Feature

Absorbing issues…

Despite recent concerns over tampon safety, it’s still only a minority of women who are aware of the dangers, warns Gill de Lacy Costello

Shani Connor was a healthy young woman until she suddenly became ill with ‘flu like symptoms in February this year. Over the following 48 hours she became progressively worse and was admitted to Stafford General Hospital on February 8. Her condition rapidly deteriorated and she was transferred to the intensive care unit. Shani died at 2.10am on February 9. She had been menstruating at the time and the post mortem report stated the cause of her death as respiratory distress syndrome and toxic shock syndrome (TSS).

In the US, the law requires manufacturers to print a health warning on tampon packets stating that tampons have been associated with TSS, a rare and potentially fatal disease. In Britain there is no such legislation: if there were, Shani might be alive today. In 1928, 12 children died in Queensland, Australia, from a ‘flu like illness with high fever, weak pulse, vomiting, diarrhoea and a blotchy rash. Fifty years later, TSS was clinically defined when a further seven children had similar symptoms. But it was not until late 1979 that a sudden increase in the incidence of TSS among young menstruating women led to the association with tampon use and this previously obscure disease began to cause concern.

One of the most alarming aspects of TSS is its rapidity. The first symptoms are similar to ‘flu with vomiting and diarrhoea, and a rash like sunburn often appears on hands and feet. As the illness progresses, hypotension and renal failure are followed by “shock lung” and respiratory failure, which may cause death.

TSS is caused by toxin produced by a common bacteria, Staphylococcus aureus. It can occur in women and men of all ages, mostly as a complication of wound infection following surgery. But it is the high incidence in young menstruating women using tampons that has caused much concern over the last decade.

Tampons were patented in 1933. Two years later, doctors conducting the first absorbency testing of tampons warned of possible damage to the vaginal wall due to irritation by a foreign body, and of infection through the introduction of bacteria into the vagina via the tampon or applicator.

But warnings went unheeded and tampons became increasingly popular. Manufacturers spent vast sums on promotion and on research into a bigger and better tampon. And at the same time as TSS was increasing in young women, concern was also growing over the damage done to the vaginal mucosa (lining of the vagina) by tampons.

In 1980, a report published in the American Journal of Obstetrics and Gynaecology found that tampons were responsible for changes in the vagina including drying of the mucosa, epithelial layering and microulcerations. The average tampon absorbs 65% menstrual flow and 35% normal vaginal secretions; tampons of a higher absorbency are significantly more likely to cause vaginal damage. The microulcerations vary in size but may be as large as 3cm by 3cm.

Biopsies have also detected foreign bodies which seem to be fibres from tampons embedded in the tissue after the microulcerations heal. Many ulcers heal once the tampon is no longer used. The possibility of infection during this healing period arises, but of much greater concern are the consequences of repeated microulcerations over a period of years.

Tampons undoubtedly cause vaginal damage and are strongly linked to TSS. Medical studies have repeatedly shown that higher absorbency tampons increase the risk of TSS. In the US, 40 years after tampons were introduced on the market, the Food and Drug Administration began to monitor their production. In 1984, after intensive campaigning by consumer pressure groups, manufacturers were legally obliged to list warnings and absorbency rates on packaging.

In Britain, women are largely unaware of the potential dangers of tampon use. At the beginning of this year, the Department of Trade and Industry (DTT) had talks with the tampon industry which agreed to a voluntary health warning on the leaflet inside the packet, and a label outside urging women to read the leaflet. However, a report in the British Medical Journal in June suggested that few women do.

The Women’s Environmental Network (WEN) has been campaigning for increased safety on sanitary protection. It is working with MPs Maria Fife and Jo Richardson to introduce a tampon safety bill in Parliament. The bill would ensure that tampon packaging carries clear warnings of the risks of TSS and has standardised absorbency rating on the outside of packaging. The voluntary agreements that manufacturers and the DTI have come up with are little more than a cosmetic exercise according to WEN.

The bill also asks for a public health campaign, particularly in schools, to educate and inform tampon users of the association between tampons and TSS. Funding of independent research into all the possible health risks associated with tampon use, including vaginal ulceration and long term effects, is also included.

The bill was launched on 24 July at a press conference in the House of Commons. Speakers included Maria Fife and Jo Richardson, Allison Costello from WEN, John Connor, Shani’s father, and Lindy Pennycook, whose 22 year old daughter Lauren was critically ill with TSS earlier this year.

Since Shani’s death, Mr Connor has carried out extensive research with what little information there is on the illness. He now believes that had his daughter not been using tampons, she would be alive today.