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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 usually made of flexible medical grade silicone, latex, or a thermoplastic isomer. They are impermeable and collect menstrual fluid, unlike tampons and menstrual pads, which absorb the fluid instead.^[1]^[2]

Menstrual cups come in two types. The older type is bell-shaped, often with a stem or a ring used for insertion and removal, and has walls more than 2mm thick.^[3] The second type is bowl-shaped, roughly hemispherical, and apart from the springy rim, has thin, flexible walls. Thick-walled cups sit over the cervix, like cervical caps,^[4] but they are generally larger than cervical caps ^[5] and cannot be worn during vaginal sex. Thin-walled cups sit in the same position as a contraceptive diaphragm; they do not block the vagina and can be worn during vaginal sex.^[6]^[7] 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.^[8] 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.^[9] Thick-walled 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. Thin-walled cups are one-size-fits-most, but some manufacturers sell multiple sizes.^[10] Some menstrual cups are sold colorless and translucent, but several brands also offer colored cups.^[11]

Reported leakage for menstrual cups is similar or rarer than for tampons and pads. Incorrect placement or cup size can cause leakage.^[9] 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.^[9]

Terminology

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 by wall thickness. The thick-walled cups are bell-shaped, and look like contraceptive cervical caps; the thin-walled cups are bowl-shaped, and look like contraceptive diaphragms.

Regulation generally does not distinguish the two types. The US Food and Drug Administration holds that "A menstrual cup is a receptacle placed in the vagina to collect menstrual flow."^[12] 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."^[13]

Because thick-walled cups are commonly depicted as being placed in the vaginal canal, well below the cervix, they are also called "vaginal cups", with the thin-walled cups called "cervical cups". MRI imaging showed that, contrary to manufacturer's depictions, thick-walled cups are placed over the cervix, in a position similar to a cervical cap (not to be confused with a cervical cup).^[4] Thin-walled "cervical cups" also cover the cervix, but have one edge located further down the vagina. Thin-walled cups are also called "menstrual discs", distinguishing them from "menstrual cups" in the narrower sense.

In the 1800s, menstrual cups were called "'catamenial sacks",^[14] and were similar external catamenial sacks of "canoe-like form" ^[15], which in turn were similar to catamenial sacks which were waterproof rubber supports for absorbant pads.^[16] These were made from latex ("india-rubber") or gutta-percha.^[15]

Use

Insertion

A thick-walled cup is first folded or pinched and then inserted into the vagina. It will normally unfold automatically and seal against the vaginal wall.^[18] In some cases, the user may need to twist the cup or flex the vaginal muscles to ensure the cup is fully open.^[19] If correctly inserted, the cup should not leak or cause any discomfort.^[20] The stem should be completely inside the vagina. If it is not, the stem can be trimmed.^[18] There are various folding techniques for insertion; common folds include the c-fold, as well as the punch-down fold.^[19]

Thin-walled menstrual discs are inserted differently than thick-walled cups: by squeezing the rim until it narrows into a "figure-of-8" shape, sliding the disc to the end of the vaginal canal, and tucking the outside edge behind the pubic bone.^[21]^[22]

If lubrication is necessary for insertion, it should be water-based, as silicone lubricant can be damaging to the silicone.^[23]

Inserting a thick-walled cup.
Users find a fold suitable for them; punchdown-fold, 7-fold, and c-fold illustrated.
The folded menstrual cup is inserted and allowed to spring open.
To ensure the menstrual cup is fully open and therefore creating a seal against the vaginal wall, users can run a finger around the vessel to feel for bumps as a sign it is not open, or users can gently pinch and twist the menstrual cup.
The menstrual cup sits lower than a tampon. The stem may need to be trimmed to avoid discomfort. The length of the vaginal canal will affect where the menstrual cup sits in relation to the cervix.
To remove, users must ensure the seal is broken by running a finger cup the side of the menstrual cup, or pinching the base of the vessel. The cup is then gently removed, and it can help shift the menstrual cup from side to side.^[24]

Emptying and removal

It is possible to empty a softer thin-walled menstrual disc by muscular effort, when sitting on a toilet, without removing it. Thick-walled cups must be removed to empty them.^[25]^[26]

After 4–12 hours of use (depending on the amount of flow), a thick-walled cup is removed by reaching up to its stem to find the base. Simply pulling on the stem is not recommended to remove the cup, as this can create suction. The base of the cup is pinched to release the seal, and the cup is removed.^[20] After emptying, a menstrual cup should be rinsed or wiped and reinserted. It can be washed with a mild soap, and sterilized in boiling water for a few minutes at the end of the cycle. Alternatively, sterilizing solutions (usually developed for baby bottles and breast pump equipment) may be used to soak the cup. Specific cleaning instructions vary by brand.^[27]

Removing a menstrual cup can be messy. Sometimes menstrual blood can spill during removal, although the device can be removed over a toilet to catch spills.^[28] Removal becomes less messy with practice, and most experienced users can remove it without spilling.^[29] If a user needs to track the amount of menses produced (e.g., for medical reasons), a menstrual cup allows one to do so accurately before emptying.^[30]

Thin-walled menstrual cups are removed by hooking the rim with a finger, or pinching with multiple fingers and pulling, typically done over a toilet or in a shower in case of spilling. Some thin-walled cups also have stems, but contrary to thick-walled cups, these stems attach to the rim of the cup, and can be pulled to break the seal.^[31]

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.^[32]

Leakage

Menstrual cups collect menstrual fluid inside the vagina and generally do not leak (if emptied often enough and inserted properly). Some women experience leakage due to improper use or cup size. For example, a menstrual 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.^[9] However, a proper seal may continue to contain fluid in the upper vagina even if the cup is full.^{[citation needed]}

Cleaning

Insertion requires thorough washing of the cup and hands to avoid introducing new bacteria into the vagina, which may heighten the risk of UTIs and other infections.^[33] Disposable and reusable pads do not demand the same hand hygiene, though reusable pads also require access to water for washing out pads.

Cleaning a menstrual cup in a public toilet can pose problems as the handwashing sinks are often in a public space rather than in the toilet cubicle.^[34] Some manufacturers suggest wiping out the cup with a clean tissue and cleaning the cup at the next private opportunity.^[35] Some carry a small bottle of water to rinse the cup privately over the toilet.^[35] Another option is to use wipes.^[36] Some users do not empty cups in public toilets; if they only empty the cup twice a day, they can wait until they return home.^[37]

Some manufacturers sell and recommend proprietary cleaning products.^[38] These are not considered necessary.^[39]^[38]^{[better source needed]}

Difficulties

A lack of clean water and soap for handwashing, needed before inserting the cup, presents a problem to women in developing countries.^[40]

Boiling menstrual cups once a month can also be a problem in developing countries, if there is a lack of water, firewood, and good hygiene practices.^[41] Other options currently in use, such as rags that are washed, may be less hygienic.^{[citation needed]}

Safety

Menstrual cups are safe when used as directed and no health risks related to their use have been found.^[42]^[43]^[44]

No medical research was conducted to ensure that menstrual cups were safe prior to introduction on the market.^[45] Early research in 1962 evaluated 50 women using a bell-shaped cup. The researchers obtained vaginal smears, gram stains, and basic aerobic cultures of vaginal secretions. Vaginal speculum examination was performed, and pH was measured. No significant changes were noted. This report was the first containing extensive information on the safety and acceptability of a widely used menstrual cup that included both preclinical and clinical testing and over 10 years of post-marketing surveillance.^[46]

One case report noted the development of endometriosis and adenomyosis in one menstrual cup user.^[47] Additionally, one survey with a small sample size indicated a possible link. Therefore, two organizations have issued a combined statement that urged further research.^[45] However, the U.S. Food and Drug Administration declined to remove menstrual cups from the market, saying that there was insufficient evidence of risk.^[48]

No differences in the growth of Staphylococcus aureus or health harms were identified among school girls provided with menstrual cups compared to those using menstrual pads, or continuing their usual practice in rural western Kenya.^[49]^[50]

Menstrual cups can be used with an IUD; however, there is an unclear association with respect to IUD expulsion.^[51]^[52]^[53]

Toxic shock syndrome

Toxic shock syndrome (TSS) is a potentially fatal bacterial illness. Scientists have recognized an association between TSS and tampon use, although the exact connection remains unclear.^[54] TSS associated with menstrual cup use appears to be very rare.^[55]^[56] The probable reason for this is that menstrual cups are not absorbent, do not irritate the vaginal mucosal tissue, and so do not change the vaginal flora in any measurable amount.^[46]

Research has shown that the cup has no impact on the vaginal flora, which means there is no effect on the presence of S. aureus, the bacterium that can cause TSS.^[46] The risk of TSS associated with cervical caps used for contraception in the female barrier method is also very low.^[57] Cervical caps and menstrual cups both use mostly medical grade silicone or latex.^[50]

A widely reported study showed that in vitro, bacteria associated with toxic shock syndrome (TSS) are capable of growing on menstrual cups.^[58]^[59]^[60]

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.^[9] Data from the United States showed rates of TSS to be lower in women using menstrual cups versus high-absorbency tampons.^[9] Infection risk is similar or less with menstrual cups compared to pads or tampons.^[9]

Size, shape, and flexibility

Thick-walled cups

Thick-walled menstrual cups come in many different shapes

Most manufacturers make at least two different sizes, sometimes confusingly labelled

Softer cups may be more comfortable for some, but firmer cups may have a better seal

A properly sized and inserted cup (blue) will form a seal against the vaginal walls, as shown. Blood flow from the (red) uterus is captured in the cup.

