Volatile organic compounds in feminine hygiene products sold in the US market: A survey of products and health risks

Intimate Care Products and Incidence of Hormone-Related Cancers: A Quantitative Bias Analysis

PURPOSE

Intimate care products may contain substances associated with increased risk of hormone-related cancers. The relationship between genital talc use and ovarian cancer, in particular, has been well studied, but concerns about recall bias and exposure misclassification have precluded conclusions. We examined the association between intimate care products and female hormone-related cancers, accounting for potential biases, using data from a US-based cohort study.

METHODS

The Sister Study enrolled 50,884 women who had a sister with breast cancer. Data on genital talc use and douching were collected at enrollment (2003-2009) and follow-up (2017-2019). We used Cox proportional hazards models to estimate hazard ratios (HRs) for associations between intimate care product use and breast, ovarian, and uterine cancers. To account for potential exposure misclassification and recall bias, we conducted quantitative bias analyses under various exposure reassignment assumptions.

RESULTS

Across considered scenarios, 41%-64% of participants douched and 35%-56% used genital talc. In models adjusted for exposure misclassification, genital talc use was positively associated with ovarian cancer (HR range, 1.17-3.34) Frequent douching and douching during young adulthood were positively associated with ovarian cancer, but neither douching nor talc was associated with breast or uterine cancer. Differential reporting of talc use by cases and noncases likely produces positive biases, but correcting for error still resulted in HRs above 1.0. For example, HR, 1.40 (95% CI, 1.04 to 1.89) when 25% of exposed cases and 10% of unexposed noncases had talc status reassigned.

CONCLUSION

Although results show how differential recall would upwardly bias estimates, corrected results support a positive association between use of intimate care products, including genital talc, and ovarian cancer.

Tampons as a source of exposure to metal(loid)s

BACKGROUND

Between 52-86% of people who menstruate in the United States use tampons-cotton and/or rayon/viscose 'plugs'-to absorb menstrual blood in the vagina. Tampons may contain metals from agricultural or manufacturing processes, which could be absorbed by the vagina's highly absorptive tissue, resulting in systemic exposure. To our knowledge, no previous studies have measured metals in tampons.

OBJECTIVES

We evaluated the concentrations of 16 metal(loid)s in 30 tampons from 14 tampon brands and 18 product lines and compared the concentrations by tampon characteristics.

METHODS

About 0.2 - 0.3 g from each tampon (n = 60 samples) were microwave-acid digested and analyzed by inductively coupled plasma mass spectrometry (ICP-MS) to determine concentrations of arsenic, barium, calcium, cadmium, cobalt, chromium, copper, iron, manganese, mercury, nickel, lead, selenium, strontium, vanadium, and zinc. We compared concentrations by several tampon characteristics (region of purchase, organic material, brand type) using median quantile mixed models.

RESULTS

We found measurable concentrations of all 16 metals assessed. We detected concentrations of several toxic metals, including elevated mean concentrations of lead (geometric mean [GM] = 120 ng/g), cadmium (GM = 6.74 ng/g), and arsenic (GM = 2.56 ng/g). Metal concentrations differed by region of tampon purchase (US versus European Union/United Kingdom), by organic versus non-organic material, and for store- versus name-brand tampons. Most metals differed by organic status; lead concentrations were higher in non-organic tampons while arsenic was higher in organic tampons. No categoriy had consistently lower concentrations of all or most metals.

DISCUSSION

Tampon use is a potential source of metal exposure. We detected all 16 metals in at least one sampled tampon, including some toxic metals like lead that has no "safe" exposure level. Future research is needed to replicate our findings and determine whether metals can leach out of tampons and cross the vaginal epithelium into systemic circulation.

Chemicals in menstrual products: A systematic review

BACKGROUND

From menarche until menopause, the average menstruator will use over 11 000 tampons or sanitary pads. Vaginal and vulvar tissue is highly permeable, and chemicals are absorbed without undergoing first-pass metabolism.

OBJECTIVES

To conduct a review of the literature to determine exposure to environmental chemicals in menstrual products.

SEARCH STRATEGY

This review identified 15 papers over the past 10 years.

SELECTION CRITERIA

Papers that measured chemicals in menstrual products and that measured human biomarkers of chemical exposure were included. Papers had to also be available in English.

