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Menstrual cups are generally regarded as safe within the medical community.

Although there are some risks, they’re considered minimal and unlikely to occur when the cup is used as recommended.

It’s also important to consider that all menstrual hygiene products carry some degree of risk.

It ultimately comes down to finding the product and method that you’re most comfortable with.

Here’s what you need to know about using menstrual cups.

You’re more likely to experience minor irritation from wearing the wrong cup size than you are to develop a severe complication like toxic shock syndrome (TSS).

Understanding how and why these complications occur can help you reduce your overall risk of adverse effects.

Irritation

Irritation can happen for a number of reasons, and, for the most part, they’re all preventable.

For example, inserting the cup without proper lubrication can cause discomfort.

In many cases, applying a small amount of water-based lube to the outside of the cup can help prevent this. Be sure to read the manufacturer’s recommendations on the product packaging for further clarification.

Irritation can also occur if the cup isn’t the right size or if it isn’t cleaned properly between uses. We’ll discuss cup selection and care later in this article.

Infection

Infection is a rare complication of menstrual cup use.

And when infection does occur, it’s more likely to result from the bacteria on your hands and transferred to the cup than from the actual cup.

For example, yeast infections and bacterial vaginosis can develop if the bacteria in your vagina — and subsequently your vaginal pH — becomes imbalanced.

You can reduce your risk by washing your hands thoroughly with warm water and antibacterial soap before handling the cup.

You should also wash your cup with warm water and a mild, fragrance-free, water-based soap before and after use.

Over-the-counter examples include Dr. Bronner’s Pure-Castile Soap (which can be found in most health food stores) or Neutrogena Liquid Soap.

Scent-free, oil-free cleansers made for infants are also good alternatives, such as Cetaphil Gentle Skin Cleanser or Dermeze Soap-Free Wash.

TSS

Toxic Shock Syndrome (TSS) is a rare but serious complication that can result from certain bacterial infections.

It occurs when Staphylococcus or Streptococcus bacteria — which naturally exist on your skin, nose, or mouth — are pushed deeper into the body.

TSS is typically associated with leaving a tampon inserted for longer than recommended or wearing a tampon with a higher-than-needed absorbency.

TSS as a result of tampon use is rare. It’s even more rare when using menstrual cups.

To date, there has only been one report of TSS associated with the use of a menstrual cup.

In this case, the user created a small scrape on the inside of their vaginal canal during one of their initial cup insertions.

This abrasion allowed Staphylococcus bacteria to enter the bloodstream and spread throughout the body.

You can reduce your already low risk for TSS by:

  • washing your hands thoroughly with warm water and antibacterial soap before removing or inserting your cup
  • cleaning your cup as recommended by the manufacturer, usually with warm water and a mild, fragrance-free, oil-free soap, before insertion
  • applying a small amount of water or water-based lube (per manufacturer’s instructions) to the outside of the cup to aid in insertion

Safety

Menstrual cups are usually safe as long as you insert them with clean hands, remove them carefully, and clean them appropriately. If you aren’t committed to keeping them clean, however, you may wish to use a disposable product, like pads or tampons.

Cost

You pay a one-time price for a reusable cup — usually between $15 and $30 — and can use it for years with proper care. Disposable cups, tampons, and pads must be continually bought.

Sustainability

Menstrual cups that are designed for reuse cut down on the number of pads or tampons in landfills.

Ease of use

Menstrual cups aren’t as easy to use as pads, but can be similar to tampons in terms of insertion. Learning to remove the menstrual cup can take time and practice, but usually gets easier with repeated use.

Volume held

Menstrual cups can hold varying amounts of blood, but on heavy days, you may have to rinse or change them more frequently than you’re used to.

You may be able to wait up to 12 hours — the max recommended time — before you have to change your cup, whereas you may need to change a pad or tampon every 4 to 6 hours.

IUDs

All menstrual hygiene products — cups included — are safe to use if you have an IUD. There hasn’t been any evidence to suggest that the process of insertion or removal will dislodge your IUD.

In fact, researchers in one 2012 study found your risk for IUD expulsion is the same regardless of whether you use a menstrual cup.

Vaginal sex

If you have vaginal sex while wearing a tampon, the tampon may get pushed higher into the body and become stuck. The longer it’s there, the more likely it is to cause complications.

Although menstrual cups won’t get dislodged in the same way as tampons, their position may make penetration uncomfortable.

Some cups may be more comfortable than others. The Ziggy Cup, for example, was designed to accommodate vaginal sex.

The general medical consensus is that menstrual cups are safe to use.

As long as you use the cup as directed, your overall risk for adverse side effects is minimal.

Some people like them because they don’t have to change them as often as other products and because they’re reusable.

