In 1936, Tampax Inc. began marketing the first commercially available tampon, heralding what the company referred to as “a day for womanhood” (Houppert, 1999). The alternative at the time was thick long menstrual pads that had to be held in place with a belt. Even though pads have since improved dramatically in size and function, tampons continue to remain immensely popular, capturing a large portion of the feminine protection market. Tampons provide a measure of convenience since they are compact and contained, but they also pose numerous health risks, some of which are not commonly known to women.

      Trace amounts of dioxin, an organochlorine produced in the chlorine bleaching of rayon, have been found in many national brands of tampons. Much of the literature on dioxin exposure from tampons is cautionary at best (Ballweg, 1998; Food and Drug Administration, 1999; Houppert, 1999; Meadows, M., 2000; Yannello, 1998;). The U.S. Food and Drug Administration (FDA) (1991) claims that due to recent changes in the bleaching process, dioxin content in tampons has been reduced so that the “ risk of adverse health effects is considered negligible” (pp.2-3). However, they concede that the source of the raw data used to reach this conclusion came from the tampon manufacturers themselves (p.4).

      Toxic shock syndrome (TSS), a life-threatening systemic infection, has also been associated with tampon use. In 1980, a sudden surge in menstrual-related TSS in American women caused the U.S. FDA to investigate the problem (Houppert, 1999; Farley, 1991). While the increase in TSS cases was attributed in part to the introduction of synthetic fibers in tampons, (particularly Proctor and Gamble’s “Rely” brand, which was subsequently taken off the market) it was also found to be increased by the use of high absorbency tampons in particular. Since a higher absorbency tampon can be worn longer, it can also increase the accumulation of staphylococcus aureus, a bacterium commonly found on the skin and mucous membranes of a healthy person. Staphylococcus aureus causes TSS when its unchecked proliferation results in high levels of toxins that gain entrance to the blood stream.

      A decade and an estimated 60,000 TSS cases later, the U.S. FDA introduced absorbency rating standards that all tampon manufacturers were required to adopt. The FDA also required that a written warning of TSS signs and risk factors be placed on tampon boxes or in their inserts, but declined to require ingredient listings (Houppert, 1999). Women have since been advised to chose tampons with the least absorbency possible and to change their tampons frequently to reduce the proliferation of TSS causing bacteria (U.S. FDA, 1999; Black, Hawks & Keene, 2001).

      While many women are aware of the risks of dioxin exposure and TSS associated with tampon use, many do not know that tampons can also cause microscopic tissue abrasions, compromising the vagina’s primary line of defense against pathogens. The U.S. FDA (1999) warns that vaginal dryness or ulceration may occur if women use tampons that are more absorbent than needed, or if they use them mid cycle to absorb vaginal discharge. Risa Denenberg (1997) further adds in her article HIV and the vaginal ecosystem, that inflammation caused by the mechanical trauma of tampon use can contribute to an increased susceptibility to infection-causing bacteria and to HIV. While frequent tampon changes may reduce the accumulation of staphylococcus aureus, the resulting tissue trauma could create a portal of entry to the bloodstream for viruses and bacteria, including staphylococcus aureus.

      Another fact about tampons not often considered is that along with menstrual flow, they also absorb the vaginal and cervical secretions that play a primary role in maintaining homeostasis and preventing infection. These epithelial secretions are high in glycogen, which is essential to the survival of normal vaginal flora, specifically lactobacilli. As suggested by the name, these bacteria produce lactic acid, which in turn maintains the low pH of the vagina. Denenberg (1997) explains that an acidic environment not only kills germs, but triggers squamous epithelial cells to cover and protect the fragile columnar cells of the cervical canal. Exposed columnar epithelial cells, known as cervical ectopy, have been associated with an increased risk of STD transmission, including HIV (p. 2). Blakeslee (as cited in Sheon, 2003) identifies that some strains of lactobacilli also produce hydrogen peroxide. This substance has been proven to be particularly toxic to the opportunistic bacteria and viruses that cause chlamydia, gonorrhea, syphilis, candidiasis and HIV infection. While tampons may neatly and conveniently soak up menstrual flow, they also soak up an important part of the vagina’s primary immune defense system.

      Lastly, many women are not aware that tampons can increase the incidence of yeast infections. Just as the acidic environment of the vagina wards off outside invaders, so too does it keep the growth of resident organisms in check, namely candidas albicans, the fungi responsible for yeast infections. During menstruation, the vagina is at its most alkaline state due to the release of estrogen. As well, the vaginal mucosal lining is more thin and vulnerable. Maintaining vaginal ecology at this time is a delicate balance that can easily be tipped. Factors that may disturb this balance include antibiotics, steroids, oral contraceptive pills, menopause or pregnancy related hormonal changes, diabetes, immune system compromise, synthetic underwear, plastic lined menstrual pads, and tampons. Doctor Arasi Thangavelu-Veluswamy and her co-author, Devi Thangavelu (2002) agree that yeast infections may be brought on by a disruption in normal vaginal flora or by scratches caused by tampon insertion. Not surprisingly many women who use tampons and plastic-lined menstrual pads find that they are most prone to yeast infections just after their menstrual cycle.

      Not only are vaginal yeast infections highly unpleasant, causing mild to severe itching, watery to thick cottage cheese-like discharge, redness, swelling, pain and burning, but they can also be quite dangerous in some circumstances. Thangavelu-Veluswamy & Thangavelu (2002) claim that candidas albicans can cause “life-threatening systemic infections mostly in people with weakened immune defenses (such as women who are pregnant and people who are HIV positive, have diabetes, or are taking steroids)” (p.2). Arguably, women in these high-risk categories should avoid tampon use altogether.

      Luckily, there exists a very simple and time-tested solution for menstrual protection. Cloth menstrual pads, which have been around for millennia, are now available in slim modern designs and colorful stain-free fabrics. They are without a doubt the healthiest choice for menstrual protection because they carry none of the health risks associated with disposable pads or tampons. Being made of cotton, they are cooler and dryer than disposable pads or panty-liners. Since they’re reusable, they are more cost effective - and they’re environmentally responsible. In addition, many women report that after using cloth pads, they become more aware of their bodies, and more in tune with their menstrual cycle.

      Tampons offer convenience at a very high personal cost to women. Like all female mammals, women’s bodies are designed to expel their menses. It is simply not natural to retain this flow until convenience dictates its release. Instead of falling into the trap of out of sight–out of mind convenience, try turning to a natural alternative. Your body will thank you. Mother Earth will thank you!