Firm-created content on YouTube for product promotion - A thematic analysis for menstrual cup

Mensuration cup is a mensural hygiene product about which people are less aware. Despite having many advantages there hasn't been much uptake. Research suggests that this is because of less accessible information. To overcome this, menstrual cup brands are creating several firm-created contents on YouTube. This study aimed at understanding and classifying the type of information available in 27 firm-created content about menstrual cup. The thematic analysis resulted in three themes Speaker & Language, Content presented, Type of information shared, contributing to the identification of promotional gaps, to be used by brands in building perspective towards menstrual cup.

Knowledge, Attitude and Experiences of Students Regarding Menstrual Cup Usage in a Medical College in North Kerala, India

BACKGROUND

Sanitary napkins form a major source of solid waste, the disposal of which often results in environmental pollution. Menstrual cups are an eco-friendly and cost-effective alternative to sanitary pads that have yet to gain much popularity among Indian women. The current study aims to assess the knowledge, attitude, and experiences of using the menstrual cup among medical students in a college in north Kerala, India.  Methods: This cross-sectional study was conducted among 109 female medical students. Data was collected through an online platform and analyzed using Epi Info version 7.2 (Centers for Disease Control and Prevention, Atlanta, GA).

RESULTS

Though all the participants had heard about the menstrual cup before, only 14 (12.8%) were using it either alone or in conjunction with sanitary pads. The majority of the participants had a positive attitude towards the usage of menstrual cups with 91.74% considering it a better alternative to other sanitary products, Among the several concerns expressed by the participants, 58.7% were concerned about the insertion of a foreign material into their bodies.

CONCLUSIONS

Though most of the participants displayed a positive attitude towards the menstrual cup, the number of participants who had ever tried it was very low. There are several apprehensions regarding the cup that need to be addressed before it can be expected to gain popularity.

Development of in vitro methods to model the impact of vaginal lactobacilli on Staphylococcus aureus biofilm formation on menstrual cups as well as validation of recommended cleaning directions

Introduction

Menstrual cups (MC) are a reusable feminine hygiene product. A recent publication suggested that Staphylococcus aureus (S. aureus) biofilms can form on MCs which may lead to increased risk of menstrual Toxic Shock Syndrome (mTSS). Additionally, there is concern that buildup of residual menses may contribute to microbial growth and biofilm formation further increasing mTSS risk. Quantitative and qualitative analysis of in vitro tests were utilized to determine if S. aureus biofilm could form on MC in the presence of the keystone species Lactobacillus after 12 h of incubation. The methodology was based on a modification of an anaerobic in vitro method that harnesses the keystone species hypothesis by including a representative of vaginal lactic acid bacteria.

Methods

MCs were incubated anaerobically for 12 h in Vaginal Defined Media (VDM) with the two morphologically distinct bacteria, Lactobacillus gasseri (L. gasseri) and S. aureus. Colony Forming Units (CFU) for each organism from the VDM broth and sonicated MC were estimated. In addition, a separate experiment was conducted where S. aureus was grown for 12 h in the absence of L. gasseri. Qualitative analysis for biofilm formation utilized micro-CT (µ-CT) and cryogenic scanning electron microscopy (Cryo-SEM).

Results

Samples collected from the media control had expected growth of both organisms after 12 h of incubation. Samples collected from VDM broth were similar to media control at the end of the 12-h study. Total S. aureus cell density on MC following sonication/rinsing was minimal. Results when using a monoculture of S. aureus demonstrated that there was a significant growth of the organism in the media control and broth as well as the sonicated cups indicating that the presence of L. gasseri was important for controlling growth and adherence of S. aureus. Few rod-shaped bacteria (L. gasseri) and cocci (S. aureus) could be identified on the MCs when grown in a dual species culture inoculum and no biofilm was noted via µ-CT and cryo-SEM. Additionally, efforts to model and understand the validity of the current labeled recommendations for MC cleaning in-between uses are supported.

Discussion

The data support continued safe use of the Tampax® cup when used and maintained as recommended.

