Toxic shock! How safe are feminine hygiene products?

The hundreds of tampon-related Toxic Shock Syndrome (TSS) cases in the early 1980s made front-page headlines at the time. But since then, warnings have been inserted in tampon boxes, and the safety of menstrual products has seldom been much of an issue. Yet there are still toxins in tampons and sanitary pads. And some of them, like dioxin and pesticides, may have grave long-term health and environmental consequences. "Most women want to trust that products will come up to some sort of standard, despite past problems," says Liz Armstrong, author of Whitewash: Exposing the Health and Environmental Dangers of Women's Sanitary Products and Disposable Diapers.

In 1992, a congressional subcommittee found that the U.S. Food and Drug Administration (FDA) failed to heed its own scientists' 1987 recommendations to test the dioxin levels in tampons and sanitary pads after trace levels of dioxin were discovered. Residues of dioxin find their way into menstrual products as a byproduct of the bleaching process. Dioxins, ubiquitous in the environment, are produced through the chlorine bleaching of wood pulp. The chlorine used to produce rayon results in additional dioxin; most manufacturers of feminine hygiene products use rayon in tampons and wood pulp in sanitary pads for absorbency.

"What people don't understand is that it's not just the product, but the manufacture of the product itself, that is an environmental and health issue," says Susie Hewson, founder of Natracare, manufacturer of all-cotton tampons and sanitary pads.

Forewarned

FDA officials admit that both International Playtex and Procter & Gamble, major manufacturers of tampons and sanitary pads, had informed the agency that their products potentially contained dioxin from wood pulp Procter & Gamble also recently purchased Tambrands, makers of Tampax tampons, giving the company leadership in the feminine hygiene market - and the power to improve the standards of the entire industry.

The FDA has yet to test dioxin levels in feminine hygiene products, in spite of mounting evidence of the chemical's carcinogenic and adverse reproductive effects. The International Agency for Research on Cancer in February 1997 announced its findings that the most biologically potent of dioxins - 2,3,7,8-tetra-chlorodibenzo-para-dioxin (TCDD) - is carcinogenic to humans and frequently found in wood pulp. A 1994 Environmental Protection Agency (EPA) study also concluded that dioxin exposure, even at low levels, can result in a number of non-cancer health effects in humans, including developmental and reproductive effects, immune suppression, and disruption of regulatory hormones. Other researchers suspect a link between dioxin exposure and endometriosis.

After learning about the presence of dioxin in tampons last year, U.S. Representative Carolyn Maloney (D-NY) introduced the "Women's Health and Dioxin Act of 1996," which would require the National Institutes of Health to determine if the levels of dioxin present in tampons pose health risks, such as cervical cancer, to women. This year, she will reintroduce the bill, expanding it to include sanitary pads and assessment of the risk of breast and ovarian cancers and endometriosis due to dioxin. The FDA would be required to determine whether warning labels should be placed on product packaging.

A Toxic Shock

Rayon, a more absorbent and inexpensive material than cotton, is in most major brands of tampons. Although evidence shows that highly absorbent synthetics like polyethylene and polyester contribute to TSS, manufacturers continue to use them, particularly in Super and Super Plus sizes. All-cotton tampons were not even available until recently.

In 1994, Drs. Philip Tierno and Bruce Hanna, researchers at the New York University Medical Center and the only independent researchers of tampons in the U.S., were able to test 100 percent cotton tampons for the first time after the introduction of all-cotton brands made by Terra Femme and Natracare. Their studies concluded that tampons containing synthetics amplify the production of the TSS-causing toxin by certain strains of bacteria, whereas the all-cotton tampons produced no measurable toxin. "Synthetic tampons absorb more water than cotton, leaving behind concentrated proteins that are used by staph bacteria to create the toxin," creating toxin factories, says Dr. Tierno.

The FDA does not require ingredient labeling of menstrual products, despite evidence that synthetic ingredients increase the risk of TSS and that additives, such as binding agents and fragrances, can cause allergic reactions. Even shampoo, a product used externally, must have its ingredients listed on packaging. Some manufacturers, like Johnson & Johnson (o.b. tampons) and Tambrands (Tampax) voluntarily list ingredients, but there is no guarantee that such listings are comprehensive. While Tambrands Naturals are hydrogen-bleached, it's not mentioned on the packaging. Natracare has filed a lawsuit against Tambrands claiming that the Naturals brand is falsely using a 100 percent cotton claim to gain an unfair market advantage. Natracare contends that 10 percent of the Naturals overwrap is made of unidentifiable, non-cotton materials.

The Organic Alternative

Simply switching to regular cotton tampons may not be enough. While unbleached or oxygen-bleached cotton tampons and sanitary pads may be better than synthetic products, conventionally grown cotton is one of the most pesticide-intensive crops in commercial agriculture. About 10 percent of the world's pesticides and 22.5 percent of all insecticides are used on cotton. According to the Sustainable Cotton Project in California, nearly one-third of a pound of chemicals is used to make just one cotton T-shirt.

A woman's vagina can absorb chemicals from a tampon easily, says Dr. Tierno. Even sanitary pad and shield users should be concerned. "These products should be as clean and pure as possible," he adds.

"Consumers today have a choice between continuing to use a toxic substance and buying a product that's organically grown and non-chlorine-bleached," says Sandra Marquardt, West Coast program coordinator of Mothers and Others For a Livable Planet. She adds that dioxin and pesticide residues may also be present in disposable diapers and incontinence pads.

Organic Essentials, a member of the Texas Organic Cotton Marketing Cooperative, has been selling 100 percent organic cotton tampons for over a year. And GladRags, makers of reusuable, organic cotton menstrual pads, began marketing its product as an environmental alternative to single-use, chemical-laden items which end up in landfills. "We started out educating people on buying reusables," says Brenda Mallory, president of Keepers, Inc., the makers of GladRags. GladRags, once used, are machine washable, and can be pre-soaked for optimum cleaning. She adds that business is growing, due in part to consumers' growing awareness of the environmental and health consequences of conventional, bleached hygiene products.

Susan Alderson, vice president of Organic Essentials, says, "We work hand-in-hand with GladRags and support each other. We feel that organic is important [for feminine hygiene] because these products are something you're inserting into your body." Organic Essentials also sells organically-grown cotton to cooperatives and individuals who make their own pads.

"We've talked to Tambrands about going organic, and they're definitely not interested," Alderson says. CONTACT: Organic Essentials, Route 1, Box 120, O'Donnell, TX 79351/[phone]; GladRags, PO Box 12648, Portland, OR 97212/[phone]; Mothers and Others, 40 West 20th Street, New York, NY 10011/(888) ECO-INFO.

AISHA IKRAMUDDIN is a research associate for The Green Guide, published by Mothers and Others for a Livable Planet.