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REVIEWS The Trouble With Tampons

Everything You Must Know About Tampons, by Nancy Friedman. Berkley Books, 1981. 176 pages.

By Linda Jane

For those of us who grew up in rags and pads, tampons offered just what the ads said they would—a new freedom. We could go swimming and wear tight pants. We could carry fresh supplies in our pockets and discreetly flush used ones away. Tampons were so comfortable and convenient that few of us really thought about the small wads we inserted into our vaginas each month. Then in mid-1980, the news reports about toxic shock syndrome and tampon use compelled many of us to stop taking our tampons for granted. A year later, how much more do we really know?

There is good reason for our ignorance. Between the manufacturers' secrecy and the government's negligence, no one knows much of anything about tampons. Fortunately, however, this situation is changing.

In a valuable and enlightening book, Nancy Friedman explores the history and controversy of tampon usage from the first disposable tampon, introduced in 1936, through the current debate over TSS. Everything You Must Know About Tampons is based on two years of investigation during which Friedman talked to doctors, manufacturers, government officials, women's health groups, and tampon users. Written from the perspective of a concerned consumer, the book is probably the most thorough and lucid compilation of information on this subject to date.

It is unrealistic, Friedman suggests, to expect women suddenly to stop using tampons, but it is our right and our responsibility to make educated choices about the menstrual products we use. It will not be an easy learning experience, since good scientific data on tampons is hard to find. But it is a necessary one; increasing evidence links tampon use to a variety of conditions, from minor irritation to life-threatening illness.

Based on existing data, Friedman outlines the following hazards of tampon use:

-Tampons are not produced under sterile conditions. Although manufacturing processes are not closely regulated, the Food and Drug Administration has reported finding mineral oil and other contaminants on a tampon assembly line.

-Deodorant tampons (like scented douches and vaginal sprays) can irritate the lining of the vagina. -The plastic inserters found on many tampons have sharp cusps that can lacerate the vagina..

-Withdrawal strings, found on all commercial brands, act as "wicks" to carry bacteria from fecal contamination into the vagina and thus cause infection.

---Chemically-altered fibers, used to increase the absorbency of tampons, can dry out the vagina and cause irritation.

Most of these hazards reflect "innovations" in the ⚫tampon industry. To help us understand them, Friedman focuses on the history of the industry itself.

Tampons are a highly profitable business. In 1979, American women bought 52 billion tampons, representing $400 million in gross sales out of a total "sanitary protection" market of $850 million. Tampon manufacturers spend approximately $60 million on advertising each year. In July of 1980, 70 percent of the menstruating women in the U.S. used tampóns. In December, 1980, after the publicity of TSS, that figure dropped to 55 percent-still a significant majority.

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Although there is evidence of tampon usage as carly as the 15th century BC, the version we know was patented by an American doctor in 1933. It consisted

Page 6/What She Wants/July-August, 1981

of compressed surgical cotton with a waterproof cord stitched down its length and a two-part cardboard applicator. Tampax, Inc. bought the patent in 1936. It was an instant success, and by 1942 there were nine major brands on the U.S. market. Consumers considered it a blessing, while the medical establishment was somewhat more skeptical. The first medical study, appearing in 1938, warned that regular tampon use could irritate the walls of the vagina and advised tampon users to have periodic check-ups. There were at least eleven more studies published in medical journals over the next ten years, most of which were funded by the manufacturers themselves. Not surprisingly, the majority were pro-tampon.

One of the most heated debates, which continued into the 1950's, revolved around the issue of whether

chusetts showed no ill effects among 903 tampon users. No new studies appeared over the next ten years; presumably the debate was settled.

Meanwhile, in the 1960's, the tampon itself started changing. Previously, the compressed cotton version had remained the state-of-the-art tampon. Then in 1963, Personal Products introduced an applicatorless tampon, Carefree. It was smaller than other tampons because it was constructed of rayon rather than cotton. Rayon, made from wood pulp, is a more refined and absorbent fiber.