UN classification of menstrual cup sizes^[3]
Size category	Length (excluding stem)	Capacity	Rim diameter	Firmness
Small	40-50mm	15-25mL	36-40mm	soft to medium
Medium	45-55mm	20-30mL	41-44mm	soft to medium
Large	48-58mm	30-40mL	45-48mm	medium to hard

File:Falttechniken der Menstruationstasse.jpg

Various methods of folding a thick-walled cup for insertion. A flexible cup may fold more easily.

Thick-walled menstrual cups are generally bell-shaped, with a few exceptions.^[9] They all have a wall thickness of about 2mm. They vary in length, capacity, firmness, and external diameter of the rim. These dimensions should be chosen to suit the user's anatomy, flow quantity, and personal preference for firmness.^[3]

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.^[61] Cups are available in lengths from about 30-80mm,^[62] with 40-60mm lengths being common;^[37] menstrual discs are shallower than most cups.^[63] Some manufacturers sell several sizes of cup that are all the same length.^[64]

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^[3] or is tilted, a shorter cup may be more suitable.^[65] Cervix height can be 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.^[61] Cervix height varies slightly over the month, and is usually lowest on the first day of bleeding; minimum height should be used for sizing.^[61]

Many thick-walled 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. The UN counterrecommends hollow stems, because solid stems are easier to clean.^[3] Moulded text, ridges, bumps, and holes can also make it harder to clean.^[38]

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.^[37] Approximately, small size cups hold 15-25 ml, medium size cups hold 20-30 ml, and large cups hold 30-40 ml.^[3] The maximum capacity for large cups is about 50mL (thin-walled cups generally hold a bit more).^[62] 80mL is more blood than most lose in a month; losing more than that is considered grounds for consulting a doctor.^[30]^[26]^{[medical citation needed]} Excessively high-volume cups can be uncomfortably large, so prioritizing fit is recommended.^[38]

Thick-walled cups also vary by firmness or flexibility. Some companies offer a range of firmness levels in their cups. A firmer cup pops open more easily after insertion and may hold a more consistent seal against the vaginal wall (preventing leaks), but some women find softer cups more comfortable to insert.^[37] The outside diameter of the rim will also affect seal and comfort.

Labelling

Manufacturers do not generally print cup dimensions on the box, but there are third-party tables of dimensions online.^[62]^[66] A requirement for quantitative measurements, including a Young's modulus measurement of firmness, has been suggested.^[24]

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 manufactuer's products, volume usually increases with number and position in the alphabet. 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).^[67]

These sizes are not consistent between manufacturers.^[24]^[38] 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.^[68]^[65] However, there is no medical evidence for sizing based on on age or parity.^[68]

Thin-walled cups or discs

Thin-walled cups (also called menstrual discs)^[9] are approximately hemispherical in shape, like a diaphragm, with a flexible outer ring 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.^[70]

Thin-walled cups are sized differently than thick-walled cups. Fit is much less individual; the flexible bowl makes depth unimportant, and any thin-walled cup between 60-70mm diameter will fit most people.^[71] As with contraceptive diaphragms, many "one-size-fits-all" cups have slightly oval or pear-shaped rims, and some have rims that arch (as seen from the side) to increase the range of sizes that fit. A contraceptive diaphragm using these techniques fit 98% of women in a multicenter study (everyone with a size of 65-80mm).^[72]^[73]

Size can be measured in the same way as for contraceptive diaphragms;^[74] 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 index finger and the thumbnail is then measured. This is the diameter of circular rim needed.^[75] Sizing rings can also be used; disposable menstrual discs are similar in size to many reusable ones, and can be used to check if an ~70mm diameter fits.^[74]^[75] A disc which is too big or too small will leak.^[74]

Thin-walled cups come in diameters from 53mm to 80mm, as of 2024^[update].^[62] They have some advantages over thick-walled cups, including that they have a higher capacity (40-80ml),^[76] enable bloodless period sex,^[77] and are more comfortable for some users.^[21]^[78] Disadvantages include messier removal^[78] and a more difficult learning experience^[22] than thick-walled cups.

Labelling

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.^[38]^[79] While manufacturers do not generally give dimensions, third-party tables of disc diameters are available online.^[62]

Materials and color

Most brands use medical grade silicone as the material for the menstrual cup, although latex and thermoplastic elastomer are also options. Silicone is durable and hypoallergenic.^[82]^[83] Menstrual cups made from silicone are reusable for up to 10 years.^[9] The majority of menstrual cups on the market are reusable, rather than disposable.^[65]

The silicone of which most brands of cups are produced is 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 sillicone, and may include additives like and 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.^[3] Some cups not made from silicone, but from latex or thermoplastic rubber.^[38]

Translucent cups lose their initial appearance faster than colored – they tend to get yellowish stains with use.^[37] It can be harder to see whether a dark-couloured cup is clean.^[38] The shade of a colored cup may change over time, though stains are often not as obvious on colored cups. Stains on any color of the cup can be removed or at least lightened by soaking the cup in diluted hydrogen peroxide, or leaving it out in the sun for a few hours.^[84] However, some cup makers recommend against the use of hydrogen peroxide.^[85]^[86]

Cost

The costs for menstrual cups vary widely, from US$0.70 to $47 per cup, with a median cost of $23.35 (based on a 2019 review of 199 brands of menstrual cups available in 99 countries).^[9]

Reusable menstrual products (including reusable menstrual cups) are more economical than disposable pads or tampons.^[55]^[87] The same 2019 review looked at costs across seven countries and found that, over 10 years, a menstrual cup costs $460.25 less than 12 disposable pads per period and $304.25 less than 12 tampons per period.^[9]

Despite the long-term cost savings, the upfront cost of a menstrual cup is a barrier for some.^[78]

Environmental impact

Since they are reusable, menstrual cups help to reduce solid waste.^[88] Some disposable menstrual pads and plastic tampon applicators can take 25 years to break down in the ocean and can cause a significant environmental impact.^[89] Biodegradable sanitary options are also available,^[90] and these decompose in a short period of time, but they must be composted, and not disposed of in a landfill.^{[citation needed]}

When considering a 10-year time period, waste from consistent use of a menstrual cup is only a small fraction of the waste of pads or tampons.^[9] For example, if compared with using 12 pads per period, use of a menstrual cup would produce only 0.4% of the plastic waste.^[9]

Each year, an estimated 20 billion pads and tampons are discarded in North America. They typically end up in landfills or are incinerated, which can have a great impact on the environment. Most of the pads and tampons are made of cotton and plastic. Plastic takes about 50 or more years and cotton starts degrading after 90 days if it is composted.^[91]

Given that the menstrual cup is reusable, its use greatly decreases the amount of waste generated from menstrual cycles, as there is no daily waste and the amount of discarded packaging decreases as well. After their life span is over, silicone cups can be burned or sent to a landfill.^[92] Alternatively, one brand offers a recycling program and some hospitals are able to recycle medical grade silicone, including cups.^[93]^[94] Cups made from TPE can be recycled in areas that accept #7 plastics. Rubber cups are compostable.^[92]

Menstrual cups may be emptied into a small hole in the soil or in compost piles, since menstrual fluid is a valuable fertilizer for plants and any pathogens of sexually transmitted diseases will quickly be destroyed by soil microbes.^[95] The water used to rinse the cups can be disposed of in the same way. This reduces the amount of wastewater that needs to be treated.^{[citation needed]}

In developing countries, solid waste management is often lacking. Here, menstrual cups have an advantage over disposable pads or tampons as they do not contribute to the solid waste issues in the communities or generate embarrassing refuse that others may see.^{[citation needed]}

History

Menstrual cups may have been inspired by other types of vaginal inserts used throughout history.^[96] Vaginal inserts had various purposes from birth control, enabling abortions, to supporting a prolapsed uterus.^[96] The first version of what we would now call a menstrual cup was a rubber sack attached to a rubber ring created by S.L. Hockert in 1867, which was patented in the United States.^[96] An early version of a bullet-shaped menstrual cup was patented in 1932, by the midwifery group of McGlasson and Perkins.^[97] Leona Chalmers patented the first usable commercial cup in 1937.^[98] Other menstrual cups were patented in 1935, 1937, and 1950.^[99]^[100]^[101] The Tassaway brand of menstrual cups was introduced in the 1960s, but it was not a commercial success.^[102] Early menstrual cups were made of rubber.^[42]

In 1987, another latex rubber menstrual cup, The Keeper, was manufactured in the United States. This proved to be the first commercially viable menstrual cup and it is still available today. The first silicone menstrual cup was the UK-manufactured Mooncup in 2001. Most menstrual cups are now manufactured from medical grade silicone properties.

An early menstrual disc, the Gynaeseal, was developed by Dr John Cattanach in 1989, but never found commercial success.^[103]^[9] In 1997, the Instead Feminine Protection Cup began to be sold across the United States.^[81]^[104] Designed by Audrey Contente, the disposable disc was made of Kraton.^[105]^[81] In 2018, reusable silicone discs were introduced.^[106]^[107] As of 2021, there were ten brands of discs available for purchase in various markets.^[106]

Menstrual cups are becoming more popular worldwide, with many different brands, shapes, and sizes on the market.^[82] Most are reusable, though there is at least one brand of disposable menstrual cups currently manufactured.^[82]

Some non-governmental organizations (NGOs) and companies have begun to propose menstrual cups to women in developing countries since about 2010, for example in Kenya and South Africa.^[108] Menstrual cups are regarded as a low-cost and environmentally friendly alternative to sanitary cloth, expensive disposable pads, or "nothing" – the reality for many women in developing countries.^[41]

Acceptability studies

In a randomized controlled feasibility study in rural western Kenya, adolescent primary school girls were provided with menstrual cups or menstrual pads instead of traditional menstrual care items of cloth or tissue.^[49] Girls provided with menstrual cups had a lower prevalence of sexually transmitted infections than control groups. Also, the prevalence of bacterial vaginosis was lower among cup users compared with menstrual pad users or those continuing other usual practice.^[49]

Society and culture

Developing countries

Menstrual cups can be useful as a means of menstrual hygiene management for women in developing countries where access to affordable sanitary products may be limited.^[40]^[109] A lack of affordable hygiene products means inadequate, unhygienic alternatives are often used, which can present a serious health risk.^[110]^[111] Menstrual cups offer a long-term solution compared to some other feminine hygiene products because they do not need to be replaced monthly.