DATA COLLECTION AND ANALYSIS

Reviewers assessed the articles and data provided. Multiple chemical groups were found.

MAIN RESULTS

Phthalates, volatile organic compounds, parabens, environmental phenols, fragrance chemicals, dioxins and dioxin-like compounds were detected in menstrual products. Research gaps were identified, including the lack of studies on newer products such as menstrual underwear and cups/discs. In addition to measuring chemicals in these products, future research should focus on clarifying the exposure per menstrual cycle to these chemicals to understand how menorrhagia and cycle length influence exposure from menstrual products.

CONCLUSION

Menstrual products contained measurable levels of a range of endocrine disrupting chemicals including phthalates, phenols and parabens. This reflects a potentially important route of exposure to chemicals that can impact women's reproductive health.

Examining differences in menstrual and intimate care product use by race/ethnicity and education among menstruating individuals

Introduction

United States consumers spend over two billion dollars a year on intimate care products. These products, along with scented menstrual products, are marketed for odor control, perceived "freshness," and vaginal/vulvar cleanliness. However, these scent-altering products may increase exposure to carcinogenic and endocrine-disrupting chemicals. Prior research has not adequately characterized demographic differences in product use. The objective of our study is to examine racial/ethnic and educational differences in menstrual and intimate care product use among people who menstruate.

Methods

We pooled data from two US-based cross sectional studies to examine demographic characteristics and product use in 661 participants aged 18-54 years. Participants reported use of scented and unscented menstrual products (tampons, sanitary pads, and menstrual cups) and intimate care products (vaginal douches, sprays, wipes, and powders). We examined differences by race/ethnicity and education using log-binomial regression and latent class analysis (LCA), which can identify groups based on product use patterns.

Results

Our sample was 33.4% Black, 30.9% Latina, 18.2% White, and 16.2% another identity. Approximately half the population had a bachelor's degree or more; 1.4% identified as transgender and 1.8% as non-binary. In adjusted models, scent-altering products (i.e., scented menstrual and intimate care products) were more likely to be used by those with less formal education (p < 0.05). Unscented menstrual products were more likely to be used by those with more formal education. Compared to Black participants, White participants were more likely to use unscented tampons and menstrual cups and less likely to use douches and wipes (p < 0.05). Using LCA we identified two groups: one more likely to use scent-altering products, and a second more likely to use unscented menstrual products. Less education and older age, but not race/ethnicity, was significantly associated with membership in the group more likely to use scent-altering products. While sex/gender composition did not statistically vary across groups, all non-binary participants fell in the unscented menstrual product group.

Discussion

Lower educational attainment was consistently associated with greater use of scent-altering menstrual and intimate care products. Future research should examine associations between body odor stigma, product use, and health risks at intersections of race, class, and gender.

Spanlastics: a novel elastic drug delivery system with potential applications via multifarious routes of administration

Drug delivery systems (DDS) based on nanocarriers are designed to transport therapeutic agents to specific areas of the body where they are required to exhibit pharmacodynamic effect. These agents rely on an appropriate carrier to protect them from rapid degradation or clearance and enhance their concentration in target tissues. Spanlastics, an elastic, deformable surfactant-based nanovesicles have the potential to be used as a drug delivery vehicle for wide array of drug molecules. Spanlastics are formed by the self-association of non-ionic surfactants and edge activators in an aqueous phase and have gained attention as promising drug carriers due to their biodegradable, biocompatible, and non-immunogenic structure. In recent years, numerous scientific journals have published research articles exploring the potential of spanlastics to serve as a DDS for various types of drugs as they offer targeted delivery and regulated release of the drugs. Following brief introduction to spanlastics, their structure and methods of preparation, this review focuses on the delivery of various drugs using spanlastics as a carrier via various routes viz. topical, transdermal, ototopical, ocular, oral and nasal. Work carried out by various researchers by employing spanlastics as a carrier for enhancing therapeutic activity of different moieties has been discussed in detail.