Carefree's success gave the green light to other manufacturers. Playtex, in 1967, introduced a tampon with a plastic applicator and its own unique absorbent construction. Personal Products struck back in 1970 with Meds-a plastic applicator, two

The following chart was constructed from information Friedman provided from published reports, direct observation, and bits of knowledge picked up from conversations with tampon company representatives.

Brand/%%% of U.S. Market

Varieties

Aber Content

Tampax 50%

Junior

Rayon (least absorbent)

23%

Applicator/Cord Construction

Water Immersion Test Results

% of TSS Coses by Brand

Not tested

5%

Cardboard strips with water-soluble glue, withdrawal cord

stitched along entire length

WI cloud water

DEN Complaints by Brand*

Vaginal ulcers, cervical burns and discharge, irritation, spotting, longer flow

Slender regular Regular

Cotton, rayon, high-absorbency carboxymethylcelluloset

Same as above

in 30 min.

All cotton (may be chemicalły modified)

Same as above

Not tested

Super

Not tested WW cloud water In 30 min.

WW cloud water in 30 min.

20%

Strings breaking off,

reactions to frag-

Kha

10%

Regular and super "stick"

Super plus

Regular, super, super plusdeodorant and nen-deedorant

Regular and super "security"'

Unmedified cotton and rayon High-absorbency rayon polyacrylate$

Rayon polyacrylate, cotton, and trace amount of polysorbate-20†† Fragrance added to deodorant versions

Cotton, rayon and super-absorbent modified carboxymethylcellulosa

Same as above but less compressed

Unknown but appears similar to s.b.

Same as above Same as above

Polyethylene applicator with 6 cusps. withdrawal string threaded through hals

Wound paper inseried into a depression. withdrawal string threaded and looped through hole

Polyethylene and

polypropylene

5 cusps

Ne applicator, withdrawal string knatted at one end

Plastic applicator with 4 cusps, withdrawal string knotted st one end

o.b. 9%

Regular, super, and super plus

Relled cotton and rayon, manulecturer claims no modified fibers

Reguler, super and super plus deodorant and nen-deadorant

Assure!

Natural FR Tampons How being

applicator with

Sheds Bibers sfter several minutes

2%

rance, ulcerations

and lacerations from plastic applicators

Lacerations from

both stick and plastic inserters

Material falling apart in vagina

Sheds fibers simest Immediately

Sheds long Albers within minates

2%

Tampon getting trapped behind bymen in virgina

Not tested

Material falling apart in vagina

Pursaties

Regular, plus

1%

Non-woven rayon over layars of rayon fbars, falded width-wise

No

icator, costed

Up

Sheds strands and chunks of Aber

<1%

Name

Rely++

dan-woven polyester bag of polyester sponger and chips of carberymethyl-

withdrawal string leoped through hala

lestie applicator with 4 comps, withdrawal string tod around and of bag

71%

Reported to the Device Experience Network (DEN), these complaints have not necessarily been confirmed nor followed up on. † A chemically-tran calluloos that can absorb 10-29 tiesos its weight in fuit. * A modified form †† A substa # Now off the mark

julhetic Übers is increase surface tensión.

but some stores may still have supplies and if may still be sold outside

virgins should use tampons. Friedman recounts one study which appeared in the AMA Journal of Medicine in 1945. It recommended tampons because, among other reasons, this "stationary interior guard" caused less erotic stimulation than a sanitary .pad.

By the 1960's, tampons were fairly well established as a safe and reliable menstrual product. A 1966 study, by the Rock Reproductive Clinic in Massa-

U.S.

Lacerations from erfer, difficulty In removing, falling apert in vagina

withdrawal strings, and the "most absorbent fiber ever made for a tampon". Friedman calls this the "public debut of superabsorbent fibers," which were basically cotton or rayon fibers chemically altered to expand to many times their original size when immersed in fluid.

Not to be outdone, Playtex came out with a deodorant tampon in 1971. It was an instant success, despite the fact that menstrual fluid is odorless until