Tampon Facts and Information About Tampon Usage in the United States about70% of the 73 million women are of menstruating age in the U.S. use tampons.

Lifetime tampon usage is about 11,400 (5 days X 5 tampons X 38 years). In the U.S., women between 11 and 60 years of age reported 216 cases of menstrual TSS reported in 1993; 244 cases in 1994. The risk of TSS is higher for women under 30 years old; 60% of patients are between15 and 24 years of age.

The fatality rate of TSS is 3% to 5%, but it is estimated that only 10% of cases of TSS are reported, as many women suffer only flu-like symptoms. Absorbency enhancers in tampons can cause peeling of the mucous membrane, vaginal dryness, ulcers, and lesions. Perfumes and fragrances in some tampons are reported to cause vaginal irritation, allergic reactions, and disruptions of a woman's microbial balance.

"Tampon users were demonstrated to be 18 times more likely to develop menstrual TSS as non-users", Infectious Diseases in Obstetrics & Gynaecology, 1993,Gilles R.G. Monif "of[Toxic Shock] cases occurring in menstruating women, up to 99% were using vaginal tampons", Obstetrics and Gynaecologic Infectious Disease, 1994,James McGregor and James Todd, (Chapter 21 – Toxic Shock Syndrome).

"Vaginal inflammation can result from rayon fibres from tampons becoming embedded in vaginal walls", Journal of Obstetrics and Gynaecology, 1980. Tampons made chiefly of rayon have some levels of dioxin.

"Rayon tampons amplify the growth of the Toxic Shock Syndrome bacteria TSST-1"American Society for Microbiology Journal, May 1994, Dr. Philip Tierno of NYUMedical Center.

Dioxin levels once thought acceptable are now reported to adversely affect the reproductive and immune systems, "A Health Assessment Document for Dioxin", published by the Environmental Protection Agency, 1996.

"Cotton tampons offer no protective advantage over cotton/rayon tampons with regard to protection from TSS" Journal of Infectious Diseases, October 1995 (study by Dept. of Microbiology, University of Minnesota.

Understanding Absorbency

Absorbency—the rate at which a tampon absorbs or soaks up menstrual blood–is measured in grams of fluid. Research suggests that the risk of toxic shock syndrome may increase with tampon absorbency. But that doesn't mean you have to steer clear of higher absorbency tampons completely, according to Colin Pollard, chief of FDA's obstetrics and gynecology branch. "You should match absorbency to your flow," he says. For a lighter flow, use regular or junior absorbency. If your tampon absorbs as much as it can and has to be changed before four hours, you may want to try a higher absorbency. There's usually less need for higher absorbency when your period is ending.

When you shop, you'll find these absorbency terms and ranges on all tampon packages:

1. Junior absorbency: 6 grams and under

2. Regular absorbency: 6 to 9 grams

3. Super absorbency: 9 to 12 grams

4. Super plus absorbency: 12 to 15 grams

According to the American College of Obstetricians and Gynecologists, your tampon is probably too absorbent if the tampon is hard to remove, you experience vaginal dryness, if a tampon shreds, or if it doesn't need to be changed after several hours. Vaginal dryness and ulcerations may occur when a tampon is too absorbent for your flow.

Tips to Avoid Tampon Trouble

The strategy had worked for years, says Tracy, 28. She always inserted a small tampon on the morning she expected her period. But a few years ago, her period started one day late. "By the time it came, I had forgotten about the first tampon," she says. "The bleeding was so heavy that I figured I must not have had one in. So I put another one in."

All day she changed her tampon every few hours like she normally does. Then on one trip to the bathroom that night, she noticed a second string. When she finally removed the first tampon, the mild cramps she had experienced all day worsened. The pain became so intense she couldn't walk. Severe cramps and heavy bleeding ultimately landed her in the emergency room.

Putting in a tampon and forgetting about it is rare, but it does happen, says Gerald Joseph, M.D., former chairman of the department of obstetrics and gynecology at the Ochsner Medical Foundation. Joseph says he sees such cases–mostly among women under 30–a few times each year. Joanne, 44, says she forgot once and didn't realize the tampon was still there until six days later when she went to her doctor complaining of foul odor and vaginal discharge.

