In recent years, the question of creating an intimate defense has sparked numerous public debates in France. More and more women are wondering about the dangers associated with using these feminine hygiene products. Between 2018 and 2020, ANSES (National Agency for Food, Environmental and Occupational Health Safety) evaluated the safety of intimate protection: tampons, sanitary napkins, panty liners and menstrual cups.
Following this evaluation and the recommendations of ANSES, the public authorities took up the subject in 2022, and prepared a decree on the labeling of feminine protection. Here’s what you need to remember.
Intimate protection products are consumer products, used to absorb menstrual flow during periods or outside (for example in the event of urine leakage). They are used by women from the age of their first period (average 12 years and 3 months).
There are two categories of intimate security in the market:
● Internal protection intended to be inserted into the vagina 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 synthetic nature (polyolefins) and superabsorbent (SAP). Tampons are made of products derived from cotton of natural origin that undergo chemical processing, and products of synthetic nature such as polyolefins. As for menstrual cups, they are made of either thermoplastic elastomer or medical grade silicone.
In 2017, studies highlighted the presence of chemical substances in intimate defenses. Some, like perfumes, are added intentionally. Others may come from contamination of raw materials, or be 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 some pesticides found in the analyzed products have been banned for use in the European Union, sometimes for several years (this is the case for lindane and quintozin, banned since 2000, or hexachlorobenzene, since 2004). . Glyphosate, which is authorized for use in the European Union, is also found in some products.
ANSES’ expertise includes assessing the health risks associated with 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 for both an adult woman (for an average weight of 60 kg) and a young girl who has had her period (30 kg).
By comparing estimated exposures of various substances present in intimate protection to toxicological thresholds that may affect health, the agency identified no chemical risk to the health of exposed women. However, ANSES has recommended that manufacturers improve the quality of raw materials and review certain manufacturing processes, in order to eliminate or minimize the presence of the above-mentioned substances as much as possible. This particularly concerns those presenting carcinogenic, mutagenic or reprotoxic effects (CMR), endocrine disruptors and skin sensitisers.
ANSES also recommends the development of a more restrictive regulatory framework at the European level, 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 placed on the market are safe for consumers for their intended and reasonable use. In contrast, in the United States, Canada or Japan, feminine protection is medical devices.
60 Million Consumers Association tested 24 period protection products (tampons, sanitary napkins, panty liners) 7 years after its first comparison. Toxic chemicals are present (glyphosate and its metabolites, dioxins, halogenated organic compounds), although given the current state of knowledge, there is a significant health risk at non-priority concentrations.
At the request of ANSES, a survey was conducted in 2017 among a sample of female representatives of the French female population. The aim of this survey was to collect information regarding their practices in terms of intimate security, the main factors that determine their choice and perceptions of potential risks associated with their use.
Regarding the type of protection worn, towels and panty liners (panties were still not very present in the French market during menstruation) were used by 91% of women, especially women aged 13-24, along with other protection. Women over 25 years of age mainly reported using tampons. Only 21% of women (33% of those aged 13 to 24) used sanitary napkins.
During the last 12 months prior to the survey date, 13% of respondents reported changing the type of protection, to primarily use a menstrual cup.
The investigation also highlighted the inadequacy of hygiene measures, particularly hand washing, whether before or after changing protection, and the duration of wear. Recommendations appearing in the instructions for use of internal protection recommend a maximum wear time of between 4 and 8 hours. It seems to be little or poorly followed by most tampon users, as 79% of them declared that they keep them on at all. Night.. About 30% of women did not change their menstrual cup for an entire day (compared to 2% for tampons).
The results of this survey were confirmed in a 2022 French study. For 10.7% of the respondents the time of day wearing tampon was more than 5 hours and for 1.7% of them it was 8 hours. , and 39.7% had more than 5 hours for a menstrual cup. 8 hours for respondents and 8.3%.
Regarding the perception of risks associated with the use of intimate protection, 81% of respondents believed that at least one type of protection involved risks (mainly tampons), but few knew them precisely. Risks of infection and “vaginal problems” (itching, ulceration, dryness, itching, etc.) were identified for all protection while menstrual toxic shock syndrome (TSS) was cited only for tampons and, to a lesser extent, menstrual cups. . Generally speaking, the menstrual cup was considered the least risky form of protection.
It should be noted that for inflammation, ulceration, dryness, etc., there are no epidemiological studies. These events are reported by users, gynecologists and manufacturers through their monitoring systems for marketed products.
Menstrual TSS represents the main risk of wearing tampons and menstrual cups. It is a rare disease caused by a toxin produced by the bacterium, Staphylococcus aureus (staphylococcal toxic shock toxin, TSST-1). About twenty cases are reported in France each year (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 about 100 cases per year in France of monthly SCT.
The first symptoms, not specific to this pathology (flu-like), appear 3 to 5 days after exposure. The poison spreads throughout the body through the bloodstream and damages various organs (liver, kidney, nervous and circulatory system). They can, in rare cases, lead to serious complications that can lead to amputation or death.
This syndrome is linked to 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 leaving the vagina, where it would form enough nutrients for this (in about 1% to 4% of women, staphylococcus is present). enough to encourage their multiplication and then the production of toxins.
To limit the risks, ANSES publishes this simple advice for users:
● Respect the specific use recommendations for each protection, not only in terms of time of wearing the tampon and the cup, 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 tampons during your period.
● Respect hygiene rules related to the use of intimate protection, especially washing hands before and after changing them.
ANSES also recommends increasing information for health professionals and women about the disease and its symptoms.
ANSES recommends that all manufacturers display clear indications regarding 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 aimed at strengthening consumer protection and information. The decree makes it mandatory to indicate the composition of these products, the conditions for use and precautions and the health risks associated with the composition or use of these products on the packaging and/or in the instructions from April 1, 2024.
For internal intimate protection, information about the risk of developing menstrual toxic shock syndrome should also be on the packaging, as well as recommendations for use to reduce this risk, such as: wearing time should not exceed 6 hours, do not use. These protections at night, if the symptoms of menstrual TSS appear, contact the doctor immediately, inform them about the current menstruation and remove the protection.
These recommendations are all the more relevant because, compared to the end of 2023, the 60 million consumer association noted that the specific composition of periodic protection is rarely visible on the packaging, or even absent.
Celine Dubois, chemical engineer and product regulatory manager for Arkema, contributed to the writing of this article.
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