Menstrual products and asbestos, toxic shock, dioxin and viscose rayon: Product safety at the Museum of Menstruation and Women's Health

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Menstrual Product Safety (and in Spanish)

Topics below: Do menstrual cups cause endometriosis? | Cleaning sponges | New bleaching process for tampons, eliminating dioxin | Asbestos, dioxin and viscose rayon in tampons | Menstrual cups and toxic shock | The new Keeper menstrual cup | All-cotton products

Do menstrual cups cause endometriosis?

There's not enough evidence to support that, says the FDA. See the FDA's documentation.

Boil sponges

Dr. Philip Tierno, Jr., a MUM board member and expert on the safety of menstrual products, writes (October 1999), in part,

Soap and water will not effectively clean the sea sponge. The odor emanating from the used and washed sponges represent the action of surviving vaginal bacteria and their degradation of menstrual debris that survives the wash. The only effective way to sanitize those sponges is by boiling for about 5 to 10 minutes. This will kill ALL bacteria there.

Interestingly, looking back in history, women used to boil their menstrual "rags" to get them clean. This is an analogous circumstance.

Tampon Manufacturers Use a Different Bleaching Process

Dr. Philip Tierno, Jr., a MUM board member and expert on the safety of menstrual products, writes (May 1999), in part,

[T]he Food and Drug Administration has said that the tampon manufacturers are now using a different bleaching method. Instead of highly reactive chlorine gas bleach they are using chlorine dioxide. There is an oxygen between the CL group and any organic, thus you don't make dioxins, by definition. Hence the problem of dioxin becomes moot. Note that even though Rep. Carolyn Maloney hasn't gotten her bill passed she has gotten her way - manufacturers are using a different bleaching process.

The Keeper compared with other products in amplifying toxic shock syndrome toxin-1

A spokesperson for The Keeper company e-mailed me (in January 2005) a 1998 statement from Dr. Philip Tierno, Jr., coauthor of the article from which the following chart (from 1994) was taken. The statement reads:

TEST RESULTS FOR THE KEEPER

Tests comparable to those [below] were recently performed on numerous Keepers.

THE NEWLY PROCESSED KEEPERS PRODUCED THE LOWEST QUANTITY OF TSST-1 AS COMPARED TO ALL AVAILABLE PRODUCTS EXCEPT FOR ALL-COTTON TAMPONS.

Perhaps if one uses tampon results as a frame of reference one might be able to glean some additional information. Tampons with synthetics (polyester, carboxymethyl cellulose, polyacrylate rayon, viscose rayon) can produce up to 426ug/ml. of TSST-1 toxin when tested by methodology outlined [below].

The products were washed in order to leach out chemicals; this presumably reproduced the environment of the vagina, where chemicals leach into the vagina, often leaving the product more able to amplify TSST toxin-1. Note that many of these products might have changed or no longer exist.

Are There Cases of Toxic Shock Associated With The Keeper Menstrual Cup? and All-Cotton Products are Best.

I printed a message, below, from Dr. Philip Tierno - MUM board member and expert on menstrual products safety Dr. Philip Tierno, Jr., chief of clinical microbiology and immunology at the New York University Medical Center - about the new Keeper menstrual cup and a test for toxic shock susceptibility in response to the first letter. By the way, I personally know of no toxic shock cases related to The Keeper.

A new Keeper user writes:

Hi,

I just discovered your Web site as I searched for info on the Keeper. I ordered one recently but haven't received it yet, so I was looking for info on 1) ease of insertion, since I have had problems inserting non-applicator tampons in the past; and 2) TSS [toxic shock syndrome] risks associated with it, if any, since their Web site at http://www.keeper.com (the official site for the company is http://www.thekeeperinc.com) is very vague about that subject. The reviews are so mixed on #1 that I'll have to reserve judgment until I've tried it, I guess!

