Archive for contraception

Menstrual Cup Reviews: Introductory Concepts

Yes, this is definitely how blogging begins again. I’m sure of it.

So, from time to time and on no predictable schedule at all, I will be posting reviews of various menstrual cups here. It’s actually a pretty exciting time in the reusable menstrual cup world, with many types and variations of cups available, unlike 15 years ago. I suspect, but have no data to back this up, that this is due to a generational shift, with many younger menstruating folks have a greater awareness of their own anatomy and being perhaps much more comfortable with touching their own genitals than past generations, along with an increased desire to have a lower environmental impact. Regardless of why though, it’s awesome.

First Principles

In these reviews I’m going to be super real with you, readers. There will be descriptions of menstrual fluids, of anatomy, and of sensations. There will, inevitably, be occasional mention of urine and feces (proximity sometimes demands it, after all). There may be swearing, for emphasis, when I’m feeling particularly passionate about something.

When describing anatomy, I’ll be using the fairly universally understood words “vagina”, “labia”, “vulva”, etc., for clarity, but please note that I don’t intend this usage to imply any gender essentialism. For myself, I identify as genderqueer/non-binary, and have some small knowledge of how menstruation can be a complicated thing to fit into a non-cis-female gender identity (though I do not wish to presume that I necessarily know anyone else’s experience). If those anatomical words don’t resonate for you or don’t fit your understanding of your body I invite you to use any terms you’d prefer in comments.

Menstruating is a fine and ordinary thing for a person to do. It’s not a curse or a punishment or something that makes you unclean, incompetent, or monstrous in some way. It’s also, thanks to science, not an obligation. Menstruating is sometimes uncomfortable, physically or psychologically or socially or in relation to a menstruator’s practiced religion. There are menstruators who enjoy it, just as there are menstruators who despise it. I will always affirm anyone’s right to take advantage of the choices offered by science to avoid menstruating regularly, or to alter a menstrual cycle in whatever way makes sense for them, to use reusable products such as a cup, cloth pads, or natural sea sponge, or to use disposable pads or tampons or cups, or anything else. Being the possessor of a uterus that, left to its own devices, would likely menstruate in a culture that associates that uterus with femaleness and associates femaleness with inferiority is complicated enough without judgment.

Why Me?

First, let me establish myself as a bit of an expert on the subject: I’ve been using menstrual cups as my primary tool (backed up by cloth menstrual pads when necessary) for dealing with menstruation since 2002, when I started menstruating again after a four-year gap thanks to hormonal contraception. Except for during my pregnancy and for the 18 months following, when I experienced Lactational amenorrhea, I’ve been menstruating somewhat regularly ever since, and I’ve used a menstrual cup every single time. I estimate that I have menstruated 130 times since 2002 (my cycles run a little long, and I occasionally skip). I would also estimate that during the five to six days I menstruate each time, I insert and remove a menstrual cup approximately 10-14 times. That makes for a total of around 1300-1820 insertion/removal episodes in total.

I’ve also used a cup in a lot of varied circumstances. I have inserted and/or removed a menstrual cup in my own home, at work, in hotels, at the mall, at the homes of friends and relatives, in hostels, in dormitories, on moving greyhound buses, on moving trains, dozens of times on airplanes and in airports. I have done so in Canada, the United States, New Zealand, Australia, India, England, France, Japan, Ireland, and the Czech Republic. I have used a cup while glamping/car camping/middle-of-nowhere camping, at conferences and retreats, while motorcycle touring, in shared bathrooms and private ones, with no running water, with no running potable water, with no access to laundry, with either hand, and several times (out of desperation) with a nursing toddler on my lap. I have done it well and I have done it badly. I have dropped the cup in the toilet and on the ground. I have managed everything tidily many hundreds of times and I have also spilled menstrual blood on the floor or on my clothing, more than once.

I have an awful lot of experiencing using cups, and I’ve also used a bunch of different cups over varying periods of time. This means that my reviews won’t be based on a a single fumbling first try, nor on longer use of only one product. I can offer observations and comparisons based on long-term regular use in many situations.