Comparative analysis of vaginal microbiota sampling using menstrual cups and high vaginal swabs in pregnant women living with HIV-1 infection

Background

Menstrual cups (MCs) are increasingly used to collect cervicovaginal secretions to characterise vaginal mucosal immunology, in conjunction with high vaginal swabs (HVS) for metataxonomics, particularly in HIV transmission studies. We hypothesised that both methods of collecting bacterial biomass are equivalent for 16S rRNA gene sequencing.

Material and Methods

Cervicovaginal fluid (CVF) samples from 16 pregnant women with HIV-1 (PWWH) were included to represent the major vaginal bacterial community state types (CST I-V). Women underwent sampling during the second trimester by liquid amies HVS followed by a MC (Soft disc™) and samples were stored at -80°C. Bacterial cell pellets obtained from swab elution and MC (500 µL, 1 in 10 dilution) were resuspended in 120 µL PBS for DNA extraction. Bacterial 16S rRNA gene sequencing was performed using V1-V2 primers and were analysed using MOTHUR. Paired total DNA, bacterial load, amplicon read counts, diversity matrices and bacterial taxa were compared by sampling method using MicrobiomeAnalyst, SPSS and R.

Results

The total DNA eluted from one aliquot of diluted CVF from an MC was similar to that of a HVS (993ng and 609ng, p=0.18); the mean bacterial loads were also comparable for both methods (MC: 8.0 log10 16S rRNA gene copies versus HVS: 7.9 log10 16S rRNA gene copies, p=0.27). The mean number of sequence reads generated from MC samples was lower than from HVS (MC: 12730; HVS:14830, p=0.05). The α-diversity metrices were similar for both techniques; MC Species Observed: 41 (range 12-96) versus HVS: 47 (range 16-96), p=0.15; MC Inverse Simpson Index: 1.98 (range 1.0-4.0) versus HVS: 0.48 (range 1.0-4.4), p=0.22). The three most abundant species observed were: Lactobacillus iners, Lactobacillus crispatus and Gardnerella vaginalis. Hierarchical clustering of relative abundance data showed that samples obtained using different techniques in an individual clustered in the same CST group.

Conclusion

These data demonstrate that despite sampling slightly different areas of the lower genital tract, there was no difference in bacterial load or composition between methods. Both are suitable for characterisation of vaginal microbiota in PWWH. The MC offers advantages, including a higher volume of sample available for DNA extraction and complimentary assays.

Determinants of menstrual cup use among undergraduate medical students: A cross-sectional study

OBJECTIVE

To identify the determinants of menstrual cup use among medical students in Brazil.

METHODS

A cross-sectional study with an online survey regularly applied to matriculate women from Medical School in January 2021.

RESULTS

Of 277 women, 164 participated. The mean age was 22.26 ± 3.21 years. In all 136 women preferred external pads, 60 internal pads, 28 menstrual cups, and 11 did not use. Using a 1-10 scale, price, efficacy, sustainability, practice, vaginal health status, hygiene, and importance of internal genital integrity were investigated. Thirty-seven (22.56%) women related the use of menstrual cups in the last year. Using any method to reduce menstruation had an adjusted odds ratio (aOR) of 0.310 (95% confidence interval [CI] 0.122-0.787). Concern about the environmental biodegradation had an aOR of 6.369 (95% CI 1.372-29.562); concern about intimal health had an aOR 1.996 (95% CI 1.183-3.368); and concern about internal genital integrity had an aOR of 0.824 (95% CI 0.682-0.995) for menstrual cup use.

CONCLUSION

The significant independent factors for the use or adherence to menstrual cups were: women using a method to reduce their menstrual flow; concerning biodegradation; concerning vaginal health; with no concerns about manipulating their genitalia. The menstrual cup was used by 22.56% of a medical school in Brazil among undergraduate women.