Whether they’re right for you ultimately comes down to your individual comfort level.

If you’ve experienced recurrent vaginal infections and are concerned about increasing your risk, talk to a doctor or other healthcare provider before use.

They can answer any questions you have and may be able to recommend a specific cup or other menstrual product.

Although there aren’t any official guidelines around this — most manufacturers recommend cups for all ages and sizes — cups may not be an option for everyone.

You may find it helpful to talk to a doctor or other healthcare provider before use if you have:

  • vaginismus, which can make vaginal insertion or penetration painful
  • uterine fibroids, which can cause heavy periods and pelvic pain
  • endometriosis, which can result in painful menstruation and penetration
  • variations in uterine position, which can affect cup placement

Having one or more of these conditions doesn’t automatically mean that you can’t use a menstrual cup. It just means that you may experience more discomfort during use.

Your provider can discuss your individual benefits and risks and may be able to guide you on product selection.

Menstrual cups can come in slightly varied shapes and sizes. Sometimes it’s hard to know the best one to purchase. Here are a few tips:

Size

Most manufacturers offer either a “small” or a “large” cup. Although the same language is used across manufacturers, there isn’t a standard for sizing dimensions.

Small cups are usually 35 to 43 millimeters (mm) in diameter at the rim of the cup. Large cups are usually 43 to 48 mm in diameter.

Pro Tip:

As a general rule, select a cup based on your age and history of childbirth rather than anticipated flow.
Although the volume held is important, you want to make sure that the cup is wide enough to stay in place.

A smaller cup may be best if you’ve never had intercourse or typically use absorbency tampons.

If you’ve had a vaginal delivery or have a weak pelvic floor, you may find that a larger cup fits best.

Sometimes, discovering the right size is a matter of trial and error.

Material

Most menstrual cups are made from silicone. However, some are made from rubber or contain rubber components.

This means if you’re allergic to latex, the material could irritate your vagina.

You should always read the product label before use to learn more about the product material

Your cup should come with instructions for care and cleaning. Here are some general guidelines:

Initial cleaning

It’s important to sterilize your menstrual cup before you insert it for the first time.

To do this:

  1. Submerge the cup completely in a pot of boiling for 5 to 10 minutes.
  2. Empty the pot and allow the cup to return to room temperature.
  3. Wash your hands with warm water and mild, antibacterial soap.
  4. Wash the cup with a mild, water-based, oil-free soap and rinse thoroughly.
  5. Dry the cup with a clean towel.

Insertion

Always wash your hands before inserting your cup.

You may also consider applying a water-based lube to the outside of the cup. This can reduce friction and make insertion easier.

Make sure you check the manufacturer’s recommendations on the product packaging before using lube.

As a general rule, silicone- and oil-based lube may cause certain cups to degrade. Water and water-based lube may be safer alternatives.

When you’re ready to insert, you should:

  1. Tightly fold the menstrual cup in half, holding it in one hand with the rim facing up.
  2. Insert the cup, rim up, into your vagina like you would a tampon without an applicator. It should sit a few inches below your cervix.
  3. Once the cup is in your vagina, rotate it. It will start to expand to create an airtight seal that stops leaks.
  4. You may find that you have to twist it or reposition it slightly for your comfort, so adjust as needed.

Emptying

Depending on how heavy your flow is, you may be able to wear your cup for up to 12 hours.

You should always remove your cup by the 12-hour mark. This ensures regular cleaning and helps prevent a buildup of bacteria

Wash your hands with warm water and mild antibacterial soap. Then:

  1. Slide your index finger and thumb into your vagina.
  2. Pinch the base of the menstrual cup and gently pull to remove it. If you pull on the stem, you could have a mess on your hands.
  3. Once it’s out, empty the cup into the sink or toilet.
  4. Rinse the cup under tap water, wash it thoroughly, and reinsert.
  5. Wash your hands after you’re done.

After your period is over, sterilize your cup by putting it in boiling water for 5 to 10 minutes. This will help prevent contamination during storage.

Storage

You shouldn’t store your cup in an airtight container, because this won’t allow moisture to evaporate.

Instead, any moisture present can linger and attract bacteria or fungi.

Most manufacturers recommend storing the cup in a cotton pouch or an open bag.

If you go to use your cup and find that it has areas that appear damaged or thin, carries a foul-smelling odor, or is discolored, throw it out.

Using the cup in this state may increase your risk of infection.

Although infection is highly unlikely, it is possible. See a doctor or other provider if you begin experiencing:

  • unusual vaginal discharge
  • vaginal pain or soreness
  • burning during urination or intercourse
  • foul odor from the vagina

You should seek immediate medical attention if you experience:

  • a high fever
  • dizziness
  • vomiting
  • rash (may resemble sunburn)