Menstrual activism (also known as radical menstruation, menstrual anarchy, or menarchy) is a movement that addresses menstrual taboos. [ 144 ]  Overcoming this taboo is a point of contention amongst  feminists . The primary argument behind this movement is that if menstruation is normal, there is no reason why the topic should be avoided: "After a while it becomes psychologically disorienting for women to look out at a world where their reality doesn't exist." [ 145 ]


The prominent rise of menstrual activism began with the rise of  feminist spiritualist  menstrual activists in the late 1960s. [ 146 ]  In 1973, a "Bleed In" was held by Janice Delaney, Mary Jane Lupton, and  Emily Toth , who believed that their shared menstruation experience merited discussion. [ 146 ]  The rise of early menstrual activism was prompted by rising cases of  toxic shock syndrome  due to unhygienic menstrual practices, which prompted responses feminists and menstrual activists alike. As such, a group of women gathered in Boston in the spring of 1969, calling themselves the  Boston Women's Health Book Collective  (BWHBC). [ 146 ]  This culminated in the publishing of a manual called  Women & Their Bodies , which has been adapted and currently sells today under the title of  Our Bodies, Ourselves . [ 146 ]  Though the manual itself rarely discussed menstruation, it opened the floodgates for an honest criticism of the way women's health is discussed. In the following decades, women's liberationists called for pushback against the status quo. A primary vehicle for these messages was through art; in 1971,  Judy Chicago  created "Red Flag", a photolithograph, and a year later, an interactive art installation called " Womanhouse ". [ 146 ]  Artistic expression transcended into national recognition, as evidenced by figures like Emily Culpepper. Culpepper released a short film in 1972 that featured menstruation images that detailed realities of having one's period. [ 146 ]  The fame generated from this piece made Culpepper the figure of knowledge surrounding menstruation for laypeople, and initiated her nationwide involvement with the BWHBC. [ citation needed ]


The height of second-wave feminism led to landmark changes during this period, including the establishment of the Society for Menstrual Cycle Research and literature that more directly addressed the existence of  menstrual stigma . [ citation needed ]


Menstruation can be conceptualized as a stigmatized condition that both reflects and reinforces women's perceived lower status in relation to men. [ 147 ]  Feminist scholars extend this theory to explain negative attitudes towards women's bodily functions. [ 148 ]  Such stigmatization occurs when menstrual blood is viewed as one of the "abominations" of the body and reflects a gendered identity among women, which leads to consequences for women's psychological and sexual well-being. [ 148 ]


Feminists such as Chella Quint have spoken against the use of shaming in advertising for feminine hygiene products. [ 149 ]  She created a  zine ,  Adventures in Menstruating , to "help alter the visibility of menstruation, so that it's at least normal to talk about it. Because, right now, it's not". [ 150 ]  Other menstrual activists include Rachel Kauder Nalebuff, who published  My Little Red Book ; filmmaker and academic Giovanna Chesler, who created the documentary  Period: The End of Menstruation ; and artist Ingrid Berthon-Moine, who exhibited a video and series of photographs at the  Venice Biennale . [ 150 ]


Menstruation activism has also begun to emerge in China in recent years. Starting with the outbreak of COVID-19 in China, a grassroots movement provided free sanitary pads to diverse groups of women in China and aims to remove the stigma of menstruation. Starting by donating menstrual products to female frontline health workers in Wuhan in February 2021, [ 151 ]  the movement features the wider discussion sparked by the hashtag "package-free sanitary pads" on social media platform  Weibo  in September 2021 and reveals the unspeakable pain of period poverty to the public. [ 152 ]  Following the campaign by the advocacy group Stand By Her on social media, [ 153 ]  university students set up "sanitary pad help boxes" and provide free sanitary pads at over 250 campuses in China. [ 154 ]


At 16 years old,  Nadya Okamoto  founded the organization PERIOD, and wrote the book  Period Power: a Manifesto for the Menstrual Movement . [ 155 ]


New York Congresswoman  Grace Meng  has been a longstanding advocate for menstrual equity, and proposed the Menstrual Equity for All Act of 2021 to Congress. [ 156 ]  Many women's rights organizations have endorsed this bill, including the Alliance for Period Supplies, Plan,  Girls Inc. ,  Human Rights Watch , and I Support the Girls in addition to their various campaigns that fight for destigmatization, free menstrual products, and more. [ citation needed ]


Activism roles have also been taken on by young Black women like the Brown sisters, who founded the organization 601 For Period Equity in response to the "white-washed" nature of many other organizations. [ 157 ]


In India and Pakistan, grass roots activism is taking place with young people coming together to break the stigma around menstruation using art workshops, murals and street theatre. For example, in Jharkhand young people painted a mural on a wall outside a post office to raise awareness in the village, many social enterprises have been established to help increase access to refugee populations, people with disabilities and other marginalised groups. [ 9 ]


Blood from female  menstruation  has been used in  medicines . In Chinese  Daoist  alchemy, menstrual blood from females who had not had sexual intercourse was used to make a substance to prolong an individual's life, called red lead ( Chinese :  红铅 ;  pinyin :  hóng qiān ). [ 158 ]  The substance was taken by the  Ming dynasty   Jiajing Emperor  and the abuses inflicted on the palace women to ensure the blood's purity led to the  Renyin palace rebellion . [ 159 ]


Menstrual synchrony  is an alleged process whereby women who begin living together in close proximity experience their  menstrual cycle  onsets (the onset of  menstruation  or menses) becoming more synchronized together in time than when previously living apart. [ 160 ] [ 161 ]  A 2013 review concluded that menstrual synchrony likely does not exist. [ 162 ]  In an interview with a woman who was incarcerated for many years in Pakistan, she claimed that her cycle was always in sync with her fellow inmates. [ 9 ]


Menstrual products are part of menstrual culture, as they are prominent in shops, through advertising and through disposal methods (such as sanitary bins and bags). Throughout the twentieth-century applicator tampons like  Tampax  ( Always ) and pads such as  Kotex  were increasingly popular in the  Global North . [ citation needed ]


There are environmental costs of using menstruation products containing plastic and chemicals. [ 163 ]  As an alternative, companies are manufacturing reusable  period panties ,  cloth menstrual pads ,  menstrual cups ,  biodegradable   sanitary napkins  and other  eco-friendly  products. [ 164 ]  Not all cultures use menstrual products, opting instead for natural materials or homemade options. [ citation needed ]


Research has shown that access to sanitation and hygiene arrangements for menstruating allotment holders in the UK limits access to these spaces. [ 165 ]


The term menstrual inequity refers to the disparities in affordability, accessibility, destigmatization, and safety of menstrual products. [ 166 ]  Furthermore, calls for menstrual equity expand into demands for reproductive justice, which includes the subtopics of education, support systems, and healthcare. Menstruation is a highly stigmatized biological process, to the extent that most women feel uncomfortable discussing their experiences. In the CBSN documentary "Period", New York Congresswoman Grace Meng discussed the complex feelings of shame that come with menstruation and how it contributes to gender inequality. [ 167 ]


Beyond the perpetuation of gender inequality, the inclination to hide menstruation experiences contributes to the phenomenon of  period poverty . Period poverty is defined as "a lack of access to menstrual products, education, hygiene facilities, waste management, or a combination of these", according to Medical News Today. [ 168 ]  In fact, 25% of women cannot purchase period products due to income limitations. [ 169 ]  Furthermore, period products cannot be purchased with government subsidies like food stamps, health spending allowances, Medicaid, or health insurance. [ 170 ] [ 171 ]


Menstruating is an expensive process, and thus difficulty in accessing period products disproportionately impacts low-income people. Especially with laws like the  tampon tax  and the lack of free menstrual products in most bathrooms, many are forced to miss school or work due to lack of access. [ 172 ]  One in five low-income women have reported missing work, school or similar events due to lack of access to period supplies. [ 173 ]


With regards to mental health, 68.1% of women experiencing monthly period poverty expressed that they were experiencing moderate or severe depression compared to 43.4% of women who experienced no period poverty. [ 174 ]


In 2021, 51% of female students wore period products for longer than recommended. [ 173 ]  Overtime use of period products may lead to the onset of toxic shock syndrome, in addition to the chances of used  pads  and  tampons  having the ability to carry  STIs . [ 175 ]  In a different study with low-income women, 64% of participants explained that they could not afford menstrual products in the previous year. [ 176 ]  Of these women, around one-third expressed that they resorted to other products like rags, toilet paper, and children's diapers.


The  COVID-19 pandemic  has only exacerbated these concerns in a time when unemployment and financial insecurity has risen. [ 173 ]  In March 2020, the  CARES  Act allowed for money from health savings and flexible spending accounts to be used for the purchasing of menstrual products. Interviews with poor women in Pakistan conducted during the pandemic highlight how access to menstrual products became impossible and was not a priority and they had to resort to sharing and using rags. [ 9 ]


In 2017, the  U.S. Department of Justice  promised to grant every  woman incarcerated in a federal prison  menstrual products free of charge. [ 172 ]  Yet countless women are not housed in a federal prison, and go without access to period products keeping them safe and hygienic. 54% of women in prisons do not have access to sufficient period supplies, as they are forced to spend their 75 cent per hour wages at commissaries that charge up to 5 dollars for pads and tampons. [ 177 ]


Efforts are now being made to reduce period poverty in Scotland, as it became the first country in the world to make period products free in August 2022. [ 178 ]  The Period Products Act made it a legal duty for local authorities to provide free period products such as tampons and sanitary pads to "anyone who needs them." [ 178 ]


Like  many other health-related concerns , menstruators' experiences are influenced by their race, amongst other factors.  Medical racism  extends to discussions of period pain as well.


Dismissal of period pain is further implicated by the history of violence against black women, originating with slavery and continuing into its aftermath. Dr.  J. Marion Sims , who is heralded as the father of obstetrics and gynecology, performed risky surgeries without anesthesia on enslaved women in order to experiment. [ 179 ]   A study performed through a series of interviews highlighted that for black and Latina women, all the women in the study reported a normalization of pain by medical professionals. [ 180 ]  This was not surprising to the author of the study, given that women are proven to be less likely to report their pain when they are shot down in their attempts to seek out help. [ 181 ]  Women in the study expressed atypical symptoms such as 47-day-long periods, excruciating cramps, and unrelenting constipation—and still were dismissed by medical professionals. These women, up to multiple decades later, were diagnosed with severe illnesses like  pituitary tumors  and  polycystic ovary syndrome . The denial of pain for women of color does not stop at delayed diagnoses and daily pain, and rather has larger implications for mental health.
A strong case has been made by some Marxist feminists for including period leave in the work place citing pain as one of the reasons while many other feminists are against it. [ 9 ]


Negative relations and perceptions of one's uterus and uterine functions potentially may make many hesitant to call on their reproductive system in the future. [ 181 ]  Especially considering high  black maternal mortality  rates, the connection between poor relationships with reproductive health and adverse consequences is glaring.


