure 4).

Advantages of the menstrual cup over conventional menstrual hygiene products
Over sanitary napkins and cloth napkins: Sanitary napkins pose many challenges may it be physical, financial and environmental.
Rashes, infections, wetness and leakages are the physical challenges while price of the sanitary napkins and the repeated demand pose financial challenges.The plastic used in sanitary napkins takes 5 to 7 years to degrade fully which poses an environmental challenge.In the entire above said field menstrual cup [6] is far more superior.There are no rashes or chances of infections as the material used is inert medical grade silicon.
It can be reused for 10 years on an average hence lesser repeated demand and the financial investment is much lesser when compared to the total amount spend on sanitary napkins.
Over tampons: The risk of toxic shock syndrome is high in tampon users as the vaginal wall becomes dry due to its absorption action, but in menstrual cup the lubrication of vaginal wall is intact as there is no absorption but just collection of menstrual blood.Hence the biggest disadvantage of tampon is bypassed with menstrual cups.
The odor of the menstrual blood is lesser when compared to that of the confessional method.
Lesser chance of bacteria's and fungus to breed as the blood is not exposed to the other environment.

Disadvantages of the menstrual cup over conventional menstrual hygiene products
1) The main disadvantage of this product is that it is not widely known.Women in general lack knowledge about the product itself.It is grossly under advertised by the manufacturers for the simple reason that the revenue generated by it is far less than the other disposable hygiene products.
2) The stigma and fear of hymen breaking is another major drawback.In Indian context where virginity is of great regard, adolescent females are not introduced to the idea of menstrual cup.
3) It can be a bit challenging at times to know the positioning of the cup inside vagina.It takes a couple of cycles to actually get the positioning right.

Conclusion
The menstrual cup provides a better option in managing the menstrual cycles.
It is safe and easy to use.The chances of infection are much lesser when compared to the conventional methods.The discomfort of sanitary napkins like rashes and leakage are eradicated with this alternative.Toxic shock syndrome which is a major drawback of tampons is nonexistent in this option.As the cup can be re used for up to 10 years, it is financially less challenging and eco-friendly.
Even though the advantages outweigh the disadvantages of the menstrual cup, it still remains unexplored.Current situation is attributed to simple reasons that even the highly literate women remains uneducated about this option.Here the role of a medical professional who specializes in women's health [7] comes into play.

Figure 2b :
Figure 2b: Sterilization and insertion of cup.

Figure 3 :
Figure 3: Removal of the cup.

Figure 4 :
Figure 4: Size of the cup.