(Organic Slant) Common feminine care products used by millions of women are laced with hazardous chemicals including carcinogens, toxins and endocrine disruptors, a new report reveals.

Hazards of exposure to these common products include reproductive harm, cancer and endocrine disruption.

Entitled Chem Fatale, the report released Wednesday from Women’s Voices for the Earth (WVE), an organization advocating “a toxic-free future for all,” highlights how current regulations covering the $3 billion industry are putting public health in jeopardy, and provides increasing evidence of the ubiquity of toxins in our everyday lives.

“The chemicals used in these products are a real concern given the inevitable exposure to sensitive and absorptive vulvar and vaginal tissue,” stated Dr. Ami Zota, a professor of occupational and environmental health at George Washington University, in a media release.

Among the products the report scrutinized are tampons and menstrual pads—products the report says are used by 70-85 percent of women.

Using them exposes women to pesticide residues, dioxins and furans, unknown fragrance chemicals and allergens. Potential hazards of exposure to them include reproductive harm, cancer and endocrine disruption.

According to the report,

Tampons and pads are regulated by the Food & Drug Administration (FDA) as medical devices. Unlike cosmetics, medical devices lack any government requirement to disclose ingredients to the consumer. This makes it nearly impossible for consumers to avoid chemicals of concern found in these products.

Other feminine care products the report highlights are washes, douches, sprays and wipes. These products also increase women’s exposure to toxins like formaldehyde-releasing preservatives and parabens.

Accompanying the report is a Hall of Shame which lists some common brand name feminine products and the chemicals of concern they contain.

WVE calls for companies to use greater transparency in the ingredients used in these products and eliminate toxic chemicals from them.

Feminine Care Products: What makes them special?

Biology of the vagina: a highly permeable route of chemical exposure

Most of the chemicals used in feminine care products are also commonly found in other cosmetic products. However, feminine care products are specifically intended for use on vaginal and vulvar tissue, which are much different and more sensitive than the skin on the rest of your body.

(Quick biology refresher: The vulva is the part of female genitals you can see from the outside of the body, and the vagina is the internal part which leads to the cervix.)

Vulvar and vaginal tissue are structurally different than the skin of the rest of the body. For example, these tissues are also more hydrated and more permeable than other skin. That means this area of the body is potentially more vulnerable to exposure to toxic chemicals and irritants. In addition, the inner parts of the vulva and the vagina are covered in mucous membranes, which serve an immune defense function, creating barrier against pathogens which could lead to disease. The walls of the vagina are filled with numerous blood vessels and lymphatic vessels, which allows for direct transfer of chemicals in to the circulatory system.

In fact, there is considerable interest in vaginal drug delivery systems because the vagina is such an effective site to transfer drugs directly into the blood without being metabolized first.

Unfortunately, this feature is a distinct disadvantage when it comes to exposure to toxic chemicals, which can also be rapidly absorbed and circulated through the rest of the body. This is especially true of hormone-mimicking chemicals.

One study found that a vaginally applied dose of estradiol (an estrogen proxy) resulted in systemic estradiol levels in the body 10 to 80 times greater compared to the same dose given orally. Similarly, vaginal exposure to hormone-mimicking chemicals that may be present in feminine care products may lead to higher than expected exposures in the rest of the body.

Cancer-causing chemicals in feminine care products are also a concern, but like many other women’s health issues, they are woefully understudied. There is relatively no research on the direct impact of exposure of carcinogens on the vagina. For the most part, risk factors given for vaginal cancer are vague, and concern about exposure of carcinogens to vaginal tissue is rarely, if ever, mentioned. Given the potential for exposure of carcinogens to vaginal tissue from feminine care products, concern is warranted and research attention is greatly needed to assess potential risk.

POTENTIAL HEALTH HAZARDS ASSOCIATED WITH CHEMICALS FOUND IN FEMININE CARE PRODUCTS

Tampons

While tampons may appear to be relatively simple devices, made with few ingredients, there is a great deal that scientists don’t know about the chemicals they may contain. Most tampons are made from cotton and/or rayon or other pulp fiber. Unfortunately these substances can be contaminated with highly toxic dioxins when bleached with chlorine compounds, as well as pesticides from non-organic cotton. Exposure to dioxins and furans has been linked to cancer, reproductive harm and endocrine disruption. FDA guidance for the marketing of tampons recommends that tampons be “…free of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) /2,3,7,8-tetrachlorofuran dioxin (TCDF) and any pesticide and herbicide residues.” unfortunately, this recommendation is not mandatory, and testing results reveal that both dioxins and pesticide residue are found in tampons.

