An Analysis of Teaching Menstrual Care Skills Using Single-Subject Methodology: A Systematic Literature Review.

PURPOSE: There is a paucity in research supporting procedures to teach skills needed during an individual's menstrual cycle. The purpose of this study was two-fold. First, a literature review was conducted to find publications on the topic of menstrual care. Second, the studies found were evaluated against What Works Clearinghouse™ (WWC) standards and analyzed to determine the presence of clinical components relevant to teaching these skills. METHODS: A literature review was conducted according to PRISMA guidelines. The review identified publications that taught menstrual care skills to individuals diagnosed with autism spectrum disorder (ASD) or other disabilities. The review focused specifically on studies that employed single-subject research methodology. Studies found were analyzed against the WWC's criteria to assess the rigor of each studies' methodology. Finally, studies were categorized across indicators that are clinically relevant to teaching menstrual care skills. RESULTS: The results highlighted a lack of empirical support for teaching menstrual care skills. 7 single-subject design studies were identified in the previous 40 years of research. One study met all criteria required to receive the WWC's highest rating. CONCLUSION: The complexity and private nature of menstrual care skills can make intervention development daunting. This paper was intended to provide menstrual care researchers with guidance in implementing high-quality studies. Additionally, scientist-practitioners can find guidance regarding important considerations to support programming that is both effective and respectful.

Maintaining vulvar, vaginal and perineal health: Clinical considerations.

Knowledge of female genital anatomy and physiology is often inadequate or incorrect among women. Precise patient-physician conversations can be inhibited by a reluctance or inability to speak accurately about the vulva and vagina, with the terms often being used interchangeably. There is a paucity of scientific evidence and clinical guidelines to support women and physicians in ensuring best practices in feminine hygiene. In this review, the unmet needs in the field are highlighted. Evidence is provided for the complex array of physiological and pathological systems, mechanisms and behaviours that either protect or, if inappropriate, predispose the vulva and vagina to infections, irritation or other conditions. The need for attention to perineal health is recommended, given the interdependence of perineal and vulvar microbiota and the risk of colonic pathogens reaching the vulva and the vagina. Differences in feminine hygiene practices can vary widely across the world and among varying age groups, and suboptimal habits (such as vaginal douching or the use of certain cleansers) can be associated with increased risks of vulvar and vaginal conditions. Critical areas for discussion when advising women on their intimate health include: advice surrounding aesthetic vulvar cosmetic trends (such as depilation and genital cosmetic surgery), bowel health and habits, and protection against sexually transmitted infections. Routine, once-daily (maximum twice-daily) washing of the vulva with a pH-balanced, mild cleanser is optimal, ideally soon after bowel voiding, when feasible. Due to the finely balanced ecosystems of the vulva, the vagina and the perineal area, a scientific and clinical perspective is essential when determining the most appropriate vulvar cleansers based on their components. Correct intimate care may contribute to improved genital and sexual health and overall well-being. An increased awareness of correct practices will empower women to be the advocates of their own intimate health.

Examining differences in menstrual and intimate care product use by race/ethnicity and education among menstruating individuals.

Introduction: United States consumers spend over two billion dollars a year on intimate care products. These products, along with scented menstrual products, are marketed for odor control, perceived "freshness," and vaginal/vulvar cleanliness. However, these scent-altering products may increase exposure to carcinogenic and endocrine-disrupting chemicals. Prior research has not adequately characterized demographic differences in product use. The objective of our study is to examine racial/ethnic and educational differences in menstrual and intimate care product use among people who menstruate. Methods: We pooled data from two US-based cross sectional studies to examine demographic characteristics and product use in 661 participants aged 18-54 years. Participants reported use of scented and unscented menstrual products (tampons, sanitary pads, and menstrual cups) and intimate care products (vaginal douches, sprays, wipes, and powders). We examined differences by race/ethnicity and education using log-binomial regression and latent class analysis (LCA), which can identify groups based on product use patterns. Results: Our sample was 33.4% Black, 30.9% Latina, 18.2% White, and 16.2% another identity. Approximately half the population had a bachelor's degree or more; 1.4% identified as transgender and 1.8% as non-binary. In adjusted models, scent-altering products (i.e., scented menstrual and intimate care products) were more likely to be used by those with less formal education (p < 0.05). Unscented menstrual products were more likely to be used by those with more formal education. Compared to Black participants, White participants were more likely to use unscented tampons and menstrual cups and less likely to use douches and wipes (p < 0.05). Using LCA we identified two groups: one more likely to use scent-altering products, and a second more likely to use unscented menstrual products. Less education and older age, but not race/ethnicity, was significantly associated with membership in the group more likely to use scent-altering products. While sex/gender composition did not statistically vary across groups, all non-binary participants fell in the unscented menstrual product group. Discussion: Lower educational attainment was consistently associated with greater use of scent-altering menstrual and intimate care products. Future research should examine associations between body odor stigma, product use, and health risks at intersections of race, class, and gender.

