Okay now everyone's asking about the public restroom thing (really, why am I writing about this again?).
Anyhow, you have a few options (also remember that you can actually keep these things in way longer than normal pads and tampons - I will often go a full 8 hours - and this will usually allow you to just avoid public restrooms).
But, if you have to change one (aka, dump and replace) one in the restroom you have a few options:
-the lazy option: dump, blot w/ some toilet paper, and replace. Probably not the best/most hygienic option, but I've been known to do it. -smart: go into the restroom, grab a wet paper towel, and wipe it down. -incredibly on top of things: either carry one of those small packs of disposable wipes (for babies), or they even make wipes specifically for these things that you carry around... the last kind of strikes me as a waste of money, but if you're super paranoid it's the thing to do.
In general, when you want to actually sterilize the thing you just stick it in boiling water for about 5 minutes.
Some people have issues with having to reach up inside to get it... I guess my response to that is to just think about what it is that you're actually touching. There's really nothing gross or bad; it's basically some mucous and some blood - nothing toxic. Personally, I'd rather get some blood on my hands (which I can then easily get off) than bleached cotton stuck inside me. Also, after you've been using one for a little while you'll probably get good enough at usinu it that you can actually avoid getting much of anything on your hands.