2024-03-12 15:06:47
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Two categories of intimate protection
Intimate protection products are consumer products, used during the period to absorb the menstrual flow or outside (for example in the event of urinary leakage). They are used by women from the age of their first period (on average 12 years and 3 months).
There are two categories of intimate protection on the market:
internal protections intended to be inserted into the vagina in order to absorb menstrual flow. They can be single-use, such as sanitary tampons, or reusable, such as menstrual cups or menstrual discs;
external protection such as sanitary napkins, panty liners and menstrual panties (which can be single-use or reusable).
Generally speaking, intimate protection for single external use is composed of products of natural origin derived from wood (cellulose), substances of a synthetic nature (polyolefins) and superabsorbent (SAP). Tampons are composed of products of natural origin derived from cotton which undergo chemical treatment, and products of a synthetic nature such as polyolefins. As for menstrual cups, they are made of thermoplastic elastomer or medical grade silicone.
Chemical substances in intimate protection
In 2017, studies highlighted the presence of chemical substances in intimate protection. Some, like perfumes, are added intentionally. Others may come from contamination of raw materials, or are due to manufacturing processes; These may include, for example, carcinogenic substances (polycyclic aromatic hydrocarbons (PAHs), dioxins, furans), reprotoxic substances (phthalates), allergenic perfume substances and pesticides. It should be noted that certain pesticides found in the products analyzed have been banned for use in the European Union, sometimes for many years (this is the case for lindane and quintozene, banned since 2000, or hexachlorobenzene, since 2004). . Glyphosate, which is authorized for use in the European Union, has also been found in certain products.
ANSES’s expertise consisted of assessing the health risks linked to the presence of these substances in intimate protection – sanitary napkins, panty liners and tampons. To assess exposure, the agency considered the use of 6 intimate protection products or 4 menstrual cups per day, considering both an adult woman (for an average weight of 60kg) and a young girl who has just had her period. (30kg).
By comparing the estimated exposure to the different substances present in intimate protection with the toxicological thresholds that can cause health effects, the Agency has not identified any chemical risk for the health of exposed women.
Nevertheless, ANSES recommended that manufacturers improve the quality of raw materials and review certain manufacturing processes, in order to eliminate or reduce as much as possible the presence of the substances mentioned above. This concerns in particular those presenting carcinogenic, mutagenic or reprotoxic effects (CMR), endocrine disruptors and skin sensitizers.
ANSES also recommends the development of a more restrictive regulatory framework at European level, in order to limit the presence of chemical substances in feminine protection. Indeed, there is no specific regulatory framework in the EU. These products are consumer products and therefore fall under the General Product Safety Directive, which ensures that products are placed on the market that are safe for their intended and reasonable use for the consumer. Conversely, in the United States, Canada or Japan, feminine protections are medical devices.
The 60 million consumers association tested 24 periodic protection products (tampons, sanitary towels, panty liners), 7 years following its first comparison. Toxic chemical substances remain present (glyphosate and its metabolite, dioxins, halogenated organic compounds), although at concentrations which do not a priori present a major health risk, given the current state of knowledge.
Women’s behavior in relation to intimate protection
At the request of ANSES, a survey was carried out in 2017 among a sample of women representative of the French female population. The aim of this survey was to collect information concerning their practices in terms of intimate protection, the main factors which determine their choice and perceptions of the possible risks associated with their use.
Concerning the type of protection worn, towels and panty liners (menstrual panties were still not very present on the French market) were used in combination with other protection by 91% of women, particularly those aged 13-24. Women over 25 reported predominantly using tampons. Only 21% of women (33% of those aged 13 to 24) used sanitary napkins exclusively.
During the last 12 months preceding the date of the survey, 13% of respondents declared having changed the type of protection, mainly to use menstrual cups.
This investigation also highlighted an inadequacy of hygiene measures, in particular hand washing, whether before or following changing protection, and the duration of wear. The recommendations contained in the instructions for use of internal protections recommend a maximum wearing time of between 4 to 8 hours. They seem to be little or poorly followed by the majority of tampon users, since 79% of them said they kept them on all night. Nearly 30% of women did not change their menstrual cup for an entire day (compared to 2% for tampons).