But on the second issue, the TSS risks, I saw your page on the new vs. the old Keeper. From that I assume that I'll probably receive the old version, since the new one doesn't appear to be on the market yet. Assuming that's the case, have any tests been done to determine the TSS risks associated with the old Keeper? [Dr. Tierno - see letter below - tested the old Keeper, because he compares it unfavorably with the new one in his first letter.] I didn't see any info on your pages regarding TSS and the old Keeper, only the newer one. I did see the note on the comments page saying that no TSS cases have been associated with the Keeper (by which I assume you mean either old or new), but are there any scientific studies to back that up?

Here is Dr. Tierno's reply:

Dear Harry,

"The absence of evidence is not evidence of absence." Therefore not hearing about any case associated with The Keeper doesn't mean much. The Harvard student is wasting her time. [This student volunteered to search for cases of toxic shock and The Keeper in the medical literature. She found none.] Since the USAGE of the Keeper pales in comparison to tampons you are not likely to discover cases (because of statistics), if any, for a long time. However I would say that only the NEWER version of the rubber Keeper (which is not yet marketed and also needs some improvement), which allows for less adherence of staphylococcus aureus, is safer than most rayon tampons but not as safe as all-cotton products. The elastomeric polymer of the old Tassaway cups were better than the newer Keeper also.

Best regards,

Phil

[22 November 1998]

Is the New Keeper Menstrual Cup Out Yet? and a Test for Toxic Shock Susceptibility

I printed a message from Dr. Philip Tierno about his test of the new Keeper menstrual cup (item below). A happy Keeper user writes:

I purchased a Keeper nine months ago and have been absolutely thrilled with it. After reading the article by Dr. Tierno regarding the safety of the newly "treated" Keepers versus the "old" Keepers, I am wondering how do I determine whether I own a "new" or an "old" Keeper? Are there any physical differences that you are aware of?

Thanks.

Here is Dr. Tierno's reply:

Dear Harry,

It is my impression that the new version of the Keeper is not yet on the market [in November 1998] and as such I believe that the woman in question has the original Keeper. There is no way to tell by looking at the product; perhaps when it is marketed the box may say "improved" on it. Further research on different formulations are underway.

Perhaps you can recommend an antibody test (anti-TSST-1) to women who are fearful. If they have antibody at a titer of 1:100 or higher, then they are usually protected against TSS development.

Best Regards,

Phil

(15 November 1998)

How Safe Is The Keeper Menstrual Cup?

An Englishwoman wrote the following e-mail to me two weeks ago (October 1998).

I asked MUM board member and expert on menstrual products safety Dr. Philip Tierno, Jr., chief of clinical microbiology and immunology at the New York University Medical Center, to tell us what he thinks about some questions raised in the mail:

Here's the woman's letter:

Dear Harry,

Congratulations on an excellent Web site!

As a happy Keeper user of more than three years standing, I was intrigued to read the e-mail from Stanford University discussing menstrual cups.

Whilst being fascinated by the wide-ranging responses to The Keeper, I was also rather horrified and concerned by some comments (especially from a woman from Bethesda, MD, second letter from the top) who talks about "blood borne pathogens" being so much more dangerous than tampons and "the incidence of toxic shock syndrome skyrocketed in women who used those things."

I would be extremely interested to know who this woman is and where she gets her information from. [People who write MUM normally have anonymity; I asked for her sources but she never responded. I must add that I introduced the letter with a warning that there was no proof backing her up.]

If such statements are going to be made please back them up with some researched corroborative evidence!

I am extremely worried and concerned that certain items on your site misrepresenting health and safety aspects of The Keeper by printing unsubstantiated information. [As I said, I prefaced the letter with a statement that I have no evidence that what she said was true.]

According to tests performed in 1998 on numerous Keepers by Philip M. Tierno Jr. and Bruce A. Hanna (Departments of Microbiology and Pathology, New York University School of Medicine, New York University Medical Centre, New York. NY): Propensity of Tampons and Barrier contraceptives to amplify Staphylococcus aureus Toxic Shock Syndrome Toxin -1: The newly processed Keepers produced the lowest quantity of TSST -1 as compared to all available products except for all-cotton tampons.

If anyone has any more scientific information I would be very happy to receive it.

Best Wishes

Here is Dr. Tierno's reply:

Dear Harry,

Firstly, there is no published work on the new Keepers.