The municipality of Alappuzha in Kerala, India launched a project in 2019 and gave away 5,000 menstrual cups for free to female residents.^[112] The purpose of this was to encourage the use of these cups instead of non-biodegradable menstrual pads to reduce waste production.^[112] In 2022, Kumbalangi, a village in Kerala, became India's first sanitary napkin free panchayat under a project called "Avalkkayi", which gave away 5,700 menstrual cups for free.^[113]

Cultural aspects

Feminine hygiene products that need to be inserted into the vagina can be unacceptable for cultural reasons. There are myths that they interfere with female reproductive organs and that they cause females to lose their virginity.^[33] Use of a menstrual cup could stretch or break the hymen.^[114] Since some cultures value the preservation of the hymen as evidence of virginity,^[115] this can discourage young women from using cups.^[116]

References

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^ Rosas, Kim (5 October 2020). "Menstrual Cup or Disc - Which to choose?". Period Nirvana.
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^ US 70865 Improvement in menstrual reciever A 1867 patent describes a sack fitting partly or wholly inside the vagina, suspended from a ring around the cervix, but with the ring held up by a U-shaped wire, which is fastened to the sack at one end and to a belt at the other. Quote:"I construct my menstrual receiver by forming a cup-shaped ring, a, made of rubber, gum, gold, silver, or any suitable substance, which may be made round, or elliptical, or of any shape to fit the os uteri. Around the lower orifice of ring is attached a sack or bag, b, made of rubber or any suitable materials. The ring a rests-around the os uteri, and the bag b rests entirely in the vagina, or may be made of such length as to rest parily outside and partly inside. I insert a small sponge in bag b to absorb the menstrual flux."
^ ^a ^b US 49915 (1865)US 626159 (1899)
^ US 574378
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[stewart-1] Elizabeth Gunther Stewart, Paula Spencer: The V Book: A Doctor's Guide to Complete Vulvovaginal Health, Bantam Books, 2002, Seiten 96 und 97, ISBN 0-553-38114-8.

[2] Leslie Garrett, Peter Greenberg: The Virtuous Consumer: Your Essential Shopping Guide for a Better, Kinder and Healthier World, New World Library, 2007, Seiten 17 bis 19, ISBN 1-930722-74-5.

[UNspec-3] ^ ^a ^b ^c ^d ^e ^f ^g "Menstrual Cup Specifications — General description" (PDF). United Nations Population Fund. Retrieved February 27, 2023.

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[relative_size-5] Cite error: The named reference relative_size was invoked but never defined (see the help page).

[thingstoknow-6] Hendricks, Sara (November 10). "10 things I learned from testing every menstrual cup on the market". USA Today. {{cite news}}: Check date values in: |date= (help)

[discFAQ-7] Ultimo, Caitlin (28 December 2023). "All of the Menstrual Disc Questions You Have, Answered". Period Nirvana.

[8] Hillard, Paula J. Adams; Hillard, Paula Adams (2008). The 5-minute Obstetrics and Gynecology Consult. Lippincott Williams & Wilkins. p. 322. ISBN 978-0-7817-6942-6.

[Van2019-9] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, et al. (August 2019). "Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis". The Lancet. Public Health. 4 (8): e376–e393. doi:10.1016/S2468-2667(19)30111-2. PMC 6669309. PMID 31324419. Text was copied from this source, which is available under a Creative Commons Attribution 4.0 International License

[disc/cup-10] Rosas, Kim (5 October 2020). "Menstrual Cup or Disc - Which to choose?". Period Nirvana.

[11] Parker, Erin (28 July 2020). "These Period Cup Reviews Might Convince You to Ditch Pads and Tampons for Good". Glamour. Retrieved 2021-04-10.

[12] "CFR - Code of Federal Regulations Title 21". www.accessdata.fda.gov.

[EUecolabel-13] "COMMISSION DECISION (EU) 2023/1809 of 14 September 2023 establishing the EU Ecolabel criteria for absorbent hygiene products and for reusable menstrual cups". Official Journal of the European Union. 22 September 2023.

[14] US 70865 Improvement in menstrual reciever A 1867 patent describes a sack fitting partly or wholly inside the vagina, suspended from a ring around the cervix, but with the ring held up by a U-shaped wire, which is fastened to the sack at one end and to a belt at the other. Quote:"I construct my menstrual receiver by forming a cup-shaped ring, a, made of rubber, gum, gold, silver, or any suitable substance, which may be made round, or elliptical, or of any shape to fit the os uteri. Around the lower orifice of ring is attached a sack or bag, b, made of rubber or any suitable materials. The ring a rests-around the os uteri, and the bag b rests entirely in the vagina, or may be made of such length as to rest parily outside and partly inside. I insert a small sponge in bag b to absorb the menstrual flux."

[externalsacks-15] US 49915 (1865)US 626159 (1899)

[16] US 574378

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[Lancet_review-37] Eijk, Anna Maria van; Zulaika, Garazi; Lenchner, Madeline; Mason, Linda; Sivakami, Muthusamy; Nyothach, Elizabeth; Unger, Holger; Laserson, Kayla; Phillips-Howard, Penelope A. (2019-08-01). "Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis". The Lancet Public Health. 4 (8): e376–e393. doi:10.1016/S2468-2667(19)30111-2. ISSN 2468-2667. PMC 6669309. PMID 31324419.

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[mayo-42] Pruthi, Sandhya (January 30, 2008). "Menstrual cup: What is it?". Mayoclinic.com.

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[64] For instance, Aisle Cup, Diva, Genial Day, Keeper, Mermaid Guppy, and Mooncup (UK) all sell several cup sizes that all have the same length; this is not an exhaustive list.^[62]

