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One of my friends uses cups when she's having her period. I've never heard of them before, but she says that they're really comfortable and easier to deal with than tampons or pads. What are cups? Are they better than tampons/pads?
Menstrual cups are devices -- usually made of silicone or latex -- you can insert into the vagina to contain menstrual flow. They're internal, like tampons, but unlike tampons, they catch flow, rather than absorbing it.
Absorbing flow with a tampon means it's also absorbing your vaginal moisture. Tampon use can result in a drier vagina, and also, for some women, in heavier or greater cramps because of that absorption, since a tampon is basically kind of tugging the sides of the vagina to draw out fluids.
As well, many commercial brands of tampons use dioxins, bleaches, fragrances and/or synthetic fibers that aren't so healthy for the vagina. Tampons can also pose the risk of TSS or Toxic Shock Syndrome, which cups have not been found to present. Given, TSS rates are very low these days, and women who are vigilant about using low-absorbency tampons and changing them often are unlikely to get TSS. Women bothered by their scent during menses will also find that when using a cup rather than tampons, their scent is better or more subtle.
One cup is designed for a single use only, while a few others are designed to be reused. Reusable cups, like washable pads, are a great choice for women who want to reduce the waste we put into the environment. A given woman will use around 15,000 pads or tampons in her lifetime, which is an awful lot of waste. The National Women’s Health Network has stated that every year almost 13 billion tampons are used once and disposed of to wait around for hundreds of years before biodegrading. Yipes!
Menstrual cups -- even the disposable ones -- also work out to be cheaper for women over time. That's a pretty big deal when you consider that not only do we get paid less as a group than men, but that menstrual products are an expense only we have. As well, many feminine "hygiene" companies (most of which are owned by men) have made a mint off of all of us for decades. Spending more than we have to doesn't make a lot of sense, especially when you consider the other pros of cups or other reusable ways of managing flow.
Two types of cups can also be used during vaginal sex, unlike tampons. For women who like to be sexually active during periods, but aren't comfortable with menses being present, or who just want to avoid staining bed linens, that can be a helpful benefit.
As far as a comparison to pads, cups are different than pads. They go inside the vagina, rather than sitting on your underpants beneath the vaginal opening. Some women who use cups alternate use of them with pads (and often washable pads, since reusable cup users tend to be eco-conscious and/or want to avoid putting bleaches and like like found in many pads or tampons in or around their vaginas), others just use cups.
The Divacup (and others like it, like the Keeper or Mooncup) is a medical-grade silicone cup designed for long-term reuse. Reusable cups like the Divacup or Keeper come in two sizes: one for women who have given birth, and another for women who have not. They stay in via a very light suction, and because of their shape. You put one in by squeezing and folding the sides, and pushing it back: as it opens up inside, it'll create a very gentle seal. The cup is held in by the muscles of your vagina, and you shouldn't feel it after it's been in for a few minutes. It also is not going to fall out.
You can keep a cup in for up to 12 hours, and when inserted properly, reusable cups very infrequently will leak. To take it out, you squeeze to break that seal and just pull it out carefully, dumping your flow in the toilet or sink. You rinse it out and can reinsert it again if you need to. The manufacturers suggest washing it once or twice a day with a very gentle, unfragranced soap or cleanser, or a mix of a little vinegar diluted with water. If you like, you can also boil your cup once a month to help keep it clean.
Because of the shape of the cup and where it sits -- in the lower half of the vagina -- reusable cups like the Divacup or Keeper can't be in during vaginal sex. They can be in for things like oral sex, but not for any activities where something else is inside your vagina.
The cost of a reusable cup may seem expensive at first, but since they can be reused for a long time, they wind up much being cheaper than disposable cups as well as much cheaper than tampons in the long run. Most women spend close to a couple hundred bucks a year on disposable tampons and/or pads, and one cup that you can use for a year or two (and the Keeper can be used for up to ten years) costs around $35. Reusable cups are getting easier to find these days. You can order them from online retailers like Lunapads or Glad Rags, often find them at natural foods stores, and some pharmacies and mainstream grocery stores have started to carry them as well. The manufacturers of most cups usually offer money-back guarantees if you find that the cup doesn't work for you or just isn't something you like.
Update: A Scarleteen reader wrote in to give us a nice big list of many reusable cup brands: Divacup, Femmecup, Fleurcup, Green Donna (only in Brazil so far), The Keeper, Lady Cup (which comes in totally awesome colors!), Lunette (known in France as Lunacup), MeLuna, Miacup, Mooncup, Mpowercup snd Yuuki. She also mentioned that the Lunette and the LadyCup are smaller with a smaller rim and are great for beginners. Thanks, Klaartje!
You can also use a diaphragm as a menstrual cup. Diaphragms like the Milex Wide Seal (which is also a silicone diaphragm, and not latex like many, so it's great for folks with latex allergies or sensitivities) have a lip inside the seal which can make it more secure, which makes them even more perfect for use as a menstrual cup. Like the Divacup, diaphragms are meant to be reused, and unless you give birth, have a late-term abortion or gain or lose 15 pounds or more (in which case you may need a different size), a diaphragm can last you a couple of years. They usually cost between $30 and $50 dollars.
The big bonus of using a diaphragm as a cup is obviously the fact that the diaphragm is also a reliable, non-hormonal method of birth control. To be used as both, you will still have to use a spermicide inside your diaphragm, though. You put a diaphragm in by folding it like a taco, then sliding it to the very back of your vaginal canal, where it covers the cervix. The rim of the diaphragm is anchored in place by the public bone and also held by the muscles of the vagina.
To get a diaphragm, you'll need a fitting by a sexual or general healthcare professional (you can ask for this during your annual exam and pap smear), who will then give you a prescription for a given type and size to have filled at any pharmacy. Many pharmacies don't keep a stock of diaphragms, so you may have to wait a week or two for yours to come in.
The Instead Softcup is another cup option. You can purchase those at many pharmacies, in the same aisle you'd buy tampons or pads. Unlike the Divacup, they are not meant to be reused: each cup is only designed for a single use. Like a diaphragm used as a menstrual cup, the Instead can be left in during vaginal sex, but unlike the diaphragm, it is not a method of contraception, and will not prevent pregnancy. You insert an Instead the same way you insert a diaphragm.
The cons of the Instead are that regular use can be a little spendy (they cost around 50 cents per cup), and if one reason you want to use cups is to be more environmentally-sound, they aren't helpful there since they are disposed after each use. Like reusable cups, they can be left in for up to 12 hours, but since women tend to report more leakage with Instead cups (likely due to the difference in design, both in shape and because the cup is not made of a firmer material like that of diaphragms) than reusable ones, you may want to empty them more frequently than that.
With any style of cup you use, it'll usually take a bit of practice to get in the hang of putting it in, the same way it can take a little bit of time for women to get the hang of using tampons. If you have trouble, you can put a little lube around the edges of a cup to help it slide in more easily. You might also want to pair a cup with a pad or pantiliner -- or just try it at home in a pair of ratty sweatpants when you're new to it -- the first few times you use it just in case you didn't get the seal just right.
Want to know more basics about all your menstrual flow options? We've got a big walk-through here: On the Rag: A Guide to Menstruation. You can also read an article about washable pads -- which make a great partner to alternate with when you're using cups, or which you might prefer to cups altogether -- here: Eight Myths About Washable Menstrual Pads Dispelled.