Association of genital talc and douche use in early adolescence or adulthood with uterine fibroids diagnoses.

BACKGROUND: Genital talc and douching are practices that can involve exposure to chemical compounds linked to certain gynecologic cancers. However, it is unclear if they are associated with fibroid risk or age at fibroid diagnosis among women. OBJECTIVE: This study aimed to evaluate the impact of early-adolescence genital talc use and douching on prevalence of fibroids diagnosed before the age of 35 and 50 years among Black/African American and non-Hispanic White women. STUDY DESIGN: Data were derived from the Sister Study (2003-2020), a prospective cohort of 50,884 US women aged 35 to 74 years at enrollment. Participants were asked if they ever had a fibroid diagnosis and at what age, and if they used genital talc and/or douched between the ages of 10 and 13 years or in the past 12 months. After applying predefined exclusion criteria, our analytical sample size was n=46,316 (Black, n=4310; non-Hispanic White, n=42,006). Multivariable logistic regression was used to compute adjusted odds ratios and 95% confidence intervals for having vs not having early-onset fibroids diagnosed before age 35 among women aged 35 to 74 years at enrollment, and fibroids diagnosed before age 50 among women aged 50 to 74 years at enrollment. We adjusted for early life factors (in utero diethylstilbestrol exposure, singleton or multiple birth, fed soy formula during infancy), childhood socioeconomic status, and relative weight and height compared with peers at age 10. We used multiple imputation (<10% missing in all analyses). Results were stratified by race/ethnicity given that Black women are more likely to develop fibroids at a younger age than non-Hispanic White women. RESULTS: Among Black/African American women, 29% had fibroids diagnosed before age 35. Both genital talc use at age 10 to 13 (adjusted odds ratio, 1.23; confidence interval, 1.06-1.41) and douching (adjusted odds ratio, 1.19; 95% confidence interval, 0.95-1.48) were associated with higher odds of having a fibroid diagnosed before age 35. Douching without talc use was not associated with increased odds, but combined use of genital talc and douche was associated with 52% increased odds of fibroids (confidence interval, 1.14-2.01). Among non-Hispanic White women, 9% reported fibroids diagnosed before age 35. Genital talc use (1.31; 1.20-1.44) but not douching (0.96; 0.77-1.20) at age of 10 to 13 years was associated with having a fibroid diagnosed before age 35. We observed similar patterns for non-Hispanic White women when we considered fibroids diagnosed before age 50, but neither practice was associated with fibroids diagnosed before age 50 in Black women. CONCLUSION: Genital talc use in early adolescence, alone and in combination with douching (but not douching alone), is associated with prevalence of fibroids diagnosed before age 35 among Black/African American women and before ages 35 and 50 among non-Hispanic White women. Early adolescence may be a window of susceptibility for fibroid development, suggesting that adolescent girls should be educated on abstention from or alternatives to talc use and douching.

Use of nasal tampons for on-field management of nasal bleeds (epistaxis) in sports.

In a medical setting, such as the treatment of post-operative nosebleeds, nasal packing, including the use of nasal packs, nasal plugs or nasal tampons (NTs), is widely used to temporarily control anterior epistaxis. Although some literature has documented the use of NTs as a quick, easy and temporary solution to deal with anterior epistaxis in sports-induced nasal injuries, additional research is needed to appreciate on-field versus off-field efficacy, as well as the efficiency of different brands of NTs and packing materials.

Social media exposure, interpersonal network, and tampon use intention: A multigroup comparison based on network structure.

The scarcity of tampons in China has attracted scholarly attention. Extending the theory of planned behavior with social network structure, this cross-sectional online survey (N = 763) found that exposure to tampon-related information on social media was positively related to Chinese women's tampon use intentions. This association was mediated through attitudes, descriptive norms, and self-efficacy toward using tampons. Furthermore, the effects of social media exposure differed among people with different network structures. Our findings shed light on the promotion of nonconventional feminine hygiene products, which, in turn, may enhance Chinese women's well-being and gender equity across the globe.

