Hesitancy on usage of menstrual cup in college going students a cross-sectional mixed method study in Karaikal region of Puducherry

Hesitancy on usage of menstrual cup in college going students a cross-sectional mixed method study in Karaikal region of Puducherry | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Hesitancy on usage of menstrual cup in college going students a cross-sectional mixed method study in Karaikal region of Puducherry Projatna Chaudhuri, K. Murugesan, Niranjjan Ramachandran, K. Kamala This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9050891/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background : Sanitary napkins are the primary menstrual product being used in India. They are single use and despite the availability of sustainable alternatives like menstrual cups, napkins use remains the more popular choice. The shift in usage to more sustainable menstrual product not just comes with awareness but also the preparedness of future healthcare providers who influence menstrual-health counselling. Evidence on their perceptions remains limited. Methods : A cross-sectional mixed-methods study was conducted among 292 women aged 18–49 years enrolled in medical, nursing and allied health programs at a tertiary-care institute in Karaikal (November 2023–May 2024). Quantitative data were collected using a semi-structured questionnaire via EpiCollect5 and analysed descriptively using SPSS. Qualitative data were obtained through open-ended interviews with the same participants and analysed using thematic analysis. Findings were integrated during interpretation. Results: Sanitary pads were used by 93.49% of participants, while only 1.71% had ever used a menstrual cup and 2.74% were current users despite 74.32% awareness. No inferential statistical analyses were conducted. Qualitative analysis identified seven themes: fear and discomfort; lack of knowledge; familial and societal disapproval; accessibility and hygiene challenges; preference for familiar products; reasons for acceptance; and reasons for discontinuation. Integration revealed that awareness alone did not translate into adoption due to emotional, cultural and practical barriers. Conclusion : The low level of usage of menstrual cup amongst healthcare workers reflects the gap between awareness and the actual practiced behaviour which is driven by fear, misinformation and contextual constraints. More of Informational campaigns are required to bring about the behaviour change, demonstration based training and supportive institutional infrastructure will also help in improving. menstrual cup awareness acceptability mixed-methods medical and nursing students India Introduction Menstrual health continues to be an important public-health concern in India. Most government programs still focus on providing free disposable sanitary pads through schools and public facilities ( 1 ). While this improves access, it also leads to ongoing costs, waste-management issues, and skin irritation when pads are used for long durations ( 2 ). In contrast, menstrual cups are reusable devices made of medical-grade silicone or similar materials and can be safely used for several years, offering both economic and environmental advantages ( 3 , 4 ). However, despite these benefits, their acceptance and routine use remain low across the country. Studies from different parts of India have shown that although many women are aware of menstrual cups, very few actually use them, suggesting a clear gap between awareness and behaviour ( 5 , 6 ). Most of this research has relied only on quantitative data and has focused on general populations or students, which does not explain the deeper reasons behind hesitation. For menstrual-health promotion to be effective, it is important that healthcare providers themselves are comfortable and confident with the products they may recommend, since they play a key role in counselling and behaviour-change communication ( 7 ). Yet there is limited information on whether future healthcare professionals know about menstrual cups, have personal experience using them, or feel prepared to guide others. To address this gap, the present study explored menstrual-hygiene practices and perceptions regarding menstrual-cup use among medical, nursing, and allied-health students in a tertiary-care teaching hospital. Using a cross-sectional convergent mixed-methods approach, the study described awareness and usage patterns and examined the reasons for hesitancy through thematic analysis. Understanding these barriers at a pre-adoption stage is important for strengthening menstrual-health initiatives, supporting behaviour-change strategies, and integrating sustainable menstrual products into public-health programs. Methods Study design: A cross-sectional mixed-methods study was conducted. Quantitative data were collected using a semi-structured questionnaire, and qualitative data were obtained through open-ended interviews. Datasets were analysed separately and integrated during interpretation. Qualitative data were analysed using thematic analysis. Setting and period: The study was conducted at a tertiary care institute, Karaikal, from November 2023 to May 2024. Inclusion criteria: Women aged 18–49 years; students enrolled in medical, nursing, and allied health programs. Exclusion criteria: Individuals those who are not willing. Sample size: As per NFHS 5 78% of women use menstrual hygiene products, keeping 95% confidence interval, 5% absolute precision, sample size is calculated using the following formula Z 2 (pq/d 2 ). Sample size arrived using above data is 264, considering 10% non-response rate sample size is corrected to be 292. Data collection: Quantitative data were collected using a semi structured questionnaire administered through EpiCollect5. Qualitative data were collected by in person interview to explore perspectives in greater depth. After obtaining consent, data was collected. Data analysis: Quantitative data were analysed using SPSS 27, Qualitative data underwent thematic analysis. Ethics: Ethical approval was obtained from the Institutional Ethics Committee Vinayaka Mission’s Medical College and Hospital, Karaikal, Puducherry, India via, approval number IEC/VMMCH/2024/APR/75 All methods were carried out in accordance with relevant institutional guidelines and regulations. Results Quantitative findings: A total of 292 women participated in the study, including medical (n=148), nursing (n=92), and allied health students (n=52). The mean age of participants was 20.76 ± 2.7 years, with medical students being slightly older (22 ± 3 years) compared to nursing (20 ± 1 years) and allied students (19 ± 1 years). Most participants were undergraduates (94.86%), with only 5.14% enrolled in postgraduate programs. The majority were unmarried (97.95%). Nuclear families were predominant (85.62%) across all groups Regarding residential status, 66.78% were day-scholars, while 33.22% were hostel residents. The most commonly used menstrual product was sanitary napkins (93.49%), followed by cloth pads (4.11%) and menstrual cups (1.71%). Awareness of menstrual cups was high (74.32%), but only 1.71% had ever used one, and current use was reported by just 2.74% of participants No inferential statistical associations were conducted, as the quantitative component was descriptive. Qualitative findings: Seven themes emerged ; fear and discomfort, lack of knowledge and awareness, familial and societal influence, accessibility and practical barriers, preference for familiar products, reasons for acceptance, and reasons for discontinuation. Integration showed that emotional and contextual factors, non-awareness, determined behaviour. Table.1 Descriptive Statistics Course Medical (n=148) Nursing (n=92) Allied (n=52) Overall (n=292) n (%) n (%) n (%) n (%) Age (mean (SD)) 22 (±3) 20(±1) 19 (±1) 20.76 (±2.7) Education Undergraduate 133 (89.9) 92 (100) 52 (100) 277 (94.86) Postgraduate 15 (10.1) 0 (0) 0 (0) 15 (5.14) Marital Status Married 6 (4.1) 0 (0) 0 (0) 6 (2.05) Unmarried 142 (95.9) 92 (100) 52 (100) 286 (97.95) Type of Family Joint-Family 23 (15.5) 15 (16.3) 4 (7.7) 42 (14.38) Nuclear Family 125 (84.5) 77 (83.7) 48 (92.3) 250 (85.62) Current Residential Status Day-Scholar 87 (58.8) 70 (76.1) 38 (73.1) 195 (66.78) Hosteler 61 (41.2) 22 (23.9) 14 (26.9) 97 33.22) Preferred Sanitary product Sanitary Napkin 137 (92.6) 87 (94.6) 49 (94.2) 273 (93.49) Tampon 1 (0.7) 0 (0) 0 (0) 1 (0.34) Cloth Pad 4 (2.7) 5 (5.4) 3 (5.8) 12 (4.11) Menstrual Cup 5 (3.4) 0 (0) 0 (0) 5 (1.71) Have you heard about menstrual cup Yes 125 (84.5) 59 (64.1) 33 (63.5) 217 (74.32) No 22 (14.9) 33 (35.9) 19 (36.5) 75 (25.68) Have you used menstrual cup Yes 17 (11.5) 3 (3.3) 1 (1.9) 21 (7.19) No 131 (88.5) 89 (96.7) 51 (98.1) 271 (92.81) Are you currently using menstrual cup Yes 7 (4.7) 0 (0) 1 (1.9) 8 (2.74) No 141 (95.3) 92 (100) 51 (98.1) 284 (97.26) Table 2 : Reason for not opting to use menstrual cup THEME SUB THEME VERBATIM Fear and discomfort Fear of Pain Verbatim 1.1.1“ I feel it will be painful” Verbatim 1.1.2 “Iam scared that the process of insertion will be painful” Fear of bleeding Verbatim 1.2.1 “I have a fear that insertion of a menstrual cup will lead to more bleeding” Fear of leakage Verbatim 1.3.1 “I fear that blood will leak out of the cup” General Discomfort Verbatim 1.4.1 “I think it will be uncomfortable to use” Lack of knowledge Lack of knowledge about the usage Verbatim 2.1.1 “I don’t know how to use the product well” Fear of losing virginity (Hymenal tear) Verbatim 3.1.1 “Im scared I will lose my virginity” Verbatim 3.1.2 “I fear it will be painful and will damage my hymen” Familial and Societal influence Familial disapproval Verbatim 4.1.1 “My family members do not allow me to buy anything else apart from sanitary napkins” Verbatim 4.1.2 “My mother does not allow me to use menstrual cup” Verbatim 4.1.3. “My parents done think menstrual cups are safe to use” Accessibility and practicality Verbatim 5.1.1 “Menstrual cups aren’t available readily at the local shops” Verbatim 5.1.2 “It is difficult to use on a daily basis” Table 3 : Reasons for choosing preferred hygiene products THEME SUB THEME VERBATIM Familiarity and Habit long term use Verbatim 1.1.1“ I have been using sanitary pads since the beginning” family influence Verbatim 1.2.1 “My mother has taught me to use sanitary pads ever since I started getting periods” Verbatim 1.2.2 “Everybody in my family uses sanitary pads” Comfort and Convenience Ease of use Verbatim 2.1.1 “ It is comfortable and easy to use “ Availability Verbatim 2.2.1 “It is easily available in all stores (Sanitary pads )” Lack of side effects Verbatim 2.3.1 “Sanitary pads don’t have any side effects” Reluctance to change Verbatim 2.4.1 “Iam comfortable with what I use and Iam unwilling to change to any other sanitary product” Effectiveness General effectivity of the product Verbatim 3.1.1 “Sanitary pads have good flow retention” Verbatim 3.2.1 “They absorb really well” Verbatim 3.3.1 “Cotton pads are re-usable and don’t give rashes” Lack of Awareness Limited knowledge about alternative menstrual hygiene products Verbatim 4.1.1 “Iam unaware of any other sanitary product” Verbatim 4.2.1 “I only know about sanitary pads” Affordability Cost considerations Verbatim 5.1.1 “Cloth pads are cheap and can be re-used” Verbatim 5.2.1 “They are budget friendly” Table 4 : Reasons for rejecting menstrual cups post-Demonstration THEME SUB THEME VERBATIM Fear and Discomfort Fear of insertion Verbatim 1.1.1 “Iam not comfortable with the idea of insertion” Verbatim 1.1.2 “I don’t like the idea of insertion” Fear of pain Verbatim 1.2.1 “It sounds painful” Verbatim 1.2.2 “I think the insertion will be painful” Fear of Injury Verbatim 1.3.1 “I have a feeling I’ll end up injuring myself” Skepticism and Mistrust Doubts about effectiveness Verbatim 2.1.1 “I feel like it would fall out” Hygiene concerns Verbatim 2.2.1 “I idea of re-using is not impressive” Difficulty in disposal Verbatim 3.1.1 “The disposal of the contents seem like a hassle” Comfortable with existing methods Preference for already using product Verbatim 4.1.1 “I am comfortable with sanitary napkins” Verbatim 4.1.2 “I find sanitary napkins more comfortable” Table 5 : Reasons for using menstrual cup THEME SUB THEME VERBATIM Practical Benefits Cost effectiveness Verbatim 1.1.1 “Menstrual cups are cost effective, during heavy flow you have to change only once per day” Verbatim 1.1.2 “It lasts longer and is economical in the longer run” Leakage Control Verbatim 1.2.1 “I was having troubles with leakage and menstrual cups contain the leakage well” Verbatim 1.2.2 “I wanted to stop staining my clothes” Travel and mobility Verbatim 1.3.1 “It is helpful in long journey where changing facility is not available” Verbatim 1.3.2 “It is useful in long hours of work without access to washrooms” Health and hygiene Verbatim 2.1 “It is comfortable and eco-friendly” Verbatim 2.2 “Sanitary pads cause rashes, whereas menstrual cups do not” Environmental Awareness Verbatim 3.1 “To reduce plastic waste from disposable pads” Verbatim 3.2 “It is an environmental friendly option- less waste is generated” Curiosity Experimentation Verbatim 4.1.1 “I was curious to try on a new product” Verbatim 4.1.2 “I heard about it from everyone and wanted to try it” Desire to switch Verbatim 4.2.1 “I wanted to try a new hygienic product” Influence of others Peer influence Verbatim 5.1.1 “My friend recommended using it” Social media influence Verbatim 5.2.1 “I saw influencers using it on social media” Tables 6 : Reasons for Discontinuing menstrual cups THEME SUB THEME VERBATIM Physical discomfort Pain during insertion Verbatim 1.1.1 “I was unable to insert it at times due to pain during insertion” pain during removal and inability to smoothly remove Verbatim 1.2.1 “Had a bad experience when I tried to remove it” Verbatim 1.2.2 “It got stuck while I tried to remove it, it was a scary experience” Inconvenience of usage Inconvenient environment Verbatim 2.1.1 “It is not convenient to use in a college environment” Verbatim 2.1.2 “Disposal is difficult during unavailability of adequate washroom facilities” Inconvenient re-usal Verbatim 2.2.1 “It is difficult to boil and wash while living in hostel” Fear and Anxiety Fear of leakage Verbatim 3.1.1 “There is fear of overflow, and wrong insertion technique” anxiety about incorrect usage Verbatim 3.2.1 “Wrong insertion technique can lead to harm hence I stopped using it” Discussion This mixed-methods study among women aged 18–49 years enrolled in medical, nursing and allied health courses at a tertiary-care institute in Karaikal analysed the menstrual hygiene practices and factors influencing usage of menstrual cups and the reasons for hesitancy in the same. Quantitative findings showed that, their menstrual hygiene practices remained strongly oriented towards conventional sanitary pads, with more than 93.49% reporting pad use and only 1.71% having ever used a menstrual cup; current use was as low as 2.74%. Despite relatively high awareness of menstrual cups (74.3%), adoption remained low, suggesting a substantial gap between awareness and actual behaviour. The qualitative findings helped explain why awareness did not translate into use. Many participants described worries about pain, inserting or removing the cup, bleeding, leakage, and possible damage to the hymen. Several also felt they did not have enough practical guidance on how to use a cup confidently. In addition, family restrictions, discomfort discussing menstrual products at home, and concerns about privacy and washing facilities in hostels and college settings made adoption even more difficult. At the same time, those who had tried or continued using menstrual cups reported clear advantages, including lower long-term cost, better control over leakage, convenience during travel or long working hours, improved comfort, and reduced waste. These contrasting experiences highlight that strong fears and hesitation can exist alongside an understanding of the potential benefits, which may explain why many students remain unsure about switching