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@@ Line 1: / Line 1: @@
 {{Short description|Feminine hygiene device worn inside the vagina during menstruation}}
 {{more citations needed|date=February 2023}}
-[[File:Менструальный диск и менструальная чаша (cropped).jpg|alt=A menstrual disc and cup are held next to each other. The disc is larger in diameter and flatter. It has a similarly thick rim and thinner material in the basin.|thumb|214x214px|Blue vaginal cup, and pink cervical cup or disc.]]
+[[File:Менструальный диск и менструальная чаша (cropped).jpg|alt=A menstrual disc and cup are held next to each other. The disc is larger in diameter and flatter. It has a similarly thick rim and thinner material in the basin.|thumb|214x214px|Blue bell-shaped thick-walled menstrual cup, and pink bowl-shaped thin-walled cup or disc. Note crumpling of the thin-walled cup.]]
 A '''menstrual cup''' is a [[feminine hygiene|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 usually made of flexible [[medical grade silicone]], latex, or a thermoplastic isomer. They are impermeable and collect menstrual fluid, unlike [[tampons]] and [[menstrual pad]]s, which absorb the fluid instead.<ref name="stewart">Elizabeth Gunther Stewart, Paula Spencer: ''The V Book: A Doctor's Guide to Complete Vulvovaginal Health'', Bantam Books, 2002, Seiten 96 und 97, {{ISBN|0-553-38114-8}}.</ref><ref>Leslie Garrett, Peter Greenberg: ''The Virtuous Consumer: Your Essential Shopping Guide for a Better, Kinder and Healthier World'', New World Library, 2007, Seiten 17 bis 19, {{ISBN|1-930722-74-5}}.</ref>
+Menstrual cups come in two types. The older type is bell-shaped, often with a stem or a ring used for insertion and removal, and has walls more than 2mm thick.<ref name=UNspec/> The second type is bowl-shaped, roughly [[hemispherical]], and apart from the springy rim, has thin, flexible walls. Thick-walled cups sit over the cervix, like [[cervical cap]]s,<ref name="invivoMRI"/> but they are generally larger than cervical caps {{refn|name=relative_size|text=Cervical caps come in internal diameters of 22-31mm,<ref name="capVSdiaphragm">{{cite journal |last1=Gallo |first1=MF |last2=Grimes |first2=DA |last3=Schulz |first3=KF |title=Cervical cap versus diaphragm for contraception. |journal=The Cochrane database of systematic reviews |date=2002 |volume=2002 |issue=4 |pages=CD003551 |doi=10.1002/14651858.CD003551 |pmid=12519602}}</ref> while thick-walled cups come in sizes of 31-53 mm external diameterand as long as the wearer's cervix height permits.<ref name="PNsizechart"/>}} and cannot be worn during vaginal sex. Thin-walled cups sit in the same position as a [[contraceptive diaphragm]]; they do not block the vagina and can be worn during vaginal sex.<ref name="thingstoknow">{{cite news |last1=Hendricks |first1=Sara |date=November 10 |title=10 things I learned from testing every menstrual cup on the market |url=https://reviewed.usatoday.com/health/features/using-menstrual-cup-things-to-know |work=USA Today |language=en}}</ref><ref name="discFAQ">{{cite web |last1=Ultimo |first1=Caitlin |title=All of the Menstrual Disc Questions You Have, Answered. |url=https://www.periodnirvana.com/all-of-the-menstrual-disc-questions-you-have-answered/ |website=Period Nirvana |date=28 December 2023}}</ref> Menstrual cups are not meant to prevent pregnancy.
-They come in two types. '''Vaginal cup'''s are shaped like a bell, with a stem or a ring used for insertion and removal. They sit across the vagina, and the vaginal wall seals around the rim. '''Menstrual disc'''s, also sometimes called '''cervical cup'''s, are roughly [[hemispherical]]. They sit in the [[vaginal fornix]], the area around the [[cervix]], in the same position as a [[contraceptive diaphragm]]. Discs do not block the vagina and can be worn during vaginal sex, but they 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.<ref>{{cite book |last1=Hillard |first1=Paula J. Adams |last2=Hillard |first2=Paula Adams |title=The 5-minute Obstetrics and Gynecology Consult |date=2008 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-6942-6 |page=322 |url=https://books.google.com/books?id=fOoFIQOdIhkC&pg=PA322 |language=en}}</ref> 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 [[Municipal solid waste|solid waste]] than tampons and pads, both from the products themselves and from their packaging.<ref name="Van2019" /> Vaginal 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. Menstrual discs are [[one-size-fits-most]], but some manufacturers sell multiple sizes.<ref name="disc/cup">{{cite web |last1=Rosas |first1=Kim |title=Menstrual Cup or Disc - Which to choose? |url=https://www.periodnirvana.com/menstrual-cup-or-menstrual-disc-which-to-choose/ |website=Period Nirvana |date=5 October 2020}}</ref> Some menstrual cups are sold colorless and translucent, but several brands also offer colored cups.<ref>{{Cite web|last=Parker|first=Erin|date=28 July 2020|title=These Period Cup Reviews Might Convince You to Ditch Pads and Tampons for Good|url=https://www.glamour.com/gallery/best-menstrual-cups|access-date=2021-04-10|website=Glamour|language=en-us}}</ref>
+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.<ref>{{cite book |last1=Hillard |first1=Paula J. Adams |last2=Hillard |first2=Paula Adams |title=The 5-minute Obstetrics and Gynecology Consult |date=2008 |publisher=Lippincott Williams & Wilkins |isbn=978-0-7817-6942-6 |page=322 |url=https://books.google.com/books?id=fOoFIQOdIhkC&pg=PA322 |language=en}}</ref> 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 [[Municipal solid waste|solid waste]] than tampons and pads, both from the products themselves and from their packaging.<ref name="Van2019" /> Thick-walled 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. Thin-walled cups are [[one-size-fits-most]], but some manufacturers sell multiple sizes.<ref name="disc/cup">{{cite web |last1=Rosas |first1=Kim |title=Menstrual Cup or Disc - Which to choose? |url=https://www.periodnirvana.com/menstrual-cup-or-menstrual-disc-which-to-choose/ |website=Period Nirvana |date=5 October 2020}}</ref> Some menstrual cups are sold colorless and translucent, but several brands also offer colored cups.<ref>{{Cite web|last=Parker|first=Erin|date=28 July 2020|title=These Period Cup Reviews Might Convince You to Ditch Pads and Tampons for Good|url=https://www.glamour.com/gallery/best-menstrual-cups|access-date=2021-04-10|website=Glamour|language=en-us}}</ref>
 Reported leakage for menstrual cups is similar or rarer than for tampons and pads. Incorrect placement or cup size can cause leakage.<ref name="Van2019" /> 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.<ref name=Van2019>{{cite journal | vauthors = van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, Unger H, [[Kayla Laserson|Laserson K]], Phillips-Howard PA | display-authors = 6 | title = Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis | journal = The Lancet. Public Health | volume = 4 | issue = 8 | pages = e376–e393 | date = August 2019 | pmid = 31324419 | pmc = 6669309 | doi = 10.1016/S2468-2667(19)30111-2 |doi-access=free}} [[File:CC-BY icon.svg|50px]] Text was copied from this source, which is available under a [https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License]</ref>
 {{TOC limit}}
+== Terminology ==
+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 by wall thickness. The thick-walled cups are bell-shaped, and look like contraceptive [[cervical cap]]s; the thin-walled cups are bowl-shaped, and look like [[contraceptive diaphragm]]s.
+Regulation generally does not distinguish the two types. The US Food and Drug Administration holds that "A menstrual cup is a receptacle placed in the vagina to collect menstrual flow."<ref>{{cite web |title=CFR - Code of Federal Regulations Title 21 |url=https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?fr=884.5400 |website=www.accessdata.fda.gov}}</ref> 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."<ref name="EUecolabel">{{cite journal |title=COMMISSION DECISION (EU) 2023/1809 of 14 September 2023 establishing the EU Ecolabel criteria for absorbent hygiene products and for reusable menstrual cups |journal=Official Journal of the European Union |date=22 September 2023}}</ref>
+Because thick-walled cups are commonly depicted as being placed in the vaginal canal, well below the cervix, they are also called "'''vaginal cup'''s", with the thin-walled cups called "'''cervical cup'''s". [[MRI imaging]] showed that, contrary to manufacturer's depictions, thick-walled cups are placed over the cervix, in a position similar to a [[cervical cap]] (not to be confused with a cervical ''cup'').<ref name="invivoMRI">{{cite journal |last1=Pretorius |first1=ES |last2=Barnhart |first2=K |last3=Timbers |first3=K |last4=Mauck |first4=C |title=Use of MRI to determine the in vivo position of a silicone vaginal barrier contraceptive device. |journal=Contraception |date=May 2002 |volume=65 |issue=5 |pages=343-6 |doi=10.1016/s0010-7824(02)00278-0 |pmid=12057786}}</ref> Thin-walled "cervical cups" also cover the cervix, but have one edge located further down the vagina. Thin-walled cups are also called "'''menstrual discs'''", distinguishing them from "menstrual cups" in the narrower sense.
