The Potential Long Term Effects of Tampons By: Anupama Satish

The female body is a beautiful thing. The body of a woman has many functions and is a wonder of nature. From having periods to giving birth to breastfeeding, a woman and her body should be protected and safe from harm. The menstrual cycle, commonly known as periods, is a normal bodily function that includes the shedding of the uterine lining, or the endometrium, from the uterus and the disposal of an unused egg. This is a monthly occurrence and is the body's way of preparing for pregnancy (Stanford Children's Health). To help with this natural occurrence, many products have been produced to allow women to comfortably move along their day without their periods getting in the way. Of these products, tampons are one of the most commonly used. Having been invented in 1933, tampons are still considered a relatively new invention and as such, the long-term effects of their usage are still unknown (Nuñez, 2020). Tampons are designed to be cotton cylinders that are cased in a plastic applicator which, when inserted in the vaginal canal, will absorb the tissue and blood for up to eight hours (Anderson, 2019). Many tampon companies have also been known to include detrimental ingredients such as fragrance, bleach, aluminum, alcohol, and hydrocarbons (Thompson, 2012). One disease that people are at risk of getting when they use tampons is TSS (Toxic Shock Syndrome), which is a life-threatening bacterial infection (“Toxic Shock Syndrome”). Other than that, there have not been many other findings regarding diseases or side effects caused by tampons. There is very limited research on these chemicals and many people are not aware that tampons contain such toxic chemicals. The reason behind this is that not many people know of the way tampons are manufactured due to the low transparency from many companies. Moreover, even if they are aware, many people cannot afford to abandon these products because they are usually cheaper, more convenient, and more comfortable.

Tampons that are cleared by the FDA (Food and Drug Administration) are primarily made of either cotton or rayon or both (Office of the Commissioner). A major ingredient in tampons and other menstrual products is wood pulp, which are absorbent fibers that are put through an elemental chlorine-free bleaching process to remove dioxin, a pollutant found in the environment. Though this bleaching process rids the wood pulp of most dioxins, there is no guarantee that all of it is gone. One article states, “The amount of dioxin conventional tampons contain varies between 0.1 and 1 part per trillion, FDA figures show” (Knopper, 2003). The amount of dioxin needed to be toxic in a human is stated to be, “In animal studies, dioxins are routinely used at very low doses of 1g/kg body weight per day, whereas other common types of chemical toxins are usually used at a dose of 1 mg/kg/day. Since various harmful effects have been observed even with this low dose, dioxins have the reputation of being deadly poisonous.” (Wada, 2002). This means that conventional tampons should not have the amounts of dioxin needed to be toxic to humans, though this has not been proven.

Dioxins, also known as POPs (Persistent Organic Pollutants), are extremely toxic to the body and can cause many short-term as well as long-term effects. According to the World Health Organization (WHO), the short-term effects of dioxins may include patchy discoloration in skin, skin lesions, or altered liver function. Long-term effects include the potential for dioxin to attack organs within the nervous system, the reproductive system, the immune system, as well as the endocrine system. WHO also states, “Dioxins are highly toxic and can cause reproductive and developmental problems, damage the immune system, interfere with hormones and also cause cancer” (WHO, 2016). The NCBI (National Center for Biotechnology Information)’s research from 2002 involved the analysis of four different brands of tampons and their dioxin concentrations. They reported back that “None of the products contained 2,3,7,8-tetrachlorodibenzo-p-dioxin, the most potent dioxin, although other dioxins were present at detectable concentrations in all samples”(Devito & Schecter, 2002). Their research concluded that though trace amounts of dioxins may be found in sanitary products such as tampons, the amount is not significant enough to cause dioxin exposures.

The NCBI, as well as the FDA, attest to the low dioxin concentrations in these tampons, for example, it states in the NCBI article called “Exposure assessment to dioxins from the use of tampons and diapers.”, it states, “The refined exposure analysis indicates that exposures to dioxins from tampons are approximately 13,000-240,000 times less than dietary exposures”. (Devito & Schecter, 2002). As a part of this research paper, an experiment was conducted to test how much residue could potentially leave a tampon. This was not done to disprove or confirm these organizations’ claims, but rather experiment using simple ingredients, to look into what may possibly be the effect of tampons. The hypothesis was that if tampons are used regularly, then the dioxins in the tampon would be more apparent in the vaginal canal.