FDA recommends the following tips to help avoid tampon problems:

1. Follow package directions for insertion.

2. Choose the lowest absorbency for your flow.

3. Change your tampon at least every 4 to 8 hours.

4. Consider alternating pads with tampons.

5. Know the warning signs of toxic shock syndrome.

6. Don't use tampons between periods.

The Truth About Tampons By Catherine-Elliott Lopez

All 1998

Swedish studies have shown a link between tampons containing dioxin, and other chlorine by-products, and an increased risk of cancers of the female reproductive tract (especially the uterus, ovaries and bladder). Rayon itself poses another risk. Unknown to most women, rayon and rayon-cotton blend fibers are widely used in commercial feminine hygiene products. Rayon used to make tampons is usually treated with chemicals to increase the absorption capability.

These super absorbent fibers then absorb not only the menstrual blood, but normal vaginal secretions as well, causing drying, and ulceration of vaginal tissues. The fibers can also become imbedded in the vaginal walls. Rayon fibers have been scientifically proven to amplify the production of Toxic Shock Syndrome Toxin TSST1. Toxic Shock Syndrome is a rare bacterial illness that caused over 50 deaths between 1979 and 1980. Unlike medical grade cotton, upon which the TSS toxin will not grow, the rayon acts like a petri dish encouraging bacterial growth. What makes these toxic residues even more disturbing, is that they come in direct contact with some of the most absorbent tissue in a woman's body. According to a doctor at New York University Medical Center, almost anything placed on this tissue, including Dioxin, gets absorbed into the body.

Why is it acceptable to have toxic substances in our feminine hygiene products? The tampon industry is convinced that women need bleached white products. They seem to think that we view this as "pure" and "clean." The fact is, if Dioxin puts women at risk for cancer and Dioxin is stored in fatty tissue (just like that found in the vagina), and a woman uses as many as 11,000 tampons in her lifetime, could the long term use of tampons increase cancer risk? An FDA report said that "the most effective risk-management strategy would be to assure that tampons, and menstrual pads, contain no Dioxin." Although the FDA currently requires tampon manufacturers to monitor Dioxin levels, the results are not available to the public. The dioxin tests, are done by the manufacturers themselves, who insist their products are safe. Tampon manufacturers are not required to disclose ingredients to consumers, although many will do so voluntarily.

How much Dioxin exposure is considered safe for humans? Why has there been more research done on the possible health effects of chlorine-bleached coffee filters than on chlorine bleached tampons and related products? Women need to demand that more research be done on these issues. We have a right to know about any potential hazards associated with tampons and related products. It is only when women fully understand the consequences that we can make informed decisions regarding our health and well being. Writer's note: Currently there are only a few non-chlorine bleached all cotton tampons available in the US. Ask about them at your local store, if they are not available, ask them to special order!

The Pros And Cons Of Tampons

The type of tampon you choose may affect your health By Laurel Kallenbach

Today's average woman uses an estimated 12,000 tampons in her lifetime, a convenience that allows an unprecedented freedom to be active and confident in avoiding embarrassing leaks. We've come a long way since rags pinned into under garments or belted-on bulky pads were the norm, but with our freedom comes risk. There are potential problems attached to tampon use that every consumer should know about: Chlorine-bleached products, as some tampons are, contain traces of carcinogenic dioxins. Highly absorbent tampons may still cause toxic shock syndrome, a potentially fatal bacterial infection that occurs when tampons areworn for too long. There are even environmental ramifications, including pesticides sprayed on cotton crops and pollution created when tampon ingredients are bleached.

But,there are safe and ecological alternatives that enable women to still benefit from tampons. Here, natural is the rule of thumb. "Plainer is just better when it comes to tampons," says Pam Chandler, a family nurse practitione rand certified nurse midwife who practices at the holistic clinic Wellspring for Women in Boulder , Colo. Chandler encourages patients to use nonchlorine-bleached, 100 percent-organic cotton tampons and pads. "We're lucky to have healthier choices," she says.