The influence of the menstrual cup on female pelvic floor muscles variables: a prospective case series.

The aim was to assess and report the effects of menstrual cup on pelvic floor muscles (PFM) function and tone, as well as check the acceptability after a period of three menstrual cycles in healthy young women. The data collected in assessments and reassessments included the International Consultation on Incontinence Questionnaire - Vaginal Symptoms (ICIQ-VS) questionnaire, evaluation of PFM function through PERFECT Scheme, PFM muscle tone, and PFM manometry (Peritron 9300®). A diary regarding the overall colletor acceptability and satisfaction was collected. Ten healthy young women completed the study. There was an improvement in the mean values of maximal voluntary contraction (MVC) (p = 0.032), a decrease in the vaginal resting pressure (VRP) (p = 0.05), and an increase in the number of repetitions of sustained muscle contractions (p = 0.042). Seven women reported some discomfort while using the vaginal cup only in the first cycle while three revealed discomfort during the whole experiment. This study provides preliminary case-based evidence that the use of the vaginal cup for a period of three menstrual cycles changes the VRP, MVC, and PFM tone, as well as improves the repetitions of PFM assessed by digital palpation. Moreover, the women reported the use of vaginal cup as a positive experience.

Determinants of menstrual cup use among undergraduate medical students: A cross-sectional study.

OBJECTIVE: To identify the determinants of menstrual cup use among medical students in Brazil. METHODS: A cross-sectional study with an online survey regularly applied to matriculate women from Medical School in January 2021. RESULTS: Of 277 women, 164 participated. The mean age was 22.26 ± 3.21 years. In all 136 women preferred external pads, 60 internal pads, 28 menstrual cups, and 11 did not use. Using a 1-10 scale, price, efficacy, sustainability, practice, vaginal health status, hygiene, and importance of internal genital integrity were investigated. Thirty-seven (22.56%) women related the use of menstrual cups in the last year. Using any method to reduce menstruation had an adjusted odds ratio (aOR) of 0.310 (95% confidence interval [CI] 0.122-0.787). Concern about the environmental biodegradation had an aOR of 6.369 (95% CI 1.372-29.562); concern about intimal health had an aOR 1.996 (95% CI 1.183-3.368); and concern about internal genital integrity had an aOR of 0.824 (95% CI 0.682-0.995) for menstrual cup use. CONCLUSION: The significant independent factors for the use or adherence to menstrual cups were: women using a method to reduce their menstrual flow; concerning biodegradation; concerning vaginal health; with no concerns about manipulating their genitalia. The menstrual cup was used by 22.56% of a medical school in Brazil among undergraduate women.

Safety assessment scheme for menstrual cups and application for the evaluation of a menstrual cup comprised of medical grade silicone.

BACKGROUND: Ensuring menstrual cup safety is paramount, yet a menstrual cup safety assessment scheme is lacking. This paper presents a quadripartite scheme, showing how it can be applied. METHODS: The Tampax Menstrual Cup was evaluated in the safety assessment scheme: (1) Biocompatibility and chemical safety of cup constituents. Extractables were obtained under different use condition; exposure-based risk assessments (EBRA) were conducted for extractables exceeding thresholds of toxicological concern. (2) Physical impact to vaginal mucosa. After physical evaluations, the Tampax Cup and another cup were assessed in a randomised double-blinded, two-product, two-period cross-over clinical trial (65 women, mean age 34.2 years). (3) Impact to vaginal microbiota (in vitro mixed microflora assay and evaluation of vaginal swabs). (4) In vitro growth of Staphylococcus aureus and toxic shock syndrome toxin-1 (TSST-1) production. FINDINGS: Biocompatibility assessments and EBRA of cup constituents showed no safety concerns. In the randomised clinical trial, all potentially product-related adverse effects were mild, vaginal exams were unremarkable, no clinically relevant pH changes occurred, post-void residual urine volume with and without cup were similar, and self-reported measures of comfort along with reports of burning, itching and stinging between cups were comparable. Cup use had no effect on microbial growth in vitro or in the 62 subjects who completed the trial or on in vitro TSST-1 production. INTERPRETATION: The quadripartite safety assessment scheme allows evaluation of menstrual cup safety. The Tampax Cup is safe and well-tolerated upon intended use. As with all feminine hygiene products, post-market safety surveillance confirmed this conclusion. FUNDING: By Procter & Gamble.

