Pity the poor tampon. For the first half-century of its history, the humble wad of absorbent fiber enjoyed a reputation for reliability. Some even heralded tampons as the great emancipator, the answer to women’s dreams of independence and autonomy.
Then came the 1980s and concern about toxic shock syndrome (TSS). Researchers found that highly absorbent tampons, if infrequently changed, could lead to a vaginal infection caused by staphylococcus bacteria. What’s more, in rare cases, bacterial toxins could suddenly overwhelm the victim, causing severe illness and even death. Modifications in tampon design and product labeling, combined with a vigorous
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Then in the late 1990s, rumors about tampon safety began making the rounds on the Internet. Critics accused tampon manufacturers of adding asbestos to their product to encourage excessive menstrual bleeding and raised concerns that tampons contained dioxin, a known carcinogen that was said to be generated by the chemical process for bleaching tampon materials.
Eager to quell the alarm over tampon safety, manufacturers launched an aggressive public relations campaign designed to allay consumer fears. Testing confirmed that asbestos is not an ingredient or even a trace contaminant in any brand of tampon manufactured in the United States. The FDA also dismissed dioxin concerns, stating that 'cellulose used in U.S. tampons is now produced using elemental chlorine-free bleaching processes that produce no dioxin.'
But not all environmental and women’s health activists are convinced that chlorine-free bleaching eliminates dioxin concerns. In E Magazine (March/April 2001), Jennifer Bogo questions whether elemental chlorine-free bleaching is truly safe. 'Even the Food and Drug Administration acknowledges that chlorine dioxide, though [it is] elementally chlorine free, can still ‘theoretically generate dioxins at extremely low levels,’ ' she writes, 'and according to the Environmental Protection Agency, no safe level for dioxin exposure exists.'
In response to dioxin fears, a number of smaller companies, including Natracare and Organic Essentials, began producing unbleached-cotton tampons. And a growing number of women are questioning the ultimate value of tampons. The zine Femmenstruation Rites Rag gathers stories about and tips for celebrating menses. In issue #4, Karen F. writes, 'For quite a few years now, I have chosen not to cram tampons up inside my body. I never thought it was a wise thing to do, especially after that Toxic Shock scare of the early ’80s. . . . And now they’re finding dioxins & carcinogens in the lily-white bleached tampons they think we require. So I say—use big, bulky pads from a health-food store—or choose to bleed freely, ’coz that’s OK too!'
Yet many women may dismiss Karen F.’s advice. Tampons are still the most popular form of menstrual protection in the United States, and manufacturers continue to introduce new products into the market. One development particularly concerns Dr. Philip Tierno, director of clinical microbiology and diagnostic immunology at New York University Medical Center.
Increases in tampon absorbency may lead to another increase in the number of cases of TSS, Tierno warns. The FDA has approved a new classification for tampons with absorbency levels of 15 to 18 grams. The new high-absorbency tampons will be labeled 'ultra,' one step up from 'super plus,' which holds no more than 15 grams of fluid. Though most earlier cases of TSS were linked to a woman’s use of certain high-absorbency tampons made of carboxymethylcellulose, polyacrylate rayon, and polyester, three ingredients that were determined unsafe and are no longer used in tampons made in the United States, Tierno is still concerned that the new product labeling may spark a round of the sometimes deadly disease.
In the U.S., Tampons are now made of cotton, viscous rayon, or a combination of the two. In order to absorb large volumes of liquid, tampons must contain viscous rayon. Tierno remains concerned about the safety of the fiber. ('It’s the least bad of the bad ingredients,' he says, 'but it’s still not great.') He also believes that the higher a tampon’s absorbency, the greater the possibility of toxin development. Tierno—as well as tampon manufacturers —recommend that women use the lightest absorbency possible for their menstrual flow. They also recommend that women change their tampons frequently. Ultra tampons are too absorbent, Tierno cautions, and run the risk of misuse.
'As Yogi Berra famously said, it’s déjà vu all over again,' Tierno remarks. 'In the various epidemiologic studies that were published in the late 1970s to the early 1980s, it was made clear that absorbency is one of the key factors as to why toxin is amplified. Fifteen to eighteen grams of fluid is just too much.'
But such thinking assumes that women will use ultra tampons irresponsibly, says Dr. Jay Gooch, senior scientist for Procter & Gamble, the nation’s largest manufacturer of feminine hygiene products. 'The ultra tampon is currently marketed in Canada and other places around the globe,' he says. 'The FDA’s conclusion is that ultra tampons can be used safely as directed,' he adds.
Amy Allina, program director of the National Women’s Health Network, says that while renewed concerns about TSS are justified, she is convinced that public health campaigns educating women about safe tampon use have been effective. The introduction of ultra tampons was a direct response to consumer demand, she adds.
'We certainly believe that the labeling changes and the standardization of the absorption rates were an important step forward for women’s health,' Allina says. 'We think it’s important for women to have information about all aspects of tampon safety and then make choices for themselves.'
Perhaps in response to flagging U.S. sales (Tampax, for instance, was down 4 percent last year), Procter & Gamble has stepped up its worldwide marketing efforts. In Mexico and Venezuela, where tampon use is often taboo, the company has created special awareness campaigns, featuring 'bonding sessions' designed to introduce potential consumers to tampons.
While Allina praises any effort that expands women’s ability to make informed health care decisions, she is concerned that foreign manufacturers won’t be held to the same regulatory standards as they are in the United States.
'Never underestimate the capacity of the advertising industry to sell a product,' she says. 'I suspect they will find ways to be successful in [foreign] markets. If that’s the case, I hope we can count on companies to learn from our mistakes and be responsible in the manufacturing and labeling of tampons. If companies do not follow a responsible course of action, they could pose a serious health risk to women.'
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