Perceptions among adolescent girls and their mothers regarding tampon use

Assessing menstrual equity amongst BAMER women fleeing gender-based abuse in Sheffield (UK): A cross-sectional study

OBJECTIVES

Menstruation is not openly discussed in numerous Black, Asian, minority ethnic and refugee (BAMER) communities. Consequently, it is unclear if transitioning between cultures impacts BAMER women's menstrual health. This study aimed to evaluate menstrual equity and sanitary protection preference amongst BAMER abuse survivors displaced to Sheffield (UK).

METHODS

Fifty participants were recruited from women's support services between December 2018 and May 2019. Selection criteria required participants to menstruate, identify as BAMER, be displaced, and have experienced gender-based abuse. Descriptive and inferential statistical analyses were performed using SPSS (IBM, USA) to assess menstrual equity.

RESULTS

Many struggled to afford products (86 %), changed them infrequently (68 %) or improvised sanitary wear (40 %). Financially restricted women often changed products irregularly (p = 0.02) or used proxy items (p = 0.02). Participants disliked reusable pads (48 %) and vaginally inserted products (tampons 46 %, cups 78 %) without having tried them. Negativity surrounding reusable pads (p = 0.01) and cups (p = 0.04) was linked to menstrual taboo. Few women knew of menstruation prior to menarche (28 %). These participants were more likely to accept male doctors (p = 0.04), unlike those that regarded menstruation as taboo (p = 0.02), unclean (p = 0.02) or shameful (p = 0.001).

CONCLUSION

We provide key information regarding the menstrual health status of marginalised women. Our findings suggest limited menstrual-health education at menarche and negative belief-systems may compromise access to products and healthcare in adulthood. This study advises policymakers to unify distribution of hygienic absorbents and menstrual-health education to normalise menstruation, thereby reducing menstrual shame and empowering women to make informed sanitary protective choices.

Menstrual hygiene products: A practice evaluation

OBJECTIVE

The choice and use of a type of hygienic protection depends on many factors. Due to growing media interest, the field of hygienic protection is evolving, however, to date no study has been carried out on this subject in France. The objective of this study was to evaluate women's practices regarding the use of hygienic protection.

MATERIAL AND METHODS

From 2 June 2019 to 4 January 2020, 1,153 patients responding to a self-report questionnaire were included in a prospective, cross-sectional, observational, single-center study. The aim of the study was to describe women's practices with regard to menstrual hygiene products and the factors determining their choices, as well as their knowledge of the potential risks associated with these protections and their sources of information.

RESULTS

Disposable sanitary pads were preferred by 930/1148 (81%) of patients, and menstrual tampons were used half as much (525/1150 (45.6%) of women surveyed)). The new menstrual hygiene products (washable sanitary pads, menstrual panties, and menstrual cups) were used by only 51/1150 (4.4%); 20/1149 (1.7%); 108/1150 (9.4%) of the patients; however, among the 92/1136 (8.1%) of the patients who had recently changed the type of protection, these new protections were the most popular because they were considered more ecological and less harmful to health. Menstrual hygiene products were perceived as a health risk for 924/1129 (81.8%) of patients. Menstrual toxic shock syndrome was knowledeg in only 473/1133 (41.7%) of patients. This lack of knowledge could lead to risky behavior. The majority of patients said they were not informed about hygiene protection, with only 151//1108 (13.6%) having discussed the subject with a health professional, yet 973/1067 (91.2%) wanted more information.

CONCLUSION

This is the first French study on menstrual hygiene products. It showed that traditional sanitary protection was still the most widely used, but there was a growing awareness among patients about the products they used and their potential health risks as well as the consequences for the environment. Patients wanted to receive information on the subject from health professionals as well as manufacturers in order to be able to choose the product deemed the most suitable and in which they have confidence.

Tampon loss - management among adolescents and adult women

The widespread use of tampons carries a risk of tampon loss due to imperfect use. We performed a retrospective study including all women attending the emergency room (ER) with the complaint of tampon loss during 2011-2018. Overall, 72 women presented to the ER with a complaint of tampon loss. In 25% (18/72), a lost tampon was found on physical examination. The lost tampon was found in a higher rate among adolescents as compared to older women (4 (80%) vs. 14 (21%), 15.1, p = .01). Time from tampon loss to referral for evaluation was shorter among adolescents as compared to older women (7 ± 3 vs. 21 ± 21 h, p = .007). In most adolescents with a complaint of a lost tampon - it was eventually found on pelvic examination, as opposed to older women, in whom a finding was present in only one-fifth of cases. This highlights the importance of thorough examination of adolescents presenting due to tampon loss. The study protocol was approved by the Sheba Medical Center review board (March 15, 2018), 6345-19-SMC.IMPACT STATEMENTWhat is already known on this subject? Very little is known regarding the distinguished phenomena of tampon loss among adult females.What do the results of this study add? In most adolescents referred due to tampon loss - a tampon was found on pelvic examination, as opposed to older women.What are the implications of these findings for future clinical practice and/or further research? In most adolescents referred due to tampon loss - a tampon will be found on pelvic examination, as opposed to older women, in whom a finding is present in only one-fifth of cases. This highlights the importance of thorough examination of adolescents presenting with a loss of tampon.