Fibroids  are a particularly important condition to mention when discussing racial disparities in menstrual health. Uterine fibroids are significantly more likely to occur in black women, with 9 out of 10 black women being diagnosed with fibroids before the age of 50. [ 182 ]  Black women also face higher rates of adverse symptoms, like extreme pain and  heavy menstrual bleeding . Impacts on black women are further worsened by the fact that 42 percent of black women wait four years or more before seeking out treatment for fibroids, compared to 29 percent of white women. [ 183 ]  Fibroids have immense consequences in terms of cancer risk, as black women who have fibroids have shown to be 40 percent more likely to have some form of endometrial cancer. [ 184 ]  Analogously, it has been demonstrated that black women are equally as likely to have  endometriosis , but are significantly less likely to be diagnosed with the disease compared to white women. [ 185 ]


All of the aforementioned health risks result in what physicians and activists alike label as "period trauma". Dr. Charis Chambers, a board certified  OB/GYN , explains that "I would define period trauma as any sustained psychological, social, or emotional injury/distress related to or caused by menstruation". [ 186 ]  Almost half of black school-attending women reported that they are not able to do their best on school work because of their periods. [ 173 ]  Especially considering the additional  systemic burdens  faced by black people, missing school and becoming further behind in the system worsens phenomena like the wage gap between white and black women.


66 percent of  trans men  feel uncomfortable or unsafe using their  preferred restroom . [ 187 ]
Correspondingly, 66% of transgender men thought people felt negative or very negative about masculine-presenting people who menstruate. Menstruating on its own is difficult, when accounting for period stigma and period pain, but the added burden of  gender dysphoria  can be traumatizing [ 187 ]


Many trans men and trans masculine people feel uncomfortable with  vaginal penetration , as penetration in itself is strongly associated with femininity and womanhood. [ 187 ]  Period poverty disproportionately affects transgender menstruators, because these populations already face poverty, [ 9 ]  unemployment, incarceration, and underemployment at much higher rates. [ 187 ]


Menstruation  activism  has become more prominent during  third-wave feminism , with a range of arguments being made across global scholarship and cultures. Much of the menstruation activism in the West has centered on arguments against what many feminists believe to be the misuse of menstruation to 'prove' female biological inferiority. [ 188 ]  While some feminists have argued that Western  patriarchy  has used the inability for women to control their menstruation as evidence of the female body suffering from limitations, [ 189 ]  others have focused on historical works that deem menstrual blood 'dirtier' than other blood, because it results from the failed reproductive cycle. [ 188 ]  Activists in literary fields and gender studies have noted a history of menstruation as being symbolic for evil or secrecy, and argue against the long standing  stigmatization  of menstruation in order to elevate masculinity. [ 189 ]  Thus, menstrual activism has grown to include a variety of arguments, including, but not limited to: social, philosophical, political, and theoretical. All of these efforts make up the  Menstrual Equity  Movement, which seeks to correct menstruation as a driving force for social and political inequality. [ 190 ]


One focus of activism has been to challenge high taxes on menstrual products, otherwise known as  period tax . [ 191 ]  In recent years, activists around the world have turned their attention to lowering or abolishing the higher taxes placed on menstrual products, because some states and countries consider them "luxury items". [ 191 ]  In the US, the tax on menstrual products can reach up to 10%, depending on state legislature. [ 192 ]  In 2020, Hungary had one of the largest, taxing up to 27% on menstrual products. [ 192 ]  In Switzerland, menstrual products are taxed at a rate of 7.7% which is the same tax rate applied to cars, alcohol and watches, as opposed to other everyday items such as groceries which are taxed at 2.5%.  [ 193 ]  Still, some activists have raised concerns that the focus on period tax is halting broader, more important activism, like challenging the social and medical stigma that surrounds menstruation. [ 194 ]  Still, the movement to lower period tax has persisted, and has been deeply connected to another movement against  period poverty . For many menstrual activists, the call for the exemption of menstrual products from taxation is based on the unjust nature of the tax, since menstruation is a natural biological process that women have no control over whether it occurs or not. [ 194 ]  In China, the movement towards the abolishment of  period tax  also referred to as  tampon tax  continues to gain traction, with various activists on  Weibo  calling for the abolition of the tax by the Chinese government aided by various hashtags such as "sanitary pads tax-free" in a curious intersection of technology, digital activism and menstruation activism.  [ 194 ]


Period poverty is a recent phrase and refers to anything dealing with an impoverished menstruation experience, including the shame and stigma associated with the lack of a dignified experience  [ 9 ]  as well as affordability and access to a choice of menstrual products from tampons, pads, underpants or menstrual cup,  sanitation facilities with clean running water, reproductive health education, and waste management. [ 192 ]  A global study conducted in 2021 showed that roughly 500 million women and girls experience period poverty. [ 191 ]  The effects of period poverty can range from physically not being able to attend school, work, or both while menstruating, as well as negatively impact mental health. [ 191 ]  A US study conducted in 2021 showed that roughly 68% of women who reported experiencing period poverty monthly, also expressed having feelings of moderate to severe depression. [ 191 ]  This same study also revealed differences across racial lines in the US, as  Latinx  women reported the highest rates of period poverty, followed by Black women, and then white women, particularly from low-income communities. [ 191 ]  Although research into period poverty has focused primarily on  cisgender  women in low/middle income communities and countries, [ 190 ]  other scholars have begun examining how period poverty affects  non-binary  and  transgender  individuals as well. [ 190 ]


With the rise of  commodity feminism , menstruation activism has evolved from just promoting the accessibility, environmental-friendliness and affordability of menstrual products to center more critical issues with regards to menstrual products such as the manner in which menstrual products perpetuate menstrual stigma. Besides environmental concerns, menstrual activists have addressed the various ways in which the advertising and manner of production of menstrual products such as disposable pads and tampons has framed menstruation as a problem to be managed, hidden, or suppressed in private with commercial products.  [ 118 ]  Consequently, menstruation activists have adopted various strategies in combatting the menstrual stigma perpetuated by menstrual products, with the use of 'alternative menstrual products' and do-it-yourself menstrual products being at the forefront.  In this case, alternative menstrual products are products that are not produced by the four multinationals that dominate the menstrual products and include menstrual cups and discs, cloth pads, period underwear and organic pads and tampons in some instance.  [ 118 ]  Producers of alternative menstrual products focus on the elimination of stigma around menstruation through positive and educational messages about menstruation in their marketing.  [ 118 ]  They address a wide range of topics with regards to menstruation from period positivity, access to affordable and sustainable products, access to menstrual education and women's health, challenging the status quo maintained by producers of mainstream menstrual products.  [ 118 ]


Recent scholarship has argued that menstruation, although a strictly biological function, has been imbued with  gender /sex identity. Thus, as advocacy for, and awareness of transgender and non-binary individuals increases across the globe, menstrual activism is evolving as well. [ 189 ]


As trans men and non-binary individuals who were  assigned female at birth  (AFAB) may still menstruate, they often experience the same negative side-effects of menstruation, like cramping. [ 190 ]  Similarly some argue that the negative effects it may have on mental health have been underexplored. [ 189 ]  As menstruating conflicts with conventional ideas about  masculinity , [ 188 ]  activists are concerned about the  dysphoric  gender identity that can arise from menstruating, after someone has chosen to transition or adopt a gender identity not linked to their sex at birth. [ 189 ]  Some AFAB individuals have expressed concern about the tension between menstruating and affirming their chosen gender identity. [ 190 ]  Scholars have begun arguing for a non-gendered conception of menstruation in both social and medical settings, in an attempt to alleviate the discomfort AFAB individuals feel during menstruation. [ 190 ]  Examples of this can include but are not limited to: using clinical, non-gendered language to describe menstruation, saying 'cycle' rather than 'period', or 'menstrual products' rather than 'feminine hygiene products'. [ 190 ]  Finally, researchers have also noted that many AFAB individuals who menstruate encounter barriers in public restrooms, as men's restrooms do not have sanitary disposal bins in the stalls, and there are often few cubicles in comparison to urinals. This results in AFAB individuals having to wait for access to stalls, and dispose of their menstrual products in the public waste bin. [ 190 ]  Thus, advocacy for  gender-neutral bathrooms  has become a more recent part of menstruation activism. [ 189 ] [ 190 ]


Femtech  (Female Technology), a phrase coined by  Ida Tin , [ 70 ]  is a subclass of technology with a core focus in women's health. [ 70 ] [ 195 ] [ 196 ]  Apps, devices and other technologies under the category of Femtech provide services such as tracking menstruation, fertility, pregnancy or other reproductive health issues. In regards to menstruation and fertility apps, these services often collect data about a person's period, symptoms, sexual activity or fertility. These apps provide predictions and health observations by analyzing user's data. However, the collection and access of sensitive menstrual and fertility data from users isn't regulated and serves many people across different countries who have differing cultural views about topics such as menstruation and abortion which can put users at risk. [ 86 ]


After the overturning of  Roe v. Wade , the U.S.  Congressional Research Service  noted that personal data such as health records, financial records, geolocation information, and electronic communications may be acquired and used by law enforcement to identify and persecute the act of an abortion. Under the  Health Insurance Portability and Accountability Act (HIPAA) , the HIPAA Privacy Rule generally prohibits sharing an individual's identifiable health information, although exceptions can be granted under court order or warrant to provide law enforcement with identifiable health information under the premise that it will lessen a serious or imminent threat. [ 129 ] [ 197 ]  However, many consumer health apps which only make general wellness claims do not need to comply with the HIPAA Privacy Act and may share or sell consumer data. [ 129 ] [ 71 ] [ 198 ]  These consumer health apps include ones that track menstruation, fertility and sexual information. Acquisition of data from either a primary collector or sold from another entity can be acquired by law enforcement to enforce local abortion laws. [ 129 ]  Concerns have been expressed especially for individuals who are  Black, Indigenous and People of Color (BIPOC)  or low-income who are disproportionately surveilled at higher rates. [ 86 ]


Flo Health which offers services such as period calendars, ovulation and fertility tracker, menstrual cycle reminders etc. was charged by the  Federal Trade Commission  in 2021 for mishandling user data and sharing it with third parties. Members of Congress have even requested  Apple  and  Google  to remove period trackers that do not give users the ability to opt out of data collection. [ 71 ] [ 199 ]


Data from menstrual apps poses a new area of study in Women's Health research. Menstrual apps collect data on various period metrics such as bleeding, pain patterns, energy levels, mood and sexual activity. This poses as a new source of data for researchers to better understand women's health, who have historically been underrepresented in medical research. Clue also suggests that by analyzing user data it can create suggestions for users to check for health issues such as polycystic-ovary syndrome if symptoms arise in user's inputted data. [ 71 ] [ 200 ]


