Feminine hygiene

• 1. Introduction

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  Feminine hygiene products touch the lives of roughly 1.9 billion women of reproductive age worldwide, yet their history stretches from papyrus in ancient Egypt to medical-grade silicone today. In ancient Japan, paper tampons held in place by a fabric binder called kama were changed up to 12 times a day. Wool, grass, and papyrus served as absorbent materials across Egypt, Rome, and Indonesia long before any commercial product existed. The questions that run through this story are deceptively practical: who has access to these products, what does science say about when to use them and when to leave well enough alone, and how did a category of goods that barely existed in records before the industrial era become a global market touching issues of taxation, incarceration, and environmental impact?

• 2. From Cloth to Commerce

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  In 18th-century Sweden, visible period stains on clothing drew little social attention, and menstruation was described in everyday speech as "wearing the clothes" or "wearing the sarsk," a chemise-like undergarment. Cloth pieces and rags likely collected menstrual fluid, but almost no physical artifacts survive; the cloths were discarded when worn out or when menopause ended the need for them. Commercial menstrual products arrived in Sweden at the end of the 19th century, tied directly to growing urban interest in cleanliness and personal health. By that same period, Johnson and Johnson had introduced the first commercial sanitary napkin on the American market, made of flannel.

  The very first menstrual hygiene product launched commercially in Sweden was the menstrual receptacle, as early as 1879. Made of rubber like many hygiene articles of the era, it was bowl-shaped and sat on the outside of the abdomen; it never became popular. Patents for early intravaginal devices resembling the menstrual cup appeared as early as 1903. Menstrual belts emerged in the late 19th century as well, with a "Suction pad for menstruation" patent recorded in Swedish documents from 1889. A belt at that time could cost between 2.75 and 3.50 Swedish kronor, with pads priced at roughly 4-5 kronor per pack depending on size, making menstrual protection a costly purchase out of reach for many women.

  The sanitary belt evolved through the 20th century into something closer to a girdle, introduced in Sweden in the 1940s and used there until the 1960s. By the 1970s, an adhesive strip on the underside of the pad replaced the need for any belt, pin, or girdle entirely, allowing the pad to attach directly to underwear. Advertisements and product information remain the primary historical record of how sanitary pads developed, since the cloth artifacts themselves did not survive.

• 3. A Landscape of Products

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  Menstrual pads today are made of cellulose, available in multiple absorbencies and lengths, and may include wings and adhesive backing to stay in place. Pantyliners are smaller and thinner, designed for lighter flow, vaginal discharge, or as backup to a tampon. Tampons can be used while swimming and come in different absorbency levels, inserted inside the vagina to absorb menstrual blood.

  Reusable options cover a wide range of materials and designs. Menstrual cups are made of silicone, natural rubber, or plastic; they are inserted to catch blood and uterine lining, then emptied, washed, or boiled. Cloth menstrual pads can be made of cotton, flannel, or terry cloth. Period underwear functions either as a holder for pads or as an absorbent garment on its own. Menstrual sponges are inserted like a tampon or cup and worn inside the body. Menstrual discs, made of medical-grade silicone, are designed to collect menstrual fluid for up to 12 hours, sitting higher in the vaginal canal than traditional pads or tampons; they are built to last over five years.

  Beyond menstrual products, feminine hygiene includes cleansing items such as douches, feminine wipes, and soaps. Health professionals widely advise against douching, as it disrupts the balance of vaginal flora and acidity that the body relies on for its own defense. The vagina maintains acidic pH and resident bacteria that produce antimicrobial compounds called bacteriocin, which help block external pathogens from adhering to the vaginal mucosa.

• 4. The Body's Own Defenses

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  Vaginal discharge is a normal, healthy occurrence from before puberty until after menopause. It is composed of bacteria, cells shedding from the vaginal walls, and mucus and plasma produced by the cervix and vagina. At the start and end of the menstrual cycle, when estrogen levels are low, discharge is dense and adhesive. As estrogen rises before ovulation, it becomes clearer, more liquid, and stretchier.

  In vitro testing of vaginal fluids from five women showed activity against non-resident bacteria including Escherichia coli and Group B Streptococcus. That protection against Group B Streptococcus matters especially for pregnant women, since the bacterium commonly colonizes the vagina via the gastrointestinal tract and raises the risk of preterm delivery, neonatal meningitis, and fetal death. Disrupting the vaginal environment can also lead to asymptomatic bacteriuria, urinary tract infections, and postpartum endometritis.

  The vulva itself is the initial physical barrier for the genital tract. Its skin differs from skin elsewhere on the body: it has higher hydration, more friction, a thin stratum corneum, and large hair follicles that make it easier for substances to permeate. Increased moisture, sweating, menstruation, and hormonal shifts can disturb the microbial balance there, potentially leading to odor or infection. These biological realities shape which hygiene practices medical professionals recommend and which they warn against.