Volatile Organic Compounds in Disposable Diapers and Baby Wipes in the US: A Survey of Products and Health Risks

Many thousands of diapers are worn by young children and the elderly, who have thin and sensitive skin that is highly vulnerable to chemicals, including volatile organic compounds (VOCs) that may be ingredients of these products or present as inadvertent or residual components. The levels and potential health risks of VOCs in diapers have not been reported previously. In this study, we collected 31 disposable hygiene products in the US market based on market share and analyzed 98 target VOCs using purge and trap sampling and thermal desorption/gas chromatography/mass spectrometer analysis. Exposures and risks were modeled using reasonable upper level exposure scenarios. Adult diapers contained the highest total target VOC concentration (median level of 23.5 μg/g), and the predominant VOCs were alkanes. In some diapers, the estimated noncancer risk from these VOCs was sometimes very large (hazard quotient of 1609) due to n-heptane. Baby diapers contained several known or suspected carcinogens, including benzene and 1,4-dioxane, and the lifetime cancer risk from some diapers approached 1 per million under a worst-case scenario. Store-brand products had higher levels of VOCs than generic brands, and products labeled "organic" or "for sensitive skin" did not necessarily have lower levels. Our results show that toxic VOCs were found in all tested disposable diapers and wipes at trace levels, and risks from using some diapers in high use exposure scenarios are high enough to warrant additional attention and possibly corrective measures. We recommend eliminating and monitoring toxic ingredients and disclosing all chemicals that may be in these products.

Assessing the Impact of Polyethylene Nano/Microplastic Exposure on Human Vaginal Keratinocytes

The global rise of single-use throw-away plastic products has elicited a massive increase in the nano/microplastics (N/MPLs) exposure burden in humans. Recently, it has been demonstrated that disposable period products may release N/MPLs with usage, which represents a potential threat to women's health which has not been scientifically addressed yet. By using polyethyl ene (PE) particles (200 nm to 9 μm), we showed that acute exposure to a high concentration of N/MPLs induced cell toxicity in vaginal keratinocytes after effective cellular uptake, as viability and apoptosis data suggest, along with transmission electron microscopy (TEM) observations. The internalised N/MPLs altered the expression of junctional and adherence proteins and the organisation of the actin cortex, influencing the level of genes involved in oxidative stress signalling pathways and that of miRNAs related to epithelial barrier function. When the exposure to PE N/MPLs was discontinued or became chronic, cells were able to recover from the negative effects on viability and differentiation/proliferation gene expression in a few days. However, in all cases, PE N/MPL exposure prompted a sustained alteration of DNA methyltransferase and DNA demethylase expression, which might impact epigenetic regulation processes, leading to accelerated cell ageing and inflammation, or the occurrence of malignant transformation.

Explication on distribution patterns of volatile organic compounds in petro-chemistry and oil refineries of China using a species-transport model and health risk assessment

Volatile organic compounds (VOCs) from industrial emissions have attracted great attention due to their negative effects on human, but there is lack of deterministic air quality model for VOC emissions. In this study, airborne VOCs from a typical petrochemical and oil refinery region, Lanzhou, Gansu province of China, were on-site measured. The regional pollution patterns were investigated using a species transport model and the health risks were evaluated. The spatial distribution of VOCs showed that 87.5 % of the airborne VOCs were benzene, toluene, ethylbenzene, and xylene having higher concentration (146 μg/m³) in the north direction oil refinery industrial areas. The concentrations of toluene and benzene were as high as 41.5 and 33.3 μg/m³ in the 4 km² area away from the petrochemical emission source, respectively, and the concentration of o-/m + p-xylene was up to 79.7 μg/m³. Based on the measured concentration data, the numerical results showed that the accumulation of high concentration of VOC species by mass transfer in the region is related to the atmospheric diffusion driven by downward-moving air over the valley areas. Non-carcinogenic risk assessments showed that airborne benzene exposure had acceptable hazard quotient of 0.185 for adults, which was 1.8 times of children's (0.102), whereas it was found that a high carcinogenic risk (>10^-4) from benzene in several sampling sites and diffuse distance become significant for carcinogenic risk. This study verified the effectiveness of VOC atmospheric diffusion model through a large number of on-site monitoring data, providing data support for model-based risk assessment.

