The Coming Plague (69 page)
Authors: Laurie Garrett
Feminine Hygiene (As Debated, Mostly, by Men)
TOXIC SHOCK SYNDROME
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In general the adaptive relationship between microorganism and host is effective, only for the precise circumstances under which adaptation evolvedâin circumstances which constitute physiological normalcy for the host concerned. Any departure from this normal state is liable to upset the equilibrium and to bring about a state of disease.
âRené Dubos, 1961
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I have an obligation to women to be cautious, to prove Koch's Postulate first, and thenâand only thenâtell the women of America what they should do.
âDr. Michael Osterholm, 1981
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During the summer of 1982 an angry Dr. Michael Lange took the podium at a GRID conference in New York City and decried the paucity of concern and research funds from the U.S. government. With 177 GRID (AIDS) deaths recorded, he said, the mystery was receiving virtually no attention. In contrast, Toxic Shock Syndrome, which, he claimed, had killed only 85 women in four years, was grabbing headlines, national attention, and federal dollars.It was not a comparison likely to win over women's health advocates as converts to the GRID cause. Although it was certainly true that the death toll was relatively small, controversy surrounded every aspect of the heated investigation into the cause of Toxic Shock Syndrome, the pathogenesis of the disease, and what steps should be taken to prevent further cases. And for nearly two years American women would be held in the grip of a national anxiety that was fueled by confusion at the highest levels of the public health establishment.
While the cause of AIDS would be determined within two and a half years of recognition of the presence of a new disease, the emergence of Toxic Shock Syndrome, or TSS, would prompt a national debate on its etiology and pathogenesis that would persist in the United States for over
a decade. And early steps taken by top public health authorities to limit the spread of TSS would come under sharp fire, attacked as “wrongheaded” and ill-conceived.
a decade. And early steps taken by top public health authorities to limit the spread of TSS would come under sharp fire, attacked as “wrongheaded” and ill-conceived.
So much was certain:
Homo sapiens
females had monthly reproductive cycles, during which time they built up a nutrient-rich uterine endometrium that was prepared to receive a fertilized egg and, once the ovum was implanted, functioned as the blood-rich placenta, feeding the growing fetus. If no egg was implanted, the new endometrium shed out of the uterus, via the vagina, exiting the female's body. The blood-rich expulsion typically lasted for two to six days, during which time the female bled.
Homo sapiens
females had monthly reproductive cycles, during which time they built up a nutrient-rich uterine endometrium that was prepared to receive a fertilized egg and, once the ovum was implanted, functioned as the blood-rich placenta, feeding the growing fetus. If no egg was implanted, the new endometrium shed out of the uterus, via the vagina, exiting the female's body. The blood-rich expulsion typically lasted for two to six days, during which time the female bled.
It had been so since the beginning of
Homo sapiens
time. And since the beginning of human civilization, womenâand menâhad sought solutions to the menstrual bleeding problem. Some ancient cultures solved questions of social embarrassment and unsightly bleeding by banning all menstruating women from public view. Hidden away in a designated hut, or in her own home, the female would spend her period away from the males. Such a solution was economically ill-advised for most cultures, however, as women's labor, though rarely valued on a par with males', was still too essential to be easily dispensed with for three or four days a month.
Homo sapiens
time. And since the beginning of human civilization, womenâand menâhad sought solutions to the menstrual bleeding problem. Some ancient cultures solved questions of social embarrassment and unsightly bleeding by banning all menstruating women from public view. Hidden away in a designated hut, or in her own home, the female would spend her period away from the males. Such a solution was economically ill-advised for most cultures, however, as women's labor, though rarely valued on a par with males', was still too essential to be easily dispensed with for three or four days a month.
So the females invented clever solutions to the bleeding problem: over forty centuries ago women in Sumer used medicated lint tampon devices, in the early Egyptian dynasties women made diaperlike wraps of papyrus, Roman women inserted woolen balls into their vaginas, medieval Japanese women placed rolled paper tubes in their vaginas. Nineteenth-century American females used rags, cloth diaperlike contraptions, and home-rolled cotton sticks.
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None of these ingenious methods created ideal solutions to the bleeding problem, and as women began entering twentieth-century industrial and office workplaces the often embarrassing feminine hygiene issue moved to the forefront. In 1936 a Denver physician named Earle Haas invented a cardboard tube-within-a-tube of compressed cotton that enwrapped a dangling string, and packaged it all so that the outer tube could be inserted into the vagina and the inner tube would act as a plunger, shoving in the compressed cotton plug. The string hung down, allowing for easy removal of the cotton plug.
