Women's Health

By Jane Harrison-Hohner, RN, RNP

Women have been menstruating for as long as they’ve existed, and the products on the market are many and varied. In the last post, we covered sanitary pads and tampons. This post includes other, perhaps lesser known methods of dealing with “Aunt Flow.”

Sponges

As mentioned in the last post, sea sponges have been used from ancient times up to the present. One more modern version was advocated by Alicia Bay Laurel (she named herself after a favorite tree) in the hippie classic “Living on the Earth,” published in 1970. Here a 3 ½ x 4 ¾ inch natural kitchen sponge is cut length wise into four long strips. Usually natural sponge users are instructed to rinse used sponges in cold water and then boil to sterilize.

I found only one published study on sea sponge users. Compared to napkins and tampons, sea sponge users had higher counts of E. coli (common gut bacteria responsible for most UTIs), staph aureus and enterobacteria than tampon users.

Cups

The idea of using a cup-shaped device inside the vagina to collect menses reached a patentable form in 1867. The Hockert Catamenial Sack was attached via a string to a belt worn around the waist. Looking at the drawing submitted for patent made me wonder if the inventor was worried that the sack would “get lost” in the vagina. A more likely concern would be that it could drop into what passed for outdoor lavatories in those days. By 1937 a woman had received a patent for her design, which was a bell-shaped cup with a stem at the end.  This shape is still one of the most popular and is utilized by a variety of cups (e.g., the Keeper®, the Mooncup®, DivaCup®). It was also the shape of one of the first heavily marketed cups, the Tassaway®, in 1969. Tassaway users were advised that this cup could be reused throughout a period, but I remember disposing of some because of the mess.

All of these cups sit low in the vagina so that the stem/handle can be easily grasped to allow for removal and emptying collected flow into the toilet. They are designed to occlude the vaginal opening so intercourse would not be possible with the cup properly placed. Some of the reusable bell-shaped cups are available in different sizes to better accommodate different vaginal diameters. This could be very important to insure a good seal after a vaginal birth.

By contrast, there is another cup shape now being marketed as the Softcup®, or sometimes referred to as the Instead (manufactured by Instead, Inc. since 1996).  Readily available over the counter, these cups come in only one size. However they come in both single use and multi-use versions. The shape of these cups is more like a conventional 70mm diaphragm. Thus they sit high in the vagina, cover the cervical area, and could be used during intercourse.

A majority of menstrual cup studies have focused on acceptability and leakage and tend to be very short term. I could find only one study lasting 12 months. One recent study was a head-to-head comparison of the DivaCup to tampons. Women were randomly assigned to either sanitary product, then followed for three menstrual cycles. Eighty nine women completed the study, and results showed about equal satisfaction with both methods. Like many of the earlier cup studies there appears to be a “learning curve” for effective and comfortable use. Yet there was a calculated, clear environmental advantage for the reusable cup as it decreases the amount of waste—making it a “greener” alternative.

So what about safety issues with the menstrual cup? During the initial clinical studies for Softcup, 44 of the 406 women enrolled had detailed vaginal bacteria testing and colposcopies to look for potential problems. No safety problems were identified initially. In the over ten years of FDA postmarketing surveillance, only nine complaints were registered as serious. Two of these were about alleged TSS and neither was confirmed by the Centers for Disease Control (CDC). The materials used in the Softcup were exposed in the lab to the TSS bacteria, and there was no increase in the super-antigen producing bacterias.

Ultimately, menstrual flow control is a highly personal choice, just like choosing a method of birth control. And, like choosing a contraceptive, women may make different choices at different times in their lives. I clearly remember being instructed by a cousin how to use her Tampax-type tampons, but she wasn’t very clear about the part where you remove the cardboard applicator. I couldn’t figure out why the darn things were supposed to be so comfortable; I could feel it all the time! Later I switched to “tampon on a stick”. It was evident that the stick was to be removed after using it as an inserter. Menstrual cups, diaphragms, and even sea sponges rotated through my life. Menstrual management is just another example of adjusting oneself to time, place and circumstances.