Criticisms note that many menstrual tracking apps such as Clue, Flo, and Period Tracker reinforce prejudices by catering their designs towards cisgender, sexually active, heterosexual women through the designs of their applications, using colors, pictures or symbols that are typically associated with femininity. These apps do not account for individuals who identify with other genders and make assumptions that the user wishes to procreate or isn't infertile, providing features such as ovulation tracking, pregnancy avoidance and fertility treatment which don't account for queer, infertile or unpartnered women. Users have also complained of a lack of representation of other women's health issues in menstruation apps such as irregular cycles or menopause where predictive algorithms or features may be less precise or absent all together. [ 201 ] [ 202 ]


Days for Girls  ( DfG ) is a  nonprofit organization  that prepares and distributes sustainable menstrual health solutions to girls who would otherwise miss school during their monthly periods. DfG was founded in 2008 by American  Celeste Mergens . [ 1 ]  After visiting an orphanage in  Nairobi , Kenya, she discovered that  menstruating  girls stayed in their dormitories for days, sitting on cardboard to absorb their flow, because they could not afford  feminine hygiene  products. Her first response was to organize donations of disposable  sanitary pads , but she realized that this was not a sustainable solution as the girls had no way to dispose of used pads. [ 2 ]   She then developed the idea of creating washable, reusable pads and providing the girls with a personal kit of all they would need to continue their schooling with hygiene and dignity. [ 3 ]  By 2018, the DfG Kits (designed to last up to three years) and health education programs had reached more than one million girls and women in over 100 countries. [ 4 ] [ 5 ]


DfG Kits are made by volunteers who work as "teams", some of which go on to acquire the status of "chapters". [ 6 ]  Student volunteers operate as "clubs". [ 6 ]  These groups have formed in many countries, including Australia, [ 7 ]  Canada, [ 8 ]  New Zealand, [ 9 ]  the United Kingdom, [ 10 ] [ 11 ]  and the United States. [ 12 ]  Each kit is in a draw-string bag and includes reusable  cloth menstrual pads  made up of colorful shields and liners,  panties , a  washcloth  and soap, a carry pouch for washing & storing, and other items. [ 13 ]  The kit enables girls to carry their clean and used pads discreetly and to take care of their own hygiene needs. [ 14 ]  During the distributions, communities also receive health education to break stigmas and cultural taboos associated with menstruation. [ 15 ]


In 2012, Days for Girls International launched an Enterprise Program to help local women establish  social enterprises  to make and distribute kits in their own countries. [ 16 ]  Close to 70 Days for Girls Enterprises now exist in more than a dozen countries across Africa, Asia, and Latin America. [ 17 ]  In select regions and in order to improve sustainability, DfG kits also come with  menstrual cups , which have a longer use life than washable cloth pads. [ 18 ]


Days for Girls International is headquartered in  Mount Vernon, Washington , United States, and has offices in Ghana, Guatemala, Nepal, and Uganda. [ 19 ] [ 20 ]  The organization's impact and transparency have earned high ratings from  GuideStar . [ 21 ]  Celeste Mergens, the organization's founder and CEO, was awarded a Purpose Prize by  AARP  in 2017. [ 22 ]


In 2019, Days for Girls was awarded $250,000 by  Goldman Sachs , as the cause supported by the first-place winner in the  Goldman Sachs Gives  Analyst Impact Fund competition, where analysts from the firm compete to gain support for their chosen nonprofit. [ 23 ]


In 2020,  Public Interest Registry  named Days for Girls International its .ORG of the Year, awarding the organization $45,000 to continue improving female health and education across the globe ($30,000 for .ORG of the Year and $15,000 for the Combatting Coronavirus Award). [ 24 ]


Mergens announced her retirement from the organization in January 2022, [ 25 ]  and published a book,  The Power of Days: A Story of Resilience, Dignity, and the Fight for Women's Equity  in 2023. [ 26 ] [ 27 ] [ 28 ]  Tiffany Larson was named the new CEO in April 2022. [ 29 ]


This article about an  international organization  is a  stub . You can help Wikipedia by  expanding it .


A  douche  is a term for a device used to introduce a stream of water into the body for medical or hygienic reasons, or for the stream of water itself. Douche usually refers to vaginal irrigation, the rinsing of the  vagina , but it can also refer to the rinsing of any body cavity. A douche bag is a piece of equipment for douching—a bag for holding the fluid used in douching. To avoid transferring intestinal bacteria to the vagina, the same bag must not be used for both an  enema  and a vaginal douche.


Douching after sexual intercourse is not an effective form of  birth control . [ 1 ]  Additionally, douching is associated with a number of health problems, including  cervical cancer ,  pelvic inflammatory disease ,  endometritis , and increased risk of  sexually transmitted infections . [ 2 ]


The word's first known use is in 1766.  Douche  came into English via  French , from  Italian :  doccia  "conduit pipe" and  docciare  "pour by drops" to douche, from  doccia  water pipe, probably back-formation from  doccione  conduit, from  Latin :  duction- ,  ductio  means of conveying water, from  ducere  to lead. [ 3 ] [ failed verification ]  In French today it means  shower , as it does in many European languages.


Vaginal douches  may consist of water, water mixed with  vinegar , or even  antiseptic  chemicals. Douching has been touted as having a number of supposed but unproven benefits. In addition to promising to clean the vagina of unwanted odors, it can also be used by women who wish to avoid smearing a sexual partner's penis with menstrual blood while having  sexual intercourse during menstruation . In the past, douching was also used after intercourse as a method of  birth control , though it is not effective (see below).


Many health-care professionals state that douching is dangerous, as it interferes with both the vagina's normal self-cleaning and with the natural bacterial culture of the vagina, and it might spread or introduce infections. Douching is implicated in a wide variety of dangers, including: adverse pregnancy outcomes including  ectopic pregnancy ,  low birth weight , preterm labor,  preterm birth , and  chorioamnionitis ; serious gynecologic outcomes, including increased risk of  cervical cancer ,  pelvic inflammatory disease ,  endometritis , and increased risk for  sexually transmitted infections , including  HIV ; it also predisposes women to develop  bacterial vaginosis  (BV), [ 4 ]  which is further associated with adverse pregnancy outcomes and increased risk of sexually transmitted infections. [ 5 ]  Due to this, the  U.S. Department of Health and Human Services  strongly discourages douching, citing the risks of irritation, bacterial vaginosis, and pelvic inflammatory disease (PID). Frequent douching with water may result in an imbalance of the  pH  of the vagina, and thus may put women at risk for possible vaginal infections, especially yeast infections. [ 6 ]


In May 2003, a randomized, controlled, multi-center study was conducted with 1827 women ages 18–44 who were regular users of a douche product and who had been treated recently for a sexually transmitted bacterial infection or bacterial vaginosis. Women were randomly assigned to use either a newly designed and marketed douche product or a soft cloth towelette. There was little or no indication of a greater risk of PID among women assigned to use the douche product (versus soft cloth towelette). [ 7 ]


Antiseptics used during douching disturb the natural balance of bacteria in the vagina and can cause infections. [ 8 ]  Unclean douching equipment may introduce foreign bodies into the vagina. Douching may also wash bacteria into the  uterus  and  fallopian tubes , causing fertility problems. [ 9 ]  For these reasons, the practice of douching is now strongly discouraged except when ordered by a physician for medical reasons. [ 8 ]


Douching after intercourse is estimated to reduce the chances of conception by only about 30%. [ 10 ]  In comparison, proper male  condom  use reduces the chance of conception by as much as 98%. [ 11 ]  In some cases douching may force the  ejaculate  further into the vagina, increasing the chance of pregnancy. A review of studies by researchers at the  University of Rochester Medical Center  (N.Y.) showed that women who douched regularly and later became pregnant had higher rates of  ectopic pregnancy ,  infections , and low birth weight infants than women who only douched occasionally or who never douched. [ 8 ]


A 1995 survey quoted in the  University of Rochester  study found that 27% of U.S. women age 15 to 44 douched regularly, but that douching was more common among  African-American  women (over 50%) than among white women (21%), [ 8 ]  and frequent douching contributes to more frequent bacterial vaginosis among African-American women than the average. [ 4 ]


Medical doctor  Harriet Hall  writes that not only can douching change the  pH  of the vagina and lead to infections, "There is no need ... to cleanse the vagina. It cleanses itself". [ 12 ]


Douchebag  and its variants, or simply  douche , [ 13 ] [ 14 ]  are  pejorative  terms [ 14 ]  referring to an arrogant, obnoxious, or despicable person. [ 15 ]  The slang usage of the term originated in the 1960s. [ 16 ]


A  female urination device  ( FUD [ 1 ] ),  personal urination device  ( PUD ),  female urination aid , or  stand-to-pee device  ( STP ) is a device that can be used to more precisely aim the stream of urine while  urinating  standing upright. Variations range from basic disposable funnels to more elaborate reusable designs. Personal urination devices have increased in popularity since the 1990s.  They are used for outdoor occupations & recreation, gender affirmation/safety, and medical reasons.


In addition, fixed installation and relocatable urinals are available for use by females. Some designs require the user to supply their own personal female urination device, while other designs do not have this expectation.


Female urination devices are marketed towards many different groups. For sports and recreation they are sold for camping, traveling, snow sports, caving, rock climbing, diving, hunting/fishing, festivals, long car journeys, and any kind of outdoor pursuit where the toilet facilities are absent or less than desirable. People with physical restrictions such as recovery from hip surgery, broken bones, or those who find it challenging to sit or squat also benefit from these devices.


Since 2005, numerous personal urination devices have appeared on the market.  Products come in a variety of designs and materials such as plastic, rubber, silicone and paper; some are reusable and some are disposable. Several devices have been marketed for medical applications, and are sometimes available on prescription.


Occupationally, urinary devices are used by first responders, armed forces, and other outdoor jobs. Some brands are  NATO  approved, and are supplied to military personnel. [ citation needed ]


Such devices are used by  trans men  as "stand-to-pee" devices, or STPs, [ 2 ]  often to combat  gender dysphoria . More discreet solutions such as the "Snee-Kee" are specifically marketed for this purpose. Some stand-to-pee devices mimic the appearance of a  penis  and double as  packers .


Cisgender men may also want a urinary funnel if they have medical conditions that make it challenging or impossible for them to stand and pee.


Urinals for a greater variety of bodies have advantages of quick and hygienic use,  water conservation , and less need for physical space. Speed of use can be especially important when there is high peak demand, such as in music festivals, theatrical events, sports stadiums, discos, dance clubs, and convention halls.


Special fixed installation designs for female urinals have long been available, supplemented more recently by portable designs. Some designs, including  squat toilets , have been considered "unisex", usable by either gender. The fixed designs are typically used by women in a "hovering" posture, standing over them with knees slightly bent.


