The Things We Put “Up There”, Part I

By Fiona McMahon, DPT

This might seem like an odd topic to post about, but when you think about it, there seem to be more and more products on the market for you to use on or in your vagina. These products promise a range of different benefits from pelvic pain relief, to making your vagina smell like a spring meadow in bloom. For any woman, especially one with pelvic pain, it can be difficult to navigate this marketplace and find products that are not only safe, but deliver on their promises. This post will serve as a brief introduction to vaginal products and their respective risks and benefits.

When I first started this blog post I thought it would be a brief blow by blow of different products, their intended uses, and their side effects. Little did I know that the politics, history, and business interests surrounding vaginal and intrauterine devices could fill a whole book, let alone a measly little blog post. I opened Pandora’s Box. In an effort to highlight the story behind these objects, beyond the what and how, I will be making this blog a multipart series. So, if you don’t see your favorite device, despair not, dear reader. It may be coming in a future post. So for now let’s explore the first two devices in our line up: pessaries and tampons. Onward.

Source: http://www.aafp.org

Pessaries are devices that are inserted into the vagina that provide mechanical support for the pelvic organs when the muscles of the pelvic floor are not strong enough to support them. They basically do the work of the pelvic floor and can be used to treat stress incontinence (urinary leakage with increased abdominal pressure, like coughing laughing or sneezing), pelvic organ prolapse, ( a condition where the bladder, uterus, or rectum drops down in the pelvic cavity and causes increased pressure and discomfort).

Pessaries are a good option for women who do not want surgery. Women who have short vaginas, large vaginal openings, or prior repair of hernias may not be successful with finding an appropriately fitting pessary.

Pessaries acts like a little a buttress to hold up the organs of your pelvic floor to improve continence. Because we all come in different shapes and sizes, pessaries must be fitted by a trained professional to do their job correctly.

Pessaries are taking on an amazing new role in developing countries with reduced health care infrastructure. Pessaries can be used to prevent pre-term birth in mothers who may not have access to advanced Western-style neonatal intensive care units. In a study published in the Lancet, the use of pessaries spontaneously reduced the rate of preterm delivery. The implication of this finding is profound and far reaching. With the use of a $50 device,  women who do not have access to proper medical care are more likely to carry their infants to term and deliver healthier babies. It’s really amazing.

As amazing as pessaries can be, they aren’t correct for all people. If you suffer from pelvic pain, the pressure from the pessary can increase pressure on the pelvic floor muscles (usually culprit for pelvic pain), and make your pain worse. Although this is disappointing, pelvic floor physical therapy is helpful to help reduce your painful trigger points in your pelvic floor as well as strengthening your pelvic floor muscles to reduce your degree of prolapse.

Tampons are familiar to most of us. They are thin cylinders that are inserted into your body to capture menstrual blood before it escapes the body. But, oh boy, are tampons and the social politics surrounding them complex.

d5035c590a0c82232fb539ff7ae3a5e6

Source: Pinterest

Tampons come from the rather crude French word, tampion meaning plug or stopper. Tampons have been around in some form or another since well before the common era. Things such as rolled papyrus, and ferns have been used since ancient times to staunch the flow of menstrual blood.

The first modern tampon appeared in the US around 1933 by the Tampax corporation. It is estimated the American women use approximately 11,400 tampons in their lifetime and spends 6 to 7 years of their life menstruating (total bummer).

With that kind of use and ubiquity the safety of tampons is certainly a concern for women and parents of adolescent girls who have begun their cycle. In the United States, tampons are considered a grade II medical device, meaning they a subject to regulation by the food and drug association to ensure they are not only effective, but safe. Prior to 1976 tampons were not classified the way they are today and were not as rigorously tested to ensure that they were safe to use.

Anyone who has opened a box of tampons is probably aware of the little slip of paper that contains information on how to use tampons as well as Toxic Shock Syndrome (TSS). TSS is usually a result of the overgrowth of a nasty little bug, who goes by the name Staphylococcus aureus (S. aureus). S. aureus is carried in about 20% of people. These little microbes can cause a multitude of ailments from pimples, rashes, and food poisoning.

TSS is characterized by high fever, a drop in blood pressure, flaky skin, rash and muscle pain. It was first classified in 1978 and received a more precise definition in 1980. What is really fascinating about TSS is that it was found across the population at the time of its classification, in men and children (clearly, not regular tampon users).

The link between TSS and tampons came to light during the late 1970’s and early 1980’s. The tampon market ( an extremely lucrative and competitive industry) was entering a phase known as the “absorbancy wars”. In the mid 70’s and 80’s there were huge market pressures to produce a tampon that was not only cheaper to make, but also highly absorbent to compete with a market already saturated (sorry), with inexpensive and highly effective products.

In the mid 1970’s Proctor and Gamble released a highly absorbent tampon called “Rely”. This tampon was extraordinarily absorbent and distinct in its design from its competitors. The tampon contained synthetic gelling materials that absorbed  massive quantities of menstrual blood. While this designed allowed the wearer security and protection from unintentional menstrual leaking, the gelling substance provided a great environment for bacteria to grow and flourish. Furthermore, the gelling substance was manufactured in cube shape which increased the surface area for S. aureus to multiply.

A new tampon put on the market today would qualify as a class II medical device and would be under much stricter regulation by the Food and Drug Association (FDA). Rely, however, debuted on the market before such regulation was in place, and therefore was under less rigorous testing.

All tampons on the market today have won approval by the FDA and should be considered safe, but there are a few common sense recommendations to keep in mind when using these convenient little pieces of cotton. Always make sure you are inserting your tampons with clean hands, whether or not you are using tampons with applicators, or digital (applicator-less tampons). Use the lowest absorbency to do the trick. Tampons that are too absorbent  for your flow can dry and irritate the vagina, (not to mention a dry tampon is never a pleasant experience to remove). Change tampons regularly, and remove old tampons before inserting new ones. Remember tampons are only meant to be used during your period, if you feel like you are having discharge that needs to be absorbed, see your doctor as it may be a sign of infection.

That will do it for “Thing we put up there: Part 1”. Stayed tuned for our next edition. Ever hear of a pelvic wand or wonder what is the deal with douches? Well, put on your scuba gear, dear reader, we will be diving into those topics and more in future editions.

Sources:

Lamers, B.H., Broekman B.M., et al; Pessary treatment of pelvic organ prolapse and health-related quality of life: a review. International Urogynecology Review. 2011. 22(6), 637-44

Goya M, Pratocorona L, Merced C, et al. Cerivical pessary in pregnant women with a short cervix (PECEP): an open-label randomised controlled trial. The Lancet. 2012. 379(9828): 1800-06

Viera A, Larkins-Pettigrew. Practical Use of the Pessary. Am Fam Physician. 2000 1;61(9):2719-26

Tampons for menstrual hygiene: modern products with ancient roots. October 28,2014

Vostral S. Rely and toxic shock syndrome: A technological health crisis. Yale Journal of Biology and Medicine. 2011. 84: 447-59

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s