There is surprisingly little data available on the amount of pesticides in tampons. The first publically available testing of tampons commercially available in North America for pesticide residues was commissioned and published by Naturally Savvy in 2013. This study involved testing just one brand of tampons, o.b., for pesticide residues, and tests were conducted by a third party-certified laboratory. The following pesticides were detected:

Malaoxon & Malathion	1 ppm
Dichlofluanid	1 ppm
Mercarbam	6 ppm
Procymidone	37 ppm
Methidathion	5 ppm
Fensulfothion	5 ppm
Pyrethrum	66 ppm
Piperonyl Butoxide	1 ppm

Granted, these levels are relatively low, and generally below the residue levels allowable in food. However, these data clearly contradict the FDA’s recommendation that tampons be “free of pesticide residue.” The pesticides detected also pose a range of potential risks. For example, the U.S. EPA has determined that Procymidone is a “probable human carcinogen,” Piperonyl butoxide is a “possible human carcinogen,” and that the data on Malathion is “suggestive of carcinogenicity.” The Pesticide Action Network has labeled Malaoxon, Malathion, Mecarbam, Procymidone, Methidathion, Fensulfothion, and Pyrethrum as “Bad Actor” pesticides due to hazards including acute toxicity and possible endocrine disruption.

Some manufacturers offer scented tampons. This is an aesthetic choice for consumers. Unfortunately, a “fragrance” is a mixture of ingredients that can include any of over 3,000 different chemicals; and the components of any one fragrance are usually kept secret by manufacturers.

According to a master list of fragrance chemicals made available by the International Fragrance Association,
fragrances can include chemicals which are carcinogens, irritants, allergens, and potential endocrine disruptors. The impact of direct exposure of these chemicals to vaginal tissue is woefully understudied. It is especially of concern that fragrance chemicals are used in scented tampons without ingredient disclosure to the consumer.

Most conventional tampoons today are made from synthetic materials. Most feminine hygiene products are mostly made from non-cotton materials, such as:

Rayon – made from cellulose fibers derived from bleached wood pulp
Viscose – a form of wood cellulose acetate that’s fabricated to have a pleasing cotton-like touch
Wood fluff pulp – manufactured from tree wood. It is the major filler used in conventional sanitary pads

Although highly absorbent, these synthetic, tree-derived materials are NOTHING like cotton. What’s more, they can present potential dangers to your health, as the fibers can easily loosen up, stick to your vaginal wall, and be left behind inside your body.

SEE FOR YOURSELF

If you don’t believe me, here’s one experiment you can try: grab one of your regular, store-bought tampons, remove its wrapper and applicator, and then pull it open. Give the fibers a tug using your fingers. You may notice that the fibers break apart easily.

Repeat this over a dark piece of cloth or paper – notice how dusty fiber particles are falling from the tampon? These are the same fibers that are getting stuck inside your body.

This is something that you hardly have to worry about if you’re using natural tampons made from 100 percent certified organic cotton.

Menstrual pads

During use, menstrual pads (also called sanitary napkins) come in direct contact with vulvar skin. Thus the long exposures to chemicals that may be infused in the pad are of concern. Similar to tampons, pads are marketed in unscented and scented varieties by many manufacturers. The fragrances used in pads are almost never disclosed to consumers, meaning women are unknowingly exposed to numerous possible chemicals. The absorbent material within the pad may also have been chlorine-bleached, posing the potential for dioxin or furan exposure. If the pad includes traditionally-grown cotton, the risk of pesticide residue exposure exists as well.

Several case studies have been published examining health risks to women from use of menstrual pads. Common symptoms of menstrual pad use include irritation and allergic rash. Many women in these studies suffered for months before a doctor’s diagnosis determined the pads were causing the problem.