Why Menstrual Cups?

What it comes down to is this: for me, even with occasional mishaps, a menstrual cup is far and away the best solution to the problem of dealing with menstrual fluid. No other options even comes close. Cups can be life-changing. For example, while I have reason to believe that my periods have always been in the longer and heavier end of the normal range, they’re not outrageous. But as a teenager, in addition to further complicating my already stressful relationship with gender, they were a significant practical inconvenience, and the products available to me to deal with them were inadequate in a number of important ways that made every period an unnecessary trial.

Disposable pads, even the most absorbent ones, could never keep up with the two heavy days in my period (in which I’d need to change my pad at least every hour, sometimes hard to manage at school) and they often shifted in my underwear unpredictably, allowing sometimes catastrophic leaks to happen. On light days, the extreme absorbency of some pads left my vulva uncomfortably dry, sore, and irritated. The adhesive on pads pulled the fibers out of my underwear, making them threadbare much more quickly than might otherwise be the case, and many times it also stuck to my public hair or my delicate inner thigh skin, causing completely unnecessary pain.

Tampons are superior to pads, not least because they make swimming an option. But for me, tampons either also couldn’t keep up with my heaviest menstrual flow days, requiring too frequent changes, or were far too absorbent for my lighter days (even the supposed “Light Day” versions), when they irritated my vagina and caused sometimes intense pain during removal.

Cloth pads, which I started using at the same time as my cup, and which I love as a backup for my cup, are better than disposable pads in many ways – more reliably absorbent of menstrual fluid, paradoxically somewhat better at staying in place, not damaging to underwear or self, not irritating or painful. Care is unbelievably simple, since I just wash and dry mine in my ordinary laundry with no special treatment, so they don’t add any extra work to my life. And of course, they’re much much cheaper than disposal products over the long term – I’m still using some of the original pads I bought in 2002 15 years later, which really puts the $12 I paid for them in perspective. But, just like disposable products, cloth pads can’t keep up with my heaviest flow days with any reasonable replacement schedule (running out to replace your menstrual product once per hour or once every two hours is not reasonable, in my opinion), they do shift sometimes and allow leaks, and swimming is, of course, not an option.

But using a menstrual cup completely changed my relationship with my menstruating body. Menstrual cups made menstruating “okay” for me in a way that disposable pads and tampons never could. Because absorbency isn’t even a part of the equation, cups don’t cause irritation and pain as a result of dryness. They’re equally comfortably on heavy and light days, and don’t irritate my anatomy. Even on my heaviest days, I can go four hours between emptying the cup without worrying about leaks, which means I can get through a full morning or afternoon at work. On lighter days, I can get through an entire work day without needing to worry about it. I never run out and need to run to the store, hoping they’ll have the brand I like at a decent price. By not relying on disposable products I’ve both saved hundreds if not thousands of dollars over the years, and I haven’t sent thousands of disposable products to landfills. All of that is well worth the occasional mishaps.

Cups work! But some work better than others. Which is why I’m posting these reviews.

How This is All Going to Work

I’m going to rate the menstrual cups I review in three main categories, with a few sub-categories:

  1. Material Quality – The material of which the cup is made, its qualities, and how well-suited those qualities make it for the purpose. Will include observations on things like durability, sterilizability, rigidity, discolouration probability, and so on.
  2. Design – All of the properties of the cup as a designed physical object with an incredibly practical intended use, such as shape, features, size, and how it interacts with its wearer’s body and function during insertion, internal use, removal, emptying, and cleaning. This categories will be split into three sub-categories:
    1. General Shape – The shape and size of the cup itself, its rim, and its stem.
    2. Surface Details – Any textural details, measurement markings, etc.
    3. Air Holes – Size, angle, other qualities.
  3. Ease of Use and Comfort – How likely I think it is that the cup will be easy and comfortable to use for all the various categories of menstruators.