All in all, it was a clever design that caught on immediately, despite a widespread hue and cry about the immorality of such a device. It was said that tampon insertion stimulated the female excitatory nerves, prompting wanton masturbation. It was also asserted that tampons would puncture the hymen, thus destroying a girl's premarital proof of virginity.
But Haas had no trouble selling his patent to Tampax Incorporated of Palmer, Massachusetts, which promptly proceeded to manufacture the devices. It was a sensation: within a generation most menstruating females in North America used tampons, and 90 percent of all tampon users relied on a single brandâTampax. A smattering of smaller manufacturers competed
for market shares in the United States, Canada, and post-World War II Europe. By the 1960s tampons were in widespread use wherever in the world women could afford to buy them.
for market shares in the United States, Canada, and post-World War II Europe. By the 1960s tampons were in widespread use wherever in the world women could afford to buy them.
Hundreds of millions of women used billions of tampons throughout their reproductive lives. And though history showed that other approaches to the bleeding problem had been associated with elevated risks of some infectious diseases, commercial tampons were sold without any more regulation than hammers or soap. In the United States no federal or state health agencies oversaw tampon production, and the products were never submitted to any required set of safety tests.
During the early 1970s Tampax encountered serious competition as four multinational corporations launched tampon products aimed at grabbing a share of the huge baby boomer market of young women born during the post-World War II American population explosion. The Kimberly-Clark Corporation, Procter & Gamble, Playtex, and Johnson & Johnson entered the market, offering a variety of modifications on Haas's old cardboard-and-cotton design.
The competition turned to a feeding frenzy when the National Association of Broadcasters lifted their long-standing ban on radio and television advertising of tampons, and newsmagazines followed suit, accepting explicit menstrual product ads. By 1975 all five tampon manufacturers were spending millions of dollars on advertising each year. And the key pitches made to women centered on two things: comfort and security. There were few ways companies found to improve upon the relative comfort of the old cardboard tampon design, though some offered plastic tube applicators as an alternative.
Security was Tampax's vulnerable point, for no matter how careful a woman might be, there were those humiliating occasions when the old tampon failed to do its job. Playtex targeted this issue by offering perfumed tampons and the ad slogan: “When you're wearing a tampon you don't worry about odor. But should you?”âimplying that small, unseen leaks could still be detected by the sharp olfactory senses of co-workers, friends, and dates.
These new products were allowed on the market without any demonstrated prior proof of safety for either the plastic inserter designs or the perfumes. Following an outcry from Planned Parenthood, Playtex put labels on their perfumed tampon boxes, warning that some women might experience discomfort or irritation from the chemicals.
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Meanwhile, competition in the tampon industry escalated radically.
Recent entrants into the field turned to their marketing analysts to determine how better to exploit weaknesses in Tampax's long-standing monopoly, and the unanimous answer was “absorbency.” Thanks to feminist challenges to male workplace dominions, American women were filling jobs never, or rarely, before open to their gender. No woman who was among the first of her gender to work as a police detective, firefighter, bank
executive, or television news anchor could afford the embarrassment of the bleeding problem.
executive, or television news anchor could afford the embarrassment of the bleeding problem.
The first breakthrough in absorbency came in 1974 out of the Procter & Gamble laboratory, where engineers concocted a product based not on cotton and cardboard but on polyester fibers and plastic. Dozens of different types of natural stabilizing fibers had previously been mixed in with cotton to increase absorbency and maintain the tampon's shape inside the vagina. Reportedly among them in the 1950s was asbestos.
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Procter & Gamble's use of synthetic fibers, however, changed the entire picture because it allowed engineers an almost unlimited number of ways to vary the shape and relative absorbency of tampons. They could manufacture what amounted to small sponges that ranged from low-density polyester to a very high-density, superabsorbent synthetic.
As was the case with Playtex's introduction of perfumes and plastic inserters into the vaginal ecology, no regulatory agency or medical organization questioned the insertion of petrochemical by-products into the nutrient-rich environment. Again, no safety tests were required. Indeed, with all five competitors quickly putting similar synthetic products on the market, the entire industry declared tampon content to be a matter of trade secrecy.
