The disposable menstrual cup was initially marketed in the United States in 1996. The product is composed of a combination of biocompatible polymers, ensuring the product no irritation, mutagenicity, or toxicity when in contact with the vaginal epithelium6.
Menstrual cups have numerous benefits over conventional menstrual pads and tampons. Women who usually used tampons and who started using menstrual cup report advantages in the parameters of leakage and comfort4. Moreover, as collectors are unable to absorb vaginal fluids, unlike tampons, pH and vaginal microbiota are not altered, which minimizes the risk of mucosal irritation and infections13.
It seems to be a tendency that younger women are looking for new menstrual hygiene products. In this sense, menstrual cups have become popular and many studies on efficacy, safety and comfort have appeared14-15. The profile of the athletes evaluated in this study is similar to the public looking for these vaginal devices: young people with active sex life and who practice regular exercise16,18
The amount of menstrual flow may be a limiting factor to the use of the collector. Although insertion and removal of the menstrual cup was considered easy by most athletes, the complaint of menstrual flow leak was present in more than half of the participants. Similar results were found in the "Finding Lasting Options for Women (FLOW) Study: Multicentre randomized controlled trial comparing tampons with menstrual cups” 4.
However, research shows that women gain experience in using the cup over the three cycles, with their complaints of leakage and discomfort gradually reduced. There is also a direct relationship between the menstrual flow leakage complaint with the use of the cup, equivalent to the leakage that occurred with their previous methods16. In our study, we found similar results when athletes had menstrual escape during training, with a noticeable reduction of this complaint by approximately 10% over the following cycles, corroborating the hypothesis that the method of insertion and positioning of the cupimproves with the frequent use.
Despite the safety and local response of the disposable menstrual collector, one athlete reported an episode of vaginal infection, but without supporting diagnostic data and/or occasional physical examination. Similar results were found through severe post-market surveillance of the device in over 100 million users4. In this large follow-up, they evaluated pH and vaginal microbiota, urine examination, cervical oncotic colpocytology and colposcopy in women who used the menstrual collectors for three months, and no adverse effects were proven7.
It is noteworthy that most athletes did not have any discomfort during sexual intercourse, which is one of the main reasons why participants would recommend the use of the device.
The degree of general satisfaction with menstrual cup during physical exercise was high, suggesting that the device does not interfere with sports performance. This result goes against a previou report, in which the majority of participants felt comfortable during the sport6.
Approximately 66% of respondents said they would continue to use the device during their menstrual periods, not just inside the courts, but also in their daily lives. This success is repeated in several studies, especially when the cups compared to other available methods, such as vaginal tampons4. Less than 1/3 of our participants reported discontinuing use of the cup after study completion, the most frequent argument being the high financial cost versus benefit. This problem has not been reported by previous studies4,6,14.
The main limitation of this work is the relatively small sample size and the use of a non- probability methodology. Furthermore, we analized only handball players and the conclusions drawn cannot be inferred to the whole population engaged in sports. Future studies are needed, with larger sample sizes, sport modalities and should seek to compare a variety of menstrual cup.