Those ratings will be on a scale of 1-10, and are likely to be imperfectly objective at best. I’ll probably also maunder on for far too long about specific details, because I am a person for whom the details always matter. I’ll try to be thoughtful about when any specific criticism or approval is likely going to be a universal one, versus when it might be unique to me, or limited to people who share certain qualities with me.

I have no monetary or commercial relationship with anyone involved in the manufacture or sale of menstrual cups, nor am I seeking such a relationship. If I criticize or enthusiastically endorse a product in a review, it’s because I genuinely feel critical or enthusiastic about it.

I invite you to comment if you wish. Ask questions, offer feedback, contribute your own experiences with a product. Agree with me, disagree with me. Let’s try to remember that not all women menstruate and not all menstruators are women, and keep the language used gender-neutral as much as possible. Feel free to use whatever terminology makes sense for you for anatomy. Good-natured engagement with language and concepts is never off limits, and making mistakes is understandable, but pointless trolling will result in comment deletion regardless of the specific verbiage used.

Let’s do this.

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Yet another post about keywords, sort of

In which I answer the many questions posed on search engines that lead folks here. ‘Cause hey, it’s better than no post at all. Perhaps we’ll make this a regular feature? Because after all, I need to be even further up in the search engine results for “ejaculation” than I already am.

“can you get pregnant from post-ejaculation”

Yes, technically you can. Post-ejaculate can contain sperm, and as everyone keeps on saying, it only takes one. This is technically true, but realistically the reason there are so many sperm involved in an ejaculation is that it takes a lot more than one in most situations. Sperm are fragile little critters, and ova don’t succumb to the first sperm to show up in their neighbourhood in most situations – it takes the combined efforts of many sperm to produce enzymes to break down the proteins around the ovum so that conception can take place. And of course, no amount of ejaculate, including pre- or post- will get a woman pregnant if she isn’t in or near the fertile time in her cycle, which doesn’t help if she doesn’t know when that is, or if her cycle is irregular or unpredictable.

Still, I can only assume from the question that pregnancy is an unwanted consequence, in which case, it’s better to be ridiculously careful than cavalier.

“i’m 8 week pregnent can i have sex with my patner”

If you do not have a history of early miscarriage (more than a couple) then there’s no reason why you can’t have sex with your partner.  Enjoy!

But for any partner-folk who show up here to get ammunition in their strange “battle” to have sex with partners who don’t want to have sex and are claiming pregnancy as an excuse, just because you can have sex doesn’t mean that you have to. Let’s be absolutely clear that absolutely everybody can refuse to have sex at absolutely any time for absolutely any reason, and nobody has any obligation to have sex or continue sex, ever. If either partner is feeling squoogy on the topic of sex during pregnancy for any reason, that’s okay. We’re all complicated folks with complicated internal worlds, and pregnancy is an odd time – full of upheaval and change. Sex can become less of a priority or more of a priority for both or either or any partner during that time and kindness and communication should always be a primary response. Coercion is a poor sexual response.

“can a woman get pregnant after her cycle”

What does “after her cycle” mean?  Women can get pregnant if they have intercourse during or slightly before the fertile time in their cycle. This fertile time varies from woman to woman, and even from cycle to cycle for, so more information is needed to evaluate this question.

“can you get pregnant if his ejaculation is inserted in you with your fingers”

Yes. In fact, I’d say that this is a better chance than the scenario above with post-ejaculate. Look folks, if you don’t want a pregnancy to happen, the best bet is to keep male ejaculate away from female genitalia. It’s just that simple. There’s lots of ways to do that, including condoms both male and female, celibacy, and lots and lots of kinds of non-penis-in-vagina (PIV) sexual acts.

“i had sex on the 8th day of my cycle and the condom burst but there was no ejaculation is there a high chance i could be pregnant?”

