Squatting in the shower with my hands covered in blood, I cursed my menstrual cup for its leak-proof suction, which, while great at preventing leaks as it said on the box, was winning the battle I was waging to get that slippery little bugger out of me. For more than an hour, I had twisted and contorted myself trying without success to get a grip on that two-inch piece of silicone. This was my first time using a cup and the first time I had spent such an extended period of time digging inside my vaginal canal. Somewhere along the way, I was horrified to feel something warm, soft, and round bulging out far lower than I had ever felt before.
Feeling a renewed sense of urgency to get the hell out of there, I cried tears of joy when I finally managed to hook a finger under the cup’s seal and pull it out. Then, I turned to the internet to see if what I had experienced was normal. What I found was several women online reporting a similar experience and a BBC article that claimed “menstrual cup misuse ‘can cause pelvic organ prolapse.’”
Most commonly caused by childbirth, prolapse occurs when pelvic organs that serve as walls supporting the vagina collapse, like the cervix or the uterus. With toxic metals recently found in tampons and “forever chemicals” detected in menstrual pads, (though these studies should be interpreted with caution), I wasn’t ready to give up on the menstrual cup just yet. I haven’t had kids, but I wondered: Could this tiny cup possibly exert the same amount of force required to push another human being out of my vagina?
The chances are slim to non-existent, according to pelvic floor and prolapse specialists I spoke to for this story. No research has shown that menstrual cups can increase the risk for prolapse, with one study even showing that menstrual cups could potentially help strengthen pelvic floor muscles.
Dr. Christine Vaccaro, a urogynecologist in private practice and an associate professor at the Uniformed Services University of the Health Sciences, has to pull the uterus down in surgeries to work on it, which requires a significant amount of force. When she thinks about how that compares to the suction that a menstrual cup is capable of, those two measures are not on the same scale, she said.
“I really can’t see how the suction would be so strong that it would pull down an organ,” Vaccaro told Salon in a phone interview. “I don’t think that the menstrual cup causes prolapse.”
Prolapse occurs when ligaments and muscles in the pelvic floor weaken and can no longer support the pelvic floor organs. It affects nearly one in three women by age 60 and can be caused by things like repeated heavy straining and chronic constipation. People who have had hysterectomies, and people with conditions like obesity or Ehlers-Danlos syndrome, which affects collagen and makes tissues stretchier, are at a higher risk.
It would be helpful to know how menstrual cup use affected people with these conditions, but there is a paucity of research investigating menstrual products and women’s health issues in general, said Lauren Keller, a pelvic floor specialist in Texas.
“Unfortunately, we don't have studies to show this because studies on women are grossly underfunded and underdone,” Keller told Salon in a phone interview.
Estimates vary but around 50% of people who have had babies experience some degree of prolapse and the use of forceps or a vacuum during birth increases the risk. The chances of experiencing prolapse also goes up in general with age, as estrogen levels decrease the strength of the connective tissues in the area during perimenopause.
Many mild cases do not need treatment, but more severe cases can cause problems with urinary or bowel function and can be treated with physiotherapy or surgery depending on what a patient and their provider decide.
"If someone notices a bulge when they're putting in a menstrual cup and it's never bothered them before, it probably isn't anything to worry about," said Dr. Rachael Sussman, a urogynecologist in private practice and at MedStar Georgetown. "If they have a concern, they should get checked out, but if it's just a minor prolapse, then it's probably always been there."
A common treatment for prolapse, a device called a pessary, actually resembles a menstrual cup. It is inserted into the vaginal canal much like the cup and bolsters the tissues that support the pelvic floor organs, preventing them from falling down, Vacarro said. It may be that some women who unknowingly already have prolapse select the menstrual cup as their product of choice because it feels more comfortable, and then are confronted with the prolapse once they have to get up close and personal with their vaginal canal to take out the menstrual cup, Sussman said.
“I suspect a menstrual cup in a lot of women might actually help with their prolapse rather than cause prolapse,” Sussman told Salon in a phone interview. “They may become more aware of prolapse when using a menstrual cup rather than a tampon.”
Vaccaro acknowledged a chance that removing the menstrual cup incorrectly could create some damage over the course of many years. It’s recommended to always break the seal of the menstrual cup that causes the suction before pulling down on it, otherwise it can cause more strain on the muscles used to support the pelvic floor organs. Bearing down and straining can also cause issues.
“Straining itself and bearing down like you are having a bowel movement over time can contribute to pelvic floor disorders like prolapse,” Vaccaro said. “If they were straining a lot, frequently, for a long period of time they could be inducing pelvic floor microtrauma each time, especially if you are not breaking the seal and that sort of thing.”
Other women might think they are experiencing prolapse when they are really just noticing parts of their anatomy that were always there, but they hadn’t familiarized themselves with. For example, the uterus naturally shifts throughout the ovulation cycle and may sit lower during ovulation.
As such, it’s a good idea to explore the layout of the vaginal canal at various points in the cycle before using a menstrual cup to become familiar with the body and its changes to tell if there are any abnormalities that happen when using a menstrual cup, Keller said.
”The more knowledge we have before we go into this, the better, because you know where your cervix sits when you're menstruating, you know where your cervix sits when you're ovulating, and you know those natural fluctuations that happen,” Keller said.
At this point, there are various menstrual cup shapes and sizes available, and even menstrual discs that are designed to catch blood without suction. In my experience, the cup I selected was too small for my body, leaving me fishing around for it for hours.
Not long after my panicked online search, the bulge I felt when removing my menstrual cup receded back upward along with any fears I had surrounding prolapse. Still, it would have been nice had the information I was looking for been a little more readily available.
“I don't think we're ever going to be caught up on educating women about their anatomy, especially when it comes to anything related to the vagina, pelvic floor health, and genital genitalia,” Vaccaro said. “I think we need a lot more information out there.”
