Off the wagon
I stopped using my menstrual cup after about two years, when my period had gotten ridiculously light due to continued pill use. Technically, I'm bleeding as I write this, in 2004, and I'm not using any products at all to deal with it. I'm not sure I would go back to using a cup even if my periods got heavier, mostly because I haven't bothered to decide.
Over the years I have accumulated a few concerns about menstrual cups, mostly stemming from the lack of research into their use. Most cup manufacturers declare something to the effect that "no cases of TSS have ever been associated with using our product," but that is not a controlled test result, and may simply be a reflection of the still small size of the user population. I was concerned about lack of TSS testing on cup materials for some time, but lately am quite satisfied that they are safer than tampons with regard to toxic shock syndrome.
Studies cited over at The Museum of Menstruation show that the latex in The Keeper allows TSS-causing Staph. bacteria to adhere to it and grow, although less so than rayon tampons. Instead claims that extensive microbiological testing shows polyethylene "does not promote infection," and silicone, which DivaCups and Mooncups are made from, is widely used as a safe material for medical devices.
With that out of the way, I set about levelling another concern I had about cups: that they could bruise the vagina. Tampons are associated to various degrees with various kinds of vaginal ulcerations and lesions, and I wondered if inserting cups could have similar effects. Most of the research I turned up noted absorbancy as the main factor linked to vaginal ulcerations due to tampons, but it is also a concern with diaphragms, which are not absorbant. Ulcerations are a concern because they provide a focal point for Staph. aureus growth.
My final concern about menstrual cups is one that I've mostly seen referenced in discussions about menstruation and immunity, but also with reference to endometriosis risks: retrograde menstrual flow. Most women have some flow of menstrual blood back into the uterus from the vagina during their periods, and even from the uterus out the Fallopian tubes into the abdomen. Backwash from the vagina poses an infection risk, and backwash into the abdomen may pose a risk of endometriosis. Both of these risks would usually be managed by a healthy immune system. However, since menstrual cups would be expected to significantly increase retrograde flow of blood back through the cervix, maybe they increase users' risks for those problems. My mum has had a painful ordeal with endometriosis, so I will probably err on the side of caution pending more conclusive research. (But of course, practically everything is a possible risk factor for poor, misunderstood endometriosis, tampons not least.)
Wishy-washy conclusion
My personal tastes run strongly toward reusable, internally-worn period gear, and I find menstrual cups really convenient and affordable. If ulcerations were the only concern with cups, I wouldn't blink. That has been a risk with tampons since the get-go, and millions of women use them without ulceration or infection-related problems. The retrograde flow thing spooks me a little bit, mostly because I already have an endometriosis risk factor but also because it pinpoints the aspect of cups that is different from all other menstrual products and least studied.
And since right now I'm not in need of any products at all (my period is honestly about as intense as a single sneeze), I'm not going to bother concluding anything about my product preferences.
For more of my searching for reusable internal menstrual products, read about my ideal dream product.
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