The pros and cons of tampons, cups, pads, and sponges. A much shorter explanation: "Period Paraphernalia" by Adrienne Carlish.
If you don't know what to expect from your body or tampons, please borrow or buy the book Our Bodies, Ourselves or read up on periods at the Planned Parenthood website TeenWire.
The two most common technologies (in the modern US) for disposing of menstrual flow are the tampon and the sanitary napkin (a.k.a. pad). The pad principle is quite simple: a piece of absorbent material placed in the crotch of the underwear. Women have been using rags to do this for centuries; modern commercial pads have plastic and adhesive and more absorbent material.
The tampon principle is also rather simple: absorbent material inserted into the vagina. Women have also been doing this for a long time, but the industry only took off when nurses during one of the World Wars discovered that the new, super-absorbent cottons developed for bandages also worked wonders when made into tampons. Oh, and ingenious applicators now make them easier to insert.
Modern commercial pads are easy to use -- just unwrap the plastic, peel off the paper, and stick the adhesive lining inside the crotch of the underwear. I like the kind with wings (extension flaps on the sides of the pad to fold over the crotch of the panties and adhere to the underside of the crotch), to better protect panties from bleedthrough. But pads only hold so much menstrual fluid, and if they're badly made or you bleed more than you thought, then you leak, and pads sometimes create an unsightly and bulky crotch-diaper look-and-feel.
Tampons are great because they fit inside the body and therefore don't feel or look like diapers. And, in my experience, pads and tampons can hold about equal volumes of menstrual fluid, and you can wear a pad or pantiliner (sort of a pad lite) as backup for a tampon in case the tampon saturates. (Don't try to insert more than one tampon at once! But I have sometimes put an ultra-thin pad in the crotch of my pants or shorts, as a last-defense backup to the pad in my underwear.)
But usability and health are issues with tampons. The process of inserting a tampon can be time-consuming, messy, and uncomfortable. However, it should NOT be painful to remove a tampon; in fact, if you experience sharp pains while inserting or removing a tampon, you should read the tampon instructions, check out the TeenWire guide to tampons, and use a small mirror to make sure you're not trying to do something impossible. If it still hurts, SEE A DOCTOR!
Also, I hear credible rumors that most commercial tampons are made of bleached cotton (bleach? in my vagina?!) containing minute amounts of the toxic chemical dioxin (dioxin?! in my vagina?!?!), and that the super-absorbent cotton sucks out one's natural and necessary vaginal fluids, and increases and lengthens menstrual flow. It is possible to get pads and tampons made from organic, unbleached cotton, but the super-absorbency is still troubling.
A more established health threat is that of Toxic Shock Syndrome. There's a warning insert in every pack of tampons. Only use the minimum necessary absorbency; too-frequent use of too-absorbent tampons can cause fever, vomiting, fainting, rashes, death. Frightening.
And, of course, modern commercial pads and tampons are disposable, not reusable. What a bother to always have to remember to take a few with me! And any environmentally conscious woman considers this a problem. One period a month, about ten to twelve products used per period, twelve months a year, over thirty-five to forty menstruating years (12 to 50, let's say -- menarche to menopause). 4,800 items in the landfill per woman!
And don't forget the cost. If you're buying tampons or pads at, say, a grocery store or a big *-Mart superstore (not a warehouse store such as Costco, and not the convenience store around the corner), a 24-pack of products costs about $5, or 21 cents each. I tend to menstruate about 4 days a month, sometimes 5, and I use three products per day (one each for morning, evening, and overnight), with usage tapering off as my flow gets lighter at the end. So I use about ten or twelve products per period, which costs about $2.10 in tampons or pads. Again, over the twelve periods of the year, that's $25. That's infinity percent more than I spend on makeup, and probably more than I spend on other hygiene products (e.g., soap, toothpaste, shampoo) over the same time period.
$25 a year, every year, for being female.
So I, like other women, have looked into alternatives.
There are reusable pads, like reusable diapers, that use snaps or Velcro instead of adhesive. (I've never seen these available in physical stores; you can buy them from many stores online.) But I use public restrooms much of the time, and I'd either have to rinse out my pad at the sink or take along an extra, and I dislike both carrying extra Female stuff and washing cloth with my hands, in public or otherwise.
There are sponges which one inserts into her vagina, tampon-style, and then squeezes and rinses and reuses. (I hear these are available at some health-food stores, and again online.) I tried one. (I assume they're pretty much all alike.) Problems: Variable saturation, so I need to wear a pad as backup, and then am I that much better off than before? Difficult to extricate (tampons each have a string to pull). And if you don't wash it and your hands quite well before insertion or removal, one girl told me, you'll get a urinary tract infection, as she did.
Oh, and there's also the option of not moving around and about in modern urban society for the duration of your period, every month, and sitting at home and letting the menses flow uninterrupted, but I have no inclination for that. Do you?
Another solution: a menstrual cup. For at least a century, people have tried to sell the idea of a cup that fits inside the vagina and catches menstrual flow. Remove, empty, rinse, reinsert. It has the great virtues of a tampon (inside the body) without the Toxic Cotton of Death problem. It's reusable, which gladdens the hearts of frugal women and environmentalists, and means no need to carry extra anything.