The Effect and Activity of Free Radical Enzymes Due to Arsenic Exposure Through the Vulva and Vagina

BACKGROUND OF THE STUDY: Geogenic arsenic is ubiquitous, found in water and soil that is used daily, can be exposed to the female body through the genital organs. The vulva and vagina are open channels that allow toxic agents to enter the internal genitalia and distributed throughout the body. AIM OF THE STUDY: This study investigated the effects of vaginal arsenic exposure via vulvar immersion and vaginal douching in Rattus norvegicus on the damage of uterus and ovaries through oxidative mechanisms (MDA, SOD, and H₂O₂). METHODOLOGY: The experimental animals were divided into three treatment groups, i.e., K0 (control group), K1 (group treated with vulvar immersion in 0.8 mg/L arsenic solution), and K2 (group treated with vaginal douching using 0.5-mL of 0.8 mg/L arsenic solution). For each group, the treatment was repeated six times and carried out for fourteen days. Before the study, a seven-day acclimatization period was conducted for adaptation purposes. The experimental animals were euthanized using ketamine xylazine. The uterus and ovaries were collected for MDA, SOD, and H₂O analysis, as well as histopathology examination. RESULTS: The vaginal douching group had the highest MDA level both on the uterus (210.66±4.92μM) and the ovaries (214.67±2.50 μM). The immersion group also experienced an increase in MDA in the uterus (198.66±3.33μM) and ovaries (206.33± .21μM). However, a higher level of MDA was found in the ovaries. The highest H₂O₂ level was also found in the uterine and ovarian organs in the douching group. In contrast, the lowest SOD levels of uterine and ovarian were identified in the vaginal douching group. Arsenic exposure through vaginal immersion and douching affected the uterine MDA, SOD, and H₂O levels (Ρ<0.05). Arsenic exposure through vaginal douching also affected the ovarian MDA, SOD, and H₂O levels (Ρ<0.05). There was a significant difference in the mean of inflammatory cells (infiltrated neutrophils, macrophages, and lymphocytes) in the uterus and ovaries in the control, immersion, and vaginal douching groups (Ρ<0.05). CONCLUSION: Exposure to 0.8 mg/L arsenic solution through vulvar immersion and vaginal douching can cause oxidative stress and trigger inflammation of the uterine and ovarian tissue.

Occurrence of and dermal exposure to benzene, toluene and styrene found in hand sanitizers from the United States

Human exposure to carcinogenic volatile organic compounds (VOCs), such as benzene, from hand sanitizers is a topic of current concern. In light of the heavy use of hand sanitizers during the COVID-19 pandemic, determination of exposure to toxicants present in these products deserves attention. The US Food and Drug Administration (FDA) had set an interim limit for benzene in alcohol-based hand sanitizers at 2000 parts-per-billion (ppb). We determined the concentrations of and exposure to three VOCs namely, benzene, toluene and styrene, in 200 hand sanitizers using high-resolution gas chromatography coupled with high-resolution mass spectrometry (HRGC-HRMS). Benzene, toluene and styrene were found in 31%, 25% and 32%, respectively, of the samples analyzed at mean concentrations of 395 (range: 0.181-22,300), 164 (range: 0.074-20,700) and 61.3 ng/g (range: 0.082-4200 ng/g), respectively. Benzene was found at concentrations > 2000 ng/g (above the FDA interim limit) in 5% of the samples, representing 9 brands. The mean potential dermal exposure doses (DEDs) to benzene (children/teenagers: 34.6; adults: 24.7 ng/kg-bw/d) were higher than those for toluene (children/teenagers: 14.4; adults: 10.3 ng/kg-bw/d) and styrene (children/teenagers: 5.37; adults: 3.83 ng/kg-bw/d) in the 200 hand sanitizers analyzed. The estimated cancer risk from exposure to benzene in children/teenagers and adults from hand sanitizer use (at an estimated usage rate of 5 g/day) was greater than the one-in-a-million risk benchmark (1.0 × 10^-6) for 10% and 9% of the samples, respectively. To the best of our knowledge, this is the first study to determine both the concentrations of and exposure risks to benzene, toluene and styrene present in hand sanitizers.