Secondly, I did test the new, treated Keepers and they amplify TSST-1 [Toxic Shock Syndrome Toxin-1] less than the original Keepers. The reason is because some of the porous rubber is sealed off to a degree by a new treatment process.

This provides less of a nidus for bacterial proliferation and toxin production. Hence these appear to be better than the non-treated Keepers.

Only 25% of the new Keepers allowed TSST-1 toxin to be produced compared with 66% of the older devices. The new Keepers don't allow for adherence of Staphylococcus aureus [which can cause TSS] on their surface as much as occurs with the older device or with diaphragms.

You might recall that the latex diaphragms, although non-absorbent, allow for adherence of Staphylococcus aureus, and as such can act as a nidus for growth of Staphylococcus as well as for toxin production.

Hence, it is wise for any manufacturer to test prior to marketing a product.

Best regards,

Phil

(8 November 1998)

Asbestos and Tampons: An Expert Answers Our Questions

In the past two weeks [early October 1998] I received three widely disseminated e-mails alleging that tampons contained asbestos, among other claims.

I asked MUM board member and expert on menstrual products safety Dr. Philip Tierno, Jr., chief of clinical microbiology and immunology at the New York University Medical Center, to tell us what he thinks about these assertions. (Dr.Tierno appeared in the film Under Wraps, discussed here, and receives no funding from menstrual products companies for his research.) Here are Dr. Tierno's replies; I have formulated questions to raise points in the e-mail:

Dear Harry,

Let me answer your question after I build a little foundation so that one can more easily assess the asbestos problem.

Asbestos is a ubiquitous fibrous mineral silicate (including chrysotite, amosite, anthophyllite, and crocilite).This material was widely used, particularly during the 1930s through the 60s, in construction because of its strength and ability to insulate. Although it was recognized as a health hazard by the Romans more than 2000 years ago the EPA [Environmental Protection Agency] didn't regulate it until 1974. In 1989 the EPA ordered a phase out of its use. Unfortunately an appeals court overturned them in 1991.

There is no doubt that asbestos fibers cause cancer, especially lung cancers (including mesothelioma), as well as cancers of the mouth, the stomach, intestines, rectum, kidney, etc. The usual route of exposure to humans is by inhalation. You can be exposed to the risk of asbestos by inhaling any airborne fibers of this material.

That is critical to an understanding of risk of asbestos from tampon use.

It is entirely possible for there to be trace quantities of asbestos in wood pulp or paper products, including tampons. In my opinion it's possible (I know of no scientific studies on asbestos in tampons [That is why Rep. Carolyn Maloney's Tampon Safety and Research Act is so important.]) that trace quantities of asbestos may be found in tampons but I do not believe that it would be of significant quantity to be delivered into the lungs of a user of tampons or even to the vaginal mucosa.

Keep in mind asbestos is even in water supplies, in the air and elsewhere in the environment. Ideally it would be nice to have a product that is free of asbestos. The OSHA [Occupational Safety and Health Administration of the U.S. government] standard for fibers greater than 0.005 mm in length is two million fibers/meter cubed per cubic centimeter of air.

Question: Do companies put asbestos in tampons so that women will bleed more and buy more tampons?

[T]hat is absurd. I have been privy to every major manufacturer's secret documents because of my role in TSS [toxic shock syndrome] litigation and I can say that that supposition is not true!

Question: What about dioxin, which causes cancer, in menstrual products?

In my opinion, our goal should be NO dioxin in tampons. I am not aware of any scientific study that measures and compares dioxin levels of different tampon brands.

Re: Tampax's deductively arrived-at statement that their tampons contain no dioxin because of their bleaching process [I sent Dr. Tierno an e-mail message, allegedly from the manufacturer of Tampax, which said Tampax contains no dioxin]. While in all fairness that is a possibility, the proof is in the testing! Testing of all tampons for dioxin should be done. [Again, that is why Rep. Carolyn Maloney's Tampon Safety and Research Act is so important.] Some dioxins may be present for reasons other than from the bleaching process, e.g., from pesticides or fertilizers, etc. Nothing beats actual testing.

