Menstrual cups are a popular, reusable alternative to traditional menstrual products. While many users seek a safer, more sustainable option, a primary concern remains the risk of Toxic Shock Syndrome (TSS). Although TSS is a rare condition, understanding the correct usage and maintenance of a menstrual cup is necessary for minimizing risk. This article outlines the actionable steps required to use a menstrual cup safely and prevent toxin-related illness.
Understanding Toxic Shock Syndrome and Associated Risk Factors
Toxic Shock Syndrome is a rare but serious condition caused by toxins produced by certain strains of the Staphylococcus aureus bacteria. This bacterium naturally colonizes the skin and mucosal surfaces of many healthy individuals without causing harm. TSS occurs when a localized infection, often in the vagina during menstruation, allows the bacteria to produce a poison called Toxic Shock Syndrome Toxin-1 (TSST-1) that enters the bloodstream. The risk associated with internal menstrual products is tied to the environment they create. Menstrual blood is a protein-rich medium that can facilitate the rapid growth of S. aureus and the corresponding production of TSST-1.
Essential Practices for Safe Menstrual Cup Usage
The most direct way to mitigate the risk of TSS while using a cup involves strict adherence to a maximum wear time. A menstrual cup should never be worn for more than 12 continuous hours before being removed, emptied, and cleaned. Many manufacturers and medical experts recommend emptying and rinsing the cup every 8 hours, or at least two to three times within a 24-hour period, especially for new users or those with heavier flows.
Thorough handwashing must be performed immediately before both the insertion and the removal of the cup. Hands should be washed with soap and warm water for at least 20 seconds. This prevents the transfer of S. aureus from the skin or external environment to the cup and subsequently to the vaginal canal.
When emptying the cup during the cycle, it should be rinsed immediately with clean water, which can be cold water to help prevent staining. If a more thorough cleansing is desired, a mild, unscented, pH-balanced, and oil-free soap should be used to wash the cup. Strong or fragranced soaps can degrade the cup material and potentially leave residues that may disrupt the natural vaginal environment. Simple water rinsing is often sufficient for mid-cycle changes.
The cup must be gently handled during removal to avoid irritation or microscopic tears to the vaginal wall. Before pulling the cup out, the vacuum seal must be broken by gently pinching the base or inserting a finger alongside the rim. Removing the cup without breaking the seal first can cause strong suction and irritate the delicate mucosal tissue.
Proper Sanitation and Storage Between Cycles
Sanitizing the menstrual cup between menstrual cycles is a necessary step to eliminate any residual bacteria that may have colonized the device. The most effective and widely recommended method for sterilization is boiling the cup in water. The cup should be fully submerged in a pot of boiling water for a duration of three to five minutes.
Boiling achieves sterilization by reaching a temperature high enough to kill microorganisms that might survive regular washing. This process should be performed once before the first use of a new cup and again after the conclusion of every menstrual period. Care must be taken to ensure the cup does not rest on the bottom of the pot, which can cause scorching or damage to the silicone. Once completely dry, the cup should be stored properly to prevent the growth of mold or other organisms.
Storage requires a breathable container, such as a cotton pouch or bag, which allows air circulation. Storing a cup in an airtight plastic bag or container is not recommended. Trapped moisture in airtight containers creates a damp environment conducive to bacterial or fungal growth.
Recognizing Warning Signs and Taking Immediate Action
Recognizing the early symptoms of TSS is the final safety measure for any user of an internal menstrual product. Symptoms of this condition usually appear suddenly and worsen rapidly, often resembling a severe flu. A sudden high fever of 102°F (38.8°C) or higher is a common initial sign, often accompanied by vomiting, watery diarrhea, and severe muscle aches. A sunburn-like rash may appear on the body, which can be particularly noticeable on the palms of the hands and the soles of the feet. Other concerning symptoms include dizziness, lightheadedness, or fainting, which are signs of low blood pressure associated with the syndrome.
Any combination of these symptoms experienced during or shortly after cup use warrants immediate attention. If any warning signs appear, the menstrual cup must be removed immediately, and the individual should seek urgent medical care at an emergency room or clinic. Prompt diagnosis and treatment, which typically involves antibiotics and supportive care, are necessary for the best possible outcome. Mentioning the use of a menstrual cup to medical professionals is an important part of the diagnostic process.