In the EU alone, women spend more than $5 billion a year buying around 45 billion sanitary napkins, tampons and panty liners (glamorously known in the trade as ‘san pro’ products) each year. In the US the figure is around $3 billion.
Sanitary products –and tampons in particular – are also the subject of endless urban myths. The most persistent among these is the idea that manufacturers put chemicals in them to produce heavier bleeding. It seems unlikely and, in any case, because the ‘ingredients’ in tampons (including the basic fibres they are made from) are rarely, if ever, listed on the box and few manufacturers volunteer this information, we may never know.
What is true is that even in this specialised part of the global marketplace, the words ‘new’ and ‘improved’ are used to drive sales. And while it may seem that there is a limit to what can be done to radically revamp a fibre plug that you insert into your vagina, never underestimate the desperation of product manufacturers.
Tampax, for example, owned by Procter & Gamble and the global brand leader with around 30 per cent of all sales, has recently introduced a new shape of tampon with a ‘skirt’ – a fibre frill at one end – which it says prevents leaks. There are odour-absorbing tampons, perfumed tampons, ‘digital’ tampons (non-applicator types that you insert with a finger) and applicator types that use sheaths of cardboard, plastic or plastic-coated cardboard to make insertion easier. Manufacturers are also continually experimenting with new fibres or materials for increased comfort and performance.
This is nothing new. As Pulitzer Prizewinning author Laurie Garrett noted in her book The Coming Plague (Penguin, 1995), over the years manufacturers have mixed a variety of fibres with cotton to improve absorbency and maintain the tampon’s shape inside the body. These include polyester, collagen, acetyl cellulose, carboxymethyl cellulose, polyvinyl alcohol, polyurethane – and even asbestos.
It was this race to perfect the superabsorbent tampon that eventually led to the link between tampon use and Toxic Shock Syndrome (TSS), since super-absorbent tampons provided an ideal breeding ground for the Staphylococcus aureus bacterium that causes TSS.
TSS is a severe, potentially fatal infection of the blood caused by a toxin called TSST-1, which is produced by the otherwise benign Staphylococcus bacterium. This bacterium is naturally present in the warm moist parts of the human body, including the vagina, and most of the time causes no harm. But sometimes the S. aureus gets converted into the TSST-1 toxin. The vast majority of TSS cases are linked to tampon use, especially in women under 25.
Super-absorbent tampons don’t just provide a useful petri dish for this conversion. They also dry out the vagina, leading to lacerations, lesion and ulcerations when they are removed. They also leave small fibres behind that can irritate the delicate mucous membrane inside the vagina. These ulcerations and irritations provide entry points for opportunistic bacteria. The Women’s Environmental Network (www.wen.org.uk) has gathered data showing that up to three-quarters of all tampon users have some alteration to the mucous membrane of the vagina.
Symptoms of TSS include fever, rash, nausea, vomiting and hypotension during or a few days after the menstrual cycle. Rarely, it can lead to death. With tampon fibre retention, a woman may experience intermittent bleeding, headaches, fever, abdominal pain and purulent vaginal discharge, but not until a week or more after her period.
Critics of tampons also point out that most are made from cotton and rayon that is bleached white. Rayon, a synthetic fibre derived from cellulose, is also potentially dangerous because the process of extracting cellulose from wood pulp involves the use of chlorinated compounds and creates the hydrocarbon dioxin as a by-product, minute remnants of which remain in the fibre. Potentially carcinogenic, dioxin is believed to cause endometriosis. It has also been shown to cause problems with the immune and reproductive systems.
Tampon marketers are quick to note that the amount of dioxin in their products is next to nothing. A Food and Drug Administration study in the US, for instance, concluded that the dioxin level in a typical tampon is about one part in 3 trillion, a level comparable to a teaspoon in a large lake. This may be so but it is also misleading, since a teaspoon of dioxin is enough to kill thousands of people, and women, of course, use many tampons over a lifetime. Dioxins are persistent and once in the body they remain there indefinitely, building up with each new exposure.
Some of the smaller suppliers have begun offering tampons that do not contain rayon (which, being naturally brown, requires more bleach than cotton) or tampons that are unbleached. Equally, some manufacturers are switching bleaching processes away from the chlorine process that potentially leaves dioxin residues on the fibres.