In addition, small portable urinals including sealable collection containers have been available in female-only and unisex versions. They are often used for travel when immediate disposal is difficult. Initially, medical or hospital devices were pressed into service, but designs specially made for travel eventually appeared. They are used in small aircraft, and for extended  stakeouts , such as in a  hunting blind  or a wildlife observation station.


Conventional  urinals  which have been designated exclusively for female urination device users have become popular in recent years, including at some major public events where providing adequate toilet facilities is difficult, such as outdoors festivals. To expedite usage, trough urinals may be installed, which the women are expected to use while standing, with small personal female urination devices.  Pinkpop  2000 was the first event to accommodate large numbers of female urination devices, [ citation needed ]  and the practice has now spread to events in  the Netherlands ,  Belgium ,  Switzerland ,  Canada ,  Finland ,  Ireland , and the  UK . [ 3 ]


It is possible for a woman to aim her urine from a standing position without using a device. This was the norm in much earlier times, and standing to urinate was commonplace in certain cultures and situations, [ 4 ]  but this practice is no longer the norm in Western society. Changes to women's clothing in the twentieth century made the use of urination aids practical for women who wanted to urinate while standing.


Disposable female urination devices were  patented  as far back as 1922. The "Sanitary Protector" filed for in August 1918 by Edyth Lacy, specifies a "cheap device ...[to be] used but once, being especially suitable as a sanitary device in public toilet rooms." [ 5 ]  She notes that it is "accordingly unnecessary for the user to sit upon the closet seat; and the urine is led off without danger of soiling the clothes of the user or the closet". It was to be "made of a cheap readily destructible material, such as stiff paper, which can be readily disposed of after its use".


A similar device was patented in 1956: "an efficient urine conductor for use by females eliminating all need for contacting a toilet facility...usable while in a comfortable, erect standing position". [ 6 ]  Another half a dozen devices with the same basic purpose and form were patented by the end of the century. [ 7 ]


The Urinelle, [ 8 ]  which originates from France, appeared in 1996 and was the first to have mainstream manufacturing.


Feminine wipes  are  feminine hygiene products  marketed to clean the  vulvar area  and are marketed for odor control. [ 1 ]  As with other feminine hygiene products they are typically used by younger women and women of color. [ 2 ] [ 3 ]  The use of these products has increased over time [ 4 ] [ 5 ]  and the market for feminine wipe product globally is projected to be worth over $2 billion by 2027. [ 6 ]


This  product  article is a  stub . You can help Wikipedia by  expanding it .


GoGirl  is an American brand of  female urination device  introduced in 2009. A  CNN  video news story that year described the product as a "cultural phenomenon". [ 1 ]


Personal hygiene products that aid women in urinating while standing up are not new. [ 2 ]   The GoGirl product is based on a 20-year-old design by a doctor.  It was rebranded and relaunched in January 2009 at the  Minnesota State Fair  in  St. Paul, Minnesota  by FemMed, a company based in  Minnetonka, Minnesota . [ 3 ] [ 4 ]   It is a vessel made of flexible pink or purple [ 2 ]   medical-grade   silicone  with a splash guard on one end which the operator presses against her body. It has a spout on the other side, out of which the urine streams by pressure from a woman's natural flow. [ 3 ]


GoGirl was CAD engineered and refined as a design over ten years to fit a woman's body. The product is made from a "class IV" medical grade silicone, which is more supple than many rubber or silicone products. GoGirl is naturally hypoallergenic. GoGirl works with a woman's body to create pressure which creates less spray and splatter. The product comes as a kit in a small tube with the GoGirl, tissues and a storage baggie. It is designed to be a compact travel aid.


In 2013 GoGirl added an extension tube to its product, which may meet special military or medical needs.


As of 2014, GoGirl can be found in more than 3,500 US retail locations and in more than 45 countries. [ citation needed ]


This United States manufacturing company–related article is a  stub . You can help Wikipedia by  expanding it .


This is the list of healthy  vaginal  microbiota (VMB), which is defined as the group of species and  genera  that generally are found to have lack of symptoms, absence of various infections, and result in good pregnancy outcomes. [ 1 ]  VMB is dominated mainly by Lactobacillus species. This is the list of organisms that are found in the lower  reproductive tract  of  sexually mature  women who are not  immunocompromised . A partial description of  pathogens  that can be found in the lower and upper reproductive tract of women can be found in the article  sexually transmitted infection . The organisms listed below are capable of causing illness if for some reason there is a change in vaginal  pH  or a change in the ratio of one organism to another. For example,  Candida  is a normal inhabitant of a healthy reproductive tract but an overgrowth of this organism can cause  candidiasis . [ 2 ] [ 3 ] [ 4 ]


This is the list of the normal flora that are found in the lower reproductive tract of  sexually mature  women who exhibit no symptoms of illness and who are not  immunocompromised .  Lactobacilli  predominate. [ 4 ] [ 5 ] [ 6 ]  These organisms protect against infection. Vaginal microbiota composition may have a  genetic component . [ 3 ]


These bacteria may be detected as transients or are marginally discernable with PCR techniques. They are also opportunistic pathogens, and their overgrowth is considered an infection though symptoms and signs may be absent.


While the vaginal microbiota is populated predominantly by  Lactobacillus  spp. in 71% of women, 29% of asymptomatic, healthy women possess a microbiota essentially lacking in  Lactobacillus  and instead the following groups have been isolated from this population.  This microbiota is affiliated with ethnicity:


Candida albicans  and other spp. [ 2 ]


Pre-pubescent  girls, women in  menarche , and postmenopausal women have lower populations of  Lactobacillus  spp. in proportion to the other species.  Hormone replacement therapy  in  postmenopausal  women restores the microbiota to that of a reproductive-aged woman. The microbiota populations change in response to the menstrual cycle. Pregnancy alters the microbiota, with a reduction in species/genus diversity. [ 3 ]
Overgrowth of  Candida albicans  or other  Candida  ( yeast infections ) sometimes occurs after antibiotic therapy. [ 2 ]   Bacterial vaginosis  results in altered populations and ratios of the normal microbiota. [ 10 ] [ 3 ] [ 11 ]
There has been no link demonstrated between taking oral  probiotics  and maintaining normal microbiota populations of lactobacilli. [ 4 ]


madamePee  is a mobile  female urinal , without contact and without water supply. It is designed to be used at public events such as concerts or music festivals, but also in more durable situations such as construction sites, public gardens, etc.


Female urination  in public events is an ongoing issue [ 1 ]  (see section History in  female urinal ):  differences in needs, conventions and practices translate into a blatant inequality of access between men and women, with longer queues and waiting times for women. [ 2 ]  Since the beginning of the 20th century, many initiatives have been taken (see  female urinal devices ) to deal with this problem: including portable individual urinals, men-like urinals but adapted to the women morphology, unisex urinals, specific cabin urinals etc. However, who has attended outdoor  rock concerts  can attest that no standard and durable solution has been found and adopted. [ 3 ]


Studies [ 2 ]  have shown that the separation of urination and defecation devices, such as for men, increases the efficiency of women's toilets, in terms of space optimization and service duration; for event planners, this means more devices, used more efficiently, with constant resources.


Implementation in public of female urinals has psychological and social implications, which strongly depend on the cultural environment. [ 4 ]  The degree of intimacy preservation is an important issue, viewed differently in unisex toilets or in cabin toilets.


Nathalie des Isnards  was so upset to miss the show of her favorite rock group, because of the time spent to access the toilets, [ 5 ]  that she contacted several designers, installation providers and psychologists to find an industrial solution. [ 6 ]  Building on the previous experiences, such as the contactless  urination devices , madamePee is based on the following premises: [ 7 ] [ 8 ]


Several patents have been taken, for example for the urinal itself which must not retain bad smells after use.


madamePee cabins have been installed in major public events for several years (e.g.  Hellfest ,  Parisplages ,  Solidays ...) ; they are distributed by major rental companies of mobile sanitary facilities. [ 9 ]  They are now installed in countries outside France: Portugal, Belgium, Andorra, Ivory Coast, Canada.


In 2022, Nathalie des Isnards was recognized as "Woman entrepreneur of the year, favorite of the jury" at the "Women in Industry" trophies (Paris 2022) awarded by the magazine "l'Usine Nouvelle". [ 10 ]


The COVID-19 pandemic halted the holding of outdoor festivals worldwide in the years 2019–2020, they were the first outlet for Madame Pee female urinals. Since the end of 2021, again, festivals have been organized bringing together hundreds of thousands of participants; MadamePee urinals were present at major events such as HellFest2022 (420,000 tickets sold) or Solidays in Paris.


The pandemic with restrictions on access to cafes and bistros has highlighted the need for public toilets for women in cities. Large cities in Western Europe are concerned with installing toilets in public places that are easy to maintain, without a water connection; [ 11 ]  about ten cities in France are experimenting with MadamePee urinals permanently installed in urban areas.


Climate change results in extreme drought in Western Europe in 2022, after several unusually dry summers; the use of drinking water in toilets is increasingly questioned [ 12 ]  and becomes a determining factor in the development of dry toilets (without connection to the drinking water network).


Finally, human urine as fertilizer is an alternative to the use of chemical fertilizers. Urine collection is not possible in general purpose toilets; madamePee type urinals provide pure urine which is collected and transformed. [ 13 ]


A version for men has been developed (misterPee 2022) based on the same characteristics as the madamePee urinals: no contact, no water, no need for connection to the sewer. [ 14 ]


In 2022, a European standard on "mobile non-sewer-connected toilet cabins" has been adopted and published in 2023 by  AFNOR . It states the requirements of services and products relating to the deployment of cabins and sanitary products and applies to madamePee's products. [ 15 ]


A  menstrual cup  is a  menstrual hygiene  device which is inserted into the  vagina  during  menstruation . Its purpose is to collect menstrual fluid (blood from the  uterine lining  mixed with other fluids). Menstrual cups are made of elastomers ( silicone rubbers ,  latex  rubbers, or  thermoplastic rubbers ). [ 1 ] [ 2 ]  A properly fitting menstrual cup seals against the vaginal walls, so tilting and  inverting  the body will not cause it to leak. [ 3 ]  It is impermeable and collects menstrual fluid, unlike  tampons  and  menstrual pads , which absorb it. [ 4 ] [ 5 ]


Menstrual cups come in two types. The older type is bell-shaped, often with a stem, and has walls more than 2mm thick. [ 6 ]  The second type has a springy rim, and attached to the rim, a bowl with thin, flexible walls. Bell-shaped cups sit over the  cervix , like  cervical caps , [ 7 ]  but they are generally larger than cervical caps [ 10 ]  and cannot be worn during vaginal sex. Ring-shaped cups sit in the same position as a  contraceptive diaphragm ; they do not block the vagina and can be worn during vaginal sex. [ 11 ] [ 12 ]  Menstrual cups are not meant to prevent pregnancy.