Feminine Hygiene Products and Volatile Organic Compounds in Reproductive-Aged Women Across the Menstrual Cycle: A Longitudinal Pilot Study.

Background: Volatile organic compounds (VOCs) have been detected in feminine hygiene products (FHPs), especially in tampons and sanitary pads. However, little is known about whether menstrual products can contribute to VOC exposure in women. Our objectives were to: (1) examine the variations of urinary VOC concentrations during menstrual cycles; (2) evaluate the relationships between the use of menstrual products and urinary VOC concentrations; and (3) link urinary VOC concentrations to those measured in menstrual products. Methods: We measured urinary concentrations of 98 target VOCs in 25 reproductive-aged women with 100 repeated measures collected between October 2018 and February 2019. First-morning-void urine samples were collected four times for each woman during one menstrual cycle. Urinary VOC concentrations were measured using gas chromatography-mass spectroscopy. Results: Of 98 target VOCs measured in the urine samples, 36 VOCs were detected. We did not see statistically significant variations in VOC concentrations across the menstrual cycle. After multivariable adjustment, tampon users had significantly higher concentrations of 2-butanone (ß = 1.58 log ng/g, 95% confidence interval [CI]: 0.16-3.00, p = 0.03) and methyl isobutyl ketone (ß = 0.63 log ng/g, 95% CI: 0.03-1.22, p = 0.04), compared with pad users. Higher n-nonane, benzene, and toluene estimated from menstrual products were associated with higher urinary concentrations in women. Conclusion: The use of FHPs during menses might be a potential source of VOCs. A larger cohort study is warranted to confirm our results and evaluate clinical implications.

Real-World Practices and Attitudes Towards Intimate Self- Care: Results From An International Women's Survey.

OBJECTIVE: Vulvovaginal health is important to women's overall health, fertility, sexuality, self-perception, self-confidence and intimacy. It is important to identify the existing perceptions and levels of knowledge about intimate care practices from women in different countries, and with different cultures, religions, and perspectives to help women overcome barriers to optimal intimate care. METHODS: An anonymous online survey about general and intimate hygiene routines/habits was distributed across 10 countries (England, France, Germany, Italy, Portugal, Russia, China, Philippines, Taiwan, Thailand). The sample consisted of around 10,000 women (aged 18 to 60 years) recruited through an online panel. RESULTS: The survey indicates that for many women, cleaning the intimate area is not just about hygiene, but also about taking care of themselves. Intimate care practices, performed daily, varies widely among the countries (from 38% to 91%). Italy, Philippines Portugal, Russia and Thailand were the countries with higher percentage. Intimate care is mainly associated with hygiene and health benefit, but interestingly women engage in intimate care more often with age. Most women worldwide are comfortable talking about female genitalia but still consider it a taboo topic, particularly among younger generations. Asian countries continue to carry negative connotations. CONCLUSIONS: This survey is the first of its kind for number of women involved in this research and for multi-cultural design. Women perceive that practicing intimate care positively impacts their health and wellbeing. However, intimate care is still not one of the most frequent daily routines for many women.

Volatile organic compounds in feminine hygiene products sold in the US market: A survey of products and health risks.

Feminine hygiene products (FHPs) are used on highly permeable and sensitive vaginal and vulvar tissues by many women. These products contain a variety of chemicals, and few regulations require disclosure of their ingredients. The objectives of this study are to identify volatile organic compounds (VOCs) that may be present in these products and to evaluate the potential for exposure and health risk associated with product use. We collected 79 commercially available FHPs, including washes, tampons, menstrual pads, wipes, sprays, powders and moisturizers, and analyzed their composition using purge and trap sampling, thermal desorption, gas chromatography and mass spectroscopy. Exposures and risks were modeled using reasonable upper bound exposure scenarios. The highest VOC concentrations (as total target VOCs) were found in washes, sprays and powders, with median concentrations from 25,000 to 34,000 ng/g. Benzene (maximum: 3,604 ng/g) was detected in 83% of the collected products, and 1,4-dioxane (maximum: 24,354 ng/g) in 50% of the products. VOC composition depended on the FHP type, manufacturer and brand. Products labeled as "organic," "natural," or "for sensitive skin" did not necessarily have lower VOC concentrations. For most FHPs, calculated risks were low; however, menstrual pads had hazard ratios of up to 11, sprays and powders had hazard ratios of up to 2.2 and excess cancer risks of up to 2.1 × 10-6, and washes had excess cancer risks of up to 3.3 × 10-6. Our data suggest that all tested FHPs contained some toxic VOCs, and that risks of using some products should be addressed. We recommend the elimination of toxic ingredients and the disclosure of all chemicals that are used in these products.

