Questions about menstrual cups from obstetrician-gynecologist Kanako Inaba

This is the second part of our interview with obstetrician-gynecologist Dr. Kanako Inaba.
This time, we have answered various questions about menstrual cups sent in by our readers. Please read on.

●What are the advantages and disadvantages of menstrual cups in your opinion, Dr. Inaba?

The advantages of menstrual cups are that they are economical because you don't have to keep buying pads, and they're sustainable because they don't produce waste. Also, for those who exercise or swim, there are no strings like with tampons, so they're comfortable and don't feel uncomfortable.
The downside is that some people can easily take things in and out, while others have a hard time, so it may be a bit of a challenge in the sense that not everyone can use it easily.

●Are there some bodies that are suitable for using a menstrual cup and some that are not?

There are no particular body types that are not suitable for this. If you can insert it yourself, there is no problem. If you have a heavy flow and it overflows immediately after inserting the menstrual cup, please consult an obstetrician-gynaecologist.
If you are going through menopause, you may find that your vagina becomes dry and it becomes difficult to insert your penis.
Even if you get your period after giving birth, it's fine to use a menstrual cup if it's been a few months since giving birth, as your cervix is ​​not open. Similarly, if you've had a miscarriage or abortion, it's fine to use a menstrual cup from the time your period starts.
In addition, even if you use it during infertility treatment, it will not interfere with the treatment.
Even if you have a Mirena, you can still use a menstrual cup.
For those who have never had sexual intercourse, the entrance to the vagina is narrow, so it may be difficult to insert. The hymen is not a membrane but a fold, but if there is no bleeding, the hymen is not damaged. If you force the menstrual cup in even though it hurts, it may damage the hymen, but if only a little bleeding comes out, it will not have much of an effect. However, if it hurts, do not force it.

How long does the vagina continue to grow? From what age can you start using a menstrual cup?

At puberty, even if there is still some change in height, the pelvis has finished growing, so the length of the vagina remains almost the same after puberty.
However, even if the vagina is fully developed, if you have not had sexual intercourse, the opening of the vagina is a little narrow, so while you may be able to insert a tampon-sized item, you may experience pain when inserting a menstrual cup-sized item, even if you fold it.
There's no problem with junior high and high school students who want to try using a menstrual cup, but even if they can use tampons without any problems, the part that goes into a menstrual cup is larger than a tampon, so they may feel pain when inserting it or may not be able to insert it at all.

Can using a menstrual cup cause toxic shock syndrome?

This is a sepsis-like infection caused by Staphylococcus aureus that can occur even when using something other than a tampon or menstrual cup. It's not that using a tampon or menstrual cup makes you more likely to get it; if you leave a tampon or menstrual cup in for a long time, Staphylococcus aureus will grow, increasing the risk. There's no problem as long as you follow basic usage practices, such as changing them at the appropriate times. It's important to follow the usage time and wash your hands and make sure they're clean before changing them.

●Will using a menstrual cup worsen the vaginal environment?

There are no adverse effects if you follow the recommended usage time for your menstrual cup and don't leave it in for too long. Leaving a foreign object in your genitals can cause infection or toxic shock syndrome, so it's important to follow the recommended usage time.

●Will using a menstrual cup cause bacterial vaginosis or candida?

As for bacterial vaginosis, you should be fine as long as you use the menstrual cup for the recommended time and don't leave it in for too long. Candida has nothing to do with menstrual cup use.

●Is it okay to use a menstrual cup when I have a cold or other conditions that weaken my immune system?

Basically, even if you have a cold, there is no problem using it as long as you follow the correct usage instructions, such as the usage time and cleaning method.

●How do I know if the menstrual cup size is right for my body?

You can find out the length of your vagina by inserting your finger into it, but since a menstrual cup is inserted at the very back of the vagina, near the cervix, there is no need to worry about the length of your vagina. Generally, a vagina is not shorter than the length of a menstrual cup. If the menstrual cup comes out, it is often because it was not inserted far enough, but in rare cases, some women are born with a short vagina, so if you are concerned, please consult your obstetrician-gynecologist.

Why does my period gradually drop while I'm using a menstrual cup? What should I do?

This is probably because you are not inserting the menstrual cup deep enough into your vagina. Try inserting it deeper.
Also, if the pelvic floor muscles are loose, the cervix itself may be dropping, or the vagina itself may be loose, which could cause the menstrual cup to drop. In such cases, strengthening the pelvic floor muscles can improve the condition, and strengthening itself can also be a preventative measure. If you are already experiencing discomfort due to a dropped cervix, you can receive treatment by visiting an obstetrician-gynecologist. This situation is often caused by postpartum or aging.

