Tussle Over Tampons

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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public health campaign outlining proper tampon use, dramatically
reduced the number of confirmed cases of TSS from a high of 814 in
1980 to just 5 in 1997.

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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