to menstrual cups despite being aware of them. The findings of this study are consistent with earlier research from India showing a persistent gap between awareness and actual menstrual cup use; however, the current study advances existing evidence in several important ways. Previous studies among medical students in Mysuru reported high awareness (98%) but low usage (6.47%), yet were limited to quantitative assessment and could not explain the underlying reasons for hesitation ( 5 ). Similarly, the North Indian study from AIIMS Bathinda identified extremely low usage (1.2%) and highlighted inadequate knowledge as the predominant barrier, but the absence of qualitative inquiry restricted understanding of how fears, norms, and social influences shaped behaviour ( 6 ). In contrast, the present study not only documents a comparable awareness use gap (74.3% vs. 2.7%) but addresses this unanswered question by integrating qualitative findings from the same participants, enabling explanation rather than description. While evidence from Kerala suggests that acceptance improves after counselling ( 4 ), existing studies focus on post-intervention or healthcare-professional groups. The current research fills a critical gap by examining pre-adoption perceptions among young women in training, representing a population positioned to influence future menstrual health norms. Additionally, unlike national-level commentaries that emphasize policy-level barriers ( 7 ), this study identifies modifiable barriers at the individual and institutional levels, offering actionable insights for early-stage intervention before behaviour is formed. The persistence of low menstrual cup adoption despite adequate awareness in this study highlights the complex interaction between knowledge, cultural embodiment, and perceived bodily vulnerability among young women in training. The qualitative themes suggest that decision-making around menstrual products is not merely informational, but rooted in notions of bodily integrity, sexuality, and social acceptability These findings indicate that normalizing menstrual cup usage was difficult to achieve, just through information and awareness. Cognitive awareness does not override emotional, relational, and socio-cultural discomfort. The coexistence of apprehension and recognition of benefits observed in this study reflects an “ambivalence threshold,” where participants acknowledge advantages yet remain unwilling to transition due to perceived risk, stigma, and institutional constraints such as hostel facilities. The relatively large sample size (n = 292) and focus on medical, nursing, and allied health students further enhance the relevance of findings, as this group represents future healthcare providers capable of influencing menstrual health norms and counselling practices. The qualitative component adds depth by identifying previously under-represented determinants such as parental restriction, hymenal anxiety, and hostel-based feasibility concerns. There are limitations to this study as it is a single-centre study, and chance of recall and social desirability biases are there. We have made efforts like maintaining privacy during interviews and assuring anonymity to reduce biases. Despite these limitations, the mixed-methods approach will make this study as a meaningful contribution to understanding menstrual cup acceptability in Indian women. The findings of this study indicate that improving menstrual cup acceptability will require a multi-level approach rather than isolated awareness efforts. At the individual level, interventions should focus on confidence-building through demonstration-based training, peer support, and opportunities for supervised familiarization, particularly for first-time users who experience anxiety related to insertion and bodily harm. At the institutional level, colleges and hostels may play a critical enabling role by ensuring access to private washing facilities and integrating menstrual product counselling into student orientation and health services. For families and communities, engagement strategies addressing parental concerns and sociocultural misconceptions may help reduce restrictions experienced by unmarried young women. At the broader public-health level, menstrual cup messaging should shift towards behaviour-change approaches that normalize reusable products, highlight safety and sustainability, and provide pathways for trial without financial burden. Targeting participants in this study also have downstream benefits, as increasing comfort and competence within this group can translate into future clinical advocacy and more informed menstrual health counselling. Conclusion This study demonstrates that there is awareness of menstrual cups, but minimal usage among participants, with hesitancy driven by fear, limited practical knowledge, and social constraints. Addressing these barriers requires confidence-building interventions and supportive institutional environments in addition to information. Improving acceptance in this group may enhance future clinical counselling and public-health messaging in India. Declarations Data Availability Statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. ETHICAL APPROVAL Ethical approval was obtained from the Institutional Ethics Committee Vinayaka Mission’s Medical College and Hospital, Karaikal, Puducherry, India via, approval number IEC/VMMCH/2024/APR/75 CONSENT Informed consent was obtained from all participants prior to their inclusion in the study. Participation was voluntary, and responses were collected anonymously. FUNDING This research received no external funding. CLINICAL TRIAL REGISTRATION Clinical trial number: Not applicable. CONSENT TO PUBLISH Consent to publish: We give our consent for publication. CONFLICT OF INTEREST The authors declare no conflict of interest. References Sharma R, Patel A. Menstrual hygiene initiatives in India: policy perspectives and program implementation. J Public Health Policy. 2022;43(2):245–52. Yousuf A. Understanding menstruation and infections: a comprehensive review. EuroSci J Technol Innov. 2025;1(1):27–9. ࿼. van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Thakkar MB, et al. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health. 2019;4(8):e376–93. Dhanyashree DV. Exploring the diverse menstrual product options and raising awareness about the menstrual cup: an observational study. J South Asian Feder Obst Gynae. 2025;17(4):511–5. 10.5005/jp-journals-10006-2640 ࿼ . Ravali P, et al. Knowledge and practices regarding menstrual cups among medical students in Mysuru. Indian J Community Med. 2023;48(3):215–20. Bindal P, et al. Awareness and acceptability of menstrual cups among reproductive-age women in North India. Int J Reprod Contracept Obstet Gynecol. 2024;13(1):45–50. Behera S, et al. Sustainable menstrual-health strategies in India: opportunities and challenges. J Family Med Prim Care. 2024;13(2):112–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 17 May, 2026 Reviewers agreed at journal 16 May, 2026 Reviewers agreed at journal 13 May, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviews received at journal 21 Apr, 2026 Reviewers agreed at journal 20 Apr, 2026 Reviewers invited by journal 17 Apr, 2026 Editor invited by journal 23 Mar, 2026 Editor assigned by journal 16 Mar, 2026 Submission checks completed at journal 14 Mar, 2026 First submitted to journal 13 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9050891","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":628785439,"identity":"6fdd30b9-d616-4b46-8ca2-4a0d25b554c3","order_by":0,"name":"Projatna Chaudhuri","email":"","orcid":"","institution":"Vinayaka Mission's Medical College and Hospitals, Vinayaka Mission's Research Foundation - Deemed to be University (VMRF-DU)","correspondingAuthor":false,"prefix":"","firstName":"Projatna","middleName":"","lastName":"Chaudhuri","suffix":""},{"id":628785440,"identity":"e09af645-c091-44fb-88c4-482d7cb137f0","order_by":1,"name":"K. 