Provided by the author
The results of this survey were confirmed in a 2022 French study. Daytime wearing times reported for tampons were greater than 5 hours for 10.7% of respondents and 8 hours for 1.7% of them. , and for menstrual cups longer than 5 hours for 39.7% of respondents and 8 hours for 8.3%.
Concerning the perception of risks linked to the use of intimate protection, 81% of respondents believed that at least one type of protection involves a risk (mainly tampons), but few knew them precisely. The risks of infection and “vaginal problems” (irritation, ulceration, dryness, pruritus, etc.) were identified for all protections while menstrual toxic shock syndrome (TSS) was cited only for tampons and, in one to a lesser extent, menstrual cups. Generally speaking, menstrual cups were perceived as the least risky protection.
It should be noted that for irritations, ulcerations, dryness, etc., there are no epidemiological studies. These events are reported by users, gynecologists and by manufacturers through their monitoring system for marketed products.
What is menstrual toxic shock syndrome?
Menstrual TSS is the main risk associated with wearing tampons and menstrual cups. It is a rare disease caused by a toxin produced by a bacterium, Staphylococcus aureus (staphylococcal toxic shock toxin, TSST-1). Around twenty cases are recorded per year in France (11 cases in 2020). In the absence of mandatory reporting of this pathology, it is not possible to know the actual number of cases in France. The CNR for staphylococci estimates around one hundred cases per year in France of menstrual SCT.
The first symptoms, not specific to this pathology (flu-like), appear within 3 to 5 days following exposure. The toxin spreads throughout the body via the bloodstream and damage to different organs (liver, kidney, nervous and blood systems) begins to be observed. They can lead, in rare cases, to serious complications which can lead to amputation or even death.
This syndrome is linked to the conditions of use of internal intimate protection: prolonged use increases the risk. Protections with a stronger absorption capacity than necessary mechanically increase this risk, by excessively increasing the duration of wear. In fact, cups and tampons prevent menstruation from being eliminated from the vagina, where it will constitute an adequate nutrient for this [staphylocoque présent chez environ 1 % à 4 % des femmes]. Enough to encourage their multiplication and then the production of toxin.
In order to limit the risks, ANSES highlights this simple advice for users:
Respect the recommendations for use specific to each protection, not only with regard to the wearing time of tampons and cups, but also the absorbency of the tampon, which must be adapted to the menstrual flow, so that it is changed regularly . This recommendation also applies to menstrual cups.
Only use a tampon during your period.
Respect the hygiene rules related to the use of intimate protection, in particular washing your hands before and following changing them.
ANSES also recommends increasing information for health professionals and women regarding this disease and its symptoms.
And at the regulatory level?
ANSES has recommended that all manufacturers display clear indications relating to this risk on the packaging and instructions for use of internal intimate protection products.
This recommendation led the French public authorities to publish a decree which aims to strengthen the protection and information of consumers. This decree makes it compulsory, from April 1, 2024, to display on the packaging and/or in the instructions the composition of these products, the terms and precautions for use and the health risks associated with the composition or the use of these products.
For internal intimate protection, information on the risk of developing menstrual toxic shock syndrome must also be present on the packaging, as well as recommendations for use to reduce this risk, such as: do not exceed a wearing time of 6 hours, do not use these protections at night, consult a doctor immediately if symptoms of menstrual TSS appear, informing them of the current menstruation, and remove the protection.
These recommendations are all the more relevant since, in its comparison at the end of 2023, the 60 million consumers association noted that the precise composition of periodic protection rarely appears on the packaging, or is even absent.
This article is written by Aurélie Mathieu-Huart, deputy head of unit Evaluation of reference values and risks of chemical substances,
Céline Dubois participated in the writing of this article. Scientific project manager for the National Agency for Food, Environmental and Occupational Health Safety from 2007 to 2023, she is today a chemical engineer and product regulation manager for Arkema.
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