Acceptability and safety of the menstrual cup: A systematic review of the literature / Aceptabilidad y seguridad de la copa menstrual: revisión sistemática de la literatura

Objectives: To conduct a systematic review of the literature and assess the acceptability and safety of the menstrual cup as a feminine hygiene product. Materials and methods: A search was conducted in the PubMed, Cochrane Library, Scopus, PopLine and Google Scholar databases for publications be- tween 1966 and July 2019. The terms ("Menstrual" AND "Cup") OR ("Copa" AND "Menstrual") were used. Quantitative, qualitative and mixed studies were included, as well as case series and case reports published in English and Spanish assessing the menstrual cup in women in childbearing age. The studies were selected and the data extracted by two reviewers working independently. Acceptability and safety were assessed as the primary result. The summary of the information is presented in narrative form. Results: Overall, 737 titles were found for initial review and, in the end, 38 studies were included in this work. The acceptability of the menstrual cup ranges between 35 % and 90 %. Between 10 to 45 % of women found it difficult to use. It was described as more comfortable when compared to tampons and pads. Continued use of the cup ranges between 48 and 94 %. In terms of safety, there was one case of toxic shock syndrome, one case of mechanical entrapment, and another case of allergy; and a higher risk of expulsion was found among intrauterine device users. Conclusion: The menstrual cup appears to be a comfortable, safe and efficient option for menstrual hygiene. Further randomized controlled studies and long-term prospective cohort studies are needed in order to determine the risk of complications due to excess bacterial colonization or retrograde menstruation.

TITULO: ACEPTABILIDAD Y SEGURIDAD DE LA COPA MENSTRUAL: REVISIÓN SISTEMÁTICA DE LA LITERATURA. OBJETIVO: Realizar una búsqueda sistemática de la literatura para evaluar la aceptabilidad y seguridad de la copa menstrual como producto de higiene genital femenina. METODOS: Se realizó búsqueda en las bases de datos PubMed, Cochrane Library, Scopus, PopLine y Google Scholar, desde 1966 hasta julio de 2019. Se utilizaron los términos: "Menstrual" AND "Cup" OR "Copa" AND "Menstrual". Se incluyeron estudios cuantitativos, cualitativos y mixtos, series y reportes de caso publicados en inglés y español que hubieran evaluado la copa menstrual en mujeres en edad reproductiva. Los estudios fueron selecciona- dos y los datos fueron extraídos por dos evaluadores de manera independiente. Como resultado primario se evaluó la aceptabilidad y seguridad. La síntesis de información se presenta de manera narrativa. RESULTADOS: Se encontraron 737 títulos para revisión inicial. Finalmente, se incluyeron 38 estudios. La copa menstrual tiene una aceptabilidad que varía entre el 35 y el 90 %. Del 10 al 45 % la encontraron difícil de usar. Fue descrita como más cómoda comparada con el tampón y la toalla higiénica de fabricación industrial. La continuidad de su uso está entre el 48 y el 94 %. En cuanto a la seguridad se presentó un caso de síndrome de choque tóxico, uno de atrapamiento mecánico, uno de alergia al producto y mayor riesgo de expulsión en usuarias del dispositivo intrauterino. CONCLUSIONES: La copa menstrual es una alternativa cómoda, segura y eficiente para la higiene mens- trual. Se requieren más estudios controlados alea- torizados y cohortes prospectivas a largo plazo para determinar el riesgo de complicaciones por una exagerada colonización bacteriana o menstruación retrógrada.

Acceptability and safety of the menstrual cup: A systematic review of the literature / Aceptabilidad y seguridad de la copa menstrual: revisión sistemática de la literatura