This timing depends on you and your cycle, so there’s no hard and fast answer here. Every woman’s cycle is different, and if you don’t believe me join Fertility Friend (it’s free for the basic services) and check out their excellent Chart Gallery. If you’re like me with a longer cycle and later ovulation (day 19 or thereabouts) then there isn’t a high chance of pregnancy from even ejaculatory sex on day 8. If you’re the stereotypical average woman who ovulates on day 14, there’s still little risk, even from ejaculatory sex, since most sperm live no longer than 5 days (and 5 days is only likely if there is fertile cervical mucous). If you ovulate on day 10, however, ejaculatory sex would not be your pregnancy-avoiding friend.

Of course, if there was no ejaculation, then it depends on how likely it is that there was sperm in your partner’s pre-ejaculate. If he hasn’t ejaculated in at least three days, then the chance of there being live and viable sperm in his pre-ejaculate is very slim (not none, but pretty darn low). If he has ejaculated within three days, then there is a greater likelihood of their being viable sperm.

Combine these two factors – your own cycle and your partner’s ejaculatory history – and you get your answer.

None of which answers the question of STDs, just pregnancy. It’s a lot easier to pick up an STD from unintentionally unprotected sex, so if your partner isn’t someone you regularly have sex with, and/or if you are not currently monogamous, testing is a good idea, as well as letting any other current sexual partners know about the situation, before you have unprotected sex with them.

“will my breasts go droopy after an abortion?”

An abortion will not cause your breasts to change.

However, a pregnancy will. Breast changes are one of the earliest signs of pregnancy for many women, including breast growth and increased breast fullness. Pregnancy also causes relaxation of the ligaments that support your breasts – though this is more pronounced later in pregnancy.

When your pregnancy ends those changes will reverse, which can mean feelings of less fullness, smaller breasts and a bit of, yes, breast droopage or sag. Some women will notice changes like these and some women won’t. It’s a very individual thing.

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Choice and Gender

This is an older post that I’m reposting from my personal blog.

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I spent some of my break-time reading this post over on Alas, a Blog, ostensibly on the concept of “Choice for Men” (i.e., the choice of men to decide post-conception not to support children they participate in creating). I’d be more in favour of something like this if they were asking for the ability to officially declare this preference prior to having sex, and back it up with sterilization, and then not pay child support, but hey, that’s me. Regardless, the vitriole and fuzzy logic can be interesting and instructive.

Here’s how choice regarding conception and birth go for men and for women, ‘kay? And I dig that I’m talking about ideal human relationships where neither party is being coherced into sexual activity, people actually think about this stuff instead of just rut like bunnies, and both parties are respectful of each other.

First off there’s the near infinite time period prior to engaging in sexual activity for both parties to decide a) whether or not they want to have sex with someone of the opposite sex, b) what sorts of sex (vaginal vs. non-vaginal to have) and c) what sorts of contraception to utilize. They can also meet each other and talk about these issues together.

Men and Women have equal potential ability (in a relatively perfect world without abusive relationships/etc.) to choose not to be responsible to a child during this time period. Men and Women do have different options for contraception which is caused caused by both biology and politics. However, they do have three options to choose from in common which virtually guarantee a lack of responsibility to possible future children in this time period: not having sex, not having vaginal sex, and being permanently surgically sterilized (tubal ligation and vasectomy).

Then there’s the time period of the sex act itself. Men and Women have different choices that they can make during this time. Women get to choose whether to have vaginal sex, whether to have vaginal sex during what may be a more fertile time for them, whether to have vaginal sex with a fertile man (vs. a provably sterile one), whether to use condoms or a diaphragm or another barrier method, whether to use spermicides, whether to have the male ejaculate in her vagina or not, and so on. Men get to choose whether to have vaginal sex, whether to have vaginal sex with a fertile woman (vs. a probably sterile one), whether to use condoms or another barrier method, whether to use spermicides, whether to ejaculate inside the woman’s vagina, and so on.

Of course, all of these choices have varying degrees of risk for pregnancy, and the people involved in the act choose their own level of risk. Obviously, a man and a woman relying on the withdrawal method alone for contraception have a higher acceptable level of risk than does a couple relying on oral contraception, condoms and withdrawal together. Ostensibly, this means that one couple is demonstrating greater reluctance to support a child.