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Kamala","email":"","orcid":"","institution":"Vinayaka Mission's College of Nursing, Vinayaka Mission's Research Foundation - Deemed to be University (VMRF-DU)","correspondingAuthor":false,"prefix":"","firstName":"K.","middleName":"","lastName":"Kamala","suffix":""}],"badges":[],"createdAt":"2026-03-06 13:08:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9050891/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9050891/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107901290,"identity":"6badf9b3-6dbd-4f9c-a912-0a48aabe7842","added_by":"auto","created_at":"2026-04-27 11:42:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":295415,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9050891/v1/c08026b1-51f5-40d1-958c-20651ef9a40c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Hesitancy on usage of menstrual cup in college going students a cross-sectional mixed method study in Karaikal region of Puducherry","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMenstrual health continues to be an important public-health concern in India. Most government programs still focus on providing free disposable sanitary pads through schools and public facilities (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). While this improves access, it also leads to ongoing costs, waste-management issues, and skin irritation when pads are used for long durations (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In contrast, menstrual cups are reusable devices made of medical-grade silicone or similar materials and can be safely used for several years, offering both economic and environmental advantages (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). However, despite these benefits, their acceptance and routine use remain low across the country.\u003c/p\u003e \u003cp\u003eStudies from different parts of India have shown that although many women are aware of menstrual cups, very few actually use them, suggesting a clear gap between awareness and behaviour (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Most of this research has relied only on quantitative data and has focused on general populations or students, which does not explain the deeper reasons behind hesitation. For menstrual-health promotion to be effective, it is important that healthcare providers themselves are comfortable and confident with the products they may recommend, since they play a key role in counselling and behaviour-change communication (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Yet there is limited information on whether future healthcare professionals know about menstrual cups, have personal experience using them, or feel prepared to guide others.\u003c/p\u003e \u003cp\u003eTo address this gap, the present study explored menstrual-hygiene practices and perceptions regarding menstrual-cup use among medical, nursing, and allied-health students in a tertiary-care teaching hospital. Using a cross-sectional convergent mixed-methods approach, the study described awareness and usage patterns and examined the reasons for hesitancy through thematic analysis. Understanding these barriers at a pre-adoption stage is important for strengthening menstrual-health initiatives, supporting behaviour-change strategies, and integrating sustainable menstrual products into public-health programs.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design: A cross-sectional mixed-methods study was conducted. Quantitative data were collected using a semi-structured questionnaire, and qualitative data were obtained through open-ended interviews. Datasets were analysed separately and integrated during interpretation. Qualitative data were analysed using thematic analysis.\u003c/p\u003e \u003cp\u003eSetting and period: The study was conducted at a tertiary care institute, Karaikal, from November 2023 to May 2024.\u003c/p\u003e \u003cp\u003eInclusion criteria: Women aged 18\u0026ndash;49 years; students enrolled in medical, nursing, and allied health programs.\u003c/p\u003e \u003cp\u003eExclusion criteria: Individuals those who are not willing.\u003c/p\u003e \u003cp\u003eSample size: As per NFHS 5 78% of women use menstrual hygiene products, keeping 95% confidence interval, 5% absolute precision, sample size is calculated using the following formula Z\u003csup\u003e2\u003c/sup\u003e(pq/d\u003csup\u003e2\u003c/sup\u003e). Sample size arrived using above data is 264, considering 10% non-response rate sample size is corrected to be 292.\u003c/p\u003e \u003cp\u003eData collection: Quantitative data were collected using a semi structured questionnaire administered through EpiCollect5. Qualitative data were collected by in person interview to explore perspectives in greater depth. After obtaining consent, data was collected.\u003c/p\u003e \u003cp\u003eData analysis: Quantitative data were analysed using SPSS 27, Qualitative data underwent thematic analysis.\u003c/p\u003e \u003cp\u003e Ethics: Ethical approval was obtained from the Institutional Ethics Committee Vinayaka Mission\u0026rsquo;s Medical College and Hospital, Karaikal, Puducherry, India via, approval number IEC/VMMCH/2024/APR/75\u003c/p\u003e \u003cp\u003e All methods were carried out in accordance with relevant institutional guidelines and regulations.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eQuantitative findings: A total of 292 women participated in the study, including medical (n=148), nursing (n=92), and allied health students (n=52). The mean age of participants was 20.76 \u0026plusmn; 2.7 years, with medical students being slightly older (22 \u0026plusmn; 3 years) compared to nursing (20 \u0026plusmn; 1 years) and allied students (19 \u0026plusmn; 1 years).\u003c/p\u003e\n\u003cp\u003eMost participants were undergraduates (94.86%), with only 5.14% enrolled in postgraduate programs. The majority were unmarried (97.95%). Nuclear families were predominant (85.62%) across all groups \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding residential status, 66.78% were day-scholars, while 33.22% were hostel residents. The most commonly used menstrual product was sanitary napkins (93.49%), followed by cloth pads (4.11%) and menstrual cups (1.71%). Awareness of menstrual cups was high (74.32%), but only 1.71% had ever used one, and current use was reported by just 2.74% of participants \u0026nbsp; No inferential statistical associations were conducted, as the quantitative component was descriptive.\u003cbr\u003e\u0026nbsp;\u003cbr\u003eQualitative findings: Seven themes emerged ; fear and discomfort, lack of knowledge and awareness, familial and societal influence, accessibility and practical barriers, preference for familiar products, reasons for acceptance, and reasons for discontinuation. Integration showed that emotional and contextual factors, non-awareness, determined behaviour.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 577px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable.1 Descriptive Statistics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCourse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedical\u003cbr\u003e\u0026nbsp;(n=148)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNursing\u003cbr\u003e\u0026nbsp;(n=92)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAllied\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=52)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=292)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (mean (SD))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e22 (\u0026plusmn;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e20(\u0026plusmn;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e19 (\u0026plusmn;1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e20.76 (\u0026plusmn;2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e133 (89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e92 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e52 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e277 (94.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003ePostgraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e15 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e15 (5.