+In the 1800s, menstrual cups were called "''''catamenial sacks'''",<ref>{{patent|US|70865|Improvement in menstrual reciever}} A 1867 patent describes a sack fitting partly or wholly inside the vagina, suspended from a ring around the cervix, but with the ring held up by a U-shaped wire, which is fastened to the sack at one end and to a belt at the other. Quote:"I construct my menstrual receiver by forming a cup-shaped ring, ''a'', made of rubber, gum, gold, silver, or any suitable substance, which may be made round, or elliptical, or of any shape to fit the ''[[os uteri]]''. Around the lower orifice of ring is attached a sack or bag, ''b'', made of rubber or any suitable materials. The ring a rests-around the ''os uteri'', and the bag ''b'' rests entirely in the vagina, or may be made of such length as to rest parily outside and partly inside. I insert a small sponge in bag ''b'' to absorb the menstrual flux."</ref> and were similar external catamenial sacks of "canoe-like form" <ref name=externalsacks>{{patent|US|49915}}(1865){{patent|US|626159}}(1899)</ref>, which in turn were similar to catamenial sacks which were waterproof rubber supports for absorbant pads.<ref>{{patent|US|574378}}</ref> These were made from latex ("india-rubber") or [[gutta-percha]].<ref name=externalsacks/>
 == Use ==
 ===Insertion===
-[[File:Stap2 cropped.png|thumb|Inserting a menstrual disc.<ref name=":3">[[wikihow:Use-an-Instead-Softcup#.2FImage:Undefined_14872.png|How to use an Instead Softcup]], Wikihow</ref> Discs, also called cervical cups, are worn in the same position as a contraceptive diaphragm.|218x218px]]
+[[File:Stap2 cropped.png|thumb|Inserting a thin-walled menstrual disc.<ref name=":3">[[wikihow:Use-an-Instead-Softcup#.2FImage:Undefined_14872.png|How to use an Instead Softcup]], Wikihow</ref> Thin-walled menstrual discs are worn in the same position as a contraceptive diaphragm.|218x218px]]
-A vaginal cup is first folded or pinched and then inserted into the vagina. It will normally unfold automatically and create a light seal against the vaginal wall.<ref name=":13">{{Cite web |last1=Hearn |first1=Amanda |last2=Rosas |first2=Kim |date=July 26, 2018 |title=How to Insert a Menstrual Cup |url=https://www.youtube.com/watch?v=rnuomsxjBOs&ab_channel=PutACupInIt |url-status=live |archive-url=https://web.archive.org/web/20240226170306/https://www.youtube.com/watch?v=rnuomsxjBOs&ab_channel=PutACupInIt |archive-date=February 26, 2024 |access-date=February 26, 2024 |website=YouTube}}</ref> In some cases, the user may need to twist the cup or flex the vaginal muscles to ensure the cup is fully open.<ref name=":14" /> If correctly inserted, the cup should not leak or cause any discomfort.<ref name=":5">{{Cite web|url=https://uk.lunette.com/pages/cervix|title=Vagina Anatomy - Learn Your Parts|website=Lunette UK|access-date=2018-08-31}}</ref> The stem should be completely inside the vagina. If it is not, the stem can be trimmed.<ref name=":13" /> There are various folding techniques for insertion; common folds include the c-fold, as well as the punch-down fold.<ref name=":14">{{Cite news|url=https://www.wikihow.com/index.php?title=Use-a-Menstrual-Cup&oldid=16766928|archive-url=https://web.archive.org/web/20200719064757/https://www.wikihow.com/index.php?title=Use-a-Menstrual-Cup&oldid=16766928|url-status=dead|archive-date=July 19, 2020|title=How to Use a Menstrual Cup|date=March 2, 2015|work=wikiHow|access-date=2018-08-31|language=en}}</ref>
+A thick-walled cup is first folded or pinched and then inserted into the vagina. It will normally unfold automatically and seal against the vaginal wall.<ref name=":13">{{Cite web |last1=Hearn |first1=Amanda |last2=Rosas |first2=Kim |date=July 26, 2018 |title=How to Insert a Menstrual Cup |url=https://www.youtube.com/watch?v=rnuomsxjBOs&ab_channel=PutACupInIt |url-status=live |archive-url=https://web.archive.org/web/20240226170306/https://www.youtube.com/watch?v=rnuomsxjBOs&ab_channel=PutACupInIt |archive-date=February 26, 2024 |access-date=February 26, 2024 |website=YouTube}}</ref> In some cases, the user may need to twist the cup or flex the vaginal muscles to ensure the cup is fully open.<ref name=":14" /> If correctly inserted, the cup should not leak or cause any discomfort.<ref name=":5">{{Cite web|url=https://uk.lunette.com/pages/cervix|title=Vagina Anatomy - Learn Your Parts|website=Lunette UK|access-date=2018-08-31}}</ref> The stem should be completely inside the vagina. If it is not, the stem can be trimmed.<ref name=":13" /> There are various folding techniques for insertion; common folds include the c-fold, as well as the punch-down fold.<ref name=":14">{{Cite news|url=https://www.wikihow.com/index.php?title=Use-a-Menstrual-Cup&oldid=16766928|archive-url=https://web.archive.org/web/20200719064757/https://www.wikihow.com/index.php?title=Use-a-Menstrual-Cup&oldid=16766928|url-status=dead|archive-date=July 19, 2020|title=How to Use a Menstrual Cup|date=March 2, 2015|work=wikiHow|access-date=2018-08-31|language=en}}</ref>
-Menstrual discs are inserted differently than cups: by squeezing the rim until it narrows into a "figure-of-8" shape, sliding the disc to the end of the vaginal canal, and tucking the outside edge behind the pubic bone.<ref name=":1">{{Cite web |last=Savin |first=Jennifer |date=August 8, 2023 |title=What is a menstrual disc – and how do you use one? |url=https://www.cosmopolitan.com/uk/body/health/a44760585/menstrual-disc/ |url-status=live |archive-url=https://web.archive.org/web/20240226021936/https://www.cosmopolitan.com/uk/body/health/a44760585/menstrual-disc/ |archive-date=February 26, 2024 |access-date=February 24, 2024 |website=Cosmopolitan}}</ref><ref name=":2">{{Cite web |last=Hendricks |first=Sara |date=November 10, 2021 |title=10 things I learned from testing every menstrual cup on the market |url=https://reviewed.usatoday.com/health/features/using-menstrual-cup-things-to-know |url-status=live |archive-url=https://web.archive.org/web/20240226022349/https://reviewed.usatoday.com/health/features/using-menstrual-cup-things-to-know |archive-date=February 26, 2024 |access-date=February 24, 2024 |website=USA TODAY Reviewed}}</ref>
+Thin-walled menstrual discs are inserted differently than thick-walled cups: by squeezing the rim until it narrows into a "figure-of-8" shape, sliding the disc to the end of the vaginal canal, and tucking the outside edge behind the pubic bone.<ref name=":1">{{Cite web |last=Savin |first=Jennifer |date=August 8, 2023 |title=What is a menstrual disc – and how do you use one? |url=https://www.cosmopolitan.com/uk/body/health/a44760585/menstrual-disc/ |url-status=live |archive-url=https://web.archive.org/web/20240226021936/https://www.cosmopolitan.com/uk/body/health/a44760585/menstrual-disc/ |archive-date=February 26, 2024 |access-date=February 24, 2024 |website=Cosmopolitan}}</ref><ref name=":2">{{Cite web |last=Hendricks |first=Sara |date=November 10, 2021 |title=10 things I learned from testing every menstrual cup on the market |url=https://reviewed.usatoday.com/health/features/using-menstrual-cup-things-to-know |url-status=live |archive-url=https://web.archive.org/web/20240226022349/https://reviewed.usatoday.com/health/features/using-menstrual-cup-things-to-know |archive-date=February 26, 2024 |access-date=February 24, 2024 |website=USA TODAY Reviewed}}</ref>
 If lubrication is necessary for insertion, it should be [[Personal lubricant#Water-based|water-based]], as [[Personal lubricant#Silicone-based|silicone lubricant]] can be damaging to the silicone.<ref>{{Cite web |last=Rosas |first=Kim |date=2022-06-06 |title=How to Insert a Menstrual Cup for Beginners |url=https://www.periodnirvana.com/tips-for-your-first-time-easy-menstrual-cup-insertion/ |archive-url=https://web.archive.org/web/20231109220257/https://www.periodnirvana.com/tips-for-your-first-time-easy-menstrual-cup-insertion/ |archive-date=2023-11-09 |access-date=2023-11-09 |website=Period Nirvana |language=en-US}}</ref>
 <!--fit alongside big image? File:Falttechniken der Menstruationstasse.jpg-->
-[[File:Menstrual cup use 10.1177 17455065211058553-fig1.jpg|thumb|center|upright=4|Inserting a vaginal cup.
+[[File:Menstrual cup use 10.1177 17455065211058553-fig1.jpg|thumb|center|upright=4|Inserting a thick-walled cup.
 {{ordered list|type=lower-alpha
   | Users find a fold suitable for them; punchdown-fold, 7-fold, and c-fold illustrated.
@@ Line 35: / Line 44: @@
 [[File:Gestion menstrual copita copa menstrual menstruación periodicas 02.jpg|thumb|A filled menstrual cup after use]]
 [[File:Washing a menstrual cup under a stream of fresh water in a sink 3.jpg|thumb|Rinsing a cup]]
-It is possible to empty a softer menstrual disc by muscular effort, when sitting on a toilet, without removing it. Vaginal cups must be removed to empty them.<ref name="autodump">{{cite web |last1=Rosas |first1=Kim |title=Menstrual Disc Auto-Dumping: Emptying Your Disc |url=https://www.periodnirvana.com/menstrual-disc-auto-dumping-explained-3/ |website=Period Nirvana |date=11 October 2020}}</ref><ref name="cosmop">{{cite news |last1=Savin |first1=Jennifer |title=Menstrual discs are officially the best period product for a heavy flow... |url=https://www.cosmopolitan.com/uk/body/health/a44760585/menstrual-disc/ |work=Cosmopolitan |date=8 August 2023}}</ref>
+It is possible to empty a softer thin-walled menstrual disc by muscular effort, when sitting on a toilet, without removing it. Thick-walled cups must be removed to empty them.<ref name="autodump">{{cite web |last1=Rosas |first1=Kim |title=Menstrual Disc Auto-Dumping: Emptying Your Disc |url=https://www.periodnirvana.com/menstrual-disc-auto-dumping-explained-3/ |website=Period Nirvana |date=11 October 2020}}</ref><ref name="cosmop">{{cite news |last1=Savin |first1=Jennifer |title=Menstrual discs are officially the best period product for a heavy flow... |url=https://www.cosmopolitan.com/uk/body/health/a44760585/menstrual-disc/ |work=Cosmopolitan |date=8 August 2023}}</ref>