Every 4–12 hours (depending on capacity and the amount of flow), the cup is emptied (usually removed, rinsed, and reinserted). After each period, the cup requires cleaning. [ 13 ]  One cup may be reusable for up to 10 years, making their long-term cost lower than that of disposable tampons or pads, though the initial cost is higher. As menstrual cups are reusable, they generate less  solid waste  than tampons and pads, both from the products themselves and from their packaging. [ 14 ]  Bell-shaped cups have to fit fairly precisely; it is common for users to get a perfect fit from the second cup they buy, by judging the misfit of the first cup. Ring-shaped cups are one-size-fits-most, but some manufacturers sell multiple sizes. [ 15 ]


Reported leakage for menstrual cups is similar or rarer than for tampons and pads. [ 14 ]  It is possible to  urinate , [ 16 ]   defecate , sleep,  swim , [ 3 ]  do  gymnastics , [ 17 ]  run, ride  bicycles [ 18 ]  or  riding animals , weightlift, and do heavy exercise while wearing a menstrual cup. [ 17 ]  Incorrect placement or cup size can cause leakage. [ 14 ]  Most users initially find menstrual cups difficult, uncomfortable, and even painful to insert and remove. This generally gets better within 3–4 months of use; having friends who successfully use menstrual cups helps, but there is a shortage of research on factors that ease the learning curve. Menstrual cups are a safe alternative to other menstrual products; risk of  toxic shock syndrome  infection is similar or lower with menstrual cups than for pads or tampons. [ 14 ]


The terminology used for menstrual cups is sometimes inconsistent. This article uses "menstrual cup" to mean all types, and for clarity, distinguishes the two main types as "bell-shaped" and "ring-shaped".


The thick-walled bell-shaped cups are the older type, and the term "menstrual cup" is sometimes used to refer only to bell-shaped cups. But in modern formal contexts, such as academic research [ 18 ]  and regulations, [ 19 ]  "menstrual cup" usually refers to both types.


The US Food and Drug Administration holds that "A menstrual cup is a receptacle placed in the vagina to collect menstrual flow." [ 20 ]  The EU legislated that "The product group ‘reusable menstrual cups’ shall comprise reusable flexible cups or barriers worn inside the body whose function is to retain and collect menstrual fluid, and which are made of silicone or other elastomers." [ 21 ]


Ring-shaped cups are also called " menstrual discs " and sometimes " menstrual rings ", [ 22 ]  to distinguish them from bell-shaped cups. Bell-shaped cups are sometimes called " menstrual bells ". [ 23 ]


Because bell-shaped cups are commonly depicted as being placed in the vaginal canal, well below the cervix, they are also called " vaginal cup s", with the ring-shaped cups called " cervical cup s". This may not clearly reflect their position in the body.  MRI imaging  suggests that, contrary to some manufacturer's depictions, the bell-shaped cups called "vaginal cups" are placed over the cervix, in a position similar to a  cervical cap  (not to be confused with a cervical  cup ). [ 7 ]  Ring-shaped cups, called "cervical cups", also cover the cervix, but have one edge next to the cervix, and the other located further down the vagina, so that the cup is nearly parallel to the long axis of the vagina. [ 24 ]


In the 1800s, menstrual cups were called "' catamenial sacks ", [ 25 ]  and were similar external  catamenial  sacks of "canoe-like form", [ 26 ]  which in turn were similar to catamenial sacks which were waterproof rubber undersheet supports for absorbent pads. [ 27 ]  These were made from  india-rubber  or  gutta-percha , forms of  latex . [ 26 ]


Menstrual cups are favoured by backpackers and other travellers, as they are easy to pack and only one is needed. [ 28 ]


Thorough washing of the cup and hands helps to avoid introducing new bacteria into the vagina, which may heighten the risk of UTIs and other infections. [ 29 ] [ medical citation needed ]  Disposable and reusable pads do not demand the same hand hygiene, though reusable pads also require access to water for washing out pads.


If the hands have come into contact with any chemical that directly trigger sensory receptors in the skin, such as  menthol  or  capsaicin , all traces of the chemical should be removed before touching the mucous membranes. [ 30 ]


A UN spec recommends that cups should not be shared; they should only ever be used by one person. [ 6 ]


The vagina is narrowest at the entrance and becomes wider and easier to stretch further in. [ 33 ]  Menstrual cups are folded or compressed to insert them, and then opened out once inside. The innermost portion of the cup typically goes into the  vaginal fornix  (the groove around the cervix). Menstrual cups cannot  pass through the cervix  into the uterus. [ 34 ]


The muscles of the  pelvic floor , which surround the vaginal entrance, are relaxed to let the cup pass.  Involuntarily tensing the vaginal muscles  can make it impossible for anything to enter the vagina without causing pain. [ 35 ] [ 36 ]  Many initially find insertion difficult, uncomfortable, and even painful, but learn to do it within a few cycles. There is little publicly available research on learning to use menstrual cups which compares types of cup or instructions. [ 14 ]


A bell-shaped cup is folded or pinched before being inserted into the vagina. [ 37 ]  There are various folding techniques for insertion; common folds include the "C" fold, the "7" fold, and the punch-down fold. [ 31 ]  Once inside, the cup will normally unfold automatically and seal against the vaginal wall. [ 37 ]  In some cases, the user may need to twist the cup or flex the vaginal muscles to ensure the cup is fully open. [ 38 ]


In practice, the rim of a bell-shaped cup generally sits in the  vaginal fornix , the ring-shaped hollow around the cervix. [ 7 ] [ 35 ]  Some fornixes are much deeper than others. [ 33 ]  Those with deeper fornixes may use insertion techniques such as inserting the cup partway, opening it before the rim passes the cervix, and then pushing it up into place; or they may press the cup to one side and let it open slowly, the rim slipping over the cervix. [ 35 ]  If correctly sized and inserted, the cup should not leak or cause any discomfort. [ 39 ]  The stem should be completely inside the vagina. If it can't be positioned inside, the cup can be removed and the stem trimmed. [ 37 ]


Ring-shaped cups (also called menstrual discs or menstrual rings) are inserted differently than bell-shaped cups: by squeezing opposite sides of the rim together until they touch, sliding the inner end of the folded cup to the end of the vaginal canal, and tucking the outer end behind the pubic bone. [ 36 ] [ 11 ]  They can be less bulky than a bell-shaped cup, no bulkier than a tampon. [ 24 ]  Inserting a ring-shaped cup requires more knowledge of anatomy, to get the cup under and around the cervix, [ 15 ]  not rucked up in front of it. [ 40 ]  Ring-shaped cups with non-circular rims are designed to be inserted with the widest, deepest part going in first. If they are inserted the wrong way around they may leak. [ 28 ] [ 41 ]  If there are stems or other removal aids, they should be on the end inserted last. [ 36 ]


If lubricant is used for insertion, it should be  water-based , as  silicone lubricant  can be damaging to the silicone. [ 42 ]


A bell-shaped cup may protrude far enough to be uncomfortable if it is too long. It may press too firmly against the bladder, causing discomfort, frequent urination, or difficulty urinating, if it is too firm, or the wrong shape. [ 35 ]  A bell-shaped cup may leak if it is not inserted correctly, and does not pop open completely and seal against the walls of the vagina. Some factors mentioned in association with leakage included  menorrhagia , unusual  anatomy  of the  uterus , need for a larger size of menstrual cup, and incorrect placement of the menstrual cup, or that it had filled to capacity. [ 14 ]  However, a proper seal may continue to contain fluid in the upper vagina even if the cup is full. [ citation needed ]


While many diagrams show bell-shaped menstrual cups very low in the vagina, with the vagina gaping open, in-vivo imaging shows that the cups sit high, with their rim around the cervix, and the vagina squishes shut below the cup, sealing it inside the body. [ 7 ]


If a ring-shaped cup pops out at the outermost edge, either the innermost edge got caught on near side of the cervix rather than tucked into the fornix behind it, or it is too big, or the outermost edge hasn't been tucked behind the public bone firmly enough. In either any case it will leak. If it comes loose and starts to slide out when using the toilet, or leaks on exertion (when exercising, coughing, or sneezing), it is too large or too small. [ 40 ]  Some deliberately choose a ring-shaped cup which will leak when they deliberately bear down on it, but not at any other time. [ 43 ] [ 44 ]


It is possible to deliberately empty a ring-shaped menstrual disc by muscular effort, without removing it (provided it is of a fairly soft material, and the right size). This is done in a suitable location, such as when sitting on a toilet. Bell-shaped cups must be removed to empty them. [ 43 ] [ 44 ]


The cup is emptied after 4–12 hours of use (or when it is full). [ 18 ]  Leaving the cup in for at least 3–4 hours allows the menstrual fluid to provide some lubrication. [ 45 ]


If sewers are available, menstrual cups can be emptied into a flush toilet, or sink, bath, or shower drain, and the drain rinsed with water. They can also be emptied into a pit latrine. [ 46 ] [ 47 ]


When using a  urine-diverting dry toilet , menstrual blood can be emptied into the part that receives the feces. If any menstrual blood falls into the funnel for urine, it can be rinsed away with water. [ 48 ]


In the absence of other facilities, menstrual fluid can be emptied into a  cathole . This is a single-use hole 6 to 8 inches (15 to 20 cm) deep, more than 200 feet (60 m) from water (and frequented areas like trails or campsites), ideally dug in organic soil, in an area where the waste will break down fast. Water used to rinse the cup can also be disposed of in the cathole, which is then refilled and concealed. [ 49 ]


Many initially find removal difficult, uncomfortable, and even painful, but learn to do it without problems within a few cycles. [ 14 ]


The muscles of the  pelvic floor  are kept relaxed, to allow the cup to pass out  through them . [ 28 ]  Techniques like squatting, putting a leg up on the toilet seat, spreading the knees, and bearing down on the cup as if giving birth are sometimes used to make removal easier. [ 45 ] [ 34 ] [ 50 ]  Because  vaginal tenting  can make the cup harder to remove, some manufacturers recommend waiting at least an hour after sex before removal. [ 51 ]


Slow removal and a firm grip avoid dropping the cup; [ 50 ]  experience, time and privacy also help. [ 18 ]  Dropping the cup can contaminate it (see  cleaning , below). [ 18 ]  If a cup is removed or emptied over a  pit latrine , it may fall in and be unretrievable. [ 46 ]


A bell-shaped cup is removed by reaching up to its stem to find the base. Simply pulling on the stem does not break the seal, and yanking on it can cause pain. To release the seal, the base of the cup is pinched, or a finger is placed alongside the cup. [ 39 ] [ 28 ]  The exception is two-part cups with separate stems; those  can  be pulled out to break the seal. [ 52 ]  The shape of the (one-part) stem thus has little effect on how easy the cup is to remove, and many people trim the stem right off for comfort. [ 28 ]  The cup is removed slowly; [ 39 ] [ 28 ]  rocking or wriggling it gently may help. [ 34 ]  Some fold the cup in a "C" fold before removal, to break the seal and reduce the bulk; folding the cup inside the body is generally more difficult than folding it outside.


