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Reprinted From September 2, 1997 edition of SmartyPants.
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ARE THE TAMPONS YOU USE SAFE?, Smarty-Pants, September 2, 1997, by Jory Des Jardin

Like many women in their menstruating years, I take the options in the feminine protection aisle for granted. Once a month I grab my brand, grumble about the price, and then pay for protection that is as necessary to a woman’s existence as chocolate. I do so because I feel I have little choice—other than whether to buy sanitary pads or tampons. I prefer to avoid the embarrassing bulges and matronliness associated with pads. Those newfangled dry weaves and wings only make me feel infantile, like I’m swathed in a diaper. For $5, I can purchase temporary forgetfulness of the irksome process of menstruation.

This choice is made despite my knowledge of the risk of acquiring toxic shock syndrome (TSS), the possibly fatal condition whose acronym aroused as much fear in 1980 as AIDS does today. That was when 38 women died from TSS as a result of using the Rely brand tampon. Apparently the super absorbent rayon fibers that made Rely so popular so fast made a suitable breeding ground for a bacteria present in the bodies of 15 percent of women. The feminine protection industry was shaken, as was their clientele, but, almost two decades later, we’re still buying tampons, throwing out that enclosed information sheet on TSS and following the "rules" our mothers pounded into our heads when we were 13: Don’t wear the supers if you don’t have to, and change every four to six hours. Tampon manufacturers reduced the absorbency levels of their products and the rayon content, making them less likely to cultivate infection. And they standardized the sizing of their products so that women would know the absorbency of the product no matter what brand they were purchasing. Any additional fears I have had despite these improvements were quelled by thinking, "How could millions of women be wrong?"

That’s what makes a recent study all the more frightening. The study isn’t as new as the public’s awareness of it. It began as early as 1987, when an unpublished FDA memo suggested that "risk assessment" be determined for all feminine products containing dioxin—a by-product of the chlorinating process of commercial brands. Exposure to dioxin is known to cause cancer and birth defects. In 1989, another unpublished FDA report went even further, recommending that feminine products contain no dioxin at all. The report was unearthed in 1992 in a Congressional subcommittee hearing that pointed the finger at the FDA for not informing women about the risks of dioxin exposure. The hearing was given little press, however, and tampon companies such as Tambrands, the leading manufacturer, claimed that any trace of dioxin in their products was negligible. The FDA has yet to conduct a follow-up dioxin study to ensure that brand-name tampons—and other chlorinated products like panty liners and pads—are safe.

I didn’t learn about the study in The Times or Newsweek. I got wind of it on the Web, in an e-mail chain letter that originated from the computer of Kelly Fuller, a biology student at St. Olaf College. The information was sent to me with a note from my sister, a graduate student, that began, "You might find this interesting..." I certainly did find it interesting. But even more intriguing was the way I got the knowledge--through an underground, electronic, academic network. What about the millions of women who don’t get the message? Why hasn’t the press chosen to spotlight the feminine protection industry with the same alacrity as it has the tobacco industry? Like most smokers—who know of the link between cigarettes and lung cancer—most women know of the correlation between tampons and TSS. Yet the tobacco industry is paying billions of dollars over the next quarter century in part because it increased the amount of nicotine, an addictive substance, in its products. The tobacco industry, in effect, made their product more harmful to consumers and withheld this information from the public. Why aren’t we punishing an industry that is also using a poisonous substance in its products, and that’s suppressing life-threatening information that could affect 73 million women in the United States?

And why, despite the red flags (tasteless allusions aside) am I still loathe to go out the local organic market and pick up a biodegradable box of all-natural tampons?

The answer to the last question is because the industry that has masked the study results so well has been equally adept at convincing us that we need their products and their products alone. In a groundbreaking article in the Village Voice, "Pulling the Plug on the Sanitary Protection Industry" (Feb. 7, 1995), Karen Houppert traces the beginnings of women’s reliance on tampons. It began in July, 1936, when Tampax Inc. (now Tambrands Inc.) released its first ad about its revolutionary new product. "The promise of ‘No belts. No pins. No pads. No chafing. No binding,’ was irresistible," Houppert writes. The assurance of less embarrassment and less discomfort wasn’t a bad concept to sell, but wrapped up in this pioneering pitch was the insinuation that menstruation is dirty and must be hidden. In its first ad, Houppert writes, Tampax promised that its product would "permit daintiness at all times" and a Kotex tampon, called Fibs promised, like the rest of the feminine products on the market, to eliminate embarrassment and to keep women’s little secret. These new products were clean and blindingly white to prove it. White is right. Menstruation is a nasty enough business, who’d want to use a darker, unsanitary product, especially in such a delicate place?

