Last month, Alison Green of the popular Ask a Manager advice column got a question from a reader about a boss who’d been urging her female staff members to switch to menstrual cups, going so far as to bring cups into the office. “Her drive to be eco-friendly has gone off the deep end,” the person wrote. Some employees, after the cup confrontation, had apparently cried and said they couldn’t use cups, physically; others had tried cups already and knew they didn’t like them. Everyone seemed to be upset or irritated. Green agreed: The menstrual cup boss “100 percent needs to leave people alone about what menstrual products they use. She can give out cups to her friends and family,” Green wrote, “but she really can’t do that with people she manages.”
It was amusing, but it also sort of hit a nerve, personally.
I got a menstrual cup in 2015, and before my first cycle using it was over, I was already evangelizing to my friends, not unlike the Cup Boss: “It’s amazing, everyone needs one, I swear it somehow makes sense if you just put it up there once,” etc. I drew a comic about the gorier details of insertion and removal and shared it on Imgur, where it picked up steam and made it to the site’s front page. I was giddy. The top comment: “That was so persuasive that I was on Amazon about to one-click order it when I remembered I’m a dude.” Hell yeah! I thought. I’m gonna change the world. In real life it was slower going: My friends, for the most part, just weren’t that interested. This general reluctance seems to have been a theme: “Why Do Americans Refuse to Give Up Tampons?” Emily Atkin asked in The New Republic last year. “Why has it taken menstrual cups so long to go mainstream?” Natalie Shure wondered in Pacific Standard in 2016.
Are they just too weird? Too illogical? Is the idea of handling bodily fluids too gross? Or is it finally happening? Are menstrual cups finally having their long-awaited moment in the sun (incidentally, leaving cups out in the sun can bleach them of accumulated discoloration)? And are overzealous bosses haranguing their employees to use cups an obnoxious sign of their ascendency?
Well, maybe. Google searches for “menstrual cup” are up 800 percent over the past ten years, as one recent BBC story pointed out. Menstrual cups are now sold on the shelves at major chains like Walgreens, Walmart, and CVS (ten years ago you could find them only in specialty stores or online). Dozens of brands are now available on Amazon and have responsive social media presences.
There is evidence that cup-makers are finally profiting, too — although cups have been around since the 1930s and people who try them tend to love them (91 percent would recommend one to a friend), the fact that cups last so long has been something of a kiss of death for manufacturers, since it results in fewer return customers. But the company that makes the world’s most successful menstrual cup, the DivaCup, has found a way around this, growing 639 percent in the past five years. Diva International has been named to the Growth 500 list of the fastest-growing Canadian businesses for the past two years, and in 2018, Canadian Business listed DivaCup’s annual revenue as exceeding 20 million Canadian dollars. A 2017 profile credits the company’s success to the way it took an unusual product “mainstream,” in part by convincing big-chain pharmacies of cups’ profitability (a box containing a menstrual cup can be sold for significantly more than a box containing tampons, for instance — and it takes up less shelf space, too).
But perhaps the biggest sign that cups are becoming profitable and going mainstream is that last October, Tampax (which is owned by Procter & Gamble, the world’s leading producer of feminine-care products) released a press statement: It would be getting into the cup game, with a design “worthy of all vaginas.” Its design — the Tampax Cup — looks a lot like most other cups out there, with a few minor tweaks. The Tampax Cup’s tagline: “We didn’t invent the cup, we just want to perfect it.”
Have they? I’ve got a Tampax Cup in as I write this.
In case anyone isn’t familiar, a menstrual cup is a soft, bendable, egg-sized, bell-shaped cup, typically now made of medical-grade silicone. It works by being folded and inserted into the vaginal canal, where it “pops” back open to catch menstrual fluid. Inserted correctly, it’s supposed to feel undetectable. Every 12 hours or so, the user reaches in, pulls the cup out, and dumps its contents into the toilet (or into the shower). Then the user rinses it off (or dabs it off) and reinserts it. (Between cycles it’s more thoroughly cleaned.) Cups are often touted as eco-friendly, since they can last for years (the typical American woman supposedly otherwise generates 250 pounds of menstruation-related trash in her lifetime), and although cups are expensive out of the gate (most cost somewhere between $25 and $40; the new Tampax model is $40 for one and $60 for two), over time they can save a user money on disposable pads and tampons.