A cup can be removed over a toilet, bath, or shower to catch spills. [ 53 ] [ 47 ]  Removal becomes less messy with practice, and it is possible to consistently remove bell-shaped cup without spilling, by keeping it upright. [ 54 ] [ better source needed ]  If it is necessary to track the amount of menses produced (e.g., for medical reasons), a bell-shaped cup allows one to do so accurately before emptying. [ 55 ]


Ring-shaped menstrual cups are removed by hooking the rim with a finger (from either side), or by pinching it with multiple fingers and pulling. Some ring-shaped cups have a dimple in the bowl, to make it easier to hook the rim from below. Some also have stems, but contrary to bell-shaped cups, these stems attach to the rim of the cup, and can be pulled to break the seal. Others have pull loops that fold flat against the bowl, which can also be pulled to remove. [ 56 ]  Removing ring-shaped cups is typically done over a toilet in case of spilling; the softer bowl squishes flat during removal, making it very difficult not to spill any menstruum. [ 50 ] [ 56 ]  Removal aids like pull loops can make ring-shaped cups easier to remove without spilling, but they still tend to be messier than bell-shaped cups. [ 57 ]


There is little published or independent research on how to clean menstrual cups. Manufacturers generally provide cleaning instructions, but they differ widely. Manufacturers did not provide any evidence validating or giving a rationale for the various cleaning instructions, as of 2022. [ 46 ]   A UN specification says that "The cup must be washed frequently in clean, boiling water as per manufacturer's instructions." [ 6 ]


In response to the 2022 review of manufacturer's recommendations (next section), which said there was no published evidence on how well cleaning methods work, [ 46 ]  a single small  in-vitro  study was done to compare cleaning methods.


A single small  in-vitro  study (using human blood, but incubation outside the body) compared four cleaning treatments:


It did not compare boiling to steeping, or steeping after  warming the mug . All of the methods decreased the bacterial load of the cups, with steeping having a bigger individual effect than soap; when using all three cleaning methods on cups (the fourth treatment), the authors were unable to culture bacteria from them. Just rinsing and steeping, with no soap, had very similar or identical effects. [ 58 ]


The authors recommended using as many of the cleaning methods as possible, but using soap only if it can be thoroughly washed off, as soap residue can irritate the vagina. They pointed out the need for  in-vivo  studies, looking at real health outcomes, and the need for studies on more than the single model of cup they tested. [ 58 ]


A 2022 review stated that "Publicly accessible evidence is needed to create consumer confidence in the recommended cleaning practices... nearly all menstrual cup manufacturers fail to provide any publicly available independent evidence that supports their recommended cleaning practices". The review found no standards or guidelines for menstrual cup cleaning practices, and urged independent research to establish a normative standard. [ 46 ]


The most common recommendations are:


Most manufacturers recommended using water and soap if readily available. Many counterrecommend scented soaps and soaps  made with an excess of oil or fat [ 46 ]  (in order to create  moisturizing  soap [ 62 ] ). Scents and moisturizers are designed to remain as residues on the hands after washing.


Some manufacturers sell and recommend proprietary cleaning products. [ 28 ] [ 46 ]  These are not considered necessary. [ 58 ] [ 28 ] [ better source needed ]


A dedicated menstrual-cup-cleaning pot may be too expensive, and use of kitchen pots socially unacceptable. Alternatives like used paint cans may contain harmful substances. [ 46 ]   Food cans  are used; these hold their temperature better than an unwarmed ceramic mug for steeping, [ 58 ]  but there is no data on the safety of tinned or plastic-coated food cans for this use. [ 63 ]   Mason jars  made for  home canning  are heatproof and designed to be sterilized by boiling; they have been used to steep-sterilize menstrual cups. [ 64 ]  They have also been used (presumably unsealed) for storage. [ 65 ]  Mugs have also been used. [ 58 ]  USB-powered sterilizers and proprietary menstrual cup cleaning solutions are not accessible to poorer users. [ 46 ]


Some menstrual cups come with cleaning containers; the cup is intended to be steeped in the container with boiling water for five minutes or microwaved in the container with water for 3–5 minutes. Containers are made from a medical-grade silicone or polypropylene. [ 46 ]


A South African study found that 93% used tap water when cleaning their cups at home, but only 32-44% rinsed their cups with tap water outside the home; when water was not available, many women left their cups in all day. [ 58 ]


In situations where clean water is hard to get or in short supply, it may be difficult to clean the cup with water. Reusable alternatives, like washing rags, may take more water. [ 46 ]  A lack of soap also presents a problem in some developing countries. [ 66 ]


Washing a menstrual cup in a sink at a  public toilet  can pose problems, as the  handwashing  sinks are often in a public space rather than in the toilet cubicle. [ 67 ]  Accessible loos generally have sinks that can be reached from the toilet, but they may be needed by people with limited mobility. [ 59 ]  Some users do not empty cups in public toilets; if they only empty the cup twice a day, every 12 hours, they can wait until they return home. [ 18 ] [ 34 ]


Boiling menstrual cups once a month can also be a problem in developing countries, if there is a lack of water, firewood or other fuel. [ 68 ]


Smooth-surfaced cups are easier to clean; moulded text, ridges, bumps, and holes make it a bit more difficult. [ 28 ]  Some suggest scrubbing out grooves with a  toothbrush , rag, or cloth, [ 51 ]  and airholes with an  interdental brush .


Stains on any color of the cup can be removed or at least lightened by soaking the cup in diluted  hydrogen peroxide , [ 28 ]  or leaving it out in the sun for a few hours. [ 69 ]  Some cup makers recommend against the use of hydrogen peroxide. [ 46 ] [ 70 ] [ 71 ]


Some menstrual cups are sold colorless and translucent, but several brands also offer colored cups. [ 72 ]  Translucent cups lose their initial appearance faster than colored – they tend to get yellowish stains with use. [ 18 ]  It can be harder to see whether a dark-coloured cup is clean. [ 28 ]  The shade of a colored cup may change over time, though stains are often not as obvious on colored cups.


Manufacturers typically suggest letting the cup dry out fully and storing it dry in a breathable container, such as the cloth bag usually provided with the cup. Airtight wraps and containers are counterrecommended, especially if the cup is at all damp. [ 46 ]


Menstrual cups are a safe option for managing menstruation, with risks comparable to or lower than alternatives (with the possible exception of the risk of  intrauterine device  (IUD) displacement). They are safe in in low-, middle-, and high-income settings. [ 18 ]


Using a menstrual cup does not harm the  vaginal flora . Studies looked at disruptions of the vaginal flora including  excessive growth of yeast ,  excessive growth of harmful bacteria , excessive growth of  Staphylococcus aureus , and other microorganisms; subjects using menstrual cups were not more likely to have these common vaginal problems than subjects using other methods, (cloth or disposable pads, or tampons); in some studies, they were less likely. [ 18 ]


Menstrual cups can be used with an  IUD , but it isn't clear whether using a menstrual cup increases the risk of IUD expulsion, as of 2023 [update] . [ 73 ]  About 6% of all IUD users have an IUD come out unintentionally, most commonly during menstruation. In three studies of expulsion rates in menstrual cup users, the rates were 3.7%, 17.3% and 18.6%. Menstrual cup users differ demographically from the general population of IUD users (for instance, they tend to be younger, and youth independently increases the risk of losing an IUD unintentionally). It has been suggested that when removing a menstrual cup, the user might accidentally pull on the IUD string, or that the suction might pull the IUD out. There is no data on what removal techniques, brands or types of cup might be riskier. Some IUD users have had the strings of their IUD cut quite short as a precaution against accidentally pulling it out while removing a cup. [ 73 ]  So far there is no data on IUD displacement in people using ring-shaped cups, which do not suction to the cervix in the way bell-shaped cups can. [ 74 ]


The number of menstrual cup users is unknown. This makes it hard to estimate the rate of rarer health problems related to cups. There are few reports, and rare problems are unlikely to turn up in a randomized study. [ 18 ]


Serious difficulty removing the cup, requiring professional assistance, is rare but not unknown. A 2019 review found two cases with bell-shaped silicone cups, and one case with an elaborate older model of diaphragm-like cup called a Gynaeseal. There were also 46 reports with a single brand of disposable ring-shaped plastic cup (of about 100 million cups sold); most were reported to the manufacturer. [ 18 ]


A 2019 review found three cases in which a malpositioned menstrual cup pressed on a  ureter , which  blocked the flow of urine from a kidney to the bladder ; this caused  renal colic  (acute pain on the flank and lower back) which went away once the cup was removed. It also found one case of urinary incontinence while using the cup, which cleared up when the cup was removed, and five other urinary complaints. [ 18 ]


Most menstrual cups are made of silicone, and silicone allergies are rare. In 2010, there was one report to the FDA of someone with a silicone allergy who had to have reconstructive surgery to the vagina after using a silicone menstrual cup. There were two reports to the  FDA  of allergic reactions to a disposable plastic cup. A 2017 study in  Dharpur ,  Gujarat , using a silicone cup described as ring-shaped and depicted as bell-shaped, collected two reports of rashes and one report of an allergy. [ 18 ]


The 2019 review also found two reports of irritation to the vagina and cervix, neither of which had clinical consequences, and two of severe pain (one on removing a cup for the first time). There were three reports of a vaginal wound from menstrual cup use, but reviewers were not able to review any associated medical records. [ 18 ]


One case report noted the development of  endometriosis  and  adenomyosis  in one menstrual cup user. [ 18 ] [ 75 ]  Endometriosis affects 10–15% of menstruators. [ 76 ]  An online survey on the topic, with nine respondents, found three people who had used a menstrual cup and developed endometriosis. [ 77 ]  The  U.S. Food and Drug Administration  made a public statement that there was insufficient evidence of risk. [ 78 ] [ 18 ]


Toxic shock syndrome  (TSS) is a potentially fatal bacterial illness. A 2019 review found the risk of toxic shock syndrome with menstrual cup use to be low, with five cases identified via their literature search (one with an IUD, one with an  immunodeficiency ). [ 14 ]  Data from the United States showed rates of TSS to be lower in people using menstrual cups versus high-absorbency tampons. [ 14 ]  Infection risk is similar or less with menstrual cups compared to pads or tampons. [ 14 ]