However, in truth, bleaching a product is not the same as sanitizing it. In their book "Whitewash" Liz Armstrong and Adrienne Scott explain that, paradoxically, the chlorinating process meant to make feminine products "whiter than white" is actually "guilty of creating some of the most toxic pollutants ever discharged in our environment" not to mention in our bodies. When feminine products are chlorinated, the natural brown organic fibers are stripped from the pulp, and the unnatural organochlorines that replace those fibers suppress the body’s immune system and can result in a host of side effects, including infertility and cancer.

The assumption that sanitary products must be stark white—and disposable—in order to be safe is the result of a coup by the brand-name sanitary product makers—Tambrands, Playtex, Procter & Gamble, Kimberly Clark, and Johnson & Johnson—and a belief almost religiously upheld in the United States. Willi Nolan, President and founder of Bio Business International, a Canadian company that shares its profits marketing Terra Femme organic tampons to fund women’s and children’s causes, says that this bias toward white disposables is mostly shared by North American women.

"European women are more concerned about their health," she says, and are less concerned with the appearance of a product. She notes the preference for non-applicator tampons in Europe as an example of how European women are more comfortable about menstruation.

"They’re much less squeamish about getting blood on their hands," she says. And they are much more open to alternative methods of protection that offer less exposure to dioxin.

Alternative methods of protection fall into three basic types: all-natural or "organic" tampons (which are made of unbleached cotton), washable pads, and a reusable insert called the Keeper that collects menstrual blood rather than absorbing it. Brand-name maxi pads are not an option since they are also bleached and can expose women to dioxin. So far it seems that organic tampons are the No. 1 alternative choice because they require the least alteration to our lifestyle. Nolan conducted marketing research at a recent women’s conference she attended and found that 90 percent of the women surveyed said they would buy a non-chlorine tampon, even if that meant shelling out more money every month. Considering the likelihood that the women surveyed were more politically active than most women, this number is perhaps inflated. But one result of the survey is clear: Women remain quite doubtful about the other forms of protection, which require more maintenance. The washable pads are typically sold in sets (about $35 per set), which include flannel inserts that absorb the blood. When soiled the inserts are removed and must soak before being washed. The other method, the Keeper, is a bell-shaped, gum-rubber cervical cup that resembles the end of a plunger. The rim is folded and inserted into the vagina like a tampon and held in place by suction below the cervix, where it catches menstrual fluids. It must be removed periodically—by pulling on the elongated end--and emptied approximately every six to 12 hours. The point of the Keeper is that it doesn’t have the absorptive fibers of a tampon but can still offer active women less bulky mobility.

Of course, these products take some getting used to. I decided to tackle the safety issue before approaching my practical concerns. All organic tampons in the US must be FDA "accepted" (the term for products with approval) to be on the market, and the Keeper has the stamp as well. But many of the reusable pads are not FDA accepted. The rationale here is shared by the Canadian government, which considers feminine products as beauty aids rather than medicinal. In the US, only products worn internally merit a study. I asked my gynecologist about the safety of all alternative products. Aside from the organic tampons, she hadn’t heard of them before. But, being an expert in our biological processes, she offered her opinion: "That’s really gross," she said. "Who’d want to go back to washing? We did that 100 years ago…What a mess." When I explained how the Keeper was used, she said she had no idea why that product would be any better than a tampon. I told her about the FDA studies. "So, who died?" she asked. Then she pointed out that infection is not cultivated in a tampon, but in the blood. "Whatever method she uses, a woman remains in contact with her blood," she explained. "It shouldn’t matter if the product is gum rubber or a tampon."

Karen Houppert’s article explains why looking for a body count to back our concerns about dioxin is pointless: its effects are "less immediately apparent than toxic shock syndrome. It may be years before a women develops any of the symptoms, and because of the level of dioxin (already) in the environment, it would be difficult to pinpoint tampon use as a major factor." But then we confront another tendency of ours: blowing off infinitesimal numbers that suggest—not prove—that a product may be harmful. We’d prefer women to die of TSS in emergency rooms, like they did in 1980, to considering the alternatives.