Feminine Wipes

Feminine moist wipes are a convenience product designed for simple (and disposable) moist cleaning of the genital area. Moist wipes usually contain a preservative chemical in order to retain moistness and prevent bacterial growth in the package. These can be harsh or irritating to skin. The preservatives commonly used in moist wipes include:

Methylchloroisothiazolinone

Methylisothiazolinone

Parabens

Quaternium-15

DMDM Hydantoin

2-Bromo-2-Nitropropane-1,3-Diol

All of these preservatives are potential allergens which can lead to allergic contact dermatitis in the genital area, also known as anogenital dermatitis. Anogenital dermatitis is common, resulting in itching and burning, creating severe discomfort at times.

The preservatives Methylchloroisofthiazolinone and Methylisothiazolinone (MCI/MI) appear to be of particular concern in wipes. Feminine care products and moist wipes frequently contain MCI/MI, which was dubbed “Allergen of the Year” in 2013 by the American Contact Dermatitis Society.

Feminine Wash

Feminine wash is similar to many other types of liquid body wash, differing mostly from a marketing perspective. The product is sold to women specifically as a wash for the genital area. However, the instructions for use found most bottles of feminine wash state the product is “for external use only.” Feminine wash is meant to be distinguished from douche products for example, which have applicators to facilitate internal vaginal cleansing. However, given the reality of feminine wash and how it is used, it is extremely unlikely that some internal vaginal exposure would not occur from regular use.

Given that reality, it is especially concerning that ingredients are frequently included in feminine washes which are not approved for use on mucous membranes (which cover both the inner vulva and the vagina). Perhaps the best example of this are color dyes added to feminine washes for aesthetic appeal. Color dyes (color additives) in cosmetics are regulated by the U.S. Food and Drug Administration (FDA). Two commonly found colorants in feminine wash are D&C Red No. 33 and Ext. D&C Violet #2. The FDA clearly states that D&C Red No. 33 and Ext. Violet #2 may be safely used only in cosmetics that are “externally applied.” FDA explains this designation this way:

“Externally applied cosmetics: This term does not apply to the
lips or any body surface covered by mucous membrane. For
instance, if a color additive is approved for use in externally
applied cosmetics, you may not use it in products such as
lipsticks unless the regulation specifically permits this use
[21 CFR 70.3 (v)].”

Having a label on feminine wash that states the product is “for external use only” may be a legal way of allowing these colorants to be used, but it does little to prevent vaginal mucous membranes from actually being adversely impacted by these color additive ingredients. Another color additive of concern found in feminine wash is FD&C Yellow #5. While this color has been approved for use on both externally and internally applied cosmetics, there is specific warning language that is required for its use in certain prescription drugs. The regulations state:

“(3) For prescription drugs for human use containing FD&C
Yellow No. 5 that are administered orally, nasally, vaginally, or
rectally, or for use in the area of the eye, the labeling required
by § 201.100(d) of this chapter shall, in addition to the label
statement required under paragraph (c)(2) of this section, bear
the warning statement “This product contains FD&C Yellow No.
5 (tartrazine) which may cause allergic-type reactions (including
bronchial asthma) in certain susceptible persons. Although the overall incidence of FD&C Yellow No. 5 (tartrazine) sensitivity in
the general population is low, it is frequently seen in patients who
also have aspirin hypersensitivity.” This warning statement shall
appear in the “Precautions” section of the labeling.”

No such warning, however, is required for feminine care products which may be administered vaginally, contrary to the above policy. Since color additives in feminine wash are merely added for aesthetic reasons, this exposure seems unnecessary and should be carefully considered.

Douche

Douching is the practice of cleaning the vagina with water or some form of liquid solution. Women have been douching for centuries for a variety of reasons, using a variety of different formulas. Today there are a number of douche products on the market, and there are also some women who make their own solutions from ingredients such as vinegar and water. Studies show that the most common reason women douche is for personal “cleanliness.” Douching, however, appears to have the opposite effect and actually interferes with the vagina’s inherent ability to keep clean.

A healthy vagina maintains a complex and interdependent community of bacteria (the vaginal microbiome) which support a natural defense to harmful pathogens that can lead to disease. Douching can disrupt this microbiome, by altering both the vaginal pH and changing the proportions and types of bacteria in the vagina. Regular douching has been associated in numerous studies with an increased risk of bacterial vaginosis, which occurs when the balance is upset and there is an overgrowth of certain microorganisms in the vagina. Other studies link douching to pelvic inflammatory disease, cervical cancer, low-birth weight, preterm birth, HIV transmission, sexually transmitted diseases, ectopic pregnancy, chronic yeast infections, and infertility.

