A tampon is a menstrual product designed to absorb blood and vaginal secretions by insertion into the vagina during menstruation. Unlike a pad, it is placed internally, inside of the vaginal canal. Once inserted correctly, a tampon is held in place by the vagina and expands as it soaks up menstrual blood.
As tampons also absorb the vagina's natural lubrication and bacteria in addition to menstrual blood, they can increase the risk of toxic shock syndrome by changing the normal pH of the vagina and increasing the risk of infections from the bacterium Staphylococcus aureus. TSS is a rare but life-threatening infection that requires immediate medical attention.
The majority of tampons sold are made of blends of rayon and cotton, along with synthetic fibers. Some tampons are made out of organic cotton. Tampons are available in several absorbency ratings.
Several countries regulate tampons as medical devices. In the United States, they are considered to be a Class II medical device by the Food and Drug Administration (FDA). They are sometimes used for hemostasis in surgery.
Design and packaging
Tampon design varies between companies and across product lines in order to offer a variety of applicators, materials and absorbencies. There are two main categories of tampons based on the way of insertion – digital tampons inserted by finger, and applicator tampons. Tampon applicators may be made of plastic or cardboard, and are similar in design to a syringe. The applicator consists of two tubes, an "outer", or barrel, and "inner", or plunger. The outer tube has a smooth surface to aid insertion and sometimes comes with a rounded end that is petaled.
Differences exist in the way tampons expand when in use: applicator tampons generally expand axially (increase in length), while digital tampons will expand radially (increase in diameter). Most tampons have a cord or string for removal. The majority of tampons sold are made of rayon, or a blend of rayon and cotton. Organic cotton tampons are marketed as 100% cotton, but they may have plastic covering the cotton core. Tampons may also come in scented or unscented varieties.
Absorbency ratings
In the US Tampons are available in several absorbency ratings, which are consistent across manufacturers in the U.S. These differ in the amount of cotton in each product and are measured based on the amount of fluid they are able to absorb. The absorbency rates required by the U.S. Food and Drug Administration (FDA) for manufacturer labeling are listed below: +FDA Absorbency RatingsRanges of absorbency in gramsCorresponding term of absorbency6 and underLight absorbency6 to 9Regular absorbency9 to 12Super absorbency12 to 15Super plus absorbency15 to 18Ultra absorbencyAbove 18No term
In Europe Absorbency ratings outside the US may be different. The majority of non-US manufacturers use absorbency rating and Code of Practice recommended by EDANA (European Disposables and Nonwovens Association). +European absorbency ratingsDropletsGramsAlternative size description1 droplet< 62 droplets6–9Mini3 droplets9–12Regular4 droplets12–15Super5 droplets15–186 droplets18–21
In the UK In the UK, the Absorbent Hygiene Product Manufacturers Association (AHPMA) has written a Tampon Code of Practice which companies can follow on a volunteer basis. According to this code, UK manufacturers should follow the (European) EDANA code (see above).
Testing A piece of test equipment referred to as a Syngyna (short for synthetic vagina) is usually used to test absorbency. The machine uses a condom into which the tampon is inserted, and synthetic menstrual fluid is fed into the test chamber.
A novel way of testing was developed by feminist medical experts after the toxic shock syndrome (TSS) crisis, and used blood – rather than the industry standard blue saline – as a test material.
Labeling The FDA requires the manufacturer to perform absorbency testing to determine the absorbency rating using the Syngyna method or other methods that are approved by the FDA. The manufacturer is also required to include on the package label the absorbency rating and a comparison to other absorbency ratings as an attempt to help consumers choose the right product and avoid complications of TSS. In addition, The following statement of association between tampons and TSS is required by the FDA to be on the package label as part of the labeling requirements: "Attention: Tampons are associated with Toxic Shock Syndrome (TSS). TSS is a rare but serious disease that may cause death. Read and save the enclosed information."
Such guidelines for package labeling are more lenient when it comes to tampons bought from vending machines. For example, tampons sold in vending machines are not required by the FDA to include labeling such as absorbency ratings or information about TSS.
Costs
The average person who menstruates and uses only tampons uses about 11,400 tampons in their lifetime. In the 2020s, tampon prices have risen due to inflation and supply chain challenges. As of 2022, a box of tampons typically cost between $7 and US$12 and contains 16 to 40 tampons, depending on the brand and size. This means users might spend between $63 and $108 annually on tampons alone, assuming the need for around 9 boxes per year. This corresponds to an average cost of approximately $0.22–$0.75 per tampon, reflecting price increases of up to 33% since the pandemic. Activists call the problem some women have when not being able to afford menstrual products "period poverty". The fact that, in certain U.S. states, sales tax applies to menstrual products is referred to as a "tampon tax". As of 2024, 23 states exempt these products, while others impose taxes up to 7%. Local taxes can also apply, adding further costs. Some states such as Texas recently abolished this tax. Some states provide free tampons and pads in public schools and prisons, helping to alleviate period poverty.