-After 4–12 hours of use (depending on the amount of flow), the cup is removed by reaching up to its stem to find the base. Simply pulling on the stem is not recommended to remove the cup, as this can create suction. The base of the cup is pinched to release the seal, and the cup is removed.<ref name=":5"/> After emptying, a menstrual cup should be rinsed or wiped and reinserted. It can be washed with a mild soap, and sterilized in boiling water for a few minutes at the end of the cycle. Alternatively, sterilizing solutions (usually developed for baby bottles and breast pump equipment) may be used to soak the cup. Specific cleaning instructions vary by brand.<ref>{{Cite web |last=Rosas |first=Kim |date=February 16, 2021 |title=The Ultimate Guide: How To Clean Menstrual Cups |url=https://www.periodnirvana.com/how-to-clean-menstrual-cups/ |url-status=live |archive-url=https://web.archive.org/web/20240226172809/https://www.periodnirvana.com/how-to-clean-menstrual-cups/ |archive-date=February 26, 2024 |access-date=February 26, 2024 |website=Period Nirvana}}</ref>
+After 4–12 hours of use (depending on the amount of flow), a thick-walled cup is removed by reaching up to its stem to find the base. Simply pulling on the stem is not recommended to remove the cup, as this can create suction. The base of the cup is pinched to release the seal, and the cup is removed.<ref name=":5"/> After emptying, a menstrual cup should be rinsed or wiped and reinserted. It can be washed with a mild soap, and sterilized in boiling water for a few minutes at the end of the cycle. Alternatively, sterilizing solutions (usually developed for baby bottles and breast pump equipment) may be used to soak the cup. Specific cleaning instructions vary by brand.<ref>{{Cite web |last=Rosas |first=Kim |date=February 16, 2021 |title=The Ultimate Guide: How To Clean Menstrual Cups |url=https://www.periodnirvana.com/how-to-clean-menstrual-cups/ |url-status=live |archive-url=https://web.archive.org/web/20240226172809/https://www.periodnirvana.com/how-to-clean-menstrual-cups/ |archive-date=February 26, 2024 |access-date=February 26, 2024 |website=Period Nirvana}}</ref>
 Removing a menstrual cup can be messy. Sometimes menstrual blood can spill during removal, although the device can be removed over a toilet to catch spills.<ref>{{Cite web |last1=Hearn |first1=Amanda |last2=Rosas |first2=Kim |date=July 26, 2018 |title=How to Remove a Menstrual Cup |url=https://www.youtube.com/watch?v=SBZF0vHSf0c&ab_channel=PutACupInIt |url-status=live |archive-url=https://web.archive.org/web/20240226171307/https://www.youtube.com/watch?v=SBZF0vHSf0c&ab_channel=PutACupInIt |archive-date=February 26, 2024 |access-date=February 26, 2024 |website=YouTube}}</ref> Removal becomes less messy with practice, and most experienced users can remove it without spilling.<ref name="mess-free">{{cite web |last1=Rosas |first1=Kim |title=Remove Your Menstrual Cup Mess-Free {{!}} It's not a blood bath, I promise |url=https://www.periodnirvana.com/remove-menstrual-cup-mess-free/ |website=Period Nirvana |date=4 February 2022}}</ref> If a user needs to track the amount of menses produced (e.g., for medical reasons), a menstrual cup allows one to do so accurately before emptying.<ref name="HMB">{{cite journal |last1=DeLoughery |first1=Emma |last2=Colwill |first2=Alyssa C. |last3=Edelman |first3=Alison |last4=Bannow |first4=Bethany Samuelson |title=Red blood cell capacity of modern menstrual products: considerations for assessing heavy menstrual bleeding |journal=BMJ Sexual & Reproductive Health |date=1 January 2024 |volume=50 |issue=1 |pages=21–26 |doi=10.1136/bmjsrh-2023-201895 |url=https://srh.bmj.com/lookup/doi/10.1136/bmjsrh-2023-201895 |language=en |issn=2515-1991}}</ref>
-Discs are removed by hooking the rim with a finger or pinching with multiple fingers and pulling, typically done over a toilet or in a shower in case of spilling.<ref>{{Cite web |last=Rosas |first=Kim |date=January 24, 2023 |title=Menstrual Disc Removal {{!}} Step-by-Step Guide |url=https://www.periodnirvana.com/step-by-step-how-to-remove-a-menstrual-disc/ |url-status=live |archive-url=https://web.archive.org/web/20240226022637/https://www.periodnirvana.com/step-by-step-how-to-remove-a-menstrual-disc/ |archive-date=February 26, 2024 |access-date=February 25, 2024 |website=Period Nirvana}}</ref>
+Thin-walled menstrual cups are removed by hooking the rim with a finger, or pinching with multiple fingers and pulling, typically done over a toilet or in a shower in case of spilling. Some thin-walled cups also have stems, but contrary to thick-walled cups, these stems attach to the rim of the cup, and can be pulled to break the seal.<ref>{{Cite web |last=Rosas |first=Kim |date=January 24, 2023 |title=Menstrual Disc Removal {{!}} Step-by-Step Guide |url=https://www.periodnirvana.com/step-by-step-how-to-remove-a-menstrual-disc/ |url-status=live |archive-url=https://web.archive.org/web/20240226022637/https://www.periodnirvana.com/step-by-step-how-to-remove-a-menstrual-disc/ |archive-date=February 26, 2024 |access-date=February 25, 2024 |website=Period Nirvana}}</ref>
 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.<ref>WECF (2006). [http://www.susana.org/en/resources/library/details/426 Ecological sanitation and hygienic considerations for women - Fact Sheet]. Women in Europe for a Common Future, Netherlands and Germany</ref>
@@ Line 84: / Line 93: @@
 ==Size, shape, and flexibility==
-===Vaginal cups===
+===Thick-walled cups===
 {{Multiple image| align=center|
 |image1=Menstrual cups with scale bars 10.1177 17455065211058553-fig2.jpg
-|caption1=Vaginal menstrual cups come in many different shapes
+|caption1=Thick-walled menstrual cups come in many different shapes
 |image3=Fleurcups sizes.png
 |caption3=Most manufacturers make at least two different sizes, sometimes confusingly labelled
@@ Line 93: / Line 102: @@
 |caption4=Softer cups may be more comfortable for some, but firmer cups may have a better seal
 |image5=Menstrual cup insertion.svg
-|caption5=A properly sized and inserted vaginal cup (blue) will form a seal against the vaginal walls, as shown. Blood flow from the (red) uterus is captured in the cup.
+|caption5=A properly sized and inserted cup (blue) will form a seal against the vaginal walls, as shown. Blood flow from the (red) uterus is captured in the cup.
 }}
@@ Line 107: / Line 116: @@
 | Large || 48-58mm || 30-40mL || 45-48mm || medium to hard
 |}
-[[File:Falttechniken der Menstruationstasse.jpg|thumb|Various methods of folding a vaginal cup for insertion. A flexible cup may fold more easily.]]
+[[File:Falttechniken der Menstruationstasse.jpg|thumb|Various methods of folding a thick-walled cup for insertion. A flexible cup may fold more easily.]]
-Vaginal menstrual cups are generally bell-shaped, with a few exceptions.<ref name="Van2019" /> They all have a wall thickness of about 2mm. They vary in length, capacity, firmness, and external diameter of the rim. These dimensions should be chosen to suit the user's anatomy, flow quantity, and personal preference for firmness.<ref name=UNspec/>
+Thick-walled menstrual cups are generally bell-shaped, with a few exceptions.<ref name="Van2019" /> They all have a wall thickness of about 2mm. They vary in length, capacity, firmness, and external diameter of the rim. These dimensions should be chosen to suit the user's anatomy, flow quantity, and personal preference for firmness.<ref name=UNspec/>
 While [[Tenting effect|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.<ref name="cervix_height"/> Cups are available in lengths from about 30-80mm,<ref name="PNsizechart"/> with 40-60mm lengths being common;<ref name="Lancet_review"/> menstrual discs are shallower than most cups.<ref name="disc_fit">{{cite web |last1=Rosas |first1=Kim |title=Menstrual Disc Brands {{!}} Resources and Comparisons |url=https://www.periodnirvana.com/menstrual-disc-brands/ |website=Period Nirvana |access-date=11 March 2024 |date=20 October 2021}}</ref> Some manufacturers sell several sizes of cup that are all the same length.{{refn|For instance, Aisle Cup, Diva, Genial Day, Keeper, Mermaid Guppy, and Mooncup (UK) all sell several cup sizes that all have the same length; this is not an exhaustive list.<ref name="PNsizechart"/>}}
@@ Line 115: / Line 124: @@
 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<ref name=UNspec/> or is tilted, a shorter cup may be more suitable.<ref name=":6" /> Cervix height can be 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.<ref name="cervix_height">{{cite web |last1=Rosas |first1=Kim |title=High vs. Low Cervix and Menstrual Cups |url=https://www.periodnirvana.com/why-measuring-your-cervix-height-matters-low-cervix-or-high-cervix-menstrual-cups/ |website=Period Nirvana |access-date=10 March 2024 |date=31 August 2022}}</ref> Cervix height varies slightly over the month, and is usually lowest on the first day of bleeding; minimum height should be used for sizing.<ref name="cervix_height"/>
-Many cups have stems to aid removal. 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. The UN counterrecommends hollow stems, because solid stems are easier to clean.<ref name=UNspec/> Moulded text, ridges, bumps, and holes can also make it harder to clean.<ref name=wirecutter/>
+Many thick-walled 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. The UN counterrecommends hollow stems, because solid stems are easier to clean.<ref name=UNspec/> Moulded text, ridges, bumps, and holes can also make it harder to clean.<ref name=wirecutter/>
