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c h a p t e r f i v e Tampons A Case Study in Controversy Although women did not hesitate to use disposable sanitary napkins, many were not so confident that tampons were a good idea. Physicians were equally concerned during the ten years after tampons were introduced in 1936, and they studied and debated tampons’ effects on health. Women and physicians alike were concerned about tampons’ safety, efficacy, and sexual implications. Among interviewees, it was clear that these issues remained salient much longer for those outside the white, urban, well-educated middle class. Women who did not belong to this group at least recognized that they crossed social boundaries if they began using tampons, and some explained their decision not to use tampons in these terms. By the last decades of the century, young women interviewees almost all used tampons, their desire to instantiate modern bodies outweighing any persistent unease about tampons they might have acknowledged. In the 1930s and 1940s, physicians debated the safety of tampons in major medical journals such as the Journal of the American Medical Association (JAMA), as well as local journals aimed at practitioners. A parallel debate took place in Great Britain, most evident in a long series of letters to the editors of the British Medical Journal. Physicians were sharply divided in their opinions about the safety of tampons. Previously, tampons had been medical devices, made of cotton , sometimes treated with medicine, that were “tamped” into bodily orifices to provide support or deliver medicine. Tampons were therefore not regarded as inherently dangerous, but using them to absorb menstrual blood meant that they were used significantly differently: first, they were used much more frequently, and second, they were controlled by the woman herself, rather than being prescribed by a doctor and managed by a nurse. Those who opposed tampons for menstrual management feared that frequent use would irritate the vagina and that women would introduce infection by not observing the same rules of hygiene as physicians and nurses. Detractors made this argument on the basis of princi- Tampons 171 ple, as well as some experiences with women who forgot to take out tampons at the end of a cycle and came to the doctor because they were concerned about an odor or discharge. Physicians expressed not only concern for women patients but also extreme distaste at having to remove long-forgotten tampons. Physicians also worried about drainage of the menstrual blood. Through the early twentieth century, it was commonly believed that regular menstruation was necessary to rid the body of waste and that waste that was trapped inside the body would lead to illness. In the 1930s and 1940s, physicians who retained this concern translated it into a somewhat different language, seeing menstruation as equivalent to a wound. Physicians writing in the Western Journal of Surgery explained , “As an early surgical precept, we learned that whenever there is free serum, blood, or discharge from a wound or body cavity, free drainage is desired and much be encouraged.”1 Therefore, they argued, tampons were dangerous, potentially backing up the blood into the uterus, causing a great deal of harm. Physicians who opposed tampon use generally argued from their own experience and intuitions, and from their understanding of basic medical principles. In contrast, physicians who were more favorably inclined toward tampon use, including several whose research was funded by tampon manufacturers, argued from experimental results rather than principles. They shared concerns about infection and blockage of flow but undertook research to find out whether or not tampons actually caused any of the problems they were speculated to cause. Not surprisingly, the research funded by manufacturers demonstrated little cause for concern; however, university-funded research gave the same results, which should have reassured medical journal readers that the chance of infection or blockage was not nearly as great as they feared. An early study sponsored by the International Cellucotton Products Corporation (the subdivision of Kimberly-Clark which made Kotex and would soon market Fibs tampons) found some cause for concern, when it discovered that 18 out of 95 women experienced a gush of blood at some point on removing a tampon, indicating that the flow had been blocked rather than absorbed. The authors of the study concluded that this problem could be easily avoided by using smaller tampons and refraining from tampon use during the heaviest flow. As an additional caution, they recommended regular gynecological checkups for tampon users. This was the earliest of the...

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