Tampons: a long love history!

cambridgefemtech

25 lug 2024Tempo di lettura: 5 min

The origins of tampons date back to ancient times, with early civilizations using materials like wool, papyrus, and sea sponges for various purposes, including contraception and medical reasons (yes, the first use of tampons was not for menstrual care!). Modern tampons, however, were invented in the 20th century, around 1930. In 1931, precisely, Dr. Earle Haas developed and patented the first applicator tampon. Gertrude Tendrich then bought the patent from Haas and began manufacturing cardboard applicator tampons, producing each one at home until her business expanded into the famous Tampax brand [1]. Some years later, the non-applicator tampon was created by German gynecologist Dr. Judith Esser-Mittag, in the 1940s. She sold her invention to a company that Johnson & Johnson eventually acquired. Since their commercialization, tampons have dominated the period care industry and Tampax started having competitors like Playtex, Kimberly-Clark, and Johnson & Johnson, introducing their own versions [2].

Nowadays, tampons are available in different sizes, forms, and absorbances and are, after pads, the most chosen period care products. In fact, it is estimated that only in the US 52–86 % of menstruators use tampons, while in Spain and France the percentage is around 43–46 % [3].

Moreover, it is easy to correlate the use of tampons to summertime, since their use surely represents the best period product if you are at the beach (and yes, we know that our period will arrive as part of our vacation kit!).

However, in the last weeks, an article published by Berkeley University [3], shows a dark side of tampons, affirming that metals/metalloids have been found in their composition. These findings suggest a potential risk associated with tampon use, given the high absorbance capacity of the vaginal epithelium and the possibility of metals leaching into systemic circulation.

Before going deep about that last discovery, let’s say that already in the 1980s, controversy arose around tampon safety due to the risk of Toxic Shock Syndrome (TSS). TSS is a rare but potentially fatal bacterial infection that results from an overgrowth of bacteria that naturally exist in many women’s vaginas - Staphylococcus - that starts to produce a toxin, the toxic shock syndrome toxin-1 (TSST-1) [1,3,4]. At that time, tampon manufacturers responded by changing the materials used in tampons and providing more detailed instructions for safe use. Tampax launched an educational campaign to inform women about both Tampax tampons and TSS, covering the causes, symptoms, and treatment options [5]. However, nowadays, we know that the vaginal microbiome is a delicate and sensitive environment and that the use of tampons isn’t the cause of TSS. A study [6] conducted in 2013, analyzed how the vaginal microbiome of women influenced the probability of having or not TSS. They discovered that thanks to the vaginal microbiome’s ability of protecting itself by pathogens, women with a healthy microbiome (Lactobacillus dominant) as well as those with bacterial vaginosis (BV) were able to suppress TSST-1. On the other hand, women suffering from aerobic vaginitis (AV) have a vaginal microbiome not capable of inhibiting TSST-1, suggesting that having AV may pose a higher risk for developing menstrual TSS [6,7].

Returning to recent findings [3], researchers measured 16 metals (arsenic [As], barium [Ba], calcium [Ca], cadmium [Cd], cobalt [Co], chromium [Cr], copper [Cu], iron [Fe], mercury [Hg], manganese [Mn], nickel [Ni], lead [Pb], selenium [Se], strontium [Sr], vanadium [V], and zinc [Zn]) in 60 subsamples from 30 tampons across 14 brands (from the US and EU/UK). They detected all metals, including toxic ones. Metal concentrations varied based on the region of purchase, organic status, and brand type, with non-organic tampons showing higher Pb levels and organic tampons exhibiting higher As levels. Pb was present in all tested tampons, raising concerns due to its potential health risks as it can be absorbed systemically through vaginal tissues and has no safe exposure level. The authors highlighted their concern over Pb's association with a range of adverse effects, including neurological, renal, cardiovascular, hematological, immunological, reproductive, and developmental issues. It’s important to remember that the study has different limitations like an insufficient sample size for assessing differences by absorbency, lot, brand, or manufacturer, and limited representation of EU/UK tampons. Additionally, the multiple statistical tests conducted may increase the risk of Type I error (false positives). Finally, the study does not address the potential bioaccessibility of metals in tampons, so it was not possible to estimate the associated health risks.

The presence of metals and metalloids in tampons needs thorough investigation. However, let's not panic and be honest: the items we touch, wear, eat, and inhale often have significantly higher levels of lead compared to tampons. The main reason for tampons containing lead is probably because they are made from cotton, which absorbs lead from the soil as it grows. And let’s wait a minute and consider other plant-based products: textiles and clothing, tea leaves, water, cannabis, among others. Dr. Love, in her newsletter ImmunoLogic [8], pointed out an important consideration: the conditions used to test tampons are unrealistic. Researchers extracted substances using 70% nitric acid at 180°F, much harsher than the vaginal environment of 99°F and pH 4.5. According to Dr. Love, a more accurate approach would have been soaking tampons in warm saline with pH 4.5 or deionized water to simulate real-world conditions.

We undoubtedly need more studies to investigate the pros and cons of tampons, as well as other menstrual care products. However, here are some tips you should follow in order to reduce the risks of infection or problems when using tampons [8,9]:

Change your tampons every 4-8 hours (maximum).
Choose tampons that match your flow and avoid more absorbent ones if you don’t need them, as they can increase dryness.
Only use tampons when you have your period!
Always ensure your hands are clean before changing or inserting a tampon
Enjoy using tampons if they are what your body tolerates and makes you feel comfortable!