-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.<ref name="Lancet_review"/> Approximately, small size cups hold 15-25 ml, medium size cups hold 20-30 ml, and large cups hold 30-40 ml.<ref name=UNspec>{{Cite web | title=Menstrual Cup Specifications — General description | url=https://www.unfpa.org/sites/default/files/resource-pdf/Specifications%20Reusable%20Menstrual%20Cup%20%20-%20UNFPA%2C%20UNHCR%2C%20UNICEF.pdf |access-date=February 27, 2023 |website=United Nations Population Fund}}</ref> The maximum capacity for large cups is about 50mL (menstrual discs may take up to 80mL).<ref name="PNsizechart"/> 80mL is more blood than most lose in a month; losing more than that is considered grounds for consulting a doctor.<ref name="HMB"/><ref name="cosmop"/>{{medref inline|date=March 2024}} Excessively high-volume cups can be uncomfortably large, so prioritizing fit is recommended.<ref name=wirecutter/>
+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.<ref name="Lancet_review"/> Approximately, small size cups hold 15-25 ml, medium size cups hold 20-30 ml, and large cups hold 30-40 ml.<ref name=UNspec>{{Cite web | title=Menstrual Cup Specifications — General description | url=https://www.unfpa.org/sites/default/files/resource-pdf/Specifications%20Reusable%20Menstrual%20Cup%20%20-%20UNFPA%2C%20UNHCR%2C%20UNICEF.pdf |access-date=February 27, 2023 |website=United Nations Population Fund}}</ref> The maximum capacity for large cups is about 50mL (thin-walled cups generally hold a bit more).<ref name="PNsizechart"/> 80mL is more blood than most lose in a month; losing more than that is considered grounds for consulting a doctor.<ref name="HMB"/><ref name="cosmop"/>{{medref inline|date=March 2024}} Excessively high-volume cups can be uncomfortably large, so prioritizing fit is recommended.<ref name=wirecutter/>
-Menstrual cups also vary by firmness or flexibility. Some companies offer a range of firmness levels in their cups. A firmer cup pops open more easily after insertion and may hold a more consistent seal against the vaginal wall (preventing leaks), but some women find softer cups more comfortable to insert.<ref name="Lancet_review">{{Cite journal|last1=Eijk|first1=Anna Maria van|last2=Zulaika|first2=Garazi|last3=Lenchner|first3=Madeline|last4=Mason|first4=Linda|last5=Sivakami|first5=Muthusamy|last6=Nyothach|first6=Elizabeth|last7=Unger|first7=Holger|last8=Laserson|first8=Kayla|last9=Phillips-Howard|first9=Penelope A.|author-link8=Kayla Laserson|date=2019-08-01|title=Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis|journal=The Lancet Public Health|language=en|volume=4|issue=8|pages=e376–e393|doi=10.1016/S2468-2667(19)30111-2|issn=2468-2667|pmid=31324419|pmc=6669309|doi-access=free}}</ref> The outside diameter of the rim will also affect seal and comfort.
+Thick-walled cups also vary by firmness or flexibility. Some companies offer a range of firmness levels in their cups. A firmer cup pops open more easily after insertion and may hold a more consistent seal against the vaginal wall (preventing leaks), but some women find softer cups more comfortable to insert.<ref name="Lancet_review">{{Cite journal|last1=Eijk|first1=Anna Maria van|last2=Zulaika|first2=Garazi|last3=Lenchner|first3=Madeline|last4=Mason|first4=Linda|last5=Sivakami|first5=Muthusamy|last6=Nyothach|first6=Elizabeth|last7=Unger|first7=Holger|last8=Laserson|first8=Kayla|last9=Phillips-Howard|first9=Penelope A.|author-link8=Kayla Laserson|date=2019-08-01|title=Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis|journal=The Lancet Public Health|language=en|volume=4|issue=8|pages=e376–e393|doi=10.1016/S2468-2667(19)30111-2|issn=2468-2667|pmid=31324419|pmc=6669309|doi-access=free}}</ref> The outside diameter of the rim will also affect seal and comfort.
 ====Labelling====
 Manufacturers do not generally print cup dimensions on the box,<!--Lunette actually publish them online,[https://www.lunette.com/pages/size-guide] but most don't--> but there are third-party tables of dimensions online.<ref name="PNsizechart">{{cite web |last1=Rosas |first1=Kim |title=Menstrual Cup Comparison Chart |url=https://periodnirvana.com/menstrual-cup-chart/ |website=Period Nirvana}}</ref><ref>{{cite web |last1=Hearn |first1=Amanda |title=Menstrual Cup Comparison Chart (Metric) |url=https://putacupinit.com/metricchart |website=Put A Cup In It |access-date=10 March 2024 |date=24 February 2016}}</ref> A requirement for quantitative measurements, including a [[Young's modulus]] measurement of firmness, has been suggested.<ref name="quant_firmness"/>
-Most menstrual cup 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 manufactuer's products, volume ''usually'' increases with number and position in the alphabet. 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).{{refn|Libby and Juju cups do not follow the conventional order; Aislecups and Genial Day cups differ in diameter, but not length or volume; Divacups do not differ in length; Keeper and Oi differ in volume only.<ref name="PNsizechart"/>}}
+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 manufactuer's products, volume ''usually'' increases with number and position in the alphabet. 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).{{refn|Libby and Juju cups do not follow the conventional order; Aislecups and Genial Day cups differ in diameter, but not length or volume; Divacups do not differ in length; Keeper and Oi differ in volume only.<ref name="PNsizechart"/>}}
 These sizes are not consistent between manufacturers.<ref name="quant_firmness"/><ref name=wirecutter/> 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.<ref name=":9" /><ref name=":6">{{Cite web|title=What's a Menstrual Cup?|url=https://www.webmd.com/women/guide/menstrual-cup#2|website=WebMD|language=en|access-date=2020-05-22}}</ref> However, there is no medical evidence for sizing based on on age or [[Gravidity and parity#Parity|parity]].<ref name=":9">{{Cite book|last=Gunter, Jen|title=The vagina bible : the vulva and the vagina--separating the myth from the medicine|date=20 August 2019| isbn=978-0-7352-7738-0| pages=304| publisher=Random House of Canada |oclc=1099676519}}</ref>
-=== Menstrual discs ===
+=== Thin-walled cups or discs ===
-[[File:Менструальный диск и менструальная чаша (cropped to menstrual disk).jpg|alt=A menstrual disc, made of silicone, bright pink. The rim has a round cross-section and is about 1cm thick; it forms an oval. The bowl is a crumpled, slightly-translucent silicone membrane, with a latticework of slightly-raised ridges in the shape of a tesselation of hearts.|thumb|214x214px|A reusable silicone menstrual disc. The bowl is much more flexible than in a thicker vaginal cup.]]
+[[File:Менструальный диск и менструальная чаша (cropped to menstrual disk).jpg|alt=A menstrual disc, made of silicone, bright pink. The rim has a round cross-section and is about 1cm thick; it forms an oval. The bowl is a crumpled, slightly-translucent silicone membrane, with a latticework of slightly-raised ridges in the shape of a tesselation of hearts.|thumb|214x214px|A reusable silicone menstrual disc. The thin-walled bowl is much more flexible than in a thick-walled cup.]]
 [[File:Diaphragmen in verschiedenen Größen (cropped).jpg|thumb|Contraceptive diaphragms; one intended to fit sizes 65-80mm, and five in 5mm-increment diameters from 60-90mm.<ref>{{cite web |title=Das neue Singa Diaphragma – Medintim |url=https://www.medintim.de/de/news/singa-diaphragma/ |website=www.medintim.de}}</ref> These are shaped similarly to menstrual discs.]]
-'''Menstrual discs''' (also called cervical cups)<ref name="Van2019" /> are approximately hemispherical in shape, like a [[Diaphragm (birth control)|diaphragm]], with a flexible outer ring 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 [[Pubis (bone)|pubic bone]]. Menstrual discs come in both disposable and reusable varieties.<ref>{{Cite journal |last=Koskenniemi |first=Aino |date=2023-01-02 |title=Say no to shame, waste, inequality—and leaks! Menstrual activism in the market for alternative period products |url=https://www.tandfonline.com/doi/full/10.1080/14680777.2021.1948885 |journal=Feminist Media Studies |language=en |volume=23 |issue=1 |pages=19–36 |doi=10.1080/14680777.2021.1948885 |s2cid=237756421 |issn=1468-0777|hdl=10138/357657 |hdl-access=free }}</ref>
+Thin-walled cups (also called menstrual discs)<ref name="Van2019" /> are approximately hemispherical in shape, like a [[Diaphragm (birth control)|diaphragm]], with a flexible outer ring 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 [[Pubis (bone)|pubic bone]]. Menstrual discs come in both disposable and reusable varieties.<ref>{{Cite journal |last=Koskenniemi |first=Aino |date=2023-01-02 |title=Say no to shame, waste, inequality—and leaks! Menstrual activism in the market for alternative period products |url=https://www.tandfonline.com/doi/full/10.1080/14680777.2021.1948885 |journal=Feminist Media Studies |language=en |volume=23 |issue=1 |pages=19–36 |doi=10.1080/14680777.2021.1948885 |s2cid=237756421 |issn=1468-0777|hdl=10138/357657 |hdl-access=free }}</ref>
-Menstrual discs are sized differently than vaginal cups. Fit is much less individual; the flexible bowl makes depth unimportant, and any disc between 60-70mm diameter will fit most people.<ref>{{cite web |last1=Rosas |first1=Kim |title=Menstrual Disc Brands {{!}} Resources and Comparisons |url=https://www.periodnirvana.com/menstrual-disc-brands/ |website=Period Nirvana |date=20 October 2021}}</ref> As with contraceptive diaphragms, many "one-size-fits-all" menstrual cups have slightly oval or pear-shaped rims, and some have rims that arch (as seen from the side) to increase the range of sizes that fit. A contraceptive diaphragm using these techniques fit 98% of women in a multicenter study (everyone with a size of 65-80mm).<ref>{{cite journal|title=Contraceptive Efficacy, Safety, Fit, and Acceptability of a Single-Size Diaphragm Developed with End-User Input|journal=Obstetrics and Gynecology|doi=10.1097/AOG.0000000000000721|pmid=25751199|volume=125|issue=4|year=2015|pages=895–903 | last1 = Schwartz | first1 = Jill L. | last2 = Weiner | first2 = Debra H. | last3 = Jou Lai | first3 = Jaim | last4 = Frezieres | first4 = Ron G. | last5 = Creinin | first5 = Mitchell D. | last6 = Archer | first6 = David F. | last7 = Bradley | first7 = Lynn | last8 = Barnhart | first8 = Kurt T. | last9 = Poindexter | first9 = Alfred | last10 = Kilbourne-Brook | first10 = Maggie | last11 = Callahan | first11 = Marianne M. | last12 = Mauck | first12 = Christine K.|s2cid=205466445|url=http://www.escholarship.org/uc/item/65q612hq}}</ref><ref name="path">{{cite web |last1=Kilbourne-Brook |first1=Maggie |last2=Hammack |first2=Rachel |title=Reinventing the Past to Reshape the Future of Contraception: THE STORY OF THE SILCS DIAPHRAGM |url=https://www.caya.us.com/wp-content/uploads/2022/06/The-Story-of-the-SILCS-Diaphragm.pdf |publisher=PATH}}</ref>