RESUMEN Objetivo: realizar una búsqueda sistemática de la literatura para evaluar la aceptabilidad y seguridad de la copa menstrual como producto de higiene genital femenina. Materiales y métodos: se realizó búsqueda en las bases de datos PubMed, Cochrane Library, Scopus, PopLine y Google Scholar, desde 1966 hasta julio de 2019. Se utilizaron los términos: "Menstrual" AND "Cup" OR "Copa" AND "Menstrual". Se incluyeron estudios cuantitativos, cualitativos y mixtos, series y reportes de caso publicados en inglés y español que hubieran evaluado la copa menstrual en mujeres en edad reproductiva. Los estudios fueron selecciona- dos y los datos fueron extraídos por dos evaluadores de manera independiente. Como resultado primario se evaluó la aceptabilidad y seguridad. La síntesis de información se presenta de manera narrativa. Resultados: se encontraron 737 títulos para revisión inicial. Finalmente, se incluyeron 38 estudios. La copa menstrual tiene una aceptabilidad que varía entre el 35 y el 90 %. Del 10 al 45 % la encontraron difícil de usar. Fue descrita como más cómoda comparada con el tampón y la toalla higiénica de fabricación industrial. La continuidad de su uso está entre el 48 y el 94 %. En cuanto a la seguridad se presentó un caso de síndrome de choque tóxico, uno de atrapamiento mecánico, uno de alergia al producto y mayor riesgo de expulsión en usuarias del dispositivo intrauterino. Conclusión: la copa menstrual es una alternativa cómoda, segura y eficiente para la higiene mens- trual. Se requieren más estudios controlados alea- torizados y cohortes prospectivas a largo plazo para determinar el riesgo de complicaciones por una exagerada colonización bacteriana o menstruación retrógrada.

ABSTRACT Objective: To conduct a systematic review of the literature and assess the acceptability and safety of the menstrual cup as a feminine hygiene product. Materials and methods: A search was conducted in the PubMed, Cochrane Library, Scopus, PopLine and Google Scholar databases for publications be- tween 1966 and July 2019. The terms ("Menstrual" AND "Cup") OR ("Copa" AND "Menstrual") were used. Quantitative, qualitative and mixed studies were included, as well as case series and case reports published in English and Spanish assessing the menstrual cup in women in childbearing age. The studies were selected and the data extracted by two reviewers working independently. Acceptability and safety were assessed as the primary result. The summary of the information is presented in narrative form. Results: Overall, 737 titles were found for initial review and, in the end, 38 studies were included in this work. The acceptability of the menstrual cup ranges between 35 % and 90 %. Between 10 to 45 % of women found it difficult to use. It was described as more comfortable when compared to tampons and pads. Continued use of the cup ranges between 48 and 94 %. In terms of safety, there was one case of toxic shock syndrome, one case of mechanical entrapment, and another case of allergy; and a higher risk of expulsion was found among intrauterine device users. Conclusion: The menstrual cup appears to be a comfortable, safe and efficient option for menstrual hygiene. Further randomized controlled studies and long-term prospective cohort studies are needed in order to determine the risk of complications due to excess bacterial colonization or retrograde menstruation.

Pediatricians' knowledge, attitudes and practices surrounding menstruation and feminine products.

OBJECTIVE: This study investigates whether primary care pediatricians adhere to the American Academy of Pediatrics (AAP) recommendations by routinely evaluating patients' menstrual cycles and educating patients about menstruation and feminine products. Additionally, this study examines pediatricians' knowledge and attitudes surrounding menstrual health topics. METHODS: A 53-item online questionnaire was developed to evaluate pediatricians' knowledge, attitudes and clinical practices regarding menstruation-related topics. The questionnaire was emailed to 2500 AAP members using a geographically-stratified sampling approach, with pediatricians in each state selected randomly. Mann-Whitney U tests, t-tests, and logistic regressions were used to assess associations between correlates and pediatricians' knowledge, attitudes and practices. RESULTS: Five hundred and eighteen out of 2500 pediatricians participated (response rate = 20.7%), 462 met inclusion criteria; 78.8% were female, 79.2% were Caucasian. The majority of the pediatricians (58.2%) were "not at all" or only "slightly" familiar with the AAP guidelines on anticipatory guidance surrounding menarche. Many reported they do not routinely provide anticipatory guidance regarding menstruation to pre-menarchal patients (24.7%), discuss menstruation with post-menarchal patients (33.1%) or ask patients the date of their last period (28.4%). The majority were unlikely to discuss feminine products with patients. Gaps in menstruation-related knowledge were noted. Male pediatricians were significantly less likely to evaluate patients' menstrual cycles and provide patient-education regarding menstruation-related topics, and had significantly lower self-rated and measured knowledge of these topics. CONCLUSIONS: A concerning number of pediatricians in a national sample do not abide by AAP recommendations surrounding menstruation and exhibit knowledge gaps in this area. To effectively address the health needs of female patients, pediatricians should better incorporate menstrual health care into their clinical practice.