Among the synthetic materials used in marketed superabsorbent tampons in 1979â81 were polyurethane, polyester, collagen, polyvinyl alcohol, acetyl cellulose, and carboxymethyl cellulose.
In 1979 Procter & Gamble released a tampon comprised of highly compressed beads of, alternately, polyester and carboxymethyl cellulose. The product was, as its name implied, something a woman could Rely upon to prevent embarrassing bleeding accidents, as the synthetic composite was capable of absorbing nearly twenty times its own weight in fluids, and would expand to take the shape of, and fill, the vagina.
With a huge advertising kickoff, Rely hit the North American market and quickly gained enough popularity to radically alter the balance of power among tampon manufacturers. The notion that a tampon could be left in for hoursâall night longâwithout any fear of unsightly failures was extremely attractive to young consumers. Other manufacturers retaliated immediately, marketing Assure!, MaxiSorb, SuperPlus, and other new synthetic superabsorbent products.
The impact on female genital ecology was immediately obvious, as the new tampons were capable of absorbing more fluid than most women actually had in their vaginas at a given time.
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As the tampons swelled, expanding to touch the vaginal walls, dryness made the usually mucus-coated areas vulnerable. If one of the new tampons was left in the vagina long enough âsay, five or six hoursâit might adhere to the vaginal walls, and removal would leave behind a residue of synthetic pieces.
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Some women experienced pain as they removed the new tampons, resulting from the adherent sections of the devices actually tearing cells off the vaginal wall. And still other
women required medical assistance to withdraw tampons that had expanded so much that they were too big to come out of the vagina in one piece.
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As the tampons swelled, expanding to touch the vaginal walls, dryness made the usually mucus-coated areas vulnerable. If one of the new tampons was left in the vagina long enough âsay, five or six hoursâit might adhere to the vaginal walls, and removal would leave behind a residue of synthetic pieces.
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Some women experienced pain as they removed the new tampons, resulting from the adherent sections of the devices actually tearing cells off the vaginal wall. And still other
women required medical assistance to withdraw tampons that had expanded so much that they were too big to come out of the vagina in one piece.
Though nobody officially questioned the introduction of Rely and its competing synthetic products, there were studies that might have served as warnings about the vaginal ecological impact of the new tampons. Tests on rabbits, for example, showed that sterilized tampons made from collagen, polyurethane, polyvinyl alcohol, or acetyl cellulose produced lesions and ulcerations in the vagina's epithelial tissue. In addition, cell regrowth in the epithelium plummeted markedly: by 18â29 percent with collagen and 84â100 percent with other fibers.
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Another 1979 study, not intended as tampon research, found that carboxymethyl cellulose (CMC) served as an ideal filter for bacterial toxins. In particular, the researchers noted that CMC did a wonderful job of filtering toxins made by Staphylococcus bacteria.
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Another 1979 study, not intended as tampon research, found that carboxymethyl cellulose (CMC) served as an ideal filter for bacterial toxins. In particular, the researchers noted that CMC did a wonderful job of filtering toxins made by Staphylococcus bacteria.
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From the moment superabsorbent tampons hit the market there were published accounts of vaginal ulcerations, lesions, and lacerations.
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In January 1980, Dr. Jeffrey Davis, of the Wisconsin Division of Health, notified the Centers for Disease Control in Atlanta that something potentially dangerous was afoot: he had spotted a sudden surge in Toxic Shock Syndrome cases in the state.
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On July 15, 1979, a young menstruating woman was admitted to the emergency room of a Madison, Wisconsin, hospital, suffering from shock. Over the subsequent months of 1979, six more TSS victims were admitted to Madison hospitals. All but one of them were menstruating females: the exception was a thirty-six-year-old man. Madison was the state's big college town, heavily populated by postadolescents. All the TSS patients were white, otherwise healthy, and oddly infected with
Staphylococcus aureus.
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On July 15, 1979, a young menstruating woman was admitted to the emergency room of a Madison, Wisconsin, hospital, suffering from shock. Over the subsequent months of 1979, six more TSS victims were admitted to Madison hospitals. All but one of them were menstruating females: the exception was a thirty-six-year-old man. Madison was the state's big college town, heavily populated by postadolescents. All the TSS patients were white, otherwise healthy, and oddly infected with
Staphylococcus aureus.
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