●Why does the menstrual cup feel uncomfortable when it is inserted all the way in?

The vaginal walls at the back of the vagina are highly elastic, flexible, and stretchy, so once it fits deep inside, it doesn't feel uncomfortable and the menstrual cup won't fall off, but will stick tightly to the vaginal walls.

●Will using a menstrual cup cause the vagina to stretch and become unable to return to its original position?

No, that's not the case because the vaginal walls are very elastic and pliable.

●Why do I feel pain or discomfort when I'm moving or sitting with my menstrual cup inside?

This is also likely due to the menstrual cup not being properly positioned deep inside the vagina.

●I feel like the menstrual cup is putting pressure on my urethra...what's going on?

If this is the case, it may be that the menstrual cup is not properly positioned or that the uterus is protruding. In some cases, the vagina may be narrow and the menstrual cup may be pressing against the urethra from the vaginal side, in which case the menstrual cup size (diameter, not length) may not be right.

Is it normal to feel like the menstrual cup is about to come out when you poop while wearing it?

It's possible that you may experience this sensation. This is because the rectum is located directly behind the vagina, and as stool passes through it, the menstrual cup may be pressed against it from behind. This depends on the size and hardness of the menstrual cup, so if you don't feel any discomfort, you can go ahead and defecate. However, if it feels like the menstrual cup is being pushed out, remove the menstrual cup and defecate.

Are there any disadvantages to using a menstrual cup while sleeping? Will it cause menstrual blood to flow backward?

No. Menstrual blood that comes out of the vagina (outside the uterus) does not easily flow back into the uterus. It is safe to use while sleeping.

●Is it okay to use a menstrual cup when the air or water pressure changes, such as when scuba diving, skydiving, or on an airplane?

It's no problem at all. It's the same as saying that your internal organs won't get crushed.

●What should I do if I can't wash my menstrual cup when I'm out?

It's fine to discard the contents (menstrual blood) of the menstrual cup and wipe it off with toilet paper. It's also fine to wipe it off with a disinfectant wipe and reinsert it. When replacing it, be sure to do so with clean hands. Also, be sure to wash your menstrual cup at least once a day.

●Why is the menstrual cup at an angle when I remove it?

Everyone's vagina is tilted. Even if you insert it straight, it will eventually settle into a more appropriate position during sexual activity, so it's not surprising that the cup's orientation will change. Also, the relative positions of the back of the vagina and the cervix vary from person to person, but there are no major differences.

If I know my period is coming today, is it okay to put on a menstrual cup first?

There's no problem, as long as you stick to the recommended time for using the menstrual cup.

●What should I do if I accidentally use the menstrual cup for longer than the recommended time?

The recommended usage time for menstrual cups is just a guideline, so if you don't experience any physical abnormalities, there's no need to panic. Stay calm and remove the menstrual cup as soon as you notice any changes. If you do experience any physical abnormalities, consult an obstetrician-gynecologist immediately.

●If I can't remove my menstrual cup, is it okay to go to the hospital?

Of course, that's OK. Please come and visit us without any worries!

●Message from Professor Inaba

I'm assuming that anyone reading this article is interested in menstruation, so if you're experiencing any troublesome symptoms, such as PMS or heavy menstrual flow, please feel free to consult your obstetrician-gynecologist. I would like to encourage women who are eligible for the free HPV vaccine (cervical cancer vaccine) by the end of this fiscal year (women born between April 2, 1997 and April 1, 2009) to start receiving it by this summer, and I would also like to encourage everyone over the age of 20 to get a cervical cancer screening.

Thank you, Professor Inaba!
I hope this article will alleviate some of your concerns and questions about menstrual cups. If you're interested, please give one a try.

Related article: "Ask Obstetrician/Gynecologist Dr. Kanako Inaba about Menstruation"

Profile of Dr. Kanako Inaba: Obstetrician and Gynecologist, Doctor of Medicine. Graduated from Kyoto University School of Medicine and received her Doctor of Medicine from the University of Tokyo Graduate School. Raising four children, including twins. Inaba Clinic , a women's clinic directly connected to Shibuya Station, will open in July 2024. With the motto of "Supporting the health and future of women of all ages," the clinic is a family obstetrics and gynecology clinic where women can easily consult about any symptoms, including menstrual pain, PMS, pregnancy hopes, sexually transmitted diseases, and menopausal symptoms. Representative of Minpapi! Let's all learn about HPV Project / Co-representative of Minrep! Let's all learn about SRHR / Vice-representative of Medical Femtech Consortium Official commentator on Fuji News Alpha / Yahoo! Expert / NewsPicks Pro Picker Author of books such as " New Work Style: A Prescription for Women's Participation "