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The Truth about Tamponsby Hannah Holmes"Gentle glide," "blooming action," and "petal soft," read the pastel boxes. Even the word "tampon" sounds soft and fluffy, like "pom-poms." Fifty to 70 percent of American women use tampons. They look like pure, white cotton. Of course they're sterile ... aren't they? Well, some tampons still contain some cotton, but viscose-rayon is now the most common fiber. "Deodorant" tampons are doused with fragrance chemicals, a marketing ploy aimed at a woman's shame about menstruation -- a tampon inside the body has no smell.
However, a 1981 FDA study found that dozens of elements (such as boron, aluminum, and copper) and compounds -- waxes, surfactants, alcohols, acids, nitrogen compounds, and hydrocarbons -- could be leached from tampons. By weight, a few of these residuals accounted for .05 percent of an o.b. tampon; at the other extreme, 3.8 percent of the Playtex Deodorant tampon was taken up by a plethora of residuals. Manufacturers voluntarily list some ingredients on the box. But fragrance, for example, is listed only generically. So while Dr. Bruce Dan, an editor at the Journal of the American Medical Association, characterizes the deodorants as cheap perfume with organic solvents, a Playtex spokesman states that Playtex's perfume supplier won't disclose the ingredients. Ironically, FDA does require ingredient labeling on external products like shampoo and fingernail polish. Tampons are not sterile, by the way. Ethylene oxide was once used to sterilize tampons, but it was discovered that the toxic gas left a residue. Currently, doctors see no need for sterilization. Microorganisms find the dry fibers unappetizing; also, the vagina itself is already a microbial garden. When it comes to tampons, the FDA hasn't hastened to inform and protect women.
In 1982, some years after TSS began killing women, the FDA convened a task force that attempted to hammer out voluntary standards for manufacturers on: ingredients labeling, absorbency, the wicking potential of the withdrawal string (invaders can climb a wet string), the tampon's potential to irritate skin and mucous-membranes, and bacteria-promoting characteristics of the fiber. The task force dissolved after two years when the consumer contingent quit, charging that the tampon industry was withholding important research. Consequently, the standards languished. In 1990, ten years after the link between high-absorbency tampons and TSS was discovered, the FDA was finally forced by a consumer-group lawsuit to issue a mandatory standard for absorbency-labeling of tampons. The tampon makers don't reveal the number of grams a tampon absorbs, but a range it falls into. A tampon's absorbency rating is determined by the grams of tinted saltwater it takes in, which may not correlate to actual absorbency in use. What became of the standards to govern ingredients labeling, biocompatibility, string characteristics, and irritancy potential? Ms. Yin explains that for the FDA to determine such standards would take too much time and invite industry dissent. The standards might even have to be updated as technology advanced, she adds. The Toxic Shocker "I was standing at the front door and I suddenly felt like I had been hit from behind by a Sherman tank. l felt my knees buckle and thought my head was going to roll off my shoulders," says Cheryl Schwartz, who put herself to bed in Northridge, Calif., on the third day of her period in February, 1979.