Dioxin Dilemma

The most urgent tampon health concern is that chlorine-bleached andrayon-containing products carry trace amounts of dioxin, an extremely toxicchemical that is associated with cancer of the stomach, sinus lining, liver andlymph system. Many people are familiar with the danger of dioxins from publicityabout Agent Orange and the Love Canal catastrophe. Tampons are linked to carcinogenic dioxin formed during thebleaching process that manufacturers use to purify and whiten both raw cottonand the wood pulp that goes into synthetic fibers such as rayon, a common fiberin tampons. "You find trace amounts of dioxin in some tampons, which havemaximal contact with the vagina's mucous membrane, which absorbs substancesdirectly into the bloodstream," explains Philip Tierno, MD, director ofclinical microbiology and immunology at New York University Medical Center . To ensure that your tampon is free of dioxin, switch to a brand that's nonchlorine-bleached, rayon-free, and made of 100 percent-organic cotton. Thoughcotton is a natural fiber, the majority of cotton crops are heavily treated withinsecticides, pesticides and herbicides. Organically grown cotton is not.

Checkyour tampon box for a list of ingredients. Whereas natural brands state thatthey're nonchlorine bleached, some conventional brands mention little on thesubject, because along with the Food and Drug Administration (FDA) and theEnvironmental Protection Agency (EPA), they believe chlorine-dioxide bleachingis safe. Tierno disagrees: While trace quantities of dioxin aren't in and of themselves aproblem, tampons aren't your only exposure. "The problem is that measurableamounts of dioxins are everywhere, including food and water. Some portion of thedioxin that enters your bloodstream lodges in the body's fat cells and staysthere a long time," he says. "This residual effect becomesprogressively larger as you're exposed to even more dioxins". The only way to avoid vaginally absorbed dioxin, Tierno says, is to eliminatechlorine-bleached and rayon-containing tampons and switch to peroxide-bleachedproducts instead. Tierno also says if the label on your tampon box doesn't say"nonchlorine-bleached," it's possible that it contains chlorine. Mostmanufacturers proudly promote the fact that their product doesn't containchlorine.

Thecumulative risks of dioxin are unknown. While a single tampon may contain only0.1 parts per trillion of dioxin, the fact that most women use between 10,000and 15,000 tampons in a lifetime increases the exposure. "A trace quantityof dioxin is not acceptable in a tampon, because a woman does not expose herselfto a single tampon," Tierno says. "It's trace quantity upon tracequantity upon trace quantity, multiplied by the number of tampons per month,multiplied by the number of months in a year, multiplied by 40 years ofmenstruation. Then add in all the dioxins you get from your diet, plus all theones occurring in the environment".

Earth-Friendly Options

The environmental impact of the manufacturing of feminine products is anotherreason to use organic tampons. While cotton tampons may seem better than synthetic, most cotton undergoes industrial bleaching in a polluting process that dumps dioxins, along with other hazardous organochlorines, into the watersupply. Organic cotton tampons and pads are treated with hydrogen peroxideinstead of bleach, making them a safer alternative. If the label states that theproduct is third-party certified organic, that means the cotton has been grownwithout pesticides on land where no pesticides have been applied for at leastthree years.

In response to concerns over dioxin in tampons and their impact on the environment,the EPA and some manufacturers have worked to find a better way of purifyingwood pulp and cotton without creating dioxins. The result is chlorine-dioxidebleaching, a process that has replaced the elemental chlorine-gas method of thepast but still generates low trace levels of dioxins. The packaging of tampons is another troublesome environmental issue. Most are encased in a paper or cellophane wrapper, contain a cardboard or plastic applicator, and are packed in boxes. Though you can't recycle cotton tampons,there are waste-saving alternatives to dealing with menstruation, such aswashable natural sponge tampons and cloth pads, and reusable, but awkward,vaginally inserted menstrual cups that collect flow.

Toxic Shock: Still A Risk

In the '70s and '80s, toxic shock syndrome ( TSS ) struck thousands of women. The crisis peaked in 1980 with 814 cases of TSS , of which 38 women died, most due to extended use of the high-absorbency Relytampon. Today, women still get TSS , though cases are rarely publicized. Yet tampon safety is once again a nationalissue, in part due to the efforts of Rep. Carolyn Maloney, D-N.Y., whointroduced a bill to address the health problems associated with tampon use. TheRobin Danielson Act (HR 360) is named after a 44-year-old woman who died in 1998from TSS because she didn't recognize her symptoms. The bill directs the NationalInstitutes of Health to conduct reliable, independent research to determine thehealth risks posed by the presence of synthetic fibers, dioxin and otheradditives in tampons.