Question: What about viscose rayon, which has probably been in most tampons since the beginning of commercial tampons?

There is no question, in my opinion, that an all-cotton tampon is superior to viscose rayon because of viscous rayon's ability to amplify TSST-1 [toxic shock syndrome toxin-1] while cotton does not amplify such to any significant amount.

(25 October 1998)

And the rumor has been around over 20 years:

In 1981, Nancy Friedman wrote in Everything You Must Know About Tampons (Berkley Books, New York), p. 118:

In 1977, Well Being, a "new age" health and nutrition magazine, published an article advising readers not to use tampons because they contained anticoagulants, fiberglass, talc and asbestos. Similar information had already appeared in feminist publications. This time [the] Tampax [company] quickly responded, calling the magazine's claims unfounded, and Well Being retracted the article in a 1978 issue. But the damage had already been done: Dozens of other publications, including many women's newsletters, had picked up the information and circulated it.

She adds in a footnote:

Also in 1977, the California Occupational Safety and Health Administration tested five tampons and found no evidence of asbestos in any of them.

(November 26, 2000)

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There are several other good sites dealing with the safety of tampons and other products, for example, S.P.O.T. and Terrafemme. See also links.

And see also the pages on the Rely tampon, involved in toxic shock about 1980.

© 1998 Harry Finley. It is illegal to reproduce or distribute any of the work on this Web site in any manner or medium without written permission of the author. Please report suspected violations to [email protected]

You must read the definitive government site dealing with menstrual products safety: the Food and Drug Administration's at http://www.fda.gov/cdrh/ocd/tamponsabs.html

See also the pages treating the Tampon Safety and Research Act of 1997, not yet passed by the U.S. Congress (in 1998).

And see also the pages on the Rely tampon, involved in toxic shock about 1980.

Enter your search terms Submit search form Web www.mum.org

Menstrual Product Safety (and in Spanish)

Topics below: Do menstrual cups cause endometriosis? | Cleaning sponges | New bleaching process for tampons, eliminating dioxin | Asbestos, dioxin and viscose rayon in tampons | Menstrual cups and toxic shock | The new Keeper menstrual cup | All-cotton products

Do menstrual cups cause endometriosis?

There's not enough evidence to support that, says the FDA. See the FDA's documentation.

Boil sponges

Dr. Philip Tierno, Jr., a MUM board member and expert on the safety of menstrual products, writes (October 1999), in part,

Interestingly, looking back in history, women used to boil their menstrual "rags" to get them clean. This is an analogous circumstance.

Tampon Manufacturers Use a Different Bleaching Process

Dr. Philip Tierno, Jr., a MUM board member and expert on the safety of menstrual products, writes (May 1999), in part,

The Keeper compared with other products in amplifying toxic shock syndrome toxin-1

TEST RESULTS FOR THE KEEPER

Tests comparable to those [below] were recently performed on numerous Keepers.

THE NEWLY PROCESSED KEEPERS PRODUCED THE LOWEST QUANTITY OF TSST-1 AS COMPARED TO ALL AVAILABLE PRODUCTS EXCEPT FOR ALL-COTTON TAMPONS.

Perhaps if one uses tampon results as a frame of reference one might be able to glean some additional information. Tampons with synthetics (polyester, carboxymethyl cellulose, polyacrylate rayon, viscose rayon) can produce up to 426ug/ml. of TSST-1 toxin when tested by methodology outlined [below].

Are There Cases of Toxic Shock Associated With The Keeper Menstrual Cup? and All-Cotton Products are Best.

A new Keeper user writes:

Hi,

Here is Dr. Tierno's reply:

Dear Harry,

Best regards,

Phil

[22 November 1998]

Is the New Keeper Menstrual Cup Out Yet? and a Test for Toxic Shock Susceptibility

I printed a message from Dr. Philip Tierno about his test of the new Keeper menstrual cup (item below). A happy Keeper user writes:

Thanks.

Here is Dr. Tierno's reply:

Dear Harry,

Perhaps you can recommend an antibody test (anti-TSST-1) to women who are fearful. If they have antibody at a titer of 1:100 or higher, then they are usually protected against TSS development.