Over the next two days, fever, headache, sore throat, muscle pain, confusion, lethargy, hallucinations, and finally, shock set in. In the hospital, puzzled doctors treated the symptoms as best they could, always one step behind the disease. It attacked her kidneys, pancreas, liver, heart, and lungs, of which doctors amputated a part. Two weeks later her skin peeled, her hair fell out, and orange-peel sized hunks of skin shredded off of her hands and feet -- a good sign. Ms. Schwartz, whose family had made burial arrangements, says "I survived to fight these plug companies." She operates the International Toxic-Shock Syndrome Network in Beverly Hills. TSS, almost unknown in 1979, is caused by a toxin released by the bacterium Staphylococcus aureus, normally a peaceable tenant of the human nose and skin. This critter may hijack a finger or tampon for a visit to the nether regions of ten to 25 percent of women at any given time, where it normally blends in with the local population of microorganisms. It may be present during one period, and gone the next. One to three percent of the time, however, the visitor is a version of S. aureus that produces the TSS toxin. If the bug is comfortable (tampons, especially very absorbent ones, help), it may multiply logarithmically. Toxic Shock is not history. In April, 1990, a 32-year-old Arizona woman became ill while her husband and two children were away for a few days. She pulled down a shower curtain and upset furniture before dying, says Tom Riley, an Iowa attorney who has handled nearly 100 TSS cases. Mr. Riley says police found superabsorbent tampons at the house. Most of the 45 women who were tallied as TSS survivors in 1989 were wearing a tampon, according to the Centers for Disease Control (CDC), which is notified of about one case in five. The situation is better than it used to be. Ten years ago, Procter & Gamble made a bid on the tampon market with Rely, a giant tea bag stuffed with yellow polyurethane foam cubes that could swallow about ten times their volume in liquid, and white carboxymethylcellulose (CMC) confetti that turned to clear slime when wet. A Rely tampon could absorb 18.5 grams. Rely's competitors were also stuffing torpedoes with new synthetics. In 1980, CDC logged 812 menstrual TSS cases, including 42 deaths. A few developments slowed the death rate. Rely died of ignominy and lawsuits when a 1980 CDC study showed the brand was associated with 71 percent of menstrual TSS cases. In 1985, a lawsuit and a scientific study convinced Playtex and Tambrands to forswear polyacrylate rayon. Tambrands has also revived "original regular," an all-cotton plug, and stopped using CMC, called "modified cellulose" on the label. The o.b. brand k.o.'d the super plus model of its cotton and viscose-rayon tampons. In 1981, it was reported that Kotex used CMC, but Kotex refuses to discuss ingredients. Overall, absorbency, which ranged from 10.3 to 20.5 grams in the early '80s, currently falls between six and 15 grams. Since 1982 an FDA warning on tampon boxes has helped women recognize TSS symptoms. Now, the Centers for Disease Control estimates the annual incidence of TSS is one in 100,000 menstruating women, one-tenth the 1980 level. Dr. Philip M. Tierno, Jr., estimates differently. A TSS specialist at the New York University Medical Center in Manhattan, Dr. Tierno says that for every woman he sees whose symptoms match the strict CDC definition of fullblown TSS, he sees five cases that aren't counted because the symptoms fall just short. For example, a woman may have the necessary rash and diarrhea, but her fever is 101, not 102, or her systolic blood pressure is 91, not 90. "The tampon manufacturers say, 'We don't know what it is, but we know it's not that [TSS].' I've looked at hundreds of cases," says the doctor, who refused repeated offers of Procter & Gamble grant money during the TSS crisis, opting to testify in court on behalf of TSS victims. "I can pick it out." The CDC agrees that mild Toxic Shock Syndrome occurs, and goes unrecorded. The tampon giant, Tambrands, on the other hand, disagrees. "We're not aware that the incidence of TSS is greater than what the CDC reports," says spokesperson Bruce Garren. Tampons present other problems. The perfume in "deodorant" tampons can disrupt a woman's microbial balance and cause internal irritation. The sheer absorbency of tampons can cause unhealthy dryness, cell peeling, and tiny ulcers. Shreds of tampon fiber have been found embedded in vaginal ulcers and tissue. (Dunk your favorite brand in a glass of water and watch the fibers fly.) The "petals" on plastic applicators have been faulted for scratching women's insides, causing post-period bleeding. Women who use tampons after their period to staunch unusual bleeding, or even normal discharge, take a greater risk of dryness, peeling, and ulceration. This, too, can cause unusual bleeding, perpetuating tampon use. These little traumas leave delicate membranes vulnerable to infection, caused by either an imbalance in the microbial garden, or invaders. On The Tampon's Tail While the tampon holds the fort, other products are vying for entry. Unless women adopt the old ritual of Vancouver's Nitinat Indian women, gathering for a four-day tea