If menstrual cups are cost-effective, eco-friendly, and comfortable, why have people been so reluctant to use them? There are many reasons, most of which come down to cups being/seeming weird and unintuitive. They also come with a learning curve (they’re awkward at first). And most menstruators do what their moms and friends do, or have done. Also, the cups don’t always work for everyone (and there are a lot of horror stories out there).
Asking people why they weren’t interested in menstrual cups, I kept hearing the same thing: It’s gross, they said. And so I wondered what “gross” meant. Gross for oneself, or gross for others? At first I thought it was because menstrual fluid might be a vector for disease. Is menstrual fluid unusually gross? We don’t go around handling other bodily fluids with pride, so it stands to reason that we wouldn’t naturally make an exception for this one. (I’ve always wondered if having some kind of terrible accident with my menstrual cup in a public bathroom would be like — a crime, or a biohazard, for instance.) The answer is that menstrual fluid is no different than regular blood, at least as far as capacity for transmitting disease goes (menstrual fluid is roughly half blood — the other half is mostly endometrial tissue and cervical mucus). If menstrual fluid were on a toilet seat, for instance, there would be no risk of disease transmission unless the person who sat on it also had an open wound where they sat on the droplet. And if the droplet were dried, that would further reduce the likelihood.
“Yes, you are correct,” he told me. “Unless you have an opening in the skin for the blood to enter (i.e., blood to blood) it would not cause an infection. Blood splattered on the seat where a person sits wouldn’t normally lead to an infection. Additionally, blood that is dried would not be a good vehicle for spreading infection.”
But maybe cups seem gross for the user, rather than for others, which honestly didn’t occur to me until I was weeks deep into this story (and years into my own cup devotion). Which is to say, maybe it’s not the menstrual fluid that seems gross, maybe it’s the cup itself that seems gross. Maybe it’s instinctively gross to repeatedly put something up into one’s own vagina, with one’s own hand. Hm. I suddenly feel like I’ve had something in my teeth this whole time.
Tierno was not a fan of menstrual cups. He consulted with a cup manufacturer in the ‘80s, he told me, and while he acknowledged that the silicone cups that are used today are an improvement over the rubber ones that used to be popular (germs adhere better to rubber), he still wouldn’t recommend them. He surprised me with his certainty: “No,” he said. “I wouldn’t recommend menstrual cups.” He said that his advice to his own wife and daughters had been, although it was inconvenient, to use pads (although he didn’t say whether they’d taken his advice). “They’re the safest product,” he said. “The vaginal vault is meant to be an open-draining space.” His qualms with cups are the invisible bacterial biofilms that could potentially build up on menstrual cups, inherent to their reusability.
Typically, to clean and sterilize menstrual cups, users boil them between cycles, but when I brought this up, Tierno was skeptical: “Ehh. Well. Good luck with that one,” he said. “Boiling it may kill bacteria. But their carcasses remain.” A memorable visual, as I sit typing this now, weeks later, currently using my old, discolored cup. (Discoloration is supposedly normal and not a requirement for replacement, although I now personally feel less sure about it, given the “carcasses” thing.) The Diva Cup’s current recommendations are to replace cups after one year if they show signs of deterioration, “such as a sticky or powdery film,” but that “ultimately, it is up to the consumer to decide when it is necessary to replace the cup.”
