Prevalence of urogenital infections lower among women using menstrual cups: IJOGR

Girls and women need effective, safe, and affordable menstrual products. Menstruation is a natural process but it is still a taboo in Indian society as it is considered unclean and dirty.

As per the latest 2019-20 National Family Health Survey-5 (NFHS-5), 82.6 percent of women in the 15-25 years of age in the 22 states/UTs use locally prepared napkins, sanitary napkins, tampons, and menstrual cups as hygienic methods of protection. This has increased from 70.4 for the same states and UTs in the NFHS-4 survey 2015-16.

Though sanitary product is the most common used sanitary product, reusable alternatives like cloth pads and menstrual cups are gaining popularity too. Globally the choice of sanitary product made by women vary greatly due to the personal preferences, availability of resources, economic status, cultural traditions and beliefs, education status, and knowledge about menstruation.

Practices related to menstruation hygiene are of major concern as unhygienic practices can lead to infections in the genital area and can cause urinary tract and reproductive tract infections. A strong and consistent positive association has been found between prevalence of lower reproductive tract infections (RTIs) and poor menstrual hygiene practices. Usage of sanitary pads has been associated with allergic contact dermatitis across various studies.

Menstrual cup is a device for menstrual flow management and is claimed to be a health and environment friendly alternative to the conventional menstrual sanitary protections. Reusable menstrual products (including menstrual cups) are more economical than disposable ones. The menstrual cup has been explored as a means of menstrual hygiene management in developing countries like India. It is manufactured using health-grade non-toxic non-allergic silicone. Menstrual cup is made of high grade medical grade silicone, rubber, latex or elastomer, these bell-shaped receptacles collect menstrual flow when inserted into the vaginal canal. The menstrual cup should be emptied every 4–12 h, depending on menstrual flow and sterilised by boiling at the end of a cycle.

Lata Ghanshamnani and team carried out a study to determine prevalence of symptoms related to urogenital infections before and after switching to menstrual cups published in Indian Journal of Obstetrics and Gynecology Research.

The primary objective of this study was to determine prevalence of common urogenital infections, before and after usage of menstrual cups among girls and women through a random self- reported questionnaire survey. The secondary objectives was to understand uptake and usability across various age groups, occupation status and sexual and menstrual health status.

In this retrospective self-reported study, females using menstrual cup were administered a questionnaire consisting of questions related to symptoms of urogenital infections in their lifetime.

In order to understand the menstrual health status of the respondents, the questionnaire included the questions regarding the regularity of menstrual cycle, bleeding pattern, sanitary product used before switching to menstrual cup and their experience with vaginal processes (sexual intercourse, vaginal birth and usage of intra-uterine device).

In order to understand the usability of cups among the respondents, questions pertaining to the duration of use, learning cycle (number of cycles needed to start using the cup comfortably) and need for replacement of cup were included.

RESULTS:

• A total of 301 menstrual users responded to the survey. Before switching to menstrual cups, 254 (84.4%) women were using disposable sanitary pad and 33 (11%) were using tampons, while the rest (5%) were using cloth pad for managing their menstruation.

• Approximately 50% female respondents were using cup for more than one year. For majority (80%) users, learning curve for menstrual cup was within 3 cycles. 76% are reported to be satisfied with their current cup and have not replaced it.

• In case of rash, of the 48% females who suffered from this problem, 44% experienced rashes before using cup but did not report after switching to cup, for 2.7% females, symptoms persisted even after switching to cup while another 1.3% developed the symptom only after using the cup.

• A total of 76% of the total respondents reported being sexually active, which suggested that acceptability of menstrual cup among sexually active women was higher over those who are inactive.

• Approximately 50% of the respondents belonged to the age group of 30-39 years. This indicated that women in the said age group in India are ideal population to introduce menstrual cup, due to the higher possibility of women being sexually active.

• In the age group of 40-49 years, with onset of menopause or menopausal symptoms, the uptake maybe lower.
• The adoption was lowest among girls in the age group of 10-19 years, perhaps due to fear of insertion or cultural taboos regarding hymen.

• The majority of the respondents were working women, for which can be assumed that working professionals may have higher exposure to reusable alternatives like menstrual cup.

• While most respondents were sanitary pad users before switching to menstrual cups, a very small proportion of women (5%) transitioned from reusable cloth pads. Fear of use had been studied as the most common reason for women to not use menstrual cups.

• A total of 80% of the respondents were comfortable in using menstrual cup within three cycles. It is thus essential for doctors, cup brands or initiatives promoting menstrual cups to handhold and extend support for minimum three cycles to reduce any drop-outs.

• This study suggested that the most common menstrual health symptom prevalent among women using various sanitary products was rashes and itching, postulating/confirming various studies undertaken in the past.

The prevalence of health symptoms has been lower for most symptoms after switching to menstrual cups, with significantly less number of these women suffering from rashes (92%) and itching (79%). The incidence of rashes and itching, earlier due to usage of synthetic sanitary pad may have reduced with use of menstrual cup, which is an intra-vaginal product.

The menstrual cup is a satisfactory alternative to women when compared to their previously used menstrual product for symptom management. With regard to the usability of cup, the key to increase acceptability is to ensure support during the first three cycles.

SOURCE: Ghanshamnani et al. / Indian Journal of Obstetrics and Gynecology Research 2021;

https://doi.org/10.18231/j.ijogr.2021.042