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e6 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e6 (2.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e142 (95.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e92 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e52 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e286 (97.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Family\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eJoint-Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e23 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e15 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e42 (14.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eNuclear Family\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e125 (84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e77 (83.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e48 (92.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e250 (85.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent Residential Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eDay-Scholar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e87 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e70 (76.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e38 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e195 (66.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eHosteler\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e61 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e22 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e14 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e97 33.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreferred Sanitary product\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eSanitary Napkin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e137 (92.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e87 (94.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e49 (94.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e273 (93.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eTampon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 \u0026nbsp; \u0026nbsp; (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1 (0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eCloth Pad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e4 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e5 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e12 (4.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eMenstrual Cup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e5 (3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e5 (1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you heard about menstrual cup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e125 (84.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e59 (64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e33 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e217 (74.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e22 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e33 (35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e19 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e75 (25.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you used menstrual cup\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e17 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e3 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e21 (7.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e131 (88.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e89 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e51 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e271 (92.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAre you currently using menstrual cup\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e7 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e8 (2.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e141 (95.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e92 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e51 (98.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e284 (97.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"693\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 693px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2 : Reason for not opting to use menstrual cup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eTHEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSUB THEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVERBATIM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eFear and discomfort\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eFear of Pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVerbatim 1.1.1\u0026ldquo; I feel it will be painful\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 1.1.2 \u0026ldquo;Iam scared that the process of insertion will be painful\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eFear of bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVerbatim 1.2.1 \u0026ldquo;I have a fear that insertion of a menstrual cup will lead to more bleeding\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eFear of leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVerbatim 1.3.1 \u0026ldquo;I fear that blood will leak out of the cup\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 161px;\"\u003e\n \u003cp\u003eGeneral Discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVerbatim 1.4.1 \u0026ldquo;I think it will be uncomfortable to use\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eLack of knowledge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eLack of knowledge about the usage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVerbatim 2.1.1 \u0026ldquo;I don\u0026rsquo;t know how to use the product well\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eFear of losing virginity\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Hymenal tear)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVerbatim 3.1.1 \u0026ldquo;Im scared I will lose my virginity\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 3.1.2 \u0026ldquo;I fear it will be painful and will damage my hymen\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eFamilial and Societal influence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eFamilial disapproval\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVerbatim\u0026nbsp;4.1.1 \u0026ldquo;My family members do not allow me to buy anything else apart from sanitary napkins\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 4.1.2 \u0026ldquo;My mother does not allow me to use menstrual cup\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVerbatim 4.1.3. \u0026ldquo;My parents done think menstrual cups are safe to use\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eAccessibility\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eand practicality\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 374px;\"\u003e\n \u003cp\u003eVerbatim 5.1.1 \u0026ldquo;Menstrual cups aren\u0026rsquo;t available readily at the local shops\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVerbatim 5.1.2 \u0026ldquo;It is difficult to use on a daily basis\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"688\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 688px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3 :\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eReasons for choosing preferred hygiene products\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eTHEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eSUB THEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVERBATIM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eFamiliarity and Habit\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003elong term use\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim\u0026nbsp;1.1.1\u0026ldquo; I have been using sanitary pads since the beginning\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003efamily