A recent video, which was shared on TikTok by user @eely.vickere and has already accumulated over 2.9 million views and 425,000 likes, is making waves among gen Zers on the platform for supposedly proving that menstrual cups—which had so far been celebrated for their overall practicality—can cause pelvic organ prolapse.

As social media users and experts alike continue to argue online over whether that claim is true or unfounded, I looked into it all in an attempt to debunk the latest period-related myth to join a long list of misconceptions and taboos.

https://www.tiktok.com/@elly.vickere/video/7166507912884407554

First things first, it’s important that I start by explaining what the condition that is allegedly linked to the use of the sustainable period product consists of—and why it’s worrying if this claim is proven true.

Pelvic organ prolapse happens when the muscles and tissues supporting the—you guessed it—pelvic organs (the uterus, bladder, or rectum) become weak or loose, in turn moving out of place, pressing into or out of someone’s vagina.

Symptoms include discomfort, a bulge or lump in your vagina and needing to pee more than usual. Treatments for pelvic organ prolapse usually come in the form of pelvic floor exercises, hormone medicines and sometimes surgery.

In most cases however, the condition is caused by pregnancy and childbirth, going through menopause and being overweight—as opposed to wearing a menstrual cup.

In case you weren’t among the lucky ones who got to read my 2020 review of my favourite menstrual cup ever, the OrganiCup—which I still use to this day, by the way—let me run you through a quick beginner’s guide to the tampon and sanitary pad alternative.

Long story short, it’s a soft, medical-grade silicone or rubber cup that is inserted into the vagina to catch the blood flow, just like a small vessel. Once inserted, it only needs to be emptied every eight to 12 hours, rinsed under some water, and then put back in.

Unlike other single-use products, the menstrual cup is reusable and can last for a couple of years. All you need to do is to make sure that you sterilise it by boiling it in hot water once you’ve reached the end of your period.

If you’re still confused as to how the small cup stays in place down there, let me tell you, this is where things get interesting, my friend. Once correctly inserted, it pretty much all boils down to suction—meaning that when you ultimately end up taking it out, it’s important that you relax, then pull on the stem only until you can reach the base of your cup and pinch it slightly to release the suction seal and ease it out.

The argument behind the whole prolapse debate is based on the possibility that, over time, the motion of bearing down on your cup for removal could weaken your pelvic floor and result in prolapse—an argument that even the BBC debated in March 2020.

For most cup users, their vaginal canal is short enough for their cup to easily be within reach without them needing to bear down for removal. However, some users with a high cervix report that their cup moves up to a height where it is difficult to remove, and find themselves straining as they bear down to move their cup within reach.

@byallmatters

There you have it! We’re answering questions in the comments below. Go! 👀 #organicup #newperiod #menstrualcup

♬ original sound - AllMatters

It’s important to mention that currently, there are no peer-reviewed studies that show a direct correlation between menstrual cup use and prolapse. Regardless of this, period care company Saalt spoke to board-certified women’s health physical therapist, Doctor Marcy Crouch, to hear what an expert had to say about the claims.

Dr Crouch explained that repeated, prolonged bearing down beyond what you would do to begin an easy bowel movement, or release gas, can compromise the health of a cup user’s pelvic floor. A better alternative would be going into a position like a deep squat, or even a ‘Happy Baby’ pose, to encourage lengthening of the pelvic floor instead of pushing.

Further, she said that if bearing down is necessary, she would instruct people to do it with an open throat. This essentially allows for a pressure exchange to take place that decreases the force on your pelvic floor, while allowing you to safely move your cup lower.

Now back to your question, can menstrual cups actually cause prolapse? It seems that, in a few rare cases, it can lead up to it, yes—maybe. Which also guides me to the second argument presented by the BBC—that cups are not regulated in the first place.

Due to the momentum being gained within the world of sustainable period care, there are now hundreds of cup brands available to consumers online, and many of them are not regulated by health agencies in their country of origin.

Because cups are medical devices, it is important to ensure that any cup you purchase is certified by a reputable governing body. For example, Saalt and OrganiCup (now AllMatters) are both FDA-registered and compliant. This means that the two brands are continually working to ensure the safety and efficacy of their products, including the educational resources they provide.

That being said, if you somehow end up buying a brand that has not been regulated by your country’s health agency, it is possible that the instructions that come with it end up countering the advice you would have been given to avoid prolapse.

Since the beginning of 2021, as reported by the Financial Times, the Mexican capital has decided to ban the sale of menstrual products until its plastic applicators are replaced by more environmentally friendly materials. This daring decision is a fundamental part of Claudia Sheinbaum’s green agenda, Mexico City’s first mayor and climate change scientist, whose green policies have been a priority since she took office two years ago. What many publications forgot to mention, however, is that the decision had already been announced back in 2019.