Tierno said that until menstrual cup companies could prove with data that every possible kind of vaginal bacteria that might over time create a biofilm on the surface of a cup would be eliminated by boiling, “If you’re going to use a cup, don’t use it for a year.” Instead, he recommends something more like four months, which most cups’ price point — around $30 — would make prohibitive. “A lot of women have opted to use pads,” he said. Next best, in his opinion, are 100 percent cotton tampons (distinct from tampons made with synthetic ingredients like viscose rayon, which is made out of sawdust, and which is more absorbent and can more readily contribute to toxic shock syndrome). There has been at least one case of toxic shock syndrome associated with the use of a menstrual cup.
A few minutes after my call with Tierno, I was scheduled to talk with Karen Houppert. Houppert had also interviewed Tierno, extensively, for her influential 1995 Village Voice story about tampons and toxic shock syndrome. I mentioned to Houppert that I’d just gotten off the phone with Tierno, and that he’d said he didn’t like cups because as far as he knew, boiling them wouldn’t get them clean enough.
Houppert laughed and pointed out that women put lots of things inside our vaginas that aren’t sterilized, for better and for worse. “Penises, for instance.”
True. Still I can’t stop thinking about this. (Tierno, later, over email: The bacteria on penises “is not the same as a biofilm formed on cups over time. There is no biofilm on a penis, but there is normal skin flora.”)
The Tampax Cup was initially met with some skepticism — what does Big Tampon know about hippie reusability? But for the most part, cup enthusiasts seem to be hopeful about what the development could mean for the industry. (Tampax declined to share numbers of cup sales to date.) That the world’s largest feminine-hygiene company is now producing menstrual cups “possibly opens the door to having menstrual cup information distributed alongside tampon and pad pamphlets in schools,” the proprietors of Put a Cup in It wrote in their review (an aside to say that there are multiple entertaining and informative sites devoted to menstrual cups). The Tampax Cup has a shorter bell than some other models, and it was designed with bladder comfort in mind. I spoke with Procter & Gamble engineer Rebecca Stoebe-Latham, who’s been working on the project since its 2016 origins, and who’d become a cup convert herself during the research phase. “The Tampax Cup is kind of like my little baby,” she told me. She also said she’d converted her own sisters and friends. “I could talk about menstrual cups for days.” Same.
I asked DivaCup representative Sophie Zivku for her take on what it meant for Tampax to be entering the reusables field, and she also said that it opened up opportunity. Tampax is their competitor, she noted, “but it’s exciting.” That such a large brand was getting into reusables “gives additional credibility to the category,” she told me. “It’s also really flattering for us.” She said the DivaCup expected to remain the industry leader and frontrunner.
In my personal (nonmedical) opinion, the “healthiest” way to manage a period is probably with reusable cloth pads — which is what most women in the world do, and have been doing, for centuries. It’s not the most convenient, though.
For what it’s worth, I’ve tried it all: I have Thinx (for light days and to back up my menstrual cup), I’ve tried sponges (unhygienic, although they were fun to squeeze out in the shower), and I have the flannel reusable pads, too, that you snap into your underwear (fun in theory, less so in practice). I also have Flex discs (disposable cups that were rebranded as useful for period sex), as well as various tampons and pads of varying degrees of organic/hippie–ness.
And, of course, I could always get back on hormonal birth control, skip the placebo week, and stop having periods entirely, which is now officially endorsed in the U.K.
It’s not mentioned on the box or in the stories about menstrual cups, usually, but using a menstrual cup has helped me come to terms with what I used to think of as periods’ “grossness.” I never thought periods were gross-gross, but using a cup aligned with paying better attention, too. I’m more familiar with my own cycle. I don’t think you need a cup for that, and for me I think it is also in large part a function of various other actions I’ve taken — in particular, tracking it all on an app that I like and changing my lifestyle and becoming more regular as a result. But at the risk of further grossing people out, observing the menstrual fluid itself has been surprisingly interesting. Seeing it in the cup, and not on a pad or tampon, gives me new appreciation, too. This is the bed of life, we all came from this. It’s darker than I would have thought. It’s cool and sort of freaky, too. I keep thinking that if I were filming a horror movie, I’d know where to get all the blood. For myself. I would star, direct, and clean up.