Association of characteristics of tampon use with menstrual toxic shock syndrome in France

BACKGROUND

Menstrual tampons are widely used in western countries. Indirect evidence suggests that tampon misuse could be associated with an increased risk of menstrual toxic shock syndrome (MTSS). The aim of this study was to determine what characteristics of tampon use are associated with increased risk of menstrual toxic shock syndrome (MTSS).

METHODS

A nationwide, case-control study in France, was conducted with women that use tampons with MTSS diagnoses according to the CDC diagnostic criteria (n = 55, from January 2011, to December 2017) and a control group of women with no MTSS history (n = 126, from February to December 2017). Information regarding tampon use during a 6-month period was collected. Associations between tampon use and MTSS were assessed using logistic regression models stratified by residential area.

FINDINGS

Compared to controls, women diagnosed with MTSS more frequently reported maximum tampon wear of >6 h (62% vs. 41%; P = 0.02), overnight tampon use (77% vs. 54%; P = 0.006), and neither read nor followed tampon instructions in case of reading (65% vs. 42%; P = 0.006). In univariate analysis, MTSS risk was two-fold higher with tampon use for >6 consecutive hours (odds ratio, 2.3 [95% CI, 1.2-4.5]), and three-fold higher with tampon use during sleep for >8 h (odds ratio, 3.2 [95% CI, 1.4-7.7]). In multivariate logistic regression analysis, only maximum tampon use for >6 h (odds ratio, 2.03 [95% CI, 1.04-3.98]), and neither read nor followed the tampon instructions in case of reading (odds ratio, 2.25 [95% CI, 1.15-4.39]) were independently associated with MTSS.

INTERPRETATION

Our study suggests that the risk of MTSS was associated with using tampons for more than 6 h, overnight tampon use during sleep, and neither read nor followed tampon insertion instructions in case of reading.

FUNDING

LABEX ECOFECT (ANR-11-LABX-0048) of Université de Lyon within the programme "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR).

Pediatricians' knowledge, attitudes and practices surrounding menstruation and feminine products

Objective This study investigates whether primary care pediatricians adhere to the American Academy of Pediatrics (AAP) recommendations by routinely evaluating patients' menstrual cycles and educating patients about menstruation and feminine products. Additionally, this study examines pediatricians' knowledge and attitudes surrounding menstrual health topics. Methods A 53-item online questionnaire was developed to evaluate pediatricians' knowledge, attitudes and clinical practices regarding menstruation-related topics. The questionnaire was emailed to 2500 AAP members using a geographically-stratified sampling approach, with pediatricians in each state selected randomly. Mann-Whitney U tests, t-tests, and logistic regressions were used to assess associations between correlates and pediatricians' knowledge, attitudes and practices. Results Five hundred and eighteen out of 2500 pediatricians participated (response rate = 20.7%), 462 met inclusion criteria; 78.8% were female, 79.2% were Caucasian. The majority of the pediatricians (58.2%) were "not at all" or only "slightly" familiar with the AAP guidelines on anticipatory guidance surrounding menarche. Many reported they do not routinely provide anticipatory guidance regarding menstruation to pre-menarchal patients (24.7%), discuss menstruation with post-menarchal patients (33.1%) or ask patients the date of their last period (28.4%). The majority were unlikely to discuss feminine products with patients. Gaps in menstruation-related knowledge were noted. Male pediatricians were significantly less likely to evaluate patients' menstrual cycles and provide patient-education regarding menstruation-related topics, and had significantly lower self-rated and measured knowledge of these topics. Conclusions A concerning number of pediatricians in a national sample do not abide by AAP recommendations surrounding menstruation and exhibit knowledge gaps in this area. To effectively address the health needs of female patients, pediatricians should better incorporate menstrual health care into their clinical practice.

Impact of Advertising on Tampon Wear-time Practices

OBJECTIVES

(1) To determine whether advertising nighttime tampon use for up to eight hours was understood to be consistent with label recommendations and (2) to determine whether television and print advertising with this message affected tampon wear times in adults and teens.

METHODS

(1) A comprehension study (online advertising and follow-up questionnaire) among women aged 14-49 years (300 per group) who viewed either the test or a control advertising message; (2) Diary-based surveys of tampon wear times performed prior to (n = 292 adults, 18-49 years, 74 teens, 12-17 years) and after (n = 287 adults, 104 teens) the launch of national advertising.

RESULTS

Significantly more test message viewers than controls stated tampons should be worn less than or equal to eight hours (93.6% vs. 88.6%, respectively, P = 0.049). A directionally higher percentage of test message viewers said they would use a pad if sleeping longer than eight hours (52% vs. 42% of controls). Among the women who used tampons longer than eight hours when sleeping, 52% reported they would wake up and change compared with 45% of controls. No significant difference between baseline and follow-up diary surveys was found among teens or adults in various measures of tampon wear time (mean wear times; usage intervals from less than two hours to more than 10 hours; percentage of tampons used for more than or equal to eight hours; frequency of wearing at least one tampon more than eight hours).

CONCLUSIONS

Advertising nighttime tampon wear for up to eight hours effectively communicated label recommendations but did not alter tampon wear times. The informational intervention had limited impact on established habits.