Studies have not identified particular chemicals found in douches as the reason for these adverse effects, as it appears any type of physical washing of the vagina can upset the vaginal microbiome. There are, however, some chemicals found in commercially available douches that are of concern. Octoxynol-9 is one chemical frequently found in douches. Octoxynol-9 is a potent contraceptive drug, which effectively kills sperm. (However, douches containing Octoxynol-9 are not considered contraceptives, nor are they required to have any caution labeling to this effect.) Use of Octoxynol-9 in spermicides has been associated with genital irritation and increased vaginal discharge. There are only a few studies that have assessed reproductive toxicity of Octoxynol-9, and they have conflicting results. In one study, Octoxynol-9 exposure to pregnant rats was associated with skeletal deformities (most notably extra ribs), whereas another study on rats found no developmental malformations from exposure. In any case, the potential risk posed by Octoxynol-9, in addition to the risks of douching itself, make it an inappropriate chemical to include in these products.

Douches also commonly include fragrance, which can be made of hundreds of different chemicals, some quite toxic, and some certainly associated with allergies. Fragranced douche thus creates an unnecessary and potentially harmful vaginal exposure to unknown fragrance allergens, irritants and toxic chemicals. For all of these reasons, the American Public Health Association specifically recommends against douching and encourages health care providers to educate their patients on the hazards of the practice.

Feminine Deodorant (sprays, powders and suppositories)

Feminine deodorant sprays are one feminine care product with a known history of adverse effects. When they were initially marketed in the late 1960s, numerous women reported adverse effects, such as burning, rashes and other allergic reactions from their use. This caught the attention of the FDA, which in the 1970s instituted additional labeling regulations for feminine sprays to help prevent adverse effects from use of these products. The labels for feminine deodorant sprays now must state:

“Caution–For external use only. Spray at least 8 inches from
skin. Do not apply to broken, irritated, or itching skin. Persistent,
unusual odor or discharge may indicate conditions for which a
physician should be consulted. Discontinue use immediately if
rash, irritation, or discomfort develops.”

Similar to feminine wash, the caution that this product is “for external use only” does relatively little to prevent the highly likely scenario that internal vaginal skin will be affected by the product. Feminine deodorant powders and deodorant suppositories are also similar products marketed to women to control or mask genital odor. One problematic chemical that is commonly found in all of these deodorant products is Benzethonium Chloride. This chemical is a powerful disinfectant. In Europe, Benzethonium Chloride is only allowed in rinse-off cosmetic products at a maximum level of 0.1%. The most recent European safety assessment determined that that it could not guarantee safety of use of Benzethonium Chloride in leave-on products due to potential concerns about both maternal and embryo toxicity. In Japan and Canada, regulations specifically restrict Benzethonium Chloride from being used in products applied to mucous membranes. In the U.S., the Cosmetic Ingredient Review (CIR) established a safety level of 0.5% Benzethonium Chloride in cosmetics, and allows use in both rinse-off and leave on products of all kinds, including feminine care.

Interestingly, the CIR’s assessment does state that studies found that 0.2% Benzethonium Chloride applied in a foam serves as an effective spermicide. No caution labeling to this effect is required however on feminine care products containing Benzethonium Chloride which are not contraceptive products. Presumably, anyone using these products who is also trying to get pregnant should be made aware of the presence of this chemical. Benzethonium Chloride appears to be an inappropriate chemical for
feminine care products and deserves further investigation.

Over-the-counter Anti-itch Creams

Feminine anti-itch creams are marketed to women to help soothe symptoms of genital itching, which can be caused by numerous factors. Most anti-itch creams are considered “over-the-counter-drugs,” meaning that the FDA may review and approve them, but primarily is concerned with only the active ingredients. However, for many of these products, the manufacturer remains largely responsible for ensuring safety and compliance with regulations.

These products are commonly used with some studies reporting that up to 23 percent of women use anti-itch creams. Vulvar and vaginal itch is one of the most common health care problems for women in the United States, and the commonly associated condition vaginitis, is a frequent reason for patient visits to gynecologists. This is problematic because anti-itch creams commonly contain allergens or irritants, which can actually serve to exacerbate the very symptoms that women are attempting to treat.