party on moss couches each month, these are the alternatives to the commercial tampon. THE PAD: One percent of menstrual TSS cases are associated with sanitary pads (17 of the 1,824 cases reported between 1980 and 1983). Pads also offer a small risk for other problems. E. coli is a bacterium that behaves well in its native anal region, but misbehaves elsewhere. Dr. Tierno says that, using blood as transportation, E. coli can infect the urethra, and may then ascend into full-blown cystitis (bladder infection). E. coli will also digest blood, causing odor. The baby powder used in some pads may not be as benign as it sounds. A World Health Organization (WHO) document on talc and cancer cites a study that "suggested an approximate doubling of the risk of ovarian cancer among women after perineal use of talc." The theory has been around for a decade; WHO considers the data to be inadequate to draw any conclusions. A gelling chemical, sodium polyacrylate, is also used in some pads. While it has been criticized for causing rashes when used in diapers, its presence in pads hasn't been debated. THE SPONGE: With uncharacteristic vigor, the FDA squashed small businesses that in the late '70s sold sea sponges for menstrual use. Brushing aside the discovery that sponges harbor sand, fungi, bacteria, and chemicals that may come from oil spills, the FDA's Ms. Yin says the agency's concern was that women might rinse their sponges in public sinks. In 1980, marketers were forced to remove references to menstrual use. Some women still use sea sponges, available at food co-ops and beauty and health-food stores. Others even use household sponges, cut in strips. The sea sponge is linked to less than one percent of menstrual TSS cases. THE CUP: In the early '50s, a beige, gum-rubber bell called the "Tassel" appeared on the market. It rested upside down at the bottom of the vagina, collecting blood. A small loop served as a handle. It got rave reviews from medical professionals, but the company went bankrupt in 1972. However, a Cincinnati woman has resurrected the menstrual cup, dubbing it The Keeper. FDA accepted The Keeper as substantially equivalent to the Tasset, so no new testing was done. If wearing a diaphragm gives you cystitis, proceed with caution. THE RAG: Washable cotton pads have never completely surrendered to disposables. Several companies still distribute them through the mail. The National Cotton Council maintains that woven cotton is not chlorine bleached, eliminating the dioxin possibility. To avoid pesticide residues, though, at least one manufacturer is looking into organically grown cotton. Dyes may be a concern for people who are chemically sensitive. THE GYNASEAL: Something to watch for is an Australian device designed to work as a blood collector and contraceptive by covering the cervix. It can be worn 24 hours at a time, is reusable, and preliminary studies indicate a low TSS risk. Flushed With Shame We call it the big flush," says Cindy Zipf, a coordinator at New Jersey's Clean Ocean Action, describing the cascade of raw sewage, street garbage, and tampon applicators that pours into the ocean when old sewage systems are flooded by storm water. After a couple of days at sea, the weary plastic flings itself onto the beach, where Ms. Zipf and her cohorts can estimate how much rain fell by the number of applicators that return--sometimes one per yard of beach. They make fishing lures out of them to raise awareness of the problem. Jay Critchley, a Provincetown, R.I., artist, also reaps the tampon-applicator bounty, building translucent pink and white sculptures, including a wearable, 3,000 applicator Statue of Liberty outfit. Health professionals haven't declared "beach whistles" harmless, emphasizing instead that they should never get onto the beach. However, they agree the cold, salty ocean is disheartening for bugs used to a cuddly human host. Consumers are to blame for putting plastic in the toilet, but it's the manufacturers who are flushing with embarrassment over the schools of beached tampon applicators. Playtex Family Products, alarmed by Clean Ocean Action's 1985 legislative drive to outlaw plastic applicators, flirted with the idea of making heavier applicators that would sink. Playtex has also looked at biodegradable plastics. Tambrands, in a two-faced marketing move, is pushing Tampax in both plastic and paper plungers. A woman in Tambrands' 1989 plastic-tube ads burbled, "I want my plastic," while the label on the paper-tube box boasts, "ecologically safe... biodegradable... no plastic to dispose of." (Both boxes are made of recycled paperboard.) Kimberly-Clark's Kotex is standing by its plastic applicator. Johnson & Johnson's applicator-free, biodegradable-cellophane-wrapped, recycled-paper-boxed o.b. tampon looks like the beachgoer's buddy. What happens to the parts that don't float? Actual tampons and pad-filling will degenerate into fibers in the river or the ocean, if they make it past sewage-treatment-plant skimmers and strainers. But neither tampons, applicators, nor pads should be flushed. "The idea that you can flush it and it's gone is very popular in this country," says Jackie Sartoris, an analyst with the New York City Department of Environmental Protection.