Sustainable Treatment Techniques for Emerging Pollutants—The Case of Personal Hygiene Products

Personal care products (PCPs) enter wastewater primarily through greywater. Treatment plants have not been able to remove this type of contaminant, although PCP abatement techniques have been developed in recent years. The objective of the current study has been to encounter the sustainable technique that keeps the optimal balance between the criteria considered in the comparison. Therefore, a bibliographic review was conducted in scientific databases of the last eight years, demonstrating that co-composting, anaerobic–aerobic sequencing bioreactors and contaminant absorption through the use of carbon nanotubes are the ones with the least environmental impact. Subsequently, the Saaty and Modified Saaty methods were applied, with a comparative criteria of construction costs, maintenance costs, efficiency and the stage of development. The results indicated that the co-composting technique is the best sustainable technique of those studied, with a score of 0.86/1, which means that the criteria analyzed maintain very close values between them. The co-composting technique yields a low environmental impact in eliminating personal care products. This research work constitutes a practical and easy-to-use tool for decision makers, since it allows finding an optimal elimination treatment for PCPs.

Be alert for vapor intrusion of 1,4-dioxane from contaminated groundwater

Vapor intrusion (VI) poses significant environmental problems that can degrade indoor air and pose human health risks. This study focuses on 1,4-dioxane, a widely-used volatile organic compound (VOC) that is found in groundwater, however, this compound has not received much attention in indoor air and measurement methods are not well developed. 1,4-dioxane is sufficiently volatile and highly mobile in groundwater, and thus can present a VI risk. In this study, we develop a sensitive analytical method for quantifying airborne 1,4-dioxane, provide a performance evaluation of the method, and initiate preliminary field measurements above a 1,4-dioxane groundwater plume. The method uses passive sampling, automated thermal desorption, and gas chromatography/mass spectroscopy. Numerous other VOCs can be simultaneously measured. A low detection limit (0.067 μg/m³) is attained, which allows quantification at concentrations below health-based guidelines. The performance evaluation suggests limits to sampling times in high humidity environments and other means to ensure good performance. The scenario analyses demonstrate potential impacts from shallow plumes, especially in flooded basements, and thus monitoring of 1,4-dioxane vapor intrusion in the flood season is an urgent need.

Menstrual Products as a Source of Environmental Chemical Exposure: A Review from the Epidemiologic Perspective

PURPOSE OF REVIEW

Menstrual bleeding is a regular, common occurrence in a substantial portion of the population. Menstruators may use more than 10,000 menstrual products over the lifetime. Given the potential for environmental chemicals in menstrual products to be absorbed by the vulvar and vaginal epithelium into systemic circulation, we reviewed the available data on menstrual products as a source of environmental chemical exposure.

RECENT FINDINGS

Nearly two dozen studies have been conducted measuring environmental contaminants in menstrual products; all have detected environmental chemicals but had discrepant conclusions on exposure risks. Only three human studies have investigated menstrual product use and environmental chemical concentrations and all observed associations. Detection of environmental chemicals in menstrual products, in combination with challenges of exposure assessment, scarcity of human studies, and the exceedingly common occurrence of menstrual bleeding, motivates the need for further research. We provide recommendations to move this field forward.

Feminine Hygiene Products and Volatile Organic Compounds in Reproductive-Aged Women Across the Menstrual Cycle: A Longitudinal Pilot Study

Background: Volatile organic compounds (VOCs) have been detected in feminine hygiene products (FHPs), especially in tampons and sanitary pads. However, little is known about whether menstrual products can contribute to VOC exposure in women. Our objectives were to: (1) examine the variations of urinary VOC concentrations during menstrual cycles; (2) evaluate the relationships between the use of menstrual products and urinary VOC concentrations; and (3) link urinary VOC concentrations to those measured in menstrual products. Methods: We measured urinary concentrations of 98 target VOCs in 25 reproductive-aged women with 100 repeated measures collected between October 2018 and February 2019. First-morning-void urine samples were collected four times for each woman during one menstrual cycle. Urinary VOC concentrations were measured using gas chromatography-mass spectroscopy. Results: Of 98 target VOCs measured in the urine samples, 36 VOCs were detected. We did not see statistically significant variations in VOC concentrations across the menstrual cycle. After multivariable adjustment, tampon users had significantly higher concentrations of 2-butanone (β = 1.58 log ng/g, 95% confidence interval [CI]: 0.16-3.00, p = 0.03) and methyl isobutyl ketone (β = 0.63 log ng/g, 95% CI: 0.03-1.22, p = 0.04), compared with pad users. Higher n-nonane, benzene, and toluene estimated from menstrual products were associated with higher urinary concentrations in women. Conclusion: The use of FHPs during menses might be a potential source of VOCs. A larger cohort study is warranted to confirm our results and evaluate clinical implications.

