AMAZING the decisions that are made in the bathroom at 2 a.m. For Susie Hewson, it was at this time and place that a crucial decision was made to set up her own company manufacturing all cotton tampons.
It was 1989 and she was "cross" after seeing a World In Action programme claiming that dioxins - a by product of pulp processing - were present in tampons. "Dioxins have been linked to cancer, endometriosis and Toxic Shock Syndrome," she says. Considering that a woman can use up to 11,000 tampons in one lifetime, this is enough to give pause for thought. "It is not just a women's issue," Hewson adds. "Dioxin pollution in the environment has been linked to lower sperm counts in men."
Existing tampons she investigated contained rayon: "Dioxins are produced when the rayon is bleached with chlorine. I had lived in Sweden, where they were phasing out the use of chlorine bleach in the pulp industry. I couldn't understand why nothing was changing in Britain."
Fuelled by her impatience, Hewson set up Natracare. With the help of a Swedish chemist and a Bristol manufacturer she developed an oxygen bleached, all cotton tampon with no additives. Natracare now produces all cotton tampons, sanitary towels and panty shields. They are available in 12 different countries, including Ireland, mainly through health food outlets.
Peter Stephenson, a spokesperson for Tambrands, the manufacturers of Tampax, says that in 1989 the UK's Department of Health found dioxins in feminine hygiene products did not pose a health risk. Since then, he says, the use of chlorine bleach and chlorine gas in the manufacturing of tampons has been virtually eliminated, leading to a huge reduction in dioxin levels: "Although the fibre used in the manufacture of tampons might contain trace levels of dioxin, such levels are ordinarily lower than those found in beef, fish, and dairy foods."
In 1994 the Environmental Protection Agency in the US concluded that dioxins probably cause cancer, she notes, adding that a study came to light in the US in 1992 showing that trace levels of dioxins found in some tampons were potentially carcinogenic and should be removed: "Dioxin accumulates in the fatty tissues of the body, where it can be measured 20 to 30 years later. The fatty tissue that lines the vagina stores it. It attaches to cells and can change their DNA to create cancer," she maintains.
HOWEVER, Stephenson says Tambrands has not found any medical evidence to link use of their tampons with cancer. He draws attention to the fact that there is an all cotton tampon produced by Tambrands called Tampax Satin available in Ireland: "We decided to produce an all cotton tampon because it is more comfortable for some women, not for health reasons.
Ironically, the first tampon (similar to today's product) was made of cotton and was developed by a doctor in Colorado in the 1930s. The reason that rayon is now used in tampons, says Hewson, is that it is cheaper than cotton and is more easily compressed. "It heightens absorbency," she adds.
Toxic Shock Syndrome (TSS) first defined by doctors in 1980, is associated with using higher absorbency tampons. TSS is a severe blood infection with symptoms which range from headache to a sunburn like rash and vomiting. Left untreated, the infection can rapidly cause respiratory and kidney failure.
"Some women can be dead within 48 hours," says Hewson. "We had three deaths in Britain last year." She says survivors of TSS can lose their eyesight as a result of the disease, or suffer from kidney damage. In the early 1980s, a number of super absorbent tampons were linked with an upsurge of TSS deaths in American women: such tampons have been since withdrawn.
TSS is caused by toxins produced by a common bacterium, Staphylococcus aureus. It can affect men and non menstruating women. Of the menstruating women who develop TSS those between 15 and 25 who use tampons are most at risk.
In 1994 a team from New York University School of Medicine concluded that the risk of developing menstrual TSS was lowered by using all cotton tampons. The results of their study - which looked at 20 varieties of tampons, a latex diaphragm and other products - were published in Infectious Diseases in Obstetrics and Gynecology. Peter Stephenson says this is an isolated study and that many other similarly reputable studies have not produced the same results.
Pete and Jenny Kilvert lost their 15 year old daughter, Alice, to TSS six years ago. They have since set up The Alice Kilvert Tampon Alert: "We have asked tampon manufacturers to put a bright yellow triangle warning symbol on their packaging, something more visible than the tiny warning about TSS which they currently print," says Pete Kilvert.
Kilvert is also concerned about a new ad for Tampax which he feels suggests overnight use. "Research shows the risk TSS increases if tampons are used continuously" he says.
"OUR research says that 72 per cent of tampon users use them overnight," says Stephenson. "We can't tell women what to do. All we can do is advise them, in our information leaflets, not to use tampons continuously. Women are capable of making their own decisions."
But what about the many women who probably don't bother reading the leaflet? "There comes a point when responsible behaviour has to be transferred from the manufacturer to the individual," he says. "After all, there is no causal in substantiated between menstrual TSS and tampon use. The numbers of deaths each year are very low. Ten million women use tampons in the UK every year. Between 1985 and 1993, there were only seven fatalities from menstrual TSS."