Menstrual cup: Temporary relief for fistula patients
Sep 24, 2012
The menstrual cup is the talk of town. While the bell-shaped cup is being hyped as a cheaper, eco-friendly, less-risky and cost-saving menstruation product, there is another debate brewing about how it can be used in managing obstetric fistula before surgery.
By Shamilla Kara
The menstrual cup is the talk of town. While the bell-shaped cup is being hyped as a cheaper, eco-friendly, less-risky and cost-saving menstruation product, there is another debate brewing about how it can be used in managing obstetric fistula before surgery.
As an alternative to sanitary pads and tampons, the silicone cup comes with compliments galore.
“They are more hygienic and cost-effective than sanitary pads and tampons,” says Dr. Romano Byaruhanga, a senior gynaecologist at the Kampala Medical Chambers, where the cup is sold. At sh50,000, it is still considered cheaper than tampons and pads because it can last for five to 10 years.
“It is reusable and one does not have to purchase it on a monthly basis. It also has a lower risk of toxic shock syndrome compared to tampons,” says Dr. Fred Kirya, a senior consultant surgeon at Soroti Referral Hospital.
“A toxic shock syndrome is caused by a bacterium Staphylococcus Aureus that produces a substance which is absorbed by the menstruating woman’s body,” he adds.
The cup and fistula
“A fistula is an abnormal hole between the urinary bladder and the birth canal,” says Kirya.
As an accessory in the management of urine leakage in fistula patients, the reviews on the cup are mixed, probably because it is relatively new in Uganda.
“The social consequence of incontinence is reduced and patients retain their dignity and place in society,” says Liliane Barenzi, the communications coordinator of Valvisions Foundation, a US-based charity that supports NGOs working with female health and fistula.
“The cup is also discreet and provides patients with some control,” Barenzi adds.
Winnie Nakalema, the in-charge of the Vesicovaginal Fistula Unit at Kitovu Hospital (one of the hospitals that have used the menstrual cups), is optimistic about the cup’s usefulness.
“The first patient we used the cup on was comfortable and is still using it. She was a fistula patient who had been repaired,” says Nakalema. The unit also used the cup in over 30 patients waiting for surgery at one of their fistula camps recently.
Challenges
The menstrual cup cannot work for all fistula patients.
“We could not recommend the cups to two of our patients because their vaginas were so narrow and the cup could not go in,” says Nakalema who recommends the cup after the history of a woman is taken and extensive counselling on use and care offered.
Kirya reiterates: “Where a lot of injury on the urethra and bladder neck has occurred, the use of the menstrual cup is not applicable.”
He adds: “The cup will only work on a patient whose vagina is normal or near normal and is moist, elastic and easy to open and spring back. With urinary fistula patients, some of those qualities are taken away by the injury caused by the fistula.”
Kirya also says the cup is not applicable in patients whose fistula is stenosed (abnormally constricted body canal or passage), or closed off, since they cannot freely insert the cup.
“The cup will also not work where a fibrosis (scar tissue) develops due to the injury caused by fistula,” says a fistula surgeon who was not comfortable being quoted.
The surgeon further argues that it is also not economically feasible to spend $20-$30 (about sh70,000) on the menstrual cup for each patient who is awaiting surgery.
“Sometimes these women have been suffering from fistula for a year or more before they are identified for surgery and are put on a waiting list for a week or two. The cup would be better for them before they are identified for surgery,” he adds.
Facts on the cup
The cup, an alternative to sanitary pads and tampons, comes in two sizes; one is for those who have delivered vaginally while the other, which is smaller, is for those who have not delivered yet or have had c-sections.
Additionally, it has a higher capacity of absorption than pads and tampons. One needs only one cup and does not have to move with replacements like extra pads or tampons.
How to insert the cup
One has to fold it before inserting in the vagina as one would a tampon (see graphic). To fold, place a finger on the rim of the cup and push it down into the cup. Once it is inside the vagina, the cup will automatically open and form a light seal with the vaginal walls. To take the cup out, you need to squat and then use your index finger and thumb to grab the bottom of the cup and pull it out.
How it works in fistula patients
“It is the abnormal flow of urine that the menstrual cup tries to contain. The cup drains urine from the bladder to the canal and holds the urine inside the vagina,” says Dr. Kirya.
The cup is inserted in the vagina and when it is full, it is removed and cleaned before reuse.
“The cup has to be removed and urine poured out every hour,” advises Nakalema.