As a part of the experiment, a regular-sized Tampax pearl tampon was used and a droplet of orange food dye (color code: Hex#ff4500) was dropped on it using a pipette. Orange food dye was used because it is made of coal tar (Rohrig, 2015), and coal is a commonly found dioxin (Environmental Protection Agency). The tampon was then submerged in 1 cup of water. Water was used as the solvent in this experiment as a representation of the menstrual environment because as the University of Texas states, “The majority of these secretions are mostly made up of water and electrolytes such as sodium or potassium” (Casia, 2019). There was little to no change in the color of the water. After four hours, the tampon was taken out and replaced by a new, identical tampon with one droplet of orange food dye in it, and placed in the same water. The water turned a little bit more orange. This process was repeated 3 more times at 4-hour intervals, at which the water was almost fully orange in color. This experiment then went through Trial 2, where the same experiment was conducted with the same ingredients and the results were fairly the same, the changes being after tampon 1 and after tampon 2, where it showed a slightly darker tint than in Trial 1. The last trial was Trial 3, where the first tampon showed a lighter hue than the other two trials, the second tampon showed the same hue as the first trial and the third tampon showed a darker hue than both of the other trials. The control of this experiment was a tampon without dye that would be submerged in water and replaced by another tampon every 4 hours, where the result was relatively clear water after each interval. This data is represented in Table 1 which is attached below.

In this experiment, the orange dye symbolized the dioxin in the tampon and the water symbolized the vaginal canal. Though this experiment was not an entirely accurate representation of a tampon in the vaginal canal, it was conducted to test a basic principle. From this experiment, it could be observed that as more tampons with the orange food dye were submerged in the water, the darker the hue of orange the water became. A question that came up in the later stages of the experiment was: though many companies and administrations have found that the traces of dioxin in individual tampons are not harmful, would the sum of the dioxin emitted from multiple tampons worn throughout the day be harmful?

The research done found that dioxins are a risk to people, and traces of it are often found in tampons which may cause long-term effects on the body. These effects are mostly detrimental to one’s reproductive health, though the tampons themselves have not yet been proven to have negative effects. The data from the experiment done supports the hypothesis because the dye residue, representing the dioxins, became more apparent in the solvent, representing the vaginal canal, with greater usage of tampons. Further research would help provide more accurate data to support this conclusion as well as provide evidence for the long-term effects of dioxins in tampons.