influence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim\u0026nbsp;1.2.1 \u0026ldquo;My mother has taught me to use sanitary pads ever since I started getting periods\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 1.2.2 \u0026ldquo;Everybody in my family uses sanitary pads\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eComfort and Convenience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eEase of use\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim 2.1.1 \u0026ldquo; It is comfortable and easy to use \u0026ldquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eAvailability\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim 2.2.1 \u0026ldquo;It is easily available in all stores (Sanitary pads )\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eLack of side effects\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim 2.3.1 \u0026ldquo;Sanitary pads don\u0026rsquo;t have any side effects\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eReluctance to change\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim 2.4.1 \u0026ldquo;Iam comfortable with what I use and Iam unwilling to change to any other sanitary product\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eEffectiveness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eGeneral effectivity of the product\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim 3.1.1 \u0026ldquo;Sanitary pads have good flow retention\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVerbatim 3.2.1 \u0026ldquo;They absorb really well\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 3.3.1 \u0026ldquo;Cotton pads are re-usable and don\u0026rsquo;t give rashes\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eLack of Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eLimited knowledge about alternative menstrual hygiene products\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim 4.1.1 \u0026ldquo;Iam unaware of any other sanitary product\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 4.2.1 \u0026ldquo;I only know about sanitary pads\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eAffordability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eCost considerations\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eVerbatim 5.1.1 \u0026ldquo;Cloth pads are cheap and can be re-used\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVerbatim 5.2.1 \u0026ldquo;They are budget friendly\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"699\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 699px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 4 :\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eReasons for rejecting menstrual cups post-Demonstration\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eTHEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSUB THEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eVERBATIM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eFear and Discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFear of insertion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eVerbatim 1.1.1 \u0026ldquo;Iam not comfortable with the idea of insertion\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVerbatim 1.1.2 \u0026ldquo;I don\u0026rsquo;t like the idea of insertion\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFear of pain\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eVerbatim 1.2.1 \u0026ldquo;It sounds painful\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 1.2.2 \u0026ldquo;I think the insertion will be painful\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eFear of Injury\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eVerbatim 1.3.1 \u0026ldquo;I have a feeling I\u0026rsquo;ll end up injuring myself\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eSkepticism and Mistrust\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDoubts about effectiveness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eVerbatim 2.1.1 \u0026ldquo;I feel like it would fall out\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eHygiene concerns\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eVerbatim 2.2.1 \u0026ldquo;I idea of re-using is not impressive\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDifficulty in disposal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eVerbatim 3.1.1 \u0026ldquo;The disposal of the contents seem like a hassle\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eComfortable with existing methods\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003ePreference for already using product\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 387px;\"\u003e\n \u003cp\u003eVerbatim 4.1.1 \u0026ldquo;I\u0026nbsp;am comfortable with sanitary napkins\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 4.1.2 \u0026ldquo;I find sanitary napkins more comfortable\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"699\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 699px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5 :\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eReasons for using menstrual cup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTHEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSUB THEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVERBATIM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePractical Benefits\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eCost effectiveness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 1.1.1 \u0026ldquo;Menstrual cups are cost effective, during heavy flow you have to change only once per day\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 1.1.2 \u0026ldquo;It lasts longer and is economical in the longer run\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eLeakage Control\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 1.2.1 \u0026ldquo;I was having troubles with leakage and menstrual cups contain the leakage well\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVerbatim 1.2.2 \u0026ldquo;I wanted to stop staining my clothes\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eTravel and mobility\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 1.3.1 \u0026ldquo;It is helpful in long journey where changing facility is not available\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVerbatim 1.3.2 \u0026ldquo;It is useful in long hours of work without access to washrooms\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHealth and hygiene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 2.1 \u0026ldquo;It is comfortable and eco-friendly\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 2.2 \u0026ldquo;Sanitary pads cause rashes, whereas menstrual cups do not\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eEnvironmental Awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 3.1 \u0026ldquo;To reduce plastic waste from disposable pads\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 3.2 \u0026ldquo;It is an environmental friendly option- less waste is generated\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCuriosity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eExperimentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 4.1.1 \u0026ldquo;I was curious to try on a new product\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 4.1.2 \u0026ldquo;I heard about it from everyone and wanted to try it\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eDesire to switch\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 4.2.1 \u0026ldquo;I wanted to try a new hygienic product\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eInfluence of others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003ePeer influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 5.1.1 \u0026ldquo;My friend recommended using it\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eSocial media influence\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eVerbatim 5.2.1 \u0026ldquo;I saw influencers using it on social media\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 