A Behind-the-Scenes Look at the Safety Assessment of Feminine Hygiene Pads

A pharmacist's role in increasing access to menstrual products: an education and advocacy approach

Individuals who menstruate grapple with diverse challenges in menstrual and reproductive health. This includes financial burdens, societal stigmas, and negative mental and physical health implications. Period poverty, marked by insufficient access to menstrual products, education, and sanitation, remains a prevalent and poorly addressed issue. Alarming statistics highlight the extent of this problem and shed light on the staggering number of individuals lacking access to essential menstrual products. The discourse extends to the safety and accessibility of a diverse array of menstrual products. A comprehensive comparison of the cost of available period products was conducted using data obtained from various retail websites. The often-overlooked potential indirect expenses and profound impacts on quality of life were also discussed. Amidst other public health initiatives, pharmacists have emerged as pivotal advocates and educators. Pharmacists are poised to drive initiatives that increase access to menstrual products through public health education and advocacy. By providing education on different menstrual product options, pharmacists can empower individuals to make informed decisions based on their needs. This perspective illuminates the complex impacts of menstruation on individuals and proposes that pharmacists can play a role in overcoming barriers to access. The proposed strategies, rooted in education, research, and advocacy, pave the way for enhancing access, reducing stigma, and elevating the quality of life for those navigating the intricate complexities of menstruation.

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.

"My body is the evidence, assess my health": Women's disposable sanitary pads social health movement in Korea

Researcher focused on the sanitary pads health movement in Korea from the feminist health perspective. The methodology was based on web content/statement analysis. Statements were collected and analyzed from government, women NGOs, online petitions, news articles, and reports gathered for three years from March 2017 to September 2020. The disposable sanitary pads health movement was triggered by the Korean Women's Environmental Network KWEN unveiled that it detected carcinogenic substances in its harmful substance detection tests with Professor Kim in March 2017. Women who were silenced for a long time could finally argue for their health rights in the Korean society.

Safety Evaluation of Absorbent Hygiene Pads: A Review on Assessment Framework and Test Methods

Disposable absorbent hygiene products have evolved for superior performance, enhancing the convenience of daily lives. However, the use of disposable hygiene pads has brought safety concerns on chemical exposure, and significant efforts have been made to assess the potential risks associated with use of hygiene pads. This article intends to overview the safety assessment framework of diapers and feminine pads, which includes hazard identification, hazard characterization, exposure assessment, risk characterization, and post-market risk management. Risk assessment of various constituents are reviewed for quantification methods and conservative estimation of exposure parameters. By reviewing the up-to-date considerations in risk assessment, we aim to provide insightful discussion on safety evaluation of current versions of disposable absorbent products. More clinical testing and post-market surveillance are needed for continuous monitoring of potential health impacts of advanced products and constituents.

A Feminine Care Clinical Research Program Transforms Women's Lives

Feminine hygiene products and menstruation education have transformed the lives of women throughout the world. The P&G Feminine Care Clinical Innovation Research Program has played a key role by expanding scientific knowledge as well as developing technical insights and tools for the development of feminine hygiene products. The aim has been to meet the needs of women throughout their life stages, advancing their urogenital health beyond just menstruation, as well as helping to understand the role of sex hormones in various important health issues that women face. This review article highlights key contributions and research findings in female hygiene products, urogenital health research, and method development. The clinical research team focused on utilizing the results of clinical safety studies to advance the acceptance of feminine hygiene products world-wide. Key findings include that perception of skin sensitivity is not limited to the facial area, but is also relevant to the body and the genital area. Also, they shed light on the role of estrogen in autoimmune diseases as well as premenstrual syndrome. Efforts in the method development area focused on innovative tools that are reliable, predictive of clinical trial results and capable of measuring wear comfort, genital skin health, and the impact of product use on the consumer’s quality of life. A novel method, behind-the-knee (BTK) test, developed to model irritation under normal wear conditions, was the first to account for both chemical and mechanical sources of irritation. The method has been accepted by the FDA as a substitute in clinical trials in some cases, and by American Society for Testing and Materials as a global standard test method. Additional proprietary methods were developed to enhance visual grading of irritation using cross-polarized light, to measure the amount of lotion transferred from sanitary pads, and to evaluate the skin mildness. Finally, the Farage Quality of Life tool was created to measure consumer’s well-being. Based on the results of this extensive clinical research and the newly developed testing methods, the changing needs of women throughout their life stages are better met.

Dermatological testing of an improved apertured film surface for feminine hygiene pads

CONTEXT

Apertured polyethylene films (AF) have been used as a surface for sanitary pads for decades because they are compatible with the skin and keep the pad surface drier. A modified film (AF-plus) with improved fluid handling and a smoother, suppler texture has been developed. We hypothesized that these changes would improve both performance and skin compatibility. However, distinguishing the skin effects of materials that are inherently mild is a challenge.