Health aspects Menstrual toxic shock syndrome
Menstrual toxic shock syndrome (mTSS) is a life-threatening disease most commonly caused by infection of superantigen-producing Staphylococcus aureus. The superantigen toxin secreted in S. aureus infections is TSS Toxin-1, or TSST-1. Incidence ranges from 0.03 to 0.50 cases per 100,000 people, with an overall mortality around 8%. mTSS signs and symptoms include fever (greater than or equal to 38.9 °C), rash, desquamation, hypotension (systolic blood pressure less than 90 mmHg), and multi-system organ involvement with at least three systems, such as gastrointestinal complications (vomiting), central nervous system (CNS) effects (disorientation), and myalgia.
Toxic shock syndrome was named by James K. Todd in 1978. Philip M. Tierno Jr., Director of Clinical Microbiology and Immunology at the NYU Langone Medical Center, helped determine that tampons were behind toxic shock syndrome (TSS) cases in the early 1980s. Tierno blames the introduction of higher-absorbency tampons made with rayon in 1978, as well as the relatively recent decision by manufacturers to recommend that tampons can be worn overnight, for the surge in cases of TSS. However, a later meta-analysis found that the material composition of tampons is not directly correlated to the incidence of toxic shock syndrome, whereas oxygen and carbon dioxide content of menstrual fluid uptake is associated more strongly.
In 1982, a liability case called Kehm v. Procter & Gamble took place, where the family of Patricia Kehm sued Procter & Gamble for her death on September 6, 1982, from TSS, while using Rely brand tampons. The case was the first successful case to sue the company. Procter & Gamble paid $300,000 in compensatory damages to the Kehm family. This case can be attributed to the increase in regulations and safety protocol testing for current FDA requirements.
Some risk factors identified for developing TSS include recent labor and delivery, tampon use, recent staphylococcus infection, recent surgery, and foreign objects inside the body.
The FDA suggests the following guidelines for decreasing the risk of contracting TSS when using tampons: Choose the lowest absorbency needed for one's flow (test of absorbency is approved by FDA) Follow package directions and guidelines for insertion and tampon usage (located on box's label) Change the tampon at least every 4 to 8 hours Alternate usage between tampons and pads Increase awareness of the warning signs of Toxic Shock Syndrome and other tampon-associated health risks (and remove the tampon as soon as a risk factor is noticed)
The FDA also advises those with a history of TSS not to use tampons and instead turn to other feminine hygiene products to control menstrual flow. Other menstrual hygiene products available include pads, menstrual cups, menstrual discs, and reusable period underwear.
Cases of tampon-connected TSS are very rare in the United Kingdom and United States. A controversial study by Tierno found that all-cotton tampons were less likely than rayon tampons to produce the conditions in which TSS can grow. This was done using a direct comparison of 20 brands of tampons, including conventional cotton/rayon tampons and 100% organic cotton tampons. In a series of studies conducted after this initial claim, it was shown that all tampons (regardless of composition) are similar in their effect on TSS and that tampons made with rayon do not have an increased incidence of TSS. Instead, tampons should be selected based on minimum absorbency rating necessary to absorb flow corresponding to the individual.
Sea sponges are also marketed as menstrual hygiene products. A 1980 study by the University of Iowa found that commercially sold sea sponges contained harmful materials like sand and bacteria.
Studies have shown non-significantly higher mean levels of mercury in tampon users compared to non tampon users. No evidence showed an association between tampon use and inflammation biomarkers.
Other considerations
Bleached products According to the Women's Environmental Network research briefing on menstrual products made from wood pulp:The basic ingredient for menstrual pads is wood pulp, which begins life as a brown coloured product. Various 'purification' processes can be used to bleach it white. Measurable levels of dioxin have been found near paper pulping mills, where chlorine has been used to bleach the wood pulp. Dioxin is one of the most persistent and toxic chemicals, and can cause reproductive disorders, damage to the immune system and cancer (26). There are no safe levels and it builds up in our fat tissue and in our environment.
Marine pollution In the UK, the Marine Conservation Society has researched the prevalence and problem of plastic tampon applicators found on beaches.
Disposal and flushing Disposal of tampons, especially flushing (which manufacturers warn against) may lead to clogged drains and waste management problems.
Tampon-drug interactions There are multiple cases in which the use of tampons may need medical advice from a healthcare professional. For example, as part of the National Institutes of Health, the U.S. National Library of Medicine and its branch MedlinePlus advise against using tampons while being treated with any of several medications taken by the vaginal route such as vaginal suppositories and creams, as tampons may decrease the absorbance of these drugs by the body. Example of these medications include clindamycin, terconazole, miconazole, clotrimazole, when used as a vaginal cream or vaginal suppository, as well as butoconazole vaginal cream.
Increased risk for infections