ANSES received a request from the Ministries for Health and the Economy to assess the safety of intimate protection (tampons, sanitary napkins, panty liners and menstrual cups). The expertise consisted in identifying the chemical substances of concern, whether regulated or not, likely to be present in these hygiene products, then evaluating the associated health risks. The expert appraisal also covered the analysis of the microbiological risk associated with menstrual toxic shock syndrome (TSS).
Improve the manufacture of protections in order to reduce the presence of chemical substances
Laboratory tests have revealed the presence of various chemical substances in very low concentrations and without exceeding health thresholds. ANSES does not highlight any risk associated with the presence of these substances. The majority of these substances come from the contamination of raw materials or manufacturing processes.
ANSES therefore recommends that manufacturers improve the quality of raw materials and revise certain manufacturing processes in order to eliminate or, failing that, reduce as much as possible, the presence of these substances, in particular those with ” carcinogenic, mutagenic or reprotoxic” (CMR), endocrine disruptors or skin sensitizers.
On the other hand, there are no specific regulations governing the composition, manufacture or use of intimate protection products. ANSES recommends the development of a more restrictive regulatory framework at European level in order to limit the presence of these chemical substances and notably supports, within the framework of the REACh regulation, a project to restrict CMR substances in feminine hygiene products.
Menstrual toxic shock syndrome, rare but potentially serious
Menstrual toxic shock syndrome represents the main microbiological risk linked to the wearing of internal intimate protection (tampon and menstrual cup). The bacterial toxin TSST-1 produced by Staphylococcus aureus (Staphylococcus aureus) can lead to the occurrence of menstrual toxic shock syndrome which, although rare, can have serious complications.
Expertise shows that the risk of developing menstrual TSS increases with prolonged use of internal protection and/or the use of protection with a stronger absorption capacity than necessary.. It should be noted that external intimate protection (towels, panty liners) have never been implicated in the reported cases of menstrual TSS.
Also, ANSES recommends increasing the information given to health professionals and women about this disease and its symptoms. It also recommends that all manufacturers display clear indications relating to this risk on the packaging and instructions for use of internal intimate protection products.
In order to limit the risk of menstrual TSS, ANSES reminds users of the need to comply with the recommendations for use specific to each protection, in particular those on the wearing time of tampons and cups. IIt is also recommended to use a tampon only during menstruation and to choose it with an absorbency adapted to the menstrual flow in order to change it regularly.
More generally, ANSES recalls the importance of respecting hygiene rules about the use of intimate protections, and in particular the importance of washing hands before and after changing intimate protections.