Initial insights into the menstrual disc and considerations for implementation among female sex workers in Kenya

BackgroundFemale sex workers (FSWs) in Kenya face high risks of sexually transmitted infections, violence, and economic insecurity, and often continue sex work for livelihood during menstruation despite limited safe and hygienic menstrual management options. Menstrual cups that can be worn during sex (also known as menstrual discs) may offer a discreet solution to improving menstrual health and hygiene (MHH) and reducing health risks from harmful practices.ObjectiveTo explore FSWs' initial perceptions of menstrual discs, anticipated barriers to use, and their potential impacts on livelihood and client interactions prior to receiving and testing them.DesignQualitative descriptive study.MethodsBetween June and September 2023 seven focus group discussions (FGDs) among 57 FSWs were conducted in Kisumu, western Kenya. During each session, a menstrual disc was passed around for inspection and handling. Discussions were audio-recorded, transcribed, and analysed using thematic analysis to identify key themes.ResultsMost participants had no prior experience with menstrual discs. Initial concerns included disc displacement or leakage during sex, discomfort with insertion or removal, potential detection by clients, and challenges using discs while consuming alcohol. Despite these concerns, participants expressed strong interest in using menstrual discs, highlighting benefits such as discretion, reduced reliance on disposable products, decreased physical discomfort, and the ability to continue working during menses. Views on disclosing disc use to clients varied, with most preferring not to inform them. Effective implementation was anticipated to require education, peer-led demonstrations, and guidance to prevent sharing or theft. Inadequate water, sanitation, and hygiene (WASH) facilities at sex work venues were highlighted as a key barrier to safe use, particularly for street-based FSWs.ConclusionMenstrual discs designed for use during sex appear acceptable to FSWs and could support safer, more comfortable menstrual management while enabling continued sex work. These findings provide actionable insights for designing MHH interventions that address the unique needs of FSWs.