Sanitary products are a tiny part of the solid wastestream. Nobody has studied what a tampon or pad does in a landfill to learn whether its population of microorganisms might survive and join other leached pollutants to affect groundwater. However, the U.S. Environmental Protection Agency has looked generally at pathogens in landfills, concluding that viruses don't fare well and bacteria like E. cold don't migrate if the landfill is kept dry. Although tampons and the non-plastic parts of pads are biodegradable, and are processed in some municipal composting programs, the bugs in your backyard heap probably aren't hot enough to tackle a tampon. Long before tampons and pads hit the trash, however, they wreak environmental havoc. Many pads are stuffed with fluff pulp that, when bleached with chlorine, can harbor traces of tremendously toxic dioxin and other organochlorines. Although FDA says the cancer risk from using pads is below the one-per-million considered regulation-worthy, chlorine-free pads are becoming available (see The Tampon Alternatives, below). Even if the risk of human absorption is negligible, dioxin poisons the water around pulping mills, a pervasive threat to human beings and the ecosystem. Rayon, used in tampons, is also made from bleached pulp, meaning more dioxin downstream. The FDA can't detect dioxin in tampons. The Toxic 500, a National Wildlife Federation publication that ranks industrial polluters, places rayon mills at numbers 32, 71, and 278. Two of the mills spewed 46 million pounds of neurotoxic carbon disulfide into the environment in 1987. Cotton isn't unsullied, either. A USDA survey showed that the 1982 cotton crop--and the Earth around it-- received 7 million pounds of desiccants and defoliants, 17 million pounds of herbicides, and 17 million pounds of insecticides. Scant research has been done on whether these chemicals remain in finished fiber. The FDA maintains that pesticides are not present in tampons at worrisome levels. Bleeding Green A menstruating woman throws away an average of 250 or 300 pounds of tampons, pads, and applicators in her lifetime.
From a personal standpoint, the choice isn't so simple. While women in some cultures see their periods as a time to celebrate womanhood, the predominating view of menstruation as an embarrassing "curse" is a psychological obstacle to changing our habits. We could all live without the perfumed plug, but switching to a non-disposable method requires an enlightened approach to menstruation. For example, sponges are "natural" and last months, but you've either got to pack a spare or be ready to haul one out and rinse it in the ladies room at work. Menstrual cups last 10 years at least, but again present a problem in the ladies room. Washable pads involve velcro, safety pins, or belts, as well as soaking and laundering. (One pad fan suggests that you reduce your dependence on commercial fertilizer by flinging the brownish soak-water into the garden.) Whatever you choose, there are a few conclusions to keep in mind. One: No menstrual product is thoroughly regulated by the FDA. Two: Over the generations, women have stemmed the tide with everything from papyrus to wool, commercial tampons, and quartered kitchen sponges -- and lived to tell the tale. Three: Whether you call them beach whistles, New Jersey seashells, LPTs (little pink things), torpedos, finger puppets, dum-dum bullets, or tube fish, plastic applicators are a waste. Source: Garbage, Nov/Dec90, Vol. 2 Issue 6, p50, 6p, 7bw  Copyright © 1997 - 2006 Keepers! Inc. PO Box 12648 Portland, Oregon 97212 Toll Free 1-800-799-4523 |
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