A 28 Day Clinical Assessment of a Lactic Acid-containing Antimicrobial Intimate Gel Wash Formulation on Skin Tolerance and Impact on the Vulvar Microbiome.

While intimate feminine hygiene products are widely used as part of daily cleansing routines, little is known about how these products impact the vulvovaginal area and its microbiome stability. This 4 week clinical study assessed tolerance of a novel gel wash containing lactic acid (pH 4.2) for external daily use when used on the external genital area and its effects on skin moisturization, vulvar skin pH, and the vulvar microbiome. After a 7 day pre-study conditioning period, 36 healthy females in three balanced age groups (18-29, 30-44, and 45-55 years) used the gel wash to cleanse their external genital area (mons pubis and vulva) and entire body at least once per day for 28 days. Skin tolerance of the gel wash was assessed by the gynecologist. Effects of the gel wash on vulvar skin microbiota were studied by performing bacterial 16S rRNA and fungal internal transcribed spacer (ITS) microbial richness and diversity analysis. Based on gynecologic assessment after 28 days of use, the gel wash showed acceptable tolerance, with no signs of increased dryness, redness, edema, itching, stinging, or burning. Use of the gel wash was associated with a significant increase in both short-term (single application) and longer-term (daily use for 28 days) skin moisturization. There was no significant change in vulvar skin pH over time with daily product use, and the gel wash did not significantly affect the natural vulvar microbiome species richness or diversity for bacteria or fungi. Results showed that this gel wash is a mild, moisturizing cleanser that maintains the natural pH and microbial diversity of vulvar skin. To our knowledge, this was the first study to assess the effect of an antimicrobial feminine gel wash on the natural pH and vulvar microbiome habitat of the skin using bacterial 16S rRNA and fungal ITS genetic sequencing techniques.

Sensitizing fragrances in absorbent hygiene products.

BACKGROUND: Allergenic fragrances are present in a wide range of products but they are not regulated in all industries to the same extent. In Europe, absorbent hygiene products (AHPs) are only covered by the general product safety directive and therefore fragrances can be used freely, whereas in cosmetics and toys the use of these ingredients is regulated. METHOD: An analytical method was developed to evaluate the presence of 24 sensitizing fragrances in AHPs. This method allows simultaneous identification and quantification and was validated using the total error approach with an acceptance value of ±15%. RESULTS: The validated method was applied to evaluate 10 scented AHPs consisting of four tampons, three panty liners, and three sanitary pads. Eight allergenic fragrances were identified in these products and five products contained at least one allergen above 10 µg/g. CONCLUSION: The presence of these allergens is not communicated to the consumer. This is, however, a strict requirement in other industries (eg, cosmetics, toys) to ensure adequate consumer protection. Knowing that the exposed area is more susceptible to allergens and irritants, the presence of these allergens should be disclosed.

Exposure to Volatile Organic Compounds and Use of Feminine Hygiene Products Among Reproductive-Aged Women in the United States.

Background: Feminine hygiene products (FHPs) are personal care products widely used by women. A few studies have detected some volatile organic compounds (VOCs) in FHPs, but no previous epidemiological studies have linked use of these products to human exposure to VOCs using biomarkers. Therefore, we evaluated whether the use of FHPs was associated with VOC exposures among reproductive-aged women in the United States. Materials and Methods: Data on 2432 women aged 20-49 years from National Health and Nutrition Examination Survey 2001-2004 were utilized. Self-reported use of feminine products (tampons, sanitary napkins, vaginal douches, sprays, powders, wipes/towelettes, and other products) was obtained from questionnaires. Survey-weighted linear regression models were used to estimate percent changes in VOC whole blood concentrations and 95% confidence intervals (CIs). Results: Black women had significantly more use of vaginal douching and significantly higher whole blood concentrations of 1,4-dichlorobenzene (DCB) (p < 0.0001). After adjusting for confounders, we observed a dose-response relationship between the frequency of vaginal douching in the past 6 months and 1,4-DCB concentrations. Compared with never users, women with occasional use (≤1 time/month) of vaginal douching had 18% (95% CI: -12% to 59%) higher concentrations, and those with frequent use (≥2 time/month) had 81% (95% CI: 2% to 221%) higher concentrations of 1,4-DCB (p for trend = 0.04). Use of feminine powder in the past month was significantly associated with 36% (95% CI: 0.4% to 83%) higher concentrations of ethylbenzene. Conclusions: Our findings suggest that differences in whole blood VOC concentrations might be explained by feminine hygiene practices. The presence of environmental chemicals in FHPs warrants further examination.

