From Birth Control to that “Fresh Feeling”: A Historical Perspective on Feminine Hygiene in Medicine and Media

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.

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.

The clean vagina, the healthy vagina, and the dirty vagina: Exploring women’s portrayals of the vagina in relation to vaginal cleansing product use

Vaginal cleansing products such as douches, sprays, wipes, powders, washes, and deodorants are part of a growing $2 billion industry in North America. Part of the appeal of these products is supposedly attaining vaginal cleanliness, which is marketed in association with product use. Although these products are promoted as healthy, medical research indicates potential health risks for some of these products (e.g. yeast infections, bacterial vaginosis, and disruption of the vaginal microbiota). Despite these risks, many women use these products. In this paper, we draw on interviews with women who use vaginal cleansing products to examine the ways in which particular portrayals of the vagina are connected with broader societal messages about female genitalia and with motivations to use vaginal cleansing practices. These portrayals include the healthy vagina, the clean vagina, and the dirty vagina. We show that although participants in our study valued both a clean vagina and a healthy vagina, when tension occurred between these two portrayals, participants prioritized vaginal cleanliness over vaginal health. We argue that this prioritization of the idealized clean vagina is connected to societal pressures of needing to attain unrealistic standards of vaginal cleanliness.