There is an association between TSS and  tampon  use, although the exact connection remains unclear. [ 79 ]  TSS associated with menstrual cup use appears to be very rare, [ 80 ] [ 81 ]  probably because menstrual cups are not absorbent, do not irritate the vaginal  mucosal  tissue, and so do not measurably change the  vaginal flora . [ 24 ]


The risk of TSS associated with contraceptive  cervical caps   [ 82 ] [ 14 ]  and contraceptive diaphragms [ 14 ]  is also very low. Like menstrual cups, these products both use mostly medical grade silicone or latex. [ 83 ] [ 14 ]


A widely reported study showed that  in vitro , bacteria associated with toxic shock syndrome (TSS) are capable of growing on menstrual cups, [ 84 ] [ 85 ] [ 86 ]  but results from similar studies are conflicting, and results from in-vivo studies do not show cause for concern. [ 14 ]


There are no standards for the measurement or aize-labelling of menstrual cups, and each manufacturer uses their own system. [ 31 ]  Self-measurement of the vagina and third-party measurement tables are often used to get a good fit. [ 35 ] [ 87 ] [ 9 ] [ 11 ]


Capacity affects how often the cup must be emptied. Some prefer to empty the cup only twice a day, morning and evening, to avoid emptying it in public toilets. [ 18 ]  Flow rates vary. On average, about 30mL of menstrual fluid is lost per month; 10 to 35mL is normal. [ 88 ]  Menstrual blood loss of more than 80mL per month is considered  heavy menstrual bleeding , and grounds for consulting a doctor. [ 89 ] [ 90 ] [ 55 ]


The stated capacity of menstrual cup is generally measured  ex vivo  (outside the body). It is the volume of fluid that will fill the cup to just below the airholes, if there are airholes, or just below the rim, if there are none. [ 55 ]  These volume measurements are generally overestimates of  real life  capacity, because the cup may be compressed inside the body, and the cervix will often occupy some of the volume of the cup. [ 28 ] [ 35 ] [ 7 ] [ 41 ]   Ex-vivo  capacities for menstrual cups are in the range of tens of milliliters; [ 6 ] [ 9 ]  for comparison, a normal-size tampon or pad holds about 5mL when thoroughly soaked. [ 88 ]


Smooth cups with no sharp edges are recommended by the UN. [ 6 ]  Moulded text, ridges, bumps, and holes make a cup harder to clean. [ 58 ] [ 28 ]


Bell-shaped menstrual cups all have a wall thickness of about 2mm. They vary in length, capacity, firmness, and external diameter of the rim. This accommodates variety in anatomy, flow quantity, and personal preferences for firmness. [ 6 ]


While  vaginal tenting  causes the cervix to retract during sexual arousal, it is normally located within centimeters of the vaginal opening; 45-55mmm is a medium height. [ 87 ]  Cups are available in lengths from about 30-80mm, [ 9 ]  with 40-60mm lengths being common; [ 18 ]  most menstrual discs are shallower than most bell-shaped cups. [ 91 ]  Some manufacturers sell several sizes of cup that are all the same length. [ 92 ]


Cups must be short enough that the cervix does not push the cup into contact with the  vulva , where it may be uncomfortable. If the cervix sits particularly low [ 6 ]  or is tilted, a shorter cup may needed. [ 93 ]  A cup which is too short may sit too far up to remove easily. [ 28 ]


Many bell-shaped cups have stems. The stems can be trimmed to shorten the cup, giving stemmed cups a minimum and maximum length; instructions for trimming are generally included with the cup. Some cups are made in two parts, with a separate stem passing through a hole in the cup; these separate stems, unlike normal one-piece stems, can be pulled to break the seal, and were designed to make removing the cup with low dexterity easier. [ 94 ]  There also exist cups with valves in the stem, which can be slowly drained without removing the cup. [ 95 ]  The UN counterrecommends hollow stems, because solid stems are easier to clean. [ 6 ]


Ex vivo , small size cups hold about 15-25 ml, medium size cups 20-30 ml, and large cups 30-40 ml. [ 6 ]  The maximum capacity for large cups is about 50mL (ring-shaped cups generally hold a bit more than bell-shaped cups). [ 9 ]   Excessively high-volume cups can be uncomfortably large, so fit is prioritized. [ 28 ]


Bell-shaped cups also vary by firmness or flexibility. Some manufacturers make the same cups in a range of firmness levels. A firmer cup pops open more easily after insertion and may hold a more consistent seal against the vaginal wall (preventing leaks), but some people find softer cups more comfortable to insert. [ 18 ]  The outside diameter of the rim will also affect seal and comfort. [ citation needed ]


Cervix height is measured by touching the cervix with a fingertip, and using the thumb against the finger to mark the inner edge of the vaginal opening; the distance from the thumbnail to the tip of the finger is the height of the cervix. [ 87 ]  Cervix height varies slightly over the month, and is usually lowest on the first day of bleeding; minimum height is used for sizing menstrual cups. [ 87 ]  The cup length is generally taken to be equivalent to the cervix height, but as the cup rim will generally sit in the fornix, some may comfortably take a cup slightly longer than their cervical height. [ 35 ]  Fornix depth varies, but is usually between 1–5 cm (0.5-2 inches). [ 33 ]


Manufacturers do not generally print cup dimensions on the box, but there are third-party tables of dimensions online. [ 9 ] [ 96 ]  This forcers buyers to guess whether a cup will fit. A regulatory requirement for quantitative measurements, including a  Young's modulus  measurement of firmness, has been suggested. Research into what measurements would be most useful for selecting a well-sized cup is also needed. [ 31 ]


Most brands sell a smaller and a larger size, but some sell up to five sizes, and differing firmnesses. Sizes are mostly labelled transparently, (e.g. "S", "M", and "L"), but some manufacturers label sizes with ordinal numbers (e.g. "0", "1", and "2"), alphabetic letters (e.g. "A" "B" and "C"), or euphemisms (such as "Petite", "Regular", and "Full fit"). Between one manufacturer's products, volume  usually  increases with number and position in the alphabet. [ 11 ]  Mostly, each larger size is slightly larger in all dimensions, but some manufacturers have sizes that differ in only one dimension (length, diameter, or capacity). [ 97 ]


These sizes are not consistent between manufacturers. [ 31 ] [ 28 ]  Manufacturers typically recommend the smaller size for under-30s who have not given birth vaginally and have a lighter flow, and the larger for everyone else. [ 98 ] [ 93 ]  However, there is no medical evidence for sizing based on age or  parity . [ 98 ]


Ring-shaped cups (also called menstrual discs or rings) [ 14 ]  are often approximately hemispherical in shape, like a  diaphragm , with a flexible ring rim and a soft, collapsible center. They collect menstrual fluid like menstrual cups, but sit in the  vaginal fornix  and stay in place by hooking behind the  pubic bone . Menstrual discs come in both disposable and reusable varieties. [ 101 ]


Ring-shaped cups are sized differently than bell-shaped cups. Fit is much less individual; the flexible bowl makes depth unimportant, and any ring-shaped cup between 60-70mm diameter will fit most people adequately. [ 102 ] [ better source needed ]  Sizing is measured in the same way as it is for contraceptive diaphragms, which fit in the same position. [ 103 ]


A study of circular-rim diaphragms failed to find any  proxy  factor (like parity or weight) which would allow prediction of the size of diaphragm someone needed; it was necessary to take a measurement. [ 104 ]  As with contraceptive diaphragms, some "one-size-fits-all" cups have slightly oval or pear-shaped rims, and some have rims that arch (as seen from the side), increasing the range of sizes that fit. A contraceptive diaphragm using these techniques was found to fit 98% of volunteers in a multicenter study (everyone with a size of 65-80mm). [ 105 ] [ 100 ]  A disc which is too big or too small will leak. [ 103 ]


Ring-shaped cups come in diameters from 53mm to 80mm, as of 2024 [update] . [ 9 ]  They have some advantages over bell-shaped cups, including that they have a higher  ex-vivo  capacity (40-80ml), [ 106 ]  enable bloodless period sex, [ 107 ]  and are more comfortable for some users. [ 36 ] [ 108 ]  Disadvantages include messier removal [ 108 ]  and more difficulty learning to insert them than for bell-shaped cups. [ 11 ]


Some ring-shaped cups have removal aids. These may be stringlike stems, notches (dents in the outside of the bowl), and pull loops (like the  ring-pull tab  of a drinks can, or like a strap running parallel to the rim), and some have hybrid looped notches (with a strap across the rim of the notch). Notched or looped disks may rotate in the body so that the grip is out of reach, so some cups have three notches/loops spaced around the circumference of the cup. [ 56 ] [ 109 ]  Notches reduce cup volume. [ 110 ]  Removal aids like pull loops make ring-shaped cups easier to remove without spilling, but they may chafe, [ 57 ]  and can be harder to clean.


Some menstrual rings have ribbed membranes. It is difficult to mould thin membranes; the silicone or plastic has to flow into a very narrow part of the mould, and solidify only once it has filled the area. While it is possible to mould silicone membranes as thin as a quarter of a millimeter thick (0.1 in), it requires care. [ 111 ]  Adding ribs (linear thicker areas) to the membrane makes it easier to mould. It also stiffens the membrane. [ 112 ]  Stiffer membranes may be more noticeable during sex, and smoother, softer ones less noticeable. [ 113 ] [ 114 ]  It is anecdotally claimed that the increase in surface area from the ridges allows ridged cups to hold more blood; and that they may reduce effective natural  vaginal lubrication  when worn during sex. [ 113 ]  Texture may also be added to the outside of the membrane for grip, [ 109 ]  although it is usually the rim that is gripped when removing the cup. [ 56 ]


Rings with a slimmer rim can be easier to slide around the cervix. [ 115 ]  A thin spot in the rim can let the rim fold more tightly for insertion and removal. [ 116 ]  Some ring-shaped cups also have concentric grooves on the outside of the rim; these can be harder to clean than an ungrooved rim. [ 51 ]  Grooves add stiffness while using less material; see  I-beam .


Firmer ring-shaped cups can be easier to get into place, as they are stiffer, but softer rings fold more easily and tightly, and may be more comfortable to insert and remove. Firmer disks are therefore often preferred by new users. Unlike in bell-shaped cups, firmness does not affect the seal of a properly-fitting ring-shaped cup. [ 117 ] [ 91 ]


Size can be measured in the same way as for contraceptive diaphragms; [ 103 ]  the fore and middle fingers are inserted until the tip of the middle finger is in the  posterior fornix  (the hollow on the spinewards side of the cervix), and the thumb is used against the forefinger to mark where the bony  pubic arch  touches the index finger. The diagonal distance between the tip of the middle finger and the thumbnail is then measured. This is the diameter of circular rim needed. [ 118 ]  At this depth the side walls of the vagina are quite stretchy, [ 33 ]  so no side-to-side measurement is needed.


