WE HAVE REPEATEDLY WRITTEN ABOUT THE MENSTRUAL CAPAJ: did review the most popular bowls, tried their entire editorial staff, talked about CAPAJ with tech elements – such as tracker or applicator . But for many women, the question remains open – what does the cup give, in addition to convenience, economy and environmental friendliness? Manufacturers claim that switching from pads and tampons to cups will improve health, reduce soreness of menstruation and get rid of the risk of TSS (toxic shock syndrome). We figure out whether this is so, together with an obstetrician-gynecologist, candidate of medical sciences and author of the blog Tatyana Rumyantseva.
How does toxic shock syndrome occur?
Toxic shock syndrome, or TSS, is a rare but very dangerous adverse effect of using tampons. It develops due to the fact that in the “nutrient medium”, consisting of menstrual blood and tampon components, bacteria begin to multiply – Staphylococcus aureus. They secrete a toxin called TSST-1 (toxic shock syndrome toxin 1), which causes a life-threatening disorder in which fever rises, blood pressure drops and organs fail.
In the 1980s, when high absorbency tampons entered the US market, doctors began to notice a rapid increase in cases of TSS – one in 7,000 women experienced it . It became clear that keeping the tampon in the vagina for too long was not a good idea. After that, manufacturers of hygiene products stopped producing super absorbent tampons, limited the maximum use period to eight hours (with a recommendation to change more often if possible), and the situation returned to normal.
Today, TSS develops in only one in two million women. However, because of this – albeit very low risk – many are afraid to use tampons, especially at night, or fear that they will forget to change the tampon in time. That is why in 2002 a new solution appeared in the UK – the reusable silicone menstrual cup Mooncup (later renamed MCUK). Following the British, other manufacturers began to produce mouthguards, and soon the bowls flooded the market.
Is it true that there is no risk of TSS with a bowl?
One of the perks of the menstrual cup, which is actively used in marketing, is that it can be changed every twelve hours, that is, only twice a day. At the same time, as many manufacturers write , there is no risk of TSS – and it was believed that it was, until 2015, when a case of TSS was reported after using a menstrual cup. It developed in a thirty-seven-year-old woman who had started using DivaCup ten days earlier. She observed the necessary hygiene, removed and washed the bowl on time, but with one of the first introductions she scratched the wall of the vagina. Doctors considered that a large accumulation of blood with access to oxygen and carbon dioxide, as well as damage to the mucous membrane, could provoke the growth of Staphylococcus aureus and the release of dangerous toxins.
Scientists decided to test how staphylococci grow in different hygiene products, namely in eleven types of tampons and four menstrual cups. It turned out that S. aureus multiplied even faster in the trays, apparently due to the access of air, which is provided by the design of the bowl. According to the results of the study, new recommendations appeared: to adhere to more or less the same precautions as when using tampons, that is, to empty and clean the bowl at least once every eight hours. Fortunately, warnings about the risk of TSS appeared on the websites of some manufacturers – in particular, the pioneer MCUK: now they offer to change the bowl not twice, but at least three times a day.
Tatyana Rumyantseva explains that bacteria probably don’t care where they multiply – in the blood in the bowl or inside the tampon. Menstruation in itself is already a factor that provokes a violation of the microflora. To date, it is known that the cups do not increase the frequency of detection of Staphylococcus aureus in the vagina, and the materials from which they are made do not interact with toxins or enhance their effects. Nevertheless, one case of toxic shock syndrome has been described – which means that one cannot be 100% sure that there is no risk. The gynecologist adds that if you have fears and doubts, you can simply empty the mouthpiece more often.
Can the cup get stuck and do I need to run to the doctor if it has remained in the vagina for more than twelve hours?
The bowls are designed in such a way that it is enough to press on the surface and it becomes easy to remove. If the cervix has risen a little higher and the bowl has passed a little further, then you should not worry. First, take your time and relax. Then try to push: gradually the mouthguard will lower and it will be possible to grab it by the tail or the lower part.
As for a one-time long stay: according to Tatyana Rumyantseva, she has not encountered any problems associated with this either in literature or in practice. In addition, with prolonged use, the bowl can overflow, and then, even if it is “stuck”, it will be even easier to get it out.