The influence of the menstrual cup on female pelvic floor muscles variables: a prospective case series

The aim was to assess and report the effects of menstrual cup on pelvic floor muscles (PFM) function and tone, as well as check the acceptability after a period of three menstrual cycles in healthy young women. The data collected in assessments and reassessments included the International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS) questionnaire, evaluation of PFM function through PERFECT Scheme, PFM muscle tone, and PFM manometry (Peritron 9300®). A diary regarding the overall colletor acceptability and satisfaction was collected. Ten healthy young women completed the study. There was an improvement in the mean values of maximal voluntary contraction (MVC) (p = 0.032), a decrease in the vaginal resting pressure (VRP) (p = 0.05), and an increase in the number of repetitions of sustained muscle contractions (p = 0.042). Seven women reported some discomfort while using the vaginal cup only in the first cycle while three revealed discomfort during the whole experiment. This study provides preliminary case-based evidence that the use of the vaginal cup for a period of three menstrual cycles changes the VRP, MVC, and PFM tone, as well as improves the repetitions of PFM assessed by digital palpation. Moreover, the women reported the use of vaginal cup as a positive experience.

Cost-Effectiveness and Cost-Benefit Analyses of Providing Menstrual Cups and Sanitary Pads to Schoolgirls in Rural Kenya

Objective

To analyze the relative value of providing menstrual cups and sanitary pads to primary schoolgirls.

Design

Cost-effectiveness and cost-benefit analyses of three-arm single-site open cluster randomized controlled pilot study providing menstrual cups or sanitary pads for 1 year.

Participants

Girls 14-16 years of age enrolled across 30 primary schools in rural western Kenya.

Methods

Cost-effectiveness analysis was conducted based on the health effects (reductions in disability-adjusted life years [DALYs]) and education effects (reductions in school absenteeism) of both interventions. The health and education benefits were separately valued and compared with relative program costs.

Results

Compared with the control group, the cost of menstrual cups was estimated at $3,270 per year for 1000 girls, compared with $24,000 for sanitary pads. The benefit of the menstrual cup program (1.4 DALYs averted, 95% confidence interval [CI]: -4.3 to 3.1) was higher compared with a sanitary pad program (0.48 DALYs averted, 95% CI: -4.2 to 2.3), but the health effects of both interventions were not statistically significant likely due to the limited statistical power. Using point estimates, the menstrual cup intervention was cost-effective in improving health outcomes ($2,300/DALY averted). The sanitary pad intervention had a cost-effectiveness of $300/student-school year in reducing school absenteeism. When considering improvements in future earnings from reduced absenteeism, the sanitary pad program had a net benefit of +$68,000 (95% CI: -$32,000 to +$169,000).

Conclusions

The menstrual cup may provide a cost-effective solution for menstrual hygiene management in low-income settings. This study outlines a methodology for future analyses of menstrual hygiene interventions and highlights several knowledge gaps that need to be addressed. Trial registration: ISRCTN17486946.

Comparison between menstrual cups: first step to categorization and improved safety

OBJECTIVES

Menstrual cups come in a range of shapes, sizes, and firmnesses, but unlike tampons are not categorized in any way. With these factors having an impact on product leaks and comfort, as well as being linked to illness and injury, women need the same level of transparency when purchasing a menstrual cup. The comparison of physical and mechanical properties of menstrual cups will be the first step to achieve this.

METHODS

In October 2020, 14 popular and highly rated menstrual cups underwent quantitative comparison in laboratory settings (the United Kingdom), and they were compared in terms of their dimensions, volume, and compressive strength (firmness) using the Instron Universal Testing System. The overall designs were compared including shape, material, and features.

RESULTS

Although all the products in this comparison were marketed to women below 30 years of age having never given birth, total volume varied from 18.88 mL to 38.14 mL, and compressive load to compress the menstrual cup 50% (±0.5%) maximum diameter varied from 3.39 N to 13.92 N.

CONCLUSIONS

Women are not sufficiently informed when choosing a menstrual cup. With no correlation between menstrual cup size, shape, and its volume, or material, shape, and its firmness, consumers cannot estimate which menstrual cup might be most suitable, and incorrect choice could cause injury. Transparency is needed across menstrual cup brands. With this and further regulation, women will make an informed decision to choose the correct menstrual cup and minimize injury. This work recommends firmness categories, ranging from 'very soft' to 'very firm' as a first step.