Daily genital cares of female gynecologists: a descriptive study

SUMMARY INTRODUCTION: Genital hygiene can play an essential role in avoiding vulvovaginal discomfort and preventing infections. The scientific evidence on best practices on genital hygiene is scarce, and without doubt, gynecologists should be the best person to discuss and guide the subject. OBJECTIVE: Evaluate the general genital female gynecologist hygiene. METHODS: This descriptive analytic study identified genital hygiene and sexual practices of 220 female gynecologists, through a questionnaire with 60 self-answered questions. The data were analyzed and presented using frequency, percentage, mean and standard deviation. RESULTS: The studied population was constituted by middle age (37.3 years) and white (71.3%) female gynecologists. More than a half (53.6%) declared spending over 10 hours a day away from home and complained of vaginal discharge in 48.1% of the cases. Regular vulvovaginal hygiene: 17.8% reported washing genitals once a day and 52% twice a day. The use of dry paper alone was reported in 66.4% post urination and 78.5% post-evacuation. Using running water and soap was practiced by 25.9% and 21.5% respectively. Vulvovaginal hygiene related to sex: More than half of them had intercourse 1-3 times a week, and 37.4% and 24.1% had frequent oral sex and eventually anal sexof the participants, respectively. Genital hygiene before sex was positive in 52.7% of the subjects and, post-sex hygiene in 78.5% of them. Conclusion: Genital hygiene habits of female gynecologists can be improved, despite the high grade of scientific knowledge they hold.

RESUMO INTRODUÇÃO: A higiene genital pode desempenhar um papel importante na prevenção de desconfortos vulvovaginais e infecções. Evidências científicas sobre as melhores práticas em higiene genital são escassas, e o ginecologista, sem dúvida, é a melhor pessoa para discutir e orientar o assunto. OBJETIVO: Avaliar a higiene genital feminina usual de médicas ginecologistas. MÉTODOS: Estudo analítico descritivo que identificou higiene genital e práticas sexuais de 220 ginecologistas por meio de um questionário com 60 perguntas autorrespondidas. Os dados foram analisados e apresentados por frequência, porcentagem, média e desvio padrão. Resultados: A população estudada consistiu de médicas ginecologistas femininas brancas (71,3%) com idade média de 37,3 anos. Mais da metade (53,6%) relatou ficar fora de suas casas por períodos superiores a 10 horas por dia e queixaram-se de descarga vaginal em 48,1% dos casos. Higiene vulvovaginal regular: 17,8% relataram lavar os genitais uma vez por dia e 52%, duas vezes por dia. O uso apenas de papel (seco) foi relatado em 66,4% dos casos após micção e em 78,5% após a evacuação. A higiene ideal com água corrente e sabão foi praticada apenas em 25,9% e 21,5%, respectivamente. Higiene vulvovaginal relacionada ao sexo: mais da metade delas relatou relações sexuais 1-3 vezes por semana, sexo oral frequente e anal eventual em 37,4% e 24,1%, respectivamente. A higiene genital pré-sexo foi relatada por 52,7% das pessoas e em 78,5% após o coito. Conclusão: Os hábitos de higiene genital dos ginecologistas femininos estão sujeitos a melhorias, mesmo considerando o alto grau de conhecimento científico que possuem.

Acute hemorrhagic diarrhea syndrome associated with contaminated foreign bodies (used feminine hygiene products) in a Golden Retriever dog.

A one-year-old male Golden Retriever presented with acute onset of vomiting and hemorrhagic diarrhea since 2 days. The dog was depressed, showing abdominal pain, 12% dehydration, tachycardia, and a bounding pulse. Diagnostic imaging showed severe dilatation and fluid retention of the entire gastrointestinal tract with decreased motility. A foreign body was found in the gastroduodenal region, but there was no obstruction or plication. The dog was tentatively diagnosed with acute hemorrhagic diarrhea syndrome and rapidly recovered after supportive treatment. However, on the morning of day 4, anorexia and vomiting recurred, and diagnostic imaging revealed intestinal plication with free peritoneal fluid, not found on the previous image. An emergency laparotomy revealed the foreign body to be two used feminine hygiene products. These contaminated products were suspected to induce acute hemorrhagic diarrhea syndrome, and led to subsequent complication in this large dog.