女性之躯，乃大自然之杰作。女性之体，功能繁复，堪称自然奇观。自月经来潮，至孕育生命，哺乳育儿，女性及其身体应受到保护，远离伤害。月经周期，亦称月经，乃女性生理之常，涉及子宫内膜从子宫脱落，以及未受精卵之排出。此乃每月之常规，亦是身体为孕育做准备（斯坦福儿童健康中心）。为助女性从容应对此自然现象，市面上已生产出众多产品，使她们在日常生活中不受月经之干扰。其中，卫生棉条即为最常使用之物之一。自1933年发明以来，卫生棉条仍被视为一项相对较新的发明，因此，其长期使用之影响尚不明确（Nuñez, 2020）。卫生棉条设计为棉质圆柱体，外包塑料导管，插入阴道后，可吸收组织液和血液，持续长达八小时（Anderson, 2019）。许多卫生棉条制造商也常在产品中加入有害成分，如香料、漂白剂、铝、酒精和碳氢化合物（Thompson, 2012）。使用卫生棉条时，人们可能面临的一种疾病为TSS（中毒性休克综合征），这是一种危及生命的细菌感染（“中毒性休克综合征”）。除此之外，关于卫生棉条引起的疾病或副作用的研究并不多。关于这些化学物质的研究非常有限，许多人甚至不知道卫生棉条中含有的这些有毒化学物质。其原因在于，由于许多公司透明度低，许多人并不了解卫生棉条的制造方式。此外，即使他们有所了解，许多人也负担不起放弃这些产品，因为它们通常更便宜、更方便、更舒适。FDA（食品药品监督管理局）批准的卫生棉条主要由棉花或人造纤维或两者混合制成（专员办公室）。卫生棉条和其他月经用品的主要成分是木浆，这些吸水性纤维经过无元素氯漂白过程，以去除环境中发现的污染物二恶英。尽管此漂白过程可以去除木浆中的大部分二恶英，但并不能保证全部去除。有文章指出，“传统卫生棉条中二恶英的含量在0.1至1万亿分之一之间，FDA数据表明”（Knopper, 2003）。据称，对人体造成毒性的二恶英量为，“在动物研究中，二恶英通常以每日每公斤体重1克的极低剂量使用，而其他常见类型的化学毒素通常以每日每公斤体重1毫克的剂量使用。由于即使在这种低剂量下也观察到了各种有害影响，二恶英因此声名狼藉，被视为致命的有毒物质”（Wada, 2002）。这意味着，传统卫生棉条中不应含有对人体造成毒性的二恶英量，尽管这一点尚未得到证实。二恶英，也称为POPs（持久性有机污染物），对机体具有极高的毒性，可引起许多短期及长期影响。根据世界卫生组织（WHO）的说法，二恶英的短期影响可能包括皮肤斑点状着色、皮肤损伤或肝脏功能改变。长期影响包括二恶英攻击神经系统、生殖系统、免疫系统以及内分泌系统的可能性。WHO还指出，“二恶英高度有毒，可导致生殖和发育问题，损害免疫系统，干扰激素，并可能引起癌症”（WHO, 2016）。NCBI（国家生物技术信息中心）于2002年进行的研究分析了四种不同品牌的卫生棉条及其二恶英浓度。他们报告说，“所有样品中都未检测到最强的二恶英2,3,7,8-四氯二苯并-p-二恶英，尽管其他二恶英在所有样品中都存在可检测浓度”（Devito & Schecter, 2002）。他们的研究结论是，尽管卫生用品如卫生棉条中可能存在微量的二恶英，但其含量并不足以造成二恶英暴露。NCBI以及FDA均证实这些卫生棉条中的二恶英浓度较低，例如，NCBI文章《使用卫生棉条和尿布接触二恶英的暴露评估》中提到，“精细的暴露分析表明，通过卫生棉条接触二恶英的暴露量约为通过饮食接触的13,000至240,000分之一”（Devito & Schecter, 2002）。作为这篇研究论文的一部分，进行了一项实验，以测试可能从卫生棉条中残留的量。这不是为了否定或证实这些组织的主张，而是为了使用简单的成分进行实验，探究卫生棉条可能产生的影响。假设是，如果经常使用卫生棉条，那么卫生棉条中的二恶英在阴道中会更加明显。实验中，使用了一根常规尺寸的Tampax珍珠卫生棉条，并使用滴管滴上一滴橙色食用染料（颜色代码：Hex#ff4500）。使用橙色食用染料是因为它由煤焦油制成（Rohrig, 2015），而煤是一种常见的二恶英来源（环境保护署）。然后将卫生棉条浸泡在1杯水中。水在本实验中被用作溶剂，以代表月经环境，因为德克萨斯大学指出，“这些分泌物的成分主要是水和电解质，如钠或钾”（Casia, 2019）。水的颜色几乎没有变化。经过四小时后，将卫生棉条取出，并用带有橙色食用染料的新、相同的卫生棉条替换，并将其放入同一杯水中。水的颜色变得稍微有点橙色。这个过程重复了三次，每次间隔4小时，此时水的颜色几乎完全变成橙色。然后，实验进行了第二次试验，在相同的成分下进行了相同的实验，结果与第一次试验相当，变化是在第一次和第二次卫生棉条之后，颜色比第一次试验略深。最后一次试验是第三次试验，第一次卫生棉条的颜色比其他两次试验浅，第二次卫生棉条的颜色与第一次试验相同，第三次卫生棉条的颜色比其他两次试验深。本实验的控制组是一根不带染料的卫生棉条，每4小时浸泡在水中，并更换另一根卫生棉条，结果在每个间隔后都是相对清澈的水。这些数据在附表1中表示。在本实验中，橙色染料象征着卫生棉条中的二恶英，而水象征着阴道。尽管这个实验并不是阴道中卫生棉条的真实写照，但它是为了测试一个基本原理。从这个实验中，可以观察到，随着更多带有橙色食用染料的卫生棉条浸泡在水中，水的橙色颜色变得越深。实验后期出现的一个问题是：尽管许多公司和行政部门已经发现，个别卫生棉条中的二恶英痕迹并不危险，但一天中使用的多个卫生棉条释放的二恶英总和是否会造成危害？进行的研究发现，二恶英对人类构成风险，并且其痕迹经常在卫生棉条中被发现，可能对身体造成长期影响。这些影响主要损害人的生殖健康，尽管卫生棉条本身尚未被证明有负面影响。实验数据支持了这一假设，因为代表二恶英的染料残留物在代表阴道的溶剂中，随着卫生棉条使用量的增加而变得更加明显。进一步的研究将有助于提供更准确的数据来支持这一结论，并提供关于卫生棉条中二恶英的长期影响的证据。