Some tampons contain preservatives such as parabens, which are oestrogenic and are implicated in higher rates of oestrogen- dependent cancers, for instance of the breast and ovary. Others contain perfume or are in applicators that are perfumed. The ingredients of perfume are neurotoxins and have no place anywhere near the vagina, where they are easily absorbed. Any chemical that comes into contact with the delicate skin of the vulva can cause irritation and itching. If you suffer from persistent vulval itching it could simply be your choice of sanitary products.
It’s not just the tampon itself that is the subject of innovation, however. Packaging is constantly being updated. Thus, not long ago Tampax introduced a compact tampon packaged in such brightly coloured, scented plastic wrapping that – according to its TV advertising – your dolt of a boyfriend will think it is a sweetie. In the US, retailers are focusing on making the feminine hygiene aisle of the supermarket more intimate, so that women will feel ‘comfortable’ spending longer there making their purchasing decisions.
Apart from the health issues, there are also environmental concerns associated with tampons. Tampons can easily be inserted with a finger, yet nevertheless many come with applicators made from a variety of materials, including plastic. Simply by using a nonapplicator tampon you can be doing your bit to reduce waste. A woman who uses tampons is estimated to go through nearly 10,000 in her lifetime. The thousands of applicators disposed of every day contribute to over-clogged landfills and blockage problems at some municipal sewage treatment plants. Plastic applicators can take six months or more to biodegrade.
Finally, even if you do use an all-cotton tampon, it is as well to be aware of the increasing proliferation of GM cotton in the marketplace. Dr Ilya Sandra Perlingieri, author of The Uterine Crisis (1st Books, 2003), believes that more and more tampon manufacturers are using genetically modified cotton, which resists the effects of antibiotics. This is important since the rate of sexually transmitted diseases is on the rise. Bacteria exposed to GM cotton may inherit that resistance to antibiotics, making STDs increasingly difficult to treat. As with food, so with tampons; the best way to avoid this problem is to source tampons made from organic cotton.
Try this at home
If you want to know if your brand of tampon leaves fibres behind, try this. Take a glass of warm water and put a tampon in it. Keep the tampon in the glass for the same amount of time you would normally leave a tampon inside of your vagina. After you remove it from the glass you’ll be able to see the fibre loss from your tampon.
Most tampon manufacturers offer their products in a range of absorbencies. Women should always use the lowest absorbency they can and change tampons frequently. It is also a good idea to consider other types of protection, especially at night, such as pads.
Generally speaking, the vagina is a self-cleaning organ. Its basic physiology plus gravity mean that bodily secretions and blood are meant to flow down and out. Depending on a variety of factors, such as your general level of health and hygiene, anything that you put in your vagina for a long time will raise the risk of infection. Thus, if you are worried about any potential health effect of using tampons, pads should be your first-line alternative.
Disposable pads do have environmental implications, however. Often they have plastic backing and are laced with perfumes and odour neutralisers, and may even have a rayon content. Disposing of conventional pads adds to the accumulation of waste, so when choosing look for those that are organic (thus GM-free) and made to be quickly biodegradeable. Natracare provides a full range of organic feminine hygiene products including tampons and pads (www.natracare.com).
Preferably made from organic and unbleached cotton, these are highly absorbent and can be washed with your usual clothes instead of being thrown away. Look for brands like Drapers (www.drapersorganiccotton.co.uk) and Wemoon (www.treehuggermums.co.uk).
Menstrual cups are small laytex or silicone cups that fit inside the vagina. The cup can store menstrual fluid for up to 12 hours, though like a tampon it is wise to take it out after a few hours out and rinse it thoroughly before reinserting. Unlike traditional disposable feminine hygiene products, menstrual cups have a lifeexpectancy of 10 years. See www.mooncup. co.uk and www.thekeeperstore.com
These relatively new products work like tampons but are made from sea sponge. There are environmental implications to farming sea sponges and, like tampons, because they are left in the vagina the risk of bacterial growth is likely to be higher. See www. seapearls.
This article first appeared in the Ecologist November 2007