Best Regards,

Phil

(15 November 1998)

How Safe Is The Keeper Menstrual Cup?

An Englishwoman wrote the following e-mail to me two weeks ago (October 1998).

I asked MUM board member and expert on menstrual products safety Dr. Philip Tierno, Jr., chief of clinical microbiology and immunology at the New York University Medical Center, to tell us what he thinks about some questions raised in the mail:

Here's the woman's letter:

Dear Harry,

Congratulations on an excellent Web site!

As a happy Keeper user of more than three years standing, I was intrigued to read the e-mail from Stanford University discussing menstrual cups.

I would be extremely interested to know who this woman is and where she gets her information from. [People who write MUM normally have anonymity; I asked for her sources but she never responded. I must add that I introduced the letter with a warning that there was no proof backing her up.]

If such statements are going to be made please back them up with some researched corroborative evidence!

I am extremely worried and concerned that certain items on your site misrepresenting health and safety aspects of The Keeper by printing unsubstantiated information. [As I said, I prefaced the letter with a statement that I have no evidence that what she said was true.]

If anyone has any more scientific information I would be very happy to receive it.

Best Wishes

Here is Dr. Tierno's reply:

Dear Harry,

Firstly, there is no published work on the new Keepers.

Secondly, I did test the new, treated Keepers and they amplify TSST-1 [Toxic Shock Syndrome Toxin-1] less than the original Keepers. The reason is because some of the porous rubber is sealed off to a degree by a new treatment process.

This provides less of a nidus for bacterial proliferation and toxin production. Hence these appear to be better than the non-treated Keepers.

Only 25% of the new Keepers allowed TSST-1 toxin to be produced compared with 66% of the older devices. The new Keepers don't allow for adherence of Staphylococcus aureus [which can cause TSS] on their surface as much as occurs with the older device or with diaphragms.

You might recall that the latex diaphragms, although non-absorbent, allow for adherence of Staphylococcus aureus, and as such can act as a nidus for growth of Staphylococcus as well as for toxin production.

Hence, it is wise for any manufacturer to test prior to marketing a product.

Best regards,

Phil

(8 November 1998)

Asbestos and Tampons: An Expert Answers Our Questions

In the past two weeks [early October 1998] I received three widely disseminated e-mails alleging that tampons contained asbestos, among other claims.

Dear Harry,

Let me answer your question after I build a little foundation so that one can more easily assess the asbestos problem.

That is critical to an understanding of risk of asbestos from tampon use.

Question: Do companies put asbestos in tampons so that women will bleed more and buy more tampons?

[T]hat is absurd. I have been privy to every major manufacturer's secret documents because of my role in TSS [toxic shock syndrome] litigation and I can say that that supposition is not true!

Question: What about dioxin, which causes cancer, in menstrual products?

In my opinion, our goal should be NO dioxin in tampons. I am not aware of any scientific study that measures and compares dioxin levels of different tampon brands.

Question: What about viscose rayon, which has probably been in most tampons since the beginning of commercial tampons?

There is no question, in my opinion, that an all-cotton tampon is superior to viscose rayon because of viscous rayon's ability to amplify TSST-1 [toxic shock syndrome toxin-1] while cotton does not amplify such to any significant amount.

(25 October 1998)

And the rumor has been around over 20 years:

In 1981, Nancy Friedman wrote in Everything You Must Know About Tampons (Berkley Books, New York), p. 118:

She adds in a footnote:

Also in 1977, the California Occupational Safety and Health Administration tested five tampons and found no evidence of asbestos in any of them.

(November 26, 2000)

There are several other good sites dealing with the safety of tampons and other products, for example, S.P.O.T. and Terrafemme. See also links.

See also the pages treating the Tampon Safety and Research Act of 1997, not yet passed by the U.S. Congress (in 1998).

And see also the pages on the Rely tampon, involved in toxic shock about 1980.

© 1998 Harry Finley. It is illegal to reproduce or distribute any of the work on this Web site in any manner or medium without written permission of the author. Please report suspected violations to [email protected]

Enter your search terms Submit search form

Web www.mum.org