Inner Sanctum.

The Hidden Price of Feminine Hygiene Products

The feminine hygiene industry has made revolutionary innovations since the original maxipad--which was nearly three feet long. And we have come a long way from secretly paying for purchases in a box on the counter of drug stores. The products' impact, however, is still very much under wraps.

Deceptively Pure

Ads of GAP-white jeans and confident strolls down the beach don't tell the whole story. In fact, the sterile whiteness of the products themselves can be deceptively reassuring. Although the original cost of chlorine bleaching--the release of some 250 different organochlofines and a product laden with dioxin--was traded in during the mid-1990s for "elemental chlorine-free bleaching" are they really now risk-free?

Even the Food and Drug Administration (FDA) acknowledges that chlorine dioxide, though elementally chlorine free, can still "theoretically generate dioxins at extremely low levels," and, according to the Environmental Protection Agency (EPA), no safe level for dioxin exposure exists. The compound is 10 times more likely to cause cancer than was believed in 1994, says the EPA, and even background levels may lead to health effects, such as developmental delays, birth defects, hormone disruption and immune cell suppression. The toxin accumulates in humans, particularly women's body fat and breast milk, with repeated exposures, and 16,800 tampons over the course of a lifetime certainly qualifies.

Nor is the environment off the hook. The Worldwatch Institute calls elemental chlorine free bleaching a "`low-tar cigarette' approach to the problem of organo-chlorine pollution," reducing (not eliminating) pollution, and not addressing the fundamental problem--the continued use of chlorine. Hydrogen peroxide, oxygen or ozone work just as well, though any bleaching still uses energy and water unnecessarily.

Shock to the System

Another arguable improvement came with the phase-out of all synthetic fibers but one from tampons, says Dr. Philip Tierno, director of microbiology and diagnostic immunology at New York University Medical Center. Independent studies reveal that synthetic fibers, incorporated in the 1970s to increase absorbency, amplify toxins of the Staphylococcus aureus bacteria, which cause Toxic Shock Syndrome (TSS). By 1980, the potentially life-threatening bacterial illness had reached its peak, and carboxymethylcellulose, polyacrylate rayon and polyester were pulled from the market. The fourth fiber, viscous rayon, remains in use today.

"Viscous rayon does amplify toxins less than the others," says Tierno. "Manufacturers are saying nothing's wrong with it, but that's not the case. The lowest risk would be had by using all cotton." The FDA, which regulates feminine hygiene products as medical devices, disagrees, maintaining that rayon tampons are equally safe and that the exact link between tampons and TSS remains unclear.

Such government reassurance is little comfort to many women's health advocates: "FDA doesn't do independent testing, it relies on testing by manufacturers," says Amy Allina, program and policy director for the National Women's Health Network. "People may legitimately raise questions about reliability."

Get Out the Vote

Enter the proposed Tampon Safety & Research Act (H.R. 890), which would direct the National Institutes of Health to conduct research on the risks dioxin, synthetic fibers and other additives may pose for the 73 million U.S. women who regularly use tampons, and who may be at disproportionate risk for endometriosis, breast and reproductive cancers.

House representative Carolyn Maloney (D-NY) plans to introduce the bill for the third time in 2001, along with the Robin Danielson Act (H.R. 889), which would direct the Centers for Disease Control and Prevention (CDC) to establish a program to collect data on TSS. (According to the CDC reporting has so far been optional and uneven.)

"We need to find out what the healthiest feminine hygiene product is," says Susan Alderson, vice president of Organic Essentials. "And women will then have a choice." The use of certified organic cotton ensures that none of the 35 different chemicals typically applied to conventional cotton are introduced to Organic Essentials tampons, which are then whitened using totally chlorine-free hydrogen peroxide.

Jay Gooch, a toxicologist with Procter & Gamble (P&G), insists the difference between elemental chlorine-free and totally chlorine-free bleaching is "not discernible," and the difference between rayon and cotton fibers, both cellulose, "not consequential." "The research we've done and others have done for us is rigorous and we stand behind it 100 percent," says Gooch. Tampax Naturals, P&G's own all-cotton tampon, was pulled from the market after not proving a big seller.

Environmental Burden

To further complicate an extremely convoluted, personal and emotional subject, yet another aspect to feminine hygiene is often overlooked. According to waste consultant Franklin Associates, 6.5 billion tampons and 13.5 billion sanitary pads, plus their packaging, ended up in landfills or sewer systems in 1998. And according to the Center for Marine Conservation, over 170,000 tampon applicators were collected along U.S. coastal areas between 1998 and 1999.

But it's not just a landfill issue, says Brenda Mallory, founder of Glad Rags, which produces colored and organic cotton pads with washable liners. "People forget about the production end of disposable items," she says. "Constant production creates pollution, too."

Ironically, lack of exposure (no magazine would accept advertising) halted the introduction of the first disposable menstrual pad in the U.S. in 1896. Today, as sales of disposables surpass $1 billion (with $700 million more from sales of tampons), reusable menstrual pads face a similar challenge, with the added hurdle of needing to educate women on their ecological importance. Not to mention that the very concept of reusables bars repeat consumers, at least for the five-to 10-year lifespan of the product.

"We don't have built-in obsolescence," says Mallory. "It limits how we can grow as company. But you know what? That's not what it's all about."

Knowledge is Power

The FDA does not require manufacturers to print ingredients or bleaching processes, so here's the information you won't find on the box: According to company spokespeople, Johnson & Johnson (OB, Carefree and Stayfree) and Kimberly Clark (Kotex) use cotton/rayon blends, Playtex uses only rayon and Procter & Gamble (Tampax and Always) uses both cotton-rayon blends and rayon alone. All use elemental chlorine-free bleaching.

If those answers don't satisfy you, here are a few more: Natracare carries all-cotton certified organic tampons and non-chlorine, hydrogen peroxide bleached pads. Three more washable pads are Lunapads, Many Moons and Pandora Pads. Each use only totally chlorine-free bleaching, and no bleach at all on organic items.

"Women should have a drawerful of options," says Lou Crawford, founder of The Keeper, which makes natural gum rubber cups inserted to catch menstrual flow. One Keeper lasts up to 10 years. Another softcup, the disposable Instead, is made of a polyethylene and synthetic plastic blend; like the Keeper, it will not breed Staph toxins and is approved by both Health Canada and the FDA. Jade and Pearl shapes natural sea sponges to fit a woman's body, absorbing flow and likewise averting the dilemma of throwaways, synthetic fibers and bleaching.

"For hundreds of decisions that women make everyday, we are balancing health, safety, convenience and efficacy," says Allina. "And we certainly don't always choose the risk-free option." But we should at least be aware of the risks. CONTACT: Glad Rags, [phone], www.gladrags.com; Jade and Pearl, [phone], www.jadeandpearl.com; The Keeper, (877)AKEEPER, www.thekeeperinc.com; Luna Pads, [phone], www.lunapads.com; Many Moons, [phone], www.pacificcoast.net/ ~manymoons; Natracare, [phone], www.natracare.com; Organic Essentials, [phone], www.organicessentials.com; Pandora Pads, (888)558-PADS, www.pandorapads.com.

JENNIFER BOGO is E's managing editor.