+Thin-walled cups are sized differently than thick-walled cups. Fit is much less individual; the flexible bowl makes depth unimportant, and any thin-walled cup between 60-70mm diameter will fit most people.<ref>{{cite web |last1=Rosas |first1=Kim |title=Menstrual Disc Brands {{!}} Resources and Comparisons |url=https://www.periodnirvana.com/menstrual-disc-brands/ |website=Period Nirvana |date=20 October 2021}}</ref> As with contraceptive diaphragms, many "one-size-fits-all" cups have slightly oval or pear-shaped rims, and some have rims that arch (as seen from the side) to increase the range of sizes that fit. A contraceptive diaphragm using these techniques fit 98% of women in a multicenter study (everyone with a size of 65-80mm).<ref>{{cite journal|title=Contraceptive Efficacy, Safety, Fit, and Acceptability of a Single-Size Diaphragm Developed with End-User Input|journal=Obstetrics and Gynecology|doi=10.1097/AOG.0000000000000721|pmid=25751199|volume=125|issue=4|year=2015|pages=895–903 | last1 = Schwartz | first1 = Jill L. | last2 = Weiner | first2 = Debra H. | last3 = Jou Lai | first3 = Jaim | last4 = Frezieres | first4 = Ron G. | last5 = Creinin | first5 = Mitchell D. | last6 = Archer | first6 = David F. | last7 = Bradley | first7 = Lynn | last8 = Barnhart | first8 = Kurt T. | last9 = Poindexter | first9 = Alfred | last10 = Kilbourne-Brook | first10 = Maggie | last11 = Callahan | first11 = Marianne M. | last12 = Mauck | first12 = Christine K.|s2cid=205466445|url=http://www.escholarship.org/uc/item/65q612hq}}</ref><ref name="path">{{cite web |last1=Kilbourne-Brook |first1=Maggie |last2=Hammack |first2=Rachel |title=Reinventing the Past to Reshape the Future of Contraception: THE STORY OF THE SILCS DIAPHRAGM |url=https://www.caya.us.com/wp-content/uploads/2022/06/The-Story-of-the-SILCS-Diaphragm.pdf |publisher=PATH}}</ref>
 Size can be measured in the same way as for contraceptive diaphragms;<ref name="discsize">{{cite web |last1=Rosas |first1=Kim |title=How to Find Your Menstrual Disc Size |url=https://www.periodnirvana.com/find-your-menstrual-disc-size/ |website=Period Nirvana |date=13 April 2022}}</ref> 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 index finger and the thumbnail is then measured. This is the diameter of circular rim needed.<ref name="discfit">{{cite journal |last1=Allen |first1=RE |title=Diaphragm fitting. |journal=American Family Physician |date=1 January 2004 |volume=69 |issue=1 |pages=97–100 |pmid=14727824 |url=https://www.aafp.org/pubs/afp/issues/2004/0101/p97.html}}</ref> Sizing rings can also be used; disposable menstrual discs are similar in size to many reusable ones, and can be used to check if an ~70mm diameter fits.<ref name="discsize"/><ref name="discfit"/> A disc which is too big or too small will leak.<ref name="discsize"/>
+Thin-walled cups come in diameters from 53mm to 80mm, {{Asof|lc=y|2024}}.<ref name="PNsizechart"/> They have some advantages over thick-walled cups, including that they have a higher capacity (40-80ml),<ref>{{Cite journal |last1=DeLoughery |first1=Emma |last2=Colwill |first2=Alyssa |last3=Edelman |first3=Alison |last4=Samuelson Bannow |first4=Bethany |date=January 9, 2024 |title=Red blood cell capacity of modern menstrual products: considerations for assessing heavy menstrual bleeding |url=https://srh.bmj.com/content/50/1/21 |journal=BMJ Sexual & Reproductive Health |volume=50 |issue=1 |pages=21–26 |doi=10.1136/bmjsrh-2023-201895 |pmid=37550075 |pmc=10847380 |via=BMJ Journals}}</ref> enable bloodless period sex,<ref>{{Cite web |last=Loreto Cruz |first=Anne |date=January 19, 2021 |title=Everything you need to know about menstrual discs |url=https://mashable.com/article/menstrual-discs-explainer |url-status=live |archive-url=https://web.archive.org/web/20240226025049/https://mashable.com/article/menstrual-discs-explainer |archive-date=February 26, 2024 |access-date=February 24, 2024 |website=Mashable}}</ref> and are more comfortable for some users.<ref name=":1" /><ref name=":10">{{Cite journal |last1=Abigail |first1=Liberty |last2=Bethany |first2=Samuelson Bannow |last3=Matteson |first3=Kristen |last4=Edelman |first4=Alison |last5=Colwill |first5=Alyssa |date=February 15, 2023 |title=Menstrual Technology Innovations and the Implications for Heavy Menstrual Bleeding |journal=Obstetrics & Gynecology |volume=141 |issue=4 |pages=666–673 |doi=10.1097/AOG.0000000000005126 |pmid=36791417 |pmc=10026971 }}</ref> Disadvantages include messier removal<ref name=":10" /> and a more difficult learning experience<ref name=":2" /> than thick-walled cups.
-Menstrual discs come in diameters from 53mm to 80mm, {{Asof|lc=y|2024}}.<ref name="PNsizechart"/>
-Menstrual discs have some advantages over vaginal cups, including that they have a higher capacity (40-80ml),<ref>{{Cite journal |last1=DeLoughery |first1=Emma |last2=Colwill |first2=Alyssa |last3=Edelman |first3=Alison |last4=Samuelson Bannow |first4=Bethany |date=January 9, 2024 |title=Red blood cell capacity of modern menstrual products: considerations for assessing heavy menstrual bleeding |url=https://srh.bmj.com/content/50/1/21 |journal=BMJ Sexual & Reproductive Health |volume=50 |issue=1 |pages=21–26 |doi=10.1136/bmjsrh-2023-201895 |pmid=37550075 |pmc=10847380 |via=BMJ Journals}}</ref> enable bloodless period sex,<ref>{{Cite web |last=Loreto Cruz |first=Anne |date=January 19, 2021 |title=Everything you need to know about menstrual discs |url=https://mashable.com/article/menstrual-discs-explainer |url-status=live |archive-url=https://web.archive.org/web/20240226025049/https://mashable.com/article/menstrual-discs-explainer |archive-date=February 26, 2024 |access-date=February 24, 2024 |website=Mashable}}</ref> and are more comfortable for some users.<ref name=":1" /><ref name=":10">{{Cite journal |last1=Abigail |first1=Liberty |last2=Bethany |first2=Samuelson Bannow |last3=Matteson |first3=Kristen |last4=Edelman |first4=Alison |last5=Colwill |first5=Alyssa |date=February 15, 2023 |title=Menstrual Technology Innovations and the Implications for Heavy Menstrual Bleeding |journal=Obstetrics & Gynecology |volume=141 |issue=4 |pages=666–673 |doi=10.1097/AOG.0000000000005126 |pmid=36791417 |pmc=10026971 }}</ref> Disadvantages include messier removal<ref name=":10" /> and a more difficult learning experience<ref name=":2" /> than vaginal cups.
 ==== Labelling ====
@@ Line 145: / Line 153: @@
 ==Materials and color==
-[[File:Menstrual cups with scale bars 10.1177 17455065211058553-fig2 (cropped to "The Keeper" cup).jpg|thumb|A vaginal cup made from [[thermoplastic rubber]].]]
+[[File:Menstrual cups with scale bars 10.1177 17455065211058553-fig2 (cropped to "The Keeper" cup).jpg|thumb|A thick-walled cup made from [[latex]].]]
 [[File:Instead cup.jpg|thumb|A disposable menstrual disc, made of [[Kraton (polymer)|Kraton]] with a silicone rim.{{clarify|reason=vague marketing term|date=March 2024}}<ref>{{Cite news |date=November 11, 1999 |title=You Want Me To Put This Where ?? Readers Weigh In On The Latest Device In Feminine Protection. |url=https://www.nydailynews.com/1999/11/11/you-want-me-to-put-this-where-readers-weigh-in-on-the-latest-device-in-feminine-protection/ |url-status=live |archive-url=https://web.archive.org/web/20240226031409/https://www.nydailynews.com/1999/11/11/you-want-me-to-put-this-where-readers-weigh-in-on-the-latest-device-in-feminine-protection/ |archive-date=February 26, 2024 |access-date=February 24, 2024 |work=New York Daily News}}</ref><ref name=":11" />]]
 Most brands use [[medical grade silicone]] as the material for the menstrual cup, although [[latex]] and [[thermoplastic elastomer]] are also options. Silicone is durable and hypoallergenic.<ref name="youngwobost">{{cite web|url=http://www.youngwomenshealth.org/alternative_menstrual.html|title=Alternative Menstrual Products|date=28 March 2013|work=Center for Young Women's Health|publisher=Boston Children's Hospital|access-date=30 March 2013|archive-date=24 May 2014|archive-url=https://web.archive.org/web/20140524095353/http://www.youngwomenshealth.org/alternative_menstrual.html|url-status=dead}}</ref><ref>{{cite web |last1=Rosas |first1=Kim |title=TPE vs. Silicone Menstrual Cups |url=https://www.periodnirvana.com/menstrual-cup-materials-tpe-or-silicone/ |website=Period Nirvana |date=10 February 2024}}</ref> Menstrual cups made from silicone are reusable for up to 10 years.<ref name="Van2019" /> The majority of menstrual cups on the market are reusable, rather than disposable.<ref name=":6"/>

Revision as of 19:12, 14 March 2024

Terminology

Use

Insertion

Emptying and removal

Leakage

Cleaning

Difficulties

Safety

Toxic shock syndrome

Size, shape, and flexibility

Thick-walled cups

Labelling

Thin-walled cups or discs

Labelling

Materials and color

Cost

Environmental impact

History

Acceptability studies

Society and culture

Developing countries

Cultural aspects

See also

References