Sizing rings can also be used. Disposable menstrual discs are also similar in size to many reusable ones, and can be used to check if an ~70mm diameter fits. [ 103 ] [ 118 ]


Many brands have a one-size-fits-most approach. Some sell two or three sizes, based on qualitative cervix height (low or high) rather than age or previous births. [ 28 ] [ 119 ]  While North American manufacturers do not generally give dimensions, third-party tables of disc diameters are available online. [ 9 ]  European manufacturers generally do give the metric dimensions of their products online.


For circular rims, the outside rim diameter should match the diaphragm size. For oval and slightly egg-shaped rims, the sizing  should be similar , but taking an average of the  two rim dimensions . [ citation needed ]  For complex three-dimensional rims, the manufacturer should indicate the size range the cup will fit.


Cups are made from rubbers ( elastomers ). Most are made from silicone rubber; some are made from  latex  or  thermoplastic rubber . [ 28 ]  Some contain other ingredients, such as colourants [ 6 ]  or cheap bulking fillers. [ 35 ]  Cups made from good-quality materials last longer. [ 120 ]


A UN specification says that cups must be made of medical-grade silicone. [ 6 ]  There are multiple medical grades. [ 121 ] [ 122 ]  Plastics can also be medical-grade. Some jurisdictions require the use of medical-grade materials, but others do not. Where permitted, cups may be made of cheaper food-grade materials. The same make and model of cup may be made of different materials in different legal jurisdictions. [ 123 ] [ 124 ]


In many jurisdictions, menstrual products need not list ingredients. Some places, including some US states, have enacted laws requiring food-style ingredient lists, with the percentage of each ingredient. [ 125 ] [ 126 ]  These laws include menstrual cups, [ 127 ]  and have been supported by some cup manufacturers. [ 128 ]


Early cups were made from latex manufactured from plant sap (usually  gutta-percha  or  indiarubber ). Latex is biodegradable.  Latex allergy  is common; around 4% of the general population worldwide has it, and repeated exposure makes a person more likely to develop it. [ 129 ]  Biologically-sourced latex may be brown or amber-coloured (see  natural rubber ).


Latex can harden over time. [ 120 ]


Most brands use a silicone rubber (also called a silicone elastomer) as the material for their menstrual cups. Silicone is durable and hypoallergenic. [ 130 ] [ 120 ]  Menstrual cups made from silicone are reusable for up to 10 years. [ 14 ]  The majority of menstrual cups on the market are reusable, rather than disposable. [ 93 ]


Most brands, [ 130 ]  and all reputable ones, state that they use a  medical-grade silicone . [ 131 ]  A UN specification requires medical-grade silicone. [ 6 ]  In most regulation systems, there are multiple subgrades of medical-grade silicones. For instance, in the US, class V and class VI are medical grades. [ 35 ]  Class VI is  subgrouped into non-implantable (or medical-healthcare grade), shortterm-implantable, and longterm-implantable (with 30 days or more being long-term). Menstrual cups are commonly made of non-implantable medical-grade silicone. [ 121 ] [ 122 ]  There are not specific grades of silicone rubber for long-term mucous membrane contact.


There are also non-regulatory distinctions. Most cups are made from  liquid silicone rubber  (LSR), [ 122 ]  but some seem to be made from  high-consistency rubber  (HCR). [ 41 ]  While LSR is indeed liquid, HCR is a putty-like material, which makes for differences in the manufacturing process. The former generally uses platinum catalysts to initiate curing (setting); the latter mostly uses peroxide catalysts. [ 132 ]


While silicone rubbers, as  polymers , are inert and hypoallergenic, the corresponding  monomers  are not. Silicone menstrual cups must therefore be fully cured before use. [ citation needed ]  Heat accelerates curing. [ 132 ]


Silicone rubbers also come in a range of  Shore A hardnesses ; a Shore hardness of 10 is gumlike, softer than some sponges and foams (chewing gum is about 20), while 80 is harder than the heel of a shoe. [ 133 ]  The firmness of a cup will be affected by the firmness of the material, but also its shape and dimensions.


Plastics are also used for menstrual cups. The plastics used are generally  thermoplastics  (plastics that soften when heated, and can therefore be heat-moulded). They are also generally rubbery or elastomeric. The  thermoplastic elastomers  used in plastic cups are often unspecified, but are often of some medical grade.


The same brand and model of product may be made with different grades of plastic in different jurisdictions, with medical-grade plastic in jurisdictions that require it, and food-grade plastic in those that don't. This may be reflected in the price. [ 123 ]


The silicone or thermoplastics which most brands of cups are produced are naturally colorless and translucent. Several brands offer colored cups as well as, or instead of the colorless ones. A UN specification says that cups must be made of medical-grade silicone, and may include additives like "elastomer, dye or colorant", but no more than 0.5%. It also requires that the additives are non-toxic, non-carcinogenic, non-mutagenic, and do not cause skin irritation or skin sensitization. [ 6 ]


Manufacturers generally do not specify what colourants they use, even on request. [ 136 ]


In jurisdictions where cups are classed as medical devices, the colourants generally also have to be medical-grade, and fuse permanently to the raw material so that they cannot leach out. In jurisdictions where menstrual cups are classed as consumer devices, colourants need not be medical-grade. [ 123 ] [ 124 ]  Some manufacturers use colourants certified for use in plastics intended to come in contact with food, for use in toys, and for use in consumer electronics. [ 136 ]  In some cases, a broader range of colours are available in jurisdictions where menstrual cups are not classed medical devices, and food-grade dyes can be used. [ 123 ]  The same brand and model of product may be made with different grades of colourant in different jurisdictions. [ 123 ]


Because silicone rubbers are relatively expensive, some dodgier manufacturers mix cheaper fillers into their silicone. These fillers are typically not tested for safety. [ 35 ]  Such cups may or may not whiten when stretched only a small amount. [ 120 ]


Material must be treated carefully during manufacture to avoid contaminating it. ISO certification is used for silicone manufacturing processes, [ 122 ]  and is required for regulatory approval in some jurisdictions, like Canada. [ 137 ]


Injection molding of liquid silicone rubber  is used to make most cups. The setup costs (moulds etc.) are significant, so new designs are generally made in runs of about 4000 or more; production runs of existing designs are generally of about 500 or more at a time. [ 122 ]


Larger production runs make for cheaper cups, because there are  fixed set-up costs  (it takes money to design a cup, set up a production run, and to clean up afterwards).  Experience curve effects  also reduce costs as more cups are made, including for repeated production runs of the same or similar cups. For example, for an extremely complex  overmoulding  of silicone on a shaped nylon spring, used for a contraceptive diaphragm, costs on a production run of 500 in 2010 were $20 US per item, while by 2013, batches of 10,000 and improvements in the manufacturing process had brought the cost down to $5 per item. By 2016, further improvements in manufacturing techniques had reduced the  reject rate , making the product cheaper. [ 100 ]  See  costs section , below, for non-manufacturing costs.


Good manufacturing will not show  flash  or conspicuous mould lines. [ 35 ]   Gate marks  from the sprues of the mould may also be visible on some cups. [ 138 ]


Regulation varies by jurisdiction. Some international standards are used in multiple jurisdictions, especially those from the  International Standards Association . Menstrual cup manufacturers seek and advertise ISO 13485 certification. [ 121 ]   ISO 13485  (quality management for the design and manufacturing of medical devices) and  ISO 10993  (biocompatibility of medical devices) are both used for menstrual cups. [ 139 ]   ISO 14024  is an  ecolabel  which may be used by any manufacturer achieving certification to that standard; it is also used for some menstrual cups. [ 139 ]  While ISO standards are none-binding, specific ISO certifications may be legally required by some jurisdictions. [ 137 ]


Many manufacturers comply with regulations in multiple jurisdictions. They may vary their products in order to do so, using cheaper materials and methods in jurisdictions where they are allowed. [ 123 ]


Australia changed its regulatory environment in 2018, exempting menstrual cups from an obligation to register on the  Australian Register of Therapeutic Goods  (ARTG). Australia requires certain package labelling. [ 140 ]


Canada regulates menstrual cups (like tampons and other insertables) as Class II medical devices. In Canada this means that they must be licensed by  Health Canada  before being advertised, imported, or sold. There are standards for materials and manufacturing facilities; getting accreditation and meeting the requirements can take years. There is also separate strong regulation of sustainability claims. This regulation raises costs for Canadian manufacturers; large manufacturers have made statements approving of the regulatory environment, though they complain about online competition from laxer jurisdictions. [ 137 ]


Menstrual cups that meet the regulatory requirements to be sold in the United States may not be able to meet the requirements in Canada. [ 137 ]  This means that some menstrual cups manufactured in Canada are sold in the United States, but not in Canada. [ 61 ]


The EU does not regulate menstrual cups as medical devices, but categorizes them as "general products", [ 141 ]  under the  General Product Safety Directive [ 139 ]  (now replaced by the  General Product Safety Regulation [ 142 ] ). This means that manufacturers, by selling them, guarantee that they are safe, but do not face more oversight than manufacturers of other consumer products.


Some menstrual cups carry the  EU Ecolabel , which requires minimum standards for packaging, pollution, emission reduction, and toxic substances in the finished product. [ 143 ]


The EU has the power to order the removal of unsafe products, including from online shops. Manufacturers inside and outside the EU may voluntarily use the  CE mark  on packaging to assert that a product meets EU regulations. [ 139 ]


Some EU manufacturers voluntarily got ISO certifications. [ 144 ]


Menstrual cups are categorized as "quasi-drugs" in  South Korea . [ 141 ]  On the 7th of December 2017, the  Ministry of Food and Drug Safety  approved the first menstrual cup for sale in South Korea, after a process involving the submission of data from a three-cycle clinical trial on effectiveness, and screening for ten highly hazardous volatile organic compounds. [ 145 ] [ 146 ]


The US regulates menstrual cups as Class II medical devices, but this does not mean the same thing as in Canada. The manufacturers of the silicone, the manufacturer that shapes it into cups, and the vendor, must all be registered with the FDA (using a  510(k) premarket notification [ 139 ]  and clearance [ 147 ] ) for a product to be sold legally in the United States. They must submit the required paperwork detailing their manufacturing process and similarity to existing products, and provide contact information. [ 35 ]  The US regulates the end products, but not the materials. [ 139 ]  Menstrual cups, unlike tampons, do not require premarket review. [ 148 ] [ 149 ] [ contradictory ]


Some cups claim to be "FDA approved". The Food and Drug administration does not approve Class II medical devices, only Class III medical devices. Menstrual cups are categorized as class II, not class III, so they cannot be "approved", only "cleared", and these claims are inaccurate. [ 35 ] [ 147 ]


The FDA requires certain product labelling on (or in) all packaging. [ 139 ]