One common chemical found in anti-itch creams is benzocaine. Benzocaine is a mild anesthetic, thus it relieves itch by temporarily numbing the affected area. Some women, however, are allergic to benzocaine. In dermatology studies of patients with vulvar and anogenital dermatitis, benzocaine is identified as one of the most common allergens causing symptoms. other problematic chemicals found in anti-itch creams include parabens and fragrance, both of which may also induce the very itching symptoms that these creams are purported to soothe. Surprisingly little research has been conducted to appropriately assess either the efficacy or the side effects of these over the counter drugs. Greater attention and scrutiny is needed to protect and aid women who are seeking solutions for these problems.

Personal Alternatives

Reduce your use of feminine care products
Eliminate use of products that may be unnecessary to a healthy vagina
Choose unscented products where available (particularly tampons and pads)
Choose chlorine-free bleached or unbleached cotton tampons and pads
Try reusable, washable menstrual pads
Try switching brands of products you believe may be associated with allergic symptoms (and if you do switch – call the company’s 1-800 customer service to tell them why!)
Read the labels of products (where available) to avoid problematic chemicals discussed in this report
Look for brands that disclose all ingredients, including fragrance ingredients
Talk with your health care provider about how the use of feminine care products may be affecting your health
Tell the FDA if you have had any concerns about or reactions to a feminine care product – Call 1-800-332-1088 or fill out a consumer reporting form available at:
https://www.fda.gov/Safety/MedWatch/default.htm

Chemicals of Concern in Feminine Care Products

This list includes chemicals of concern that are discussed in this report. This list is not exhaustive, other problematic chemicals not on this list may also be found in feminine care products and deserve greater examination.

CHEMICAL NAME	FUNCTION	POTENTIAL HEALTH EFFECTS	FOUND IN
Benzethonium Chloride	Preservative, spermicide	Not for use on mucous membranes, maternal and embryotoxicity	Deodorant powders and suppositories, feminine wash
Benzocaine	Mild anesthetic	Allergic rash, dermatitis	Anti-itch creams
Butylparaben	Preservative	Endocrine disruption, increased risk of breast cancer, allergic rash	Wipes
D&C Red 33	Colorant (dye)	Not for use on mucous membranes	Feminine wash
Diazolidinyl urea	Preservative	Releases formaldehyde, allergic rash, cancer	Feminine wash, douche
Dioxins and Furans	Contaminant from bleaching process	Cancer, endocrine disruption, reproductive toxicity	Tampons (not disclosed on label)
DMDM Hydantoin	Preservative	Releases formaldehyde, allergic rash, cancer	Wipes, feminine wash
Ethylparaben	Preservative	Endocrine disruption, increased risk of breast cancer, allergic rash	Wipes
Ext. Violet 2	Colorant (dye)	Not for use on mucous membranes	Feminine wash
FD&C Yellow No.5	Colorant (dye)	Allergic reactions including bronchial asthma	Feminine wash
Fragrance	Fragrance	Contains undisclosed chemicals of unknown toxicity, likely to contain allergens, allergic rash, endocrine disruption, cancer	Wipes, feminine wash, tampons, pads, douche, deodorant, anti-itch creams
Methylchloroisothiazolinone	Preservative	Allergic rash	Feminine wash
Methylisothiazolinone	Preservative	Allergic rash	Wipes, feminine wash, anti-itch cream
Methylparaben	Preservative	Endocrine disruption, increased risk of breast cancer, allergic rash	Wipes, deodorant, anti-itch creams
Octoxynol 9	Spermicide	Genital irritation, increased vaginal discharge, potential reproductive toxicity	Douche
Pesticide residues	Contaminant of traditionally grown cotton	Cancer, endocrine disruption, acute toxicity	Tampons (not disclosed on label)
Polyoxymethylene Urea	Preservative	Releases formaldehyde, allergic rash, cancer	Deodorant powder
Propylparaben	Preservative	Endocrine disruption, increased risk of breast cancer, allergic rash	Wipes, anti-itch creams
Quaternium-15	Preservative	Releases formaldehyde, allergic rash, cancer	Wipes, feminine wash
2-Bromo-2-Nitropropane-1, 3-Diol	Preservative	Releases formaldehyde, allergic rash, cancer	Wipes