First came the plastic shopping bags, then straws and disposable cups. Now, the last polluting products to disappear, thanks to Mexico City’s anti-plastic campaign, are tampons. But the capital seems to have overlooked one thing: being the one taking the blame when it was actually up to the country’s leading period products companies to offer enough eco-sustainable alternatives for Mexican women.

A partir del 1 de enero en la CDMX le decimos #AdiósALosDesechables.

Esto incluye:
-Vasos, tapas y mezcladores
- Popotes
- Platos
- Charolas para alimentos
- Cubiertos
- Aplicadores de tampones
- Bastoncillos para hisopos de algodón
-Globos y varillas
-Cápsulas de café pic.twitter.com/PZ9Ugn8Mbe

— Agencia Digital de Innovación Pública (@LaAgenciaCDMX) January 6, 2021

Although many women’s rights activists have been fighting for years to get rid of the tax on menstrual products, it’s hard for them to understand the importance of the environmental approach when not being offered enough alternatives. With good reason, many are now left wondering whether the government should have taken a different approach and a more gradual one before imposing the current ban. However, as stated above, the Mexican government did warn companies (and citizens) of the upcoming changes.

Talking about the news, Anahí Rodríguez, spokeswoman for the NGO Menstruación Digna (Dignified Menstruation) said, “It’s the government’s responsibility to take steps to protect the environment. But they should have made sure there were tampons available with applicators that used an alternative to plastic, at an accessible price, before they withdrew them.”

“This is punishing women,” said student Chiara Gómez to the Irish Times. “I didn’t know they were going to do this—a lot of people depend on them. And it’s a bit strange that they are starting with tampons when there are other things that use a lot of plastic, like unnecessary packaging.”

While a few stands in the city now urge customers to bring their own containers or buy plastic bottles, many markets still use plastic bags or serve food with plastic forks with coffee shops often placing plastic lids on takeaway beverages.

This week, pharmacies and supermarkets displayed sanitary towels and menstrual cups, but not enough eco-sustainable tampons for everyone. Applicator-less tampons are not generally available or used, as Mexican citizen @yansomade told Screen Shot, “tampons without applicators are rare in Mexico because culturally, we are not used to them. They exist, but they are not popular.”

Although many publications reported that tampons could now only be purchased online, via sites such as Mercado Libre and Amazon, and with prices as high as $3.40 (£2.45) per tampon, @yansomade explained that brands specialising in period products such as Saba and Kotex had actually been warned about the new policy back in 2019—and so had the rest of the country. However, both Saba and Kotex decided to ignore the warning and continue to sell tampons with plastic applicators.

As a result, what was left of those brands in the capital flew off the shelf, and soon enough, people started looking everywhere for Tampax tampons, which have a recyclable applicator made of cardbox.

One chemist in the capital laid out the official ruling to explain why tampons had vanished from shelves: “We’re not allowed to display tampons,” before quietly offering to sell some under-the-counter “while stocks last.”

Men also criticised the move. “As if women didn’t have enough problems, now the government has given them another: no tampons,” Carlos Elizondo, a political-science professor at Tec de Monterrey university, wrote on Twitter. “In other countries, they have zero VAT. Here, they are banned—and in the middle of a pandemic too.”

Como si las mujeres no enfrentaran todo tipo de problemas ahora el gobierno le impone uno nuevo. No tener tampones. En otros países tienen IVA cero. Acá los prohíben, e medio de una pandemia. https://t.co/BquYXHQTSK

— Carlos Elizondo MS (@carloselizondom) February 9, 2021

Meanwhile, Lillian Guigue, director-general for impact regulation and environmental regulation at the city’s environment ministry, insisted the ban had been announced long in advance, adding she had been negotiating with producers, but COVID-19 was slowing down their ability to reformulate applicators without using plastic. Until then, “we all have to do our bit … if we don’t make an effort with the products we consume, we are destroying not only our future but that of all generations after us.”

For many, especially young women, that means reusable menstrual cups. But in a country where the coronavirus pandemic has pushed an estimated 10 million more people into poverty, some cannot afford them and in any case, 260,000 homes in Mexico City lack running water. Dignified menstruation “becomes a privilege, not a right, with these measures”, said Rodríguez.

Her NGO has been fighting to have Mexico’s 16 per cent sales tax waived from sanitary protection—a move backed by Olga Sánchez Cordero, Mexico’s interior minister. Legislators refused last year, but the supreme court this month agreed to review whether the tax was unconstitutional.

In the meantime, the Mexican government urged women to “rally behind the cause” for the sake of the planet. “It’s not about stopping having the products we need,” said Guigue. “It’s about making better choices.” The obvious way in which the news about this anti-plastic ban has been shifted to put the blame on the Mexican government instead of on the country’s leading period product brands highlights the problems the media still face: impartiality and researched reporting. Mexico City’s anti-plastic ban should be praised, not put down. Instead, brands like Saba and Kotex should be criticised. After all, they just chose not to listen, at the expense of Mexican women.