• 5. Health Risks and Chemical Concerns

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  Toxic shock syndrome is a rare illness associated with wearing tampons for extended periods. It is caused by toxins linked to Streptococcus pyogenes or Staphylococcus aureus bacteria, though the direct causal link to tampon use is not established. Fragrances, neomycin in pad adhesives, tea tree oil, and benzocaine can all cause irritation or inflammation.

  Bacterial vaginosis occurs when naturally present bacteria in the vagina overgrow and cause an imbalance, producing a uniform white or gray layer on the vaginal walls, a fishy odor, and a vaginal pH above 4.5. Recurrence is a recognized challenge because the bacteria adapt and normal flora often fails to re-establish fully. Research found that women who used bubble bath on the vulva were twice as likely to develop bacterial vaginosis compared to those who did not. Those who applied antiseptic solutions to the vulva or vagina were three times as likely to be diagnosed, and women who used a douching agent had bacterial vaginosis six times more frequently.

  Per- and polyfluoroalkyl substances, known as PFAS, have emerged as a chemical concern in period underwear specifically. Companies including Thinx, Ruby Love, and Knix face class action lawsuits alleging their products contain PFAS, which may be linked to adverse health outcomes including cancer. African American women are 2.9 times more likely to be diagnosed with bacterial vaginosis compared to women of European ancestry, a disparity possibly connected to differences in normal vaginal flora between these groups.

• 6. Access, Cost, and Equity

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  "Tampon tax" is the shorthand for sales tax applied to tampons, pads, and menstrual cups. At least half a million women worldwide cannot afford these products adequately. In the worst cases, the cost forces girls to miss school days or drop out entirely. Advocates in many countries have pushed to eliminate the tax, with petitions succeeding in parts of the United Kingdom and the United States. The UK abolished the 5% minimum VAT on sanitary products on the 1st of January 2021; that rate had been a requirement under European Union law, which had prohibited member states from removing it entirely while the UK remained in the EU.

  According to the World Health Organization, as of 2018 roughly 780 million people lacked access to improved water sources and about 2.5 billion lacked access to improved sanitation. In low-income countries, the choices available to women for menstrual management are constrained by cost, availability, and social norms together.

  In the United States, the Federal Bureau of Prisons announced that women in its facilities would receive free menstrual pads and tampons. Section 411 of the First Step Act, passed on the 22nd of May 2018, directs the Bureau to make specified healthcare products available to prisoners free of charge, in quantities appropriate to each prisoner's healthcare needs. A cross-sectional study published in 2008 of 160 adolescent girls at a secondary school in Singur, West Bengal, found that only 18 of those girls, 11.25%, actually used sanitary pads during menstruation, even though 78 of them, 48%, knew the pads existed.

• 7. Culture, Religion, and Variation

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  Research indicates that Afro-Caribbean immigrant women, compared to Caucasian women, are more inclined to cleanse the vulva with bubble bath or antiseptic, reflecting a cultural belief that thorough body cleansing is essential for health. Among Orthodox Jewish women, a ritual bath called mikveh is performed after menstrual periods or childbirth as a form of ritual purity. In the Muslim faith, a purification bathing ritual called full ablution, or ghusl Janabah, is practiced by both men and women after sexual intercourse or menstruation.

  In some regions of Mozambique and South Africa, certain women use lemon juice, saltwater, or vinegar for internal vaginal cleansing, intending to eliminate discharge or treat sexually transmitted diseases. A study of 500 women in Iran found a notable association between bacterial vaginosis and inadequate menstrual and vaginal hygiene practices. A household survey by Anand and colleagues found that women using unhygienic methods during menstruation, excluding sanitary pads or locally prepared napkins, were 1.04 times more likely to report reproductive tract infection symptoms and 1.3 times more likely to experience abnormal vaginal discharge, including itching, vulvar irritation, lower abdominal pain, pain during urination or defecation, and low back pain.

  Some girls and women regard tampons and menstrual cups as affecting their virginity even without sexual intercourse. For autistic individuals, using pads before menstruation begins may ease sensory challenges associated with menstrual products, with prior education and practice helping to familiarize the person with body changes. Menstruation also continues in cases of paralysis, and product use in that context depends on individual preference and circumstance.

• 8. Environmental Stakes

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  Over a lifetime, a menstruating woman in a developed country can use between 5,000 and 15,000 pads and tampons, generating around 400 pounds of packaging. Tampons carry a higher environmental burden than pads partly because of plastic applicators and synthetic fibers that do not biodegrade. The menstrual cup is considered the most environmentally friendly option available. Menstrual discs, built to last over five years, represent another durable alternative at the lower-impact end of the spectrum. The scale of waste from disposable products, set against a global population of 1.9 billion women of reproductive age, frames this as a public environmental question as much as a personal one.