690px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTables 6 :\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eReasons for Discontinuing menstrual cups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eTHEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSUB THEME\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVERBATIM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003ePhysical discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePain during insertion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVerbatim 1.1.1 \u0026ldquo;I was unable to insert it at times due to pain during insertion\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003epain during removal and inability to smoothly remove\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVerbatim 1.2.1 \u0026ldquo;Had a bad experience when I tried to remove it\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eVerbatim 1.2.2 \u0026ldquo;It got stuck while I tried to remove it, it was a scary experience\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eInconvenience of usage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eInconvenient environment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVerbatim 2.1.1 \u0026ldquo;It is not convenient to use in a college environment\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVerbatim 2.1.2 \u0026ldquo;Disposal is difficult during unavailability of adequate washroom facilities\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eInconvenient re-usal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVerbatim 2.2.1 \u0026ldquo;It is difficult to boil and wash while living in hostel\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eFear and Anxiety\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eFear of leakage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVerbatim 3.1.1 \u0026ldquo;There is fear of overflow, and wrong insertion technique\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eanxiety about incorrect usage\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eVerbatim 3.2.1 \u0026ldquo;Wrong insertion technique can lead to harm hence I stopped using it\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis mixed-methods study among women aged 18\u0026ndash;49 years enrolled in medical, nursing and allied health courses at a tertiary-care institute in Karaikal analysed the menstrual hygiene practices and factors influencing usage of menstrual cups and the reasons for hesitancy in the same. Quantitative findings showed that, their menstrual hygiene practices remained strongly oriented towards conventional sanitary pads, with more than 93.49% reporting pad use and only 1.71% having ever used a menstrual cup; current use was as low as 2.74%. Despite relatively high awareness of menstrual cups (74.3%), adoption remained low, suggesting a substantial gap between awareness and actual behaviour. The qualitative findings helped explain why awareness did not translate into use. Many participants described worries about pain, inserting or removing the cup, bleeding, leakage, and possible damage to the hymen. Several also felt they did not have enough practical guidance on how to use a cup confidently. In addition, family restrictions, discomfort discussing menstrual products at home, and concerns about privacy and washing facilities in hostels and college settings made adoption even more difficult. At the same time, those who had tried or continued using menstrual cups reported clear advantages, including lower long-term cost, better control over leakage, convenience during travel or long working hours, improved comfort, and reduced waste. These contrasting experiences highlight that strong fears and hesitation can exist alongside an understanding of the potential benefits, which may explain why many students remain unsure about switching to menstrual cups despite being aware of them.\u003c/p\u003e \u003cp\u003eThe findings of this study are consistent with earlier research from India showing a persistent gap between awareness and actual menstrual cup use; however, the current study advances existing evidence in several important ways. Previous studies among medical students in Mysuru reported high awareness (98%) but low usage (6.47%), yet were limited to quantitative assessment and could not explain the underlying reasons for hesitation (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Similarly, the North Indian study from AIIMS Bathinda identified extremely low usage (1.2%) and highlighted inadequate knowledge as the predominant barrier, but the absence of qualitative inquiry restricted understanding of how fears, norms, and social influences shaped behaviour (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In contrast, the present study not only documents a comparable awareness use gap (74.3% vs. 2.7%) but addresses this unanswered question by integrating qualitative findings from the same participants, enabling explanation rather than description. While evidence from Kerala suggests that acceptance improves after counselling (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), existing studies focus on post-intervention or healthcare-professional groups. The current research fills a critical gap by examining pre-adoption perceptions among young women in training, representing a population positioned to influence future menstrual health norms. Additionally, unlike national-level commentaries that emphasize policy-level barriers (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), this study identifies modifiable barriers at the individual and institutional levels, offering actionable insights for early-stage intervention before behaviour is formed.\u003c/p\u003e \u003cp\u003eThe persistence of low menstrual cup adoption despite adequate awareness in this study highlights the complex interaction between knowledge, cultural embodiment, and perceived bodily vulnerability among young women in training. The qualitative themes suggest that decision-making around menstrual products is not merely informational, but rooted in notions of bodily integrity, sexuality, and social acceptability\u003c/p\u003e \u003cp\u003eThese findings indicate that normalizing menstrual cup usage was difficult to achieve, just through information and awareness. Cognitive awareness does not override emotional, relational, and socio-cultural discomfort. The coexistence of apprehension and recognition of benefits observed in this study reflects an \u0026ldquo;ambivalence threshold,\u0026rdquo; where participants acknowledge advantages yet remain unwilling to transition due to perceived risk, stigma, and institutional constraints such as hostel facilities.\u003c/p\u003e \u003cp\u003e The relatively large sample size (n\u0026thinsp;=\u0026thinsp;292) and focus on medical, nursing, and allied health students further enhance the relevance of findings, as this group represents future healthcare providers capable of influencing menstrual health norms and counselling practices. The qualitative component adds depth by identifying previously under-represented determinants such as parental restriction, hymenal anxiety, and hostel-based feasibility concerns. There are limitations to this study as it is a single-centre study, and chance of recall and social desirability biases are there. We have made efforts like maintaining privacy during interviews and assuring anonymity to reduce biases. Despite these limitations, the mixed-methods approach will make this study as a meaningful contribution to understanding menstrual cup acceptability in Indian women.