Acceptability of the menstrual cup among students in further education institutions in KwaZulu-Natal, South Africa

OBJECTIVE

The primary objective of this research was to evaluate long-term user acceptability of menstrual cups in a student population in South Africa.

METHODS

A cohort of female students aged 18-24 years attending 10 further education institutions including 22 campus sites in KwaZulu-Natal, South Africa, were offered menstrual cups after receiving education and training in their use. The students were followed for up to 12 months to assess menstrual cup acceptability, user experiences and continuation.

RESULTS

A total of 509 students were enrolled. Disposable pads were the primary menstrual hygiene product used in the 3 months prior to the baseline interview (95.5%, n = 486), and 8.1% (n = 41) of students reported that they had used toilet paper or newspapers. Of the 463 (91%) students interviewed at 1 month follow-up, 86% reported that they had tried to use the menstrual cup. There was mixed reporting on ease of insertion and removal on first use. Of those who attempted use, half (49.5%, n = 197) reported that inserting the menstrual cup on first use was very easy or quite easy. Of those who did not find it easy, 80% reported that two to three insertions were required to achieve comfort. A maximum of five insertions was mentioned to achieve comfort. The majority who had used the cup (>90%) reported they would continue to use it at each follow-up visit.

CONCLUSION

The menstrual cup was well accepted among this student population and should be considered as a cost-effective and environmentally sustainable option in menstrual health management initiatives in South Africa.

Impact of Currently Marketed Tampons and Menstrual Cups on Staphylococcus aureus Growth and Toxic Shock Syndrome Toxin 1 Production In Vitro

Fifteen currently marketed intravaginal protection products (11 types of tampon and 4 types of menstrual cup) were tested by the modified tampon sac method to determine their effect on Staphylococcus aureus growth and toxic shock syndrome toxin 1 (TSST-1) production. Most tampons reduced S. aureus growth and TSST-1 production, with differences based on brand and composition, and the level of S. aureus growth was higher in destructured than in unaltered tampons. We observed higher levels of S. aureus growth and toxin production in menstrual cups than in tampons, potentially due to the additional air introduced into the bag by cups, with differences based on cup composition and size.IMPORTANCE Menstrual toxic shock syndrome is a rare but severe disease. It occurs in healthy women vaginally colonized by Staphylococcus aureus producing toxic shock syndrome toxin 1 using intravaginal protection, such as tampons or menstrual cups. Intravaginal protection induces TSS by the collection of catamenial products, which act as a growth medium for S. aureus Previous studies evaluated the impact of tampon composition on S. aureus producing toxic shock syndrome toxin 1, but they are not recent and did not include menstrual cups. This study demonstrates that highly reproducible results for S. aureus growth and TSST-1 production can be obtained by using a simple protocol that reproduces the physiological conditions of tampon and cup usage as closely as possible, providing recommendations for tampon or cup use to both manufacturers and consumers. Notably, our results do not show that menstrual cups are safer than tampons and suggest that they require similar precautions.

Comparison of sampling methods to measure HIV RNA viral load in female genital tract secretions

PROBLEM

How does menstrual cup (MC) compare to other genital sampling methods for HIV RNA recovery?

METHOD OF STUDY

We compared HIV RNA levels between MC, endocervical swab (ECS), and ECS-enriched cervicovaginal lavage (eCVL) specimens in 51 HIV-positive, antiretroviral therapy-naive women at enrollment, 3 and 6 months, with order rotated by visit. Paired comparisons were analyzed with McNemar's exact tests, signed-rank tests, and an extension of Somer's D for pooled analyses across visits.

RESULTS

MC specimens had the highest proportion of quantifiable HIV VL at enrollment and month 3, but more MC specimens (n=12.8%) were insufficient for testing, compared with ECS (2%, P=0.006) and eCVL (0%, P<0.001). Among sufficient specimens, median VL was significantly higher for MC (2.62 log₁₀ copies/mL) compared to ECS (1.30 log₁₀ copies/mL, P<0.001) and eCVL (1.60 log₁₀ copies/mL, P<0.001) across visits.

CONCLUSION

MC may be more sensitive than eCVL and CVS, provided insufficient specimens are reduced.