Post-ejaculation/sex, the man no longer has any options for whether or not he’s willing to create a new life. Sorry, it sucks, but hey, that’s how biology works. Pregnancy is a thing that occurs in a woman’s body. Men don’t get to say what happens in/to women’s bodies.

Post-sex, women have the choice (at least in Canada) to use at least two varieties of morning-after pill, if they feel their precautions weren’t sufficient or broke down at some point in the process.

They can also, should they end up pregnant, choose one of several methods of abortion (if it’s accessible/affordable/safe in their area) should they not wish to carry the pregnancy through to term for any reason. I’m not sure when their legal right to do this ends in all areas, but in North America it’s usually somewhere between three months and just pre-birth.

Yup, this is a choice that women have that men don’t, but then, men don’t get pregnant. This doesn’t mean that in this ideal and respectful situation men can’t talk to women about what choices are and so on. But as one man said, men can only really be pro-support, not pro-choice. This means they can only choose to either support a woman’s decisions either way, or not, because the choice isn’t theirs to make.

This means that women have a longer period of time to make a choice about whether or not to support a possible child. Please note that this longer period of time is really only three to nine months longer. Considering that both parties have the near-infinite period of time prior to having sex in common to make that choice, and that this longer period of time is based in the reality of biology – women get pregnant and men don’t – this isn’t really unfair.

And yes, women can choose to give babies up for adoption post-birth (which requires the father to also give consent for this, if he can be found, usually). Realistically, this doesn’t often happen, just as abortion doesn’t often happen. Most unexpected pregnancies become births and babies, not abortions.

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SMCR – The Society for Menstrual Cycle Research

I’m attending a three-day scientific conference on Menstrual Cycle Research out at the University of British Columbia. I’m volunteering, of course, because then I can get in for free. The big topic, of course, is menstrual suppression, but there’s papers and studies being presented on all sorts of related topics, including fertility awareness, menopause, and so on. Lots of interesting stuff. It’s probably the first time I’ve ever been surrounded by a bunch of PhDs who are all experts on a topic I actually know a heck of a lot about, and it’s quite exciting to get to hear a lot of high-level discussion of the issues.

I’ll be writing a couple of posts on my palm as I go along and posting them here when I’m done. Today was the opening day of the conference, and I recognize the structure, so familiar to me now from Kim Stanley Robinson’s descriptions in the Red Mars series (he has a love affair with scientific conferences and writes about them in most of his books). There was an opening plenary and a welcome from a local Musqueam elder, and then some breakout sessions. I chose the menstrual cycle topics one, and of the papers presented today, a couple had some interesting insights. One rather large and over-reported study (two groups gave talks on the same set of research data), was, unfortunately, very poorly designed, so they didn’t really get any useful data. What a waste!

They questioned women on their contraceptive usage and their menstrual product usage, and interestingly they included as the only fertility awareness-type option, the rhythm method! Unbelievable, and many in the audience were quick to point out that “the rhythm method” is an outdated term for a very poor form of natural birth control based on the calendar, quite unrelated to the modern practice of sympto-thermal charting which has an incredible success rate.
Anyway, I’ll post more about the conference soon.

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Access to Plan B

Biting Beaver‘s recent post regarding her struggle to obtain Plan B reminded me of my own story, so I thought I’d share it here.

I live in Canada, and like, I think, many Canadians my age (mid-20s) I had grown a little complacent about access to contraception. Degrassi High (the show that all Canadian youth both watched and mocked) had an episode about abortion, and although the characters went through their moral and emotional struggles, actual physical access to the abortion was guaranteed. I always assumed that obtaining Plan B would far simpler even than that, given that it was supposedly available over the counter from pharmacists in British Columbia since 2000.

For years now my primary form of contraception has been the Fertility Awareness Method (FAM), which works very well for me and my male partner. For ourselves, we chose never to have penis-in-vagina intercourse during my carefully and casually tracked fertile times. This was part of an evolving continuum of choices we made about our contraception, and it changed gradually as we became more comfortable and confident with FAM. 