Drawbacks: insertion is still messy and can be uncomfortable and time-consuming. One reusable cup costs a lot compared to any one sponge or pad or tampon. You have to clean it to reinsert it, which can take time, and might get you dirty looks in public restrooms. It might leak if it overflows or you insert it wrong, as with tampons and sponges, so at least a pantiliner for backup is a good idea.
The latest commercial incarnation, Instead, actually is available in stores. It's marketed as disposable, which (to me) is actually a drawback. Sure, you don't have to do the washing-out and/or wiping, but that means you have to carry more with you, and that's just tampons & pads all over again. (My suspicion is that most women who use Instead reuse one cup for at least the duration of one period. Who would pay $10 for a box of three, and then finish that off over one menstruation? No one I know.) And it's tough to insert and remove, like a sponge, since it sits there behind your pubic bone and you have to reach rather far into the vagina to reach the rim for a grip to pull it out. (In all fairness, that's hearsay combined with my common sense, not personal experience.)
But there's also The Keeper.
I bought The Keeper online a few years ago. It cost around $30 and came with documentation and a pretty little cloth drawstring pouch. It's a rubber cup with a short, thin rubber tube at the bottom. This pull-tab, like a tampon's applicator and string, makes the Keeper much easier to insert and remove than, say, Instead. Innovation!
The Keeper holds an ounce of fluid. You can test this. Innovation!
The documentation told me to first try out the Keeper on a light-flow day when I would be at home most of the time. I kept putting this off. Then, one week, I was out of pads anyway, so I figured that I'd already paid for the Keeper and I might as well try it.
It was difficult to insert at first, but after a try or three I got the hang of keeping my labia (lips enclosing the vagina) open with one hand and inserting the folded cup with the other. My tampon experience helped. (It also helps, as I later learned, to keep your pubic hair relatively short, so your fingers and the cup don't snag on the hair.) I also got the hang of pushing the Keeper far enough in that I could let it pop open into its cup shape, and then using the tab to pull it snug. (The tab was a little long, on purpose; the documentation encourages you to cut it to a comfortable length so that it's still useful for maneuvering but doesn't bother your labia.)
As with tampons, the Keeper seemed uncomfortable at first but then I got used to it and then didn't feel it at all. I learned how often to empty it -- for me, about three or four times a day on heavy flow days and less on later days. I made sure to wash my hands with soap and rinse the Keeper every time.
I was glad on the first day that I had worn a pad as backup; it leaked because I hadn't learned how to make sure the Keeper had a tight seal with my vaginal walls. But on later days I wore a pantiliner or nothing at all and encountered no leaks. Great!
And here's the eerie part. I'd always discounted the "tampons make you bleed more" rumor. But I used to have five-day periods, and now, as often as not, my cycles are only four days long. Maybe that's a coincidence, but I'd be quite pleased if it kept happening, and it makes me think that tampons might be even worse for me than I'd thought.
I got even more excited when I realized the monetary benefits. The Keeper, it's said, lasts for about ten years; let's assume it's only good for five. It cost me $30; let's assume it cost $60. Well, then, at $25 a year in tampon/pad purchases, which is $125 over five years, the Keeper would be worth $60 if it replaced about half of my tampon/pad expenditures. As it is, the Keeper replaces about 3/4 of my tampon/pad usage and is supposed to last for ten years, so it's worth $160 -- more than five times its price!
So, if you're female, and don't mind a bit of messiness in actually confronting your menses, and can spare $30 upfront, I recommend the Keeper. Call 1-877-AKEEPER (1-877-253-3737) or visit The Keeper's web site and save some money and much waste.
I'm very satisfied with the Keeper and use perhaps four or five pads per menstruation (one per day) as backup to the Keeper in case of overflow. I should get more disciplined about emptying the Keeper a few times a day so that I don't need the backup.
I visited a vegetarian expo and got to buy a few hundred GoodFriend Herbs Sanitary Pads from Good Friend Biotech at a wholesale price. I approve. They smell nice, but not in an artificial way, even after they are soaked with menstrual blood, and I figure the mint and whatnot can't hurt. You won't see the pads on their site but you can order them via mail, and you'll get a bulk discount even if you're not a distributor or retailer. Disclaimer: at least a few people think GoodFriend pads smell "like dirt", or at least weird.
May 2006 update: I should really crunch the numbers on the number of days in my period for all my cycles over the past few years.
And if you don't know what to expect from your body, from tampons, from pads, from the Keeper or the DivaCup, please borrow or buy Our Bodies, Ourselves or read up on the Health Info at the Planned Parenthood website.
January 2011 update: I have, I believe, developed a latex sensitivity, after about a decade of monthly Keeper usage (plus a fair amount of penis-in-vagina sex using latex condoms). I'm not sure whether the rubber in the Keeper has degraded, but I know it's only marked for ten years' use so I should have replaced it with either a new Keeper or a DivaCup already. I'll be getting a DivaCup very soon.
July 2014 update: Sadly the Teenwire links broke so I updated them with Internet Archive links. I use a DivaCup these days and it's fine.
Last updated July 2014