If our health isn’t enough of a concern, ponder this: Environmentalists are advocates of applicator-free, all-natural tampons because they are biodegradable, and of washable pads and the Keeper because they don’t add to the world’s piling chemical waste. The pads, on average, last four to five years, and the Keeper up to 10. Throughout your menstruating lifetime, you could use approximately 60 reusable pads and four Keepers, or you could toss 10,000 brand-name pads or tampons into landfills. And the release of dioxin that occurs during the manufacturing process of commercial products is an extra environmental deterrent. If your budget is a concern, consider this: Houppert estimates that women will spend approximately $2,137 on brand-name feminine products in her lifetime. Compare that to approximately $150 for four Keepers, or $350 for a lifetime of washable pads. Organic tampons—at an average of about $5 per box of 20--are more expensive than brand-name products, but they still lack wide distribution. (Incidentally, I did a price check on Tampax Naturals, the only brand-name, all-natural tampon on the market. The price is the same as its bleached counterparts--but there are five fewer tampons per box.) Even purchasing alternative products on the basis of principle would tell brand-name companies that they can’t pull the wool—or rayon—over our eyes like they did in 1991, when they subtly decreased the number of tampons in a standard size box, from 40 to 32, and charged the same price.

Another reason to consider alternative products: they have gained a loyal following by women who claim that their bodies are reacting positively to their reduced exposure to chemicals. Some online testimonials for the Keeper and washable pads claim that the incidence of yeast infections were reduced after giving up bleached products. Janet Trenaman, who heads Many Moons, another Canadian distributor of alternative products, says that women from other countries, who had to switch to bleached products when they came to North America, were happy to see more natural products available.

"They said that the bleached products just didn’t feel right to them," she says.

We could perhaps get more comfort—not to mention safety and ecological peace of mind—for our money by buying products from alternative product manufacturers, none of which hock their wares during commercial breaks, and some of which use only the Internet—and their first names—to publicize. But I must admit I looked behind me to make sure nobody was watching me download information on "GladRags," and pictures of diminutive plungers. Trenaman understands our sour looks. The first time she was introduced to alternative products in 1989, she considered the washable pads taboo. Nolan found the Keeper downright ugly. However, both women have made it their business, literally, to convince other women that the benefits of using these products are far more important than any qualms we might have about rinsing out our blood or having such direct, applicator-free exposure to our bodies. Both Terra Femme and Many Moons have enjoyed sales growth in the past five years: both won’t give exact numbers, but Trenaman says sales have grown in the thousands in the past five years, while Nolan says that in the past six months sales have increased four times over.

"A lot of women are exposed to the products and don’t do anything. But several years later they realize they’re ready," Trenaman says, noting that the majority of her customers are regular users.

But converting North American women into users of these products is an uphill battle. Can we trust these products to protect us? Can we fully reprogram ourselves to believe in something other than the subliminal message of those television ads—the ones that tell us that menstruation is something to be hidden from the public, and maybe even from ourselves? In 1993 Ms. magazine went beyond the theoretical arguments of why we should use these products and actually tested them for comfort, protection and convenience on several of their staffers under age 30. The testimonials were all candid, and they surprisingly ranged from full endorsements to guilty skepticism. An endorser found that using the Keeper, for example, minimized the length of her period (an indubitable plus that Many Moons claims is a proven benefit, although no studies have been done to explain this phenomenon); others felt they were doing a favor for their bodies and the environment. There were no unequivocal detractors, but those less than enthusiastic about the pads and the Keeper complained about staining and leakage, cleaning out the rubber cup in a public bathroom, and such practical concerns as having to remove blood filled soaking pots and hanging pads from the bathroom before company arrived. Plus, the products required some practice before they could be inserted and worn confidently. One of the Ms. staffers, "Erin M.," resolved herself to a compromise between health-conscious eco-feminism and convenience:

"Even though I won’t wear the reusable pads all the time…I’ve cut my use of tampons in half, so I’ve cut down my risk of toxic shock syndrome, I’ve cut my exposure to dioxin, and I’ve cut my contribution to landfills. I’m making progress."

Like Erin M., I’m uncertain whether I will want to part with my relatively quick trips to the ladies’ room, where I can flush away some of the less romantic aspects of being a woman. After all, we want to be seen on the level with men, not stepping down from the podium to do a "status check" in the washroom. We are not shamed by our processes anymore—we’re inconvenienced by them. And overcoming that issue will be the next task for women’s advocates once the word is spread of the risks involved in using bleached products. In the meantime, companies like Many Moons and Bio Business are treating the subject of menses with an openness it deserves. It’s just a matter of time before American women will see these alternative methods as choices, not as affronts to our hygiene. And Tampax won’t be the all-encompassing term used to define feminine protection. For now, awareness is a positive advance, and an educated "thanks but no thanks" should not be construed as a failure by women trying to convince their sisters to make their politics personal. Already I think twice before snatching my brand, contemplating if this box will be my last.