TSS is caused when staph or strep bacteria grow in the vagina, usually encouragedby the presence of a higher absorbency tampon or one that has been inserted morethan eight hours. The bacteria produce toxins that are absorbed into thebloodstream, which can cause a severe drop in blood pressure (shock) and/ororgan failure, especially of the liver and kidneys. In some cases, TSS is fatal. Its symptoms are similar to the flu, including a high fever, vomitingand diarrhea, muscle aches, dizziness or fainting, a red rash, headaches,bloodshot eyes and sore throat. "Highly absorbent tampons, especially those containing synthetic fibers, increase theamounts of toxin present in the vagina," says Tierno.

In the mid-'70s, synthetic fibers were used in tampons because manufacturers wantedto produce more absorbent, leak-resistant products. Since then, three of thefour problematic synthetics have been eliminated from tampons. "The onlyone left is viscose rayon," Tierno says. Tominimize your risk of contracting TSS , choose a tampon made of 100 percent cotton, preferably organic. "You'reat the lowest risk possible with cotton," says Tierno. "In myresearch, every synthetic fiber amplified toxin development, whereas cotton didnot. "Mostprecautions for guarding against TSS are simple, says holistic nurse practitioner Pam Chandler, a specialist inwomen's health care. Wear a tampon for a maximum of six to eight hours to avoidbacterial growth. However, she recommends leaving it in for at least two hours."If you remove a tampon too soon, it won't be saturated," she says."Then you risk scraping the dry, fragmented cotton across the vaginalmucosa, irritating it and setting the scenario for infection." Also, usinga tampon overnight, when planning to sleep longer than eight hours, is risky. Atnight, consider wearing a pad instead, she advises.

Choosing a tampon with proper absorbency is crucial to preventing TSS. "At the beginning of your period, if your flow is heavy, you may needSuper Absorbency so you don't have to change tampons too often," says Chandler. When the flow slows, however, don't be tempted to continue with a Superbecause it's more convenient. Switch to a lower absorbency tampon instead. Also,use tampons only during menstruation. Carefull Liberation within the last couple of years, a rash of e-mails warned women that tampon manufacturers put asbestos in their tampons to make women bleed more in hopes of selling more product. Tierno says the rumor was false. "I have been privyto every manufacturer's records over the last 21 years, and I have never seenanything related to asbestos in tampons," he says.

Though the asbestos scare amounted to nothing but an urban myth, true additives to beconcerned about are fragrances and deodorants. Perfumes may mask odors, but somewomen suffer allergic reactions to them. "Without question, a deodorizedtampon is dangerous," asserts Tierno, adding that deodorants encourageovergrowth of certain bacteria, upset the vagina's normal flora and irritate themucous membrane. The main point, when it comes to tampon use, is to stay informed and weigh theoptions. "Over the years, tampons have allowed women to be more active andfuss less during their periods," says Chandler, who points out that while this is liberating, it also makes it easy to taketheir use for granted.

Careful Liberation

Within the last couple of years, a rash of e-mails warned women that tampon manufacturers put asbestos in their tampons to make women bleed more in hopes of selling more products. Tierno says the rumor was false. "I have been privy to every manufacturer´s records over the last 21 years, and I have never seen anything related to asbestos in tampons," he says.

Though the asbestos scare amounted to nothing but an urban myth, true additives to be concerned about are fragrances and deodorants. Perfumes may mask odors, but some women suffer allergic reactions to them. "Without question, a deodorized tampon is dangerous," asserts Tierno, adding that deodorants encourage overgrowth of certain bacteria, upset the vagina´s normal flora and irritate the mucous membrane.

The main point, when it comes to tampon use, is to stay informed and weigh the options. "Over the years, tampons have allowed women to be more active and fuss less during their periods," says Chandler, who points out that while this is liberating, it also makes it easy to take their use for granted.

Related articles:

1. Toxic Shock Syndrome – warning signs, treatment, and how to avoid it
2. Tampon Truths and Tragedies