\u003c/p\u003e \u003cp\u003eThe findings of this study indicate that improving menstrual cup acceptability will require a multi-level approach rather than isolated awareness efforts. At the individual level, interventions should focus on confidence-building through demonstration-based training, peer support, and opportunities for supervised familiarization, particularly for first-time users who experience anxiety related to insertion and bodily harm. At the institutional level, colleges and hostels may play a critical enabling role by ensuring access to private washing facilities and integrating menstrual product counselling into student orientation and health services. For families and communities, engagement strategies addressing parental concerns and sociocultural misconceptions may help reduce restrictions experienced by unmarried young women. At the broader public-health level, menstrual cup messaging should shift towards behaviour-change approaches that normalize reusable products, highlight safety and sustainability, and provide pathways for trial without financial burden. Targeting participants in this study also have downstream benefits, as increasing comfort and competence within this group can translate into future clinical advocacy and more informed menstrual health counselling.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that there is awareness of menstrual cups, but minimal usage among participants, with hesitancy driven by fear, limited practical knowledge, and social constraints. Addressing these barriers requires confidence-building interventions and supportive institutional environments in addition to information. Improving acceptance in this group may enhance future clinical counselling and public-health messaging in India.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICAL APPROVAL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Ethics Committee\u0026nbsp;Vinayaka Mission’s Medical College and Hospital, Karaikal, Puducherry, India\u0026nbsp;via, approval number IEC/VMMCH/2024/APR/75\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants prior to their inclusion in the study. Participation was voluntary, and responses were collected anonymously.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCLINICAL TRIAL REGISTRATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial number: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT TO PUBLISH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConsent to publish: We give our consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSharma R, Patel A. Menstrual hygiene initiatives in India: policy perspectives and program implementation. J Public Health Policy. 2022;43(2):245\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYousuf A. Understanding menstruation and infections: a comprehensive review. EuroSci J Technol Innov. 2025;1(1):27\u0026ndash;9. ࿼.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Thakkar MB, et al. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health. 2019;4(8):e376\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhanyashree DV. Exploring the diverse menstrual product options and raising awareness about the menstrual cup: an observational study. J South Asian Feder Obst Gynae. 2025;17(4):511\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5005/jp-journals-10006-2640 ࿼\u003c/span\u003e\u003cspan address=\"10.5005/jp-journals-10006-2640 ࿼\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRavali P, et al. Knowledge and practices regarding menstrual cups among medical students in Mysuru. Indian J Community Med. 2023;48(3):215\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBindal P, et al. Awareness and acceptability of menstrual cups among reproductive-age women in North India. Int J Reprod Contracept Obstet Gynecol. 2024;13(1):45\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBehera S, et al. Sustainable menstrual-health strategies in India: opportunities and challenges. J Family Med Prim Care. 2024;13(2):112\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"menstrual cup, awareness, acceptability, mixed-methods, medical and nursing students, India","lastPublishedDoi":"10.21203/rs.3.rs-9050891/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9050891/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Sanitary napkins are the primary menstrual product being used in India. They are single use and despite the availability of sustainable alternatives like menstrual cups, napkins use remains the more popular choice. The shift in usage to more sustainable menstrual product not just comes with awareness but also the preparedness of future healthcare providers who influence menstrual-health counselling. Evidence on their perceptions remains limited.\u003cbr\u003e\n \u003cstrong\u003eMethods\u003c/strong\u003e: A cross-sectional mixed-methods study was conducted among 292 women aged 18–49 years enrolled in medical, nursing and allied health programs at a tertiary-care institute in Karaikal (November 2023–May 2024). Quantitative data were collected using a semi-structured questionnaire via EpiCollect5 and analysed descriptively using SPSS. Qualitative data were obtained through open-ended interviews with the same participants and analysed using thematic analysis. Findings were integrated during interpretation.\u003cbr\u003e\n\u003cstrong\u003eResults:\u003c/strong\u003e Sanitary pads were used by 93.49% of participants, while only 1.71% had ever used a menstrual cup and 2.74% were current users despite 74.32% awareness. No inferential statistical analyses were conducted. Qualitative analysis identified seven themes: fear and discomfort; lack of knowledge; familial and societal disapproval; accessibility and hygiene challenges; preference for familiar products; reasons for acceptance; and reasons for discontinuation. Integration revealed that awareness alone did not translate into adoption due to emotional, cultural and practical barriers.\u003cbr\u003e\n \u003cstrong\u003eConclusion\u003c/strong\u003e: The low level of usage of menstrual cup amongst healthcare workers reflects the gap between awareness and the actual practiced behaviour which is driven by fear, misinformation and contextual constraints. More of Informational campaigns are required to bring about the behaviour change, demonstration based training and supportive institutional infrastructure will also help in improving.\u003c/p\u003e","manuscriptTitle":"Hesitancy on usage of menstrual cup in college going students a cross-sectional mixed method study in Karaikal region of Puducherry","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-27 11:40:48","doi":"10.21203/rs.3.rs-9050891/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"88681217721316555973424245207552724494","date":"2026-05-17T08:27:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209271197000326494612087199970457948496","date":"2026-05-16T11:36:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84002747118752395084647225257479443241","date":"2026-05-13T23:20:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206636059072808550738070356637947029234","date":"2026-04-22T23:51:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T06:52:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"14878979512432295534926812935025446558","date":"2026-04-21T03:20:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-17T17:03:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-23T05:13:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-17T00:25:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-14T06:11:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-03-13T17:12:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b652ea72-8711-44ee-a2df-ae134eb1b840","owner":[],"postedDate":"April 27th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"88681217721316555973424245207552724494","date":"2026-05-17T08:27:44+00:00","index":84,"fulltext":""},{"type":"reviewerAgreed","content":"209271197000326494612087199970457948496","date":"2026-05-16T11:36:20+00:00","index":83,"fulltext":""},{"type":"reviewerAgreed","content":"84002747118752395084647225257479443241","date":"2026-05-13T23:20:20+00:00","index":82,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T11:40:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-27 11:40:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9050891","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9050891","identity":"rs-9050891","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}