OBJECTIVES

(i) To compare the skin irritation potential of pads with AF-plus modified film relative to the standard AF film and (ii) to assess the potential for the AF-plus film to induce delayed contact hypersensitivity.

MATERIALS AND METHODS

Pads bearing the AF-plus film were compared to pads with the standard AF film in a behind-the-knee (BTK) test, which assesses the combination of chemical irritation and frictional effects of materials applied to the popliteal fossa under a semi-occlusive bandage. Erythema on the skin surface was scored with the naked eye and subsurface tissue erythema was visualized and scored using cross-polarized illumination. Skin dryness was scored with the naked eye only. One-sided statistical evaluations were performed to test the hypothesis of AF-plus film superiority. The potential of the AF-plus film to induce delayed contact hypersensitivity was assessed by a human repeat insult patch test (HRIPT).

RESULTS

Pads with the AF-plus surface were significantly milder to skin in the BTK test, producing lower levels of both surface and subsurface tissue erythema. Moreover, subjects with preexisting erythema on the skin surface at study start developed comparatively less erythema over the course of the study overall with the AF-plus pad compared to the AF pad. No significant difference in skin dryness was observed between product groups. The AF-plus pad showed no evidence of inducing delayed contact hypersensitivity.

CONCLUSIONS

The AF-plus pad was superior to the AF pad in terms of skin mildness as discerned by objectively scored surface and subsurface tissue erythema. In subjects with preexisting erythema, the AF-plus pad appeared to contribute less to the further development of inflammation under the test conditions. Given the compositional similarities in the two films, the results could point to more limited contribution of the AF-plus film to skin friction, one of the factors simulated by the BTK test protocol.

The effect of "breathable" panty liners on the female lower genital tract

OBJECTIVE

To evaluate whether the use of "breathable" panty liners (BPLs) alters the normal vaginal flora, increases the incidence of bacterial vaginosis and/or vaginal candidiasis, or causes vulvar irritation.

METHODS

A randomized controlled trial assessed the vaginal ecosystem of women without complaints of vaginal discharge. The study group (n=53) wore BPLs for 10-12 hours each day for 75 consecutive days, whereas the control group (n=54) wore only their usual underwear. At each of 6 visits during 3 menstrual cycles, participants underwent gynecologic examination with colposcopic evaluation and pH measurement, in addition to assessment of vaginal microbial flora, intensity of inflammatory processes, and presence of vaginal candidiasis/bacterial vaginosis in Gram-stained smears.

RESULTS

After 75 consecutive days of BPL use, 40/44 (90.9%) and 42/44 (95.5%) women reported no complaints of vaginal discharge or vulvar itching/burning, respectively. There was no significant difference between the study group and the control group with regard to positive vaginal fungus cultures (5/44 [11.4%] vs 8/50 [16.0%]; P=0.7848) or bacterial vaginosis (3/44 [6.8%] vs 2/50 [4.0%]; P=0.7974) at the end of the study period.

CONCLUSION

After 75 days of BPL use, there was no significant increase in vulvovaginal candidiasis, bacterial vaginosis, vulvovaginal irritation, or vulvovaginal inflammation.

Identifying patients likely to have atopic dermatitis: development of a pilot algorithm

BACKGROUND

A quick method to distinguish people who are predisposed to skin complaints would be useful in a variety of fields. Certain subgroups, such as people with atopic dermatitis, might be more susceptible to skin irritation than the typical consumer and may be more likely to report product-related complaints.

OBJECTIVE

To develop a rapid, questionnaire-based algorithm to predict whether or not individuals who report skin complaints have atopic dermatitis.

METHODS

A 9-item questionnaire on self-perceived skin sensitivity and product categories reportedly associated with skin reactions was administered to two groups of patients from a dermatology clinic: one with clinically diagnosed, active atopic dermatitis (n = 25) and a control group of patients with dermatologic complaints unrelated to atopic dermatitis (n = 25). Questionnaire responses were correlated with the patients' clinical diagnoses in order to derive the minimum number of questions needed to best predict the patients' original diagnoses.

RESULTS

We demonstrated that responses to a sequence of three targeted questions related to self-perceived skin sensitivity, preference for hypoallergenic products, and reactions to or avoidance of alpha-hydroxy acids were highly predictive of atopic dermatitis among a population of dermatology clinic patients.

CONCLUSION

The predictive algorithm concept may be useful in postmarketing surveillance programs to rapidly assess the possible status of consumers who report frequent or persistent product-related complaints. Further refinement and validation of this concept is planned with samples drawn from the general population and from consumers who report skin complaints associated with personal products.