Personal care product use among diverse women in California: Taking Stock Study

BACKGROUND

Personal care product use may contribute to elevated body burdens of consumer product chemicals among women of color; however, racial/ethnic differences in product use has been understudied. Community-engaged research can support the recruitment of diverse participants.

OBJECTIVE

To document personal care product use among a diverse group of women (aged 18-34 years) living in California.

METHODS

Through a community-academic partnership, we surveyed 357 women in California about product use information for 54 cosmetic, hair, menstrual/intimate care, and leave-on and rinse-off personal care products. We compared type and frequency of product use among Black, Hispanic/Latinx, Asian, and White women. We also summarized use of scented products and reasons women select products.

RESULTS

Women reported using a median of 8 products daily, with some women reporting up to 30 products daily. Hispanic/Latinx and Asian women used more cosmetics, and Black women used more hair and menstrual/intimate products than other women. Of the 54 products compared, there were significant differences in use by race/ethnicity for 28 products, with the largest number of significant differences between Black and White women.

SIGNIFICANCE

There is growing information on chemical exposures from personal care products and consequent adverse health effects, with implications for health disparities. Yet, there remains limited information on the range and types of products used by diverse racial/ethnic communities. This study helps close an important gap on product use inventories that can enable more informed public health interventions to limit exposures from personal care products.

A novel banana fiber pad for menstrual hygiene in India: a feasibility and acceptability study

BACKGROUND

Menstrual hygiene products used by women have evolved in the past several decades with comfort, ease of use and cost driving women's choices. In a country like India, where women form nearly 50% of the population, the sheer volume of periodic menstrual non-biodegradable waste generated has significant environmental implications. With majority of the country hailing from low-middle class backgrounds, observing healthy menstrual hygiene practices with environmentally friendly products necessitates the consideration of affordable and highly sustainable alternatives. Further, during the COVID-19 pandemic, period poverty is higher than ever, causing women to turn to the reusable product market for affordable and long lasting alternatives. Hence, we studied the Feasibility and Acceptability (FA) of a novel banana fiber based menstrual pad (BFP) amongst women living in rural and urban environments.

METHODS

The quantitative study of FA of the BFP was conducted amongst 155 rural and 216 urban participants in India. For greater authenticity of the FA study, we considered participants who used BFP for more than 4 months (Rural = 111 and Urban = 186) in the study. The survey data included responses from participants from Bihar, Delhi, Karnataka, Kerala, Maharashtra, Tamil Nadu and West Bengal. A 22-item survey instrument was developed and validated using Exploratory Factor Analysis (EFA) and reliability test (Cronback's [Formula: see text]). Binomial logistic regression analysis was used to analyse the factors that affect the FA of BFP based on the survey responses. In addition to survey analysis, environmental sustainability through [Formula: see text] footprint analysis, microbial load, pH and the ability of the BFP to withstand pressure after absorption were also studied.

RESULTS

The results indicated high levels of feasibility (rural [Formula: see text], urban [Formula: see text] and acceptability (rural [Formula: see text], urban [Formula: see text]) of BFPs across both participant groups. Comparing key BFP characteristics such as leakage and comfort to participants' prior practices revealed general satisfaction on the performance of BFP, leading to them recommending BFPs to others. User perception on the reasons for their preference of BFP highlighted their concern for environment, health and cost as decisive factors. The microbial load on a 3 year reused BFP was found to be similar to an unused BFP. Regression analysis showed cost as an important indicator for feasibility ([Formula: see text]; 95% CI = 1.083-3.248) and acceptability ([Formula: see text]; 95% CI = 1.203-3.748) amongst rural participants.

CONCLUSION

Based on feasibility and acceptability results, BFP is a promising consideration as an environmentally sound, non-invasive; yet reusable alternative to fulfil MHM needs in populous countries such as India. Longer term studies in larger samples are necessary to validate these findings.