Other people choose other things, including using barriers during fertile periods, and these are all very individual choices. This is part of the appeal for me of FAM: I as a woman get to choose my own level of comfort and risk-taking in my sexual choices.

In December of 2003 I returned from an 8-week trip to Australia with family. My partner had not accompanied me and we had missed each other greatly. Because I had been travelling my fertility cycle was a little disrupted, and although I hadn’t had any signs that I was likely to ovulate I knew that the timing was generally right for that sort of thing to occur soon. For once, we chose to use barriers rather than to avoid intercourse altogether. Of course, in the midst of our passionate reunion, we weren’t as conscientious (i.e., freakishly paranoid) as we would ordinarily have been and discovered only after the act was completed that our barrier had slipped off and was lying uselessly on his stomach.

When I realized this I just got dressed and we drove over to the 24-hour pharmacy about five blocks from my house. Inside the pharmacist politely explained that although Plan B was technically available over the counter, it had to be dispensed by a specially trained pharmacist and the only one they had on staff wouldn’t be in until late in the morning the following day. Sorry, nothing they could do. Besides, it didn’t really matter, I just had to take it within three days for it to be effective.

Now, while it’s true that there is a three-day window for Plan B, taking it as soon as possible is important. The sooner the better, in fact, which was why I was at a 24-hour pharmacy at 1 in the morning. Of course, if I didn’t live in the middle of the second largest metropolitan area in Canada I probably wouldn’t be as close to a 24-hour pharmacy and would have had to wait until morning, so… fine. Wait until morning.

I decided that since the pharmacist wouldn’t be in until later in the morning I’d go to the drop-in clinic at my workplace to get a prescription as soon as it opened in the morning. Because I live in Canada all office visits are fully covered by Medical Services Plan, so I didn’t have to worry about whether or not I could afford to go to the doctor. When I got to the clinic only one doctor was on duty. He was a young man, possibly in his late 20s. I explained what I wanted and he then quizzed me for a while on what my usual birth control was and so on before announcing that he didn’t prescribe the “morning after pill” for ethical reasons.

“What??” I said. At the time I’d never heard of such a thing. I asked what ethical reasons those were exactly and he refused to explain. I asked if there were any other doctors on staff that I could see and he said that there weren’t any. I just sat and looked at him. He looked at me. I said, “Look, I didn’t do anything wrong. In fact, I’m trying to do everything right. I get the feeling that you’re passing some kind of judgement on me here and I don’t like it.” He shrugged uncomfortably and opened the door to indicate that it was time for me to leave. I left.

I went up to a different walk-in clinic close to the pharmacy. I didn’t really like this one because it was often crowded and busy and the doctors had always seemed quite indifferent to me, but I figured it was better than nothing. I waited my forty minutes to get in to see a doctor and when I did I ended up with a crusty older man. I explained what I wanted. He just sat there and looked at me. By this point I was starting to feel almost… defensive about what I was trying to do, so I said something along the lines of having used a condom but that it had broken (a lie, of course, it just came off without our noticing, but I felt guilty for what I perceived to be a rookie mistake that should never have happened).

“You don’t have to explain.” he said chidingly, “That’s none of my business. I’ll write you the prescription. Ask them to give you some gravol with it because it often makes you feel quite nauseous.” And he wrote me the prescription. I went back to the pharmacy and had no difficulty filling it. I got home and took my first dose along with a gravol just over 12 hours after having what turned out to be unprotected intercourse.

Now, in the end, did I get the prescription I wanted? Yes. Was it really that hard? I suppose not. And I realize now just how lucky I was in some respects. After all, of the four medical service providers (two doctors and two pharmacists) that I interacted with, only one of them really felt strongly that I should just get pregnant as a result of a mistake whether I wanted to or not. It only took me 12 hours and three unsuccessful attempts in the second largest city in Canada to get my hands on emergency contraception.

Really, we can do better than that.

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