Can anyone recommend a good pad for periods?

[Guest guest]

Well, Its finally come to it and the brand of pads I have always used

(Always) is now causing me crazy amounts of irritation and tenderness.

I've been mildly irritated by them before, but usually I have to

over-wear the pad or already be having a bad pain-day. Not so this time.

Does anyone know a good product to use instead? I'm pretty set on the

pads option as I'm currently on extended treatment for yeast and I

never got the hang of tampons. Also I'm pretty pungent this time a

month, so I'd prefer not to be washing out anything.

Thanks in advance.

[Guest guest]

I numben my vulvar area before I use my pads (and I prefer

Always) and my panties.

I do so with Lidocaine ointment. I would have to do this even

if I tried other brands of Pads.

My mom liked Stay Free, but I know that on some lists for

vulvodynia (and I think this one too) the subject of Glad Rags

have come up time and again.

Around the house I use toilet paper. I have to use the Charmin

Double Ultra when it comes to toilet paper on an every day basis

so when I am having a period (don't do that often b/c of my

endometriosis to try and keep it from causing me too much

discomfort) I just use the toilet paper as a pad. I know some

don't feel comfortable with the idea of the toilet paper b/c of

the little balls that could get on the area and irritate them

but this works best for me.

Kristy

__________________________________________

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[Guest guest]

Always pads were the first to use a plastic covering. Now many other

manufacturers are using the plastic covering. Always has licensed their process

to others so check out your pads and see if they have a plastic covering.

I used Always pads back in the early 1970's and they irritated me even then so I

never used them again. Always has very frequently changed their process to try

to improve it but it is still irritating to many women. Here is an article

which came up back in the early 1990's.

Canadian Medical Association; Association médicale canadienne

[Original Research]

Eason, a L. SM, MDCM, FRCSC; Feldman, Perle BSc, MDCM, CCFP

Dr. Eason is assistant professor in the departments of Obstetrics and Gynecology

and of Clinical Epidemiology, Montreal General

Hospital and McGill University, Montreal, Que.; and Dr. Feldman is assistant

professor in the Department of Family Medicine, Sir

Mortimer B. -Jewish General Hospital and McGill University, Montreal, Que .

Reprint requests to: Dr. a L. Eason, Rm. L10-412, Montreal General Hospital,

1650 Cedar Ave., Montreal QC H3G 1A4

Abstract

Objective: To report a clinical association between vulvar irritation or contact

dermatitis and the use of Always sanitary napkins.

Design: Case series.

Setting: A gynecology practice in Montreal.

Patients: Women presenting between September 1991 and September 1994 with

itching or burning of areas that would be in contact with a sanitary napkin

(mons pubis, external surfaces of the vulva and perineum) beginning at least 1

day after the use of the napkins was started and less than 5 days after the use

was stopped.

Results: Twenty-eight women experienced vulvar itching and burning, often

associated with eruptions resembling contact dermatitis, of

the vulvar and perineal surfaces after using Always sanitary napkins. Twenty-six

reported that symptoms disappeared after they stopped

using that brand of sanitary napkin. Seven women who later used the same brand

again reported a recurrence of the vulvar irritation.

Conclusion: The findings of this case series reveal Always sanitary napkins as a

potentially important cause of recurrent vulvitis.

Physician awareness of the association will enable effective advice and relief

for a large number of women suffering " chronic vaginitis. "

Some years ago each of us observed several patients who presented with similar

and unusual histories. These women complained of " vaginal infections every

month'', but our clinical and microscopic examinations revealed no evidence of

vaginitis.

Some of the women had received repeated treatments elsewhere with anti-fungal

medications, without a decrease in recurrence of symptoms.

All of the women had itching or burning of the mons pubis, labia and perineum

but

no associated odour or vaginal discharge and no redness or swelling of the inner

labia and vestibule. Symptoms subsided after several days, with or without

treatment. In some cases we noted an erythematous papular eruption over the

groin, mons pubis and perineum.

We suspected contact dermatitis rather than the much more common vulvovaginitis

due to Candida albicans, Trichomonas or bacteria. [1,2] However, questioning

about the usual suspects like -- exposure to perfumes or deodorants, detergents

and

fabric softeners, or a change in soap [1-3] -- it revealed no obvious cause.

Two clues alerted us to a connection between the symptoms and the use of

sanitary napkins.

First, in some of the women the sharp margins of the eruption outlined the

contact area of a sanitary napkin. In parous women the clitoral hood and the

tips of the labia minora extending beyond the labia majora were often most

severely affected.

Second, the symptoms started during or a few days after menses; microbial

vaginitis usually presents in the premenstrual period and is somewhat relieved

during menses. When questioned about the brand of tampons or sanitary napkins

they used, the women gave us the same answer: Always sanitary napkins (Procter &

Gamble Inc., Toronto). Changing the brand, without specific treatment of the

irritation, prevented recurrence of the symptoms.

We have not seen this periodic menstrual vulvitis in women using other brands of

sanitary napkins. The US Food and Drug Administration (FDA) has received a few

reports of similar adverse reactions to Always sanitary napkins (FDA,

Washington: Medical Device Report [list edition], June 1993).

Our search of the medical literature revealed two cases of allergy to the

perfume used in sanitary napkins [4,5] but no reports of contact dermatitis or

irritation associated with any particular brand. When asked, most of our

colleagues had not noticed this association; however, those who had recognized

it had seen it several times, and others reported cases to us after we alerted

them to it.

To document this problem and to inform physicians of the diagnosis, we present a

series of 28 cases of vulvar irritation associated with the use of Always

sanitary napkins.

Methods;

We reviewed the charts of all women seen in a gynecology practice in Montreal

between September 1991 and September 1994 who had presented with symptoms

indicative of contact vulvitis associated with the use of sanitary

napkins. Suspected cases had to meet the following criteria: itching or burning

of areas that would be in contact with a sanitary napkin (mons pubis, external

surfaces of the vulva and perineum) and onset of symptoms at least 1 day after

the

use of sanitary napkins was started and less than 5 days after the use was

stopped.

Patients were interviewed by telephone by their attending physician to obtain

more detailed information about their previous and subsequent use of products

for menstrual protection, any associated symptoms, other potential causes or

risk factors for vulvitis and pertinent aspects of the medical history. To

assess the proportion of women in the practice population who used Always

sanitary napkins we interviewed a comparison group of women from the same

practice,

matched for date of visit, age within 5 years, referral status and reason for

using sanitary product (e.g., menses, urinary incontinence or discharge).

Results

Thirty-four women met the symptoms criteria, and all had been using Always

sanitary napkins. After the interviews, five women were excluded because of

coexisting chronic vulvar or vaginal conditions (recurrent herpes, known local

skin allergies and chronic introital dyspareunia).

Their symptoms diminished after they stopped using the Always napkins, but we

excluded them because of the confounding causes of the vulvitis. An additional

woman was excluded because subsequent use of Always napkins was well tolerated.

The 28 remaining women ranged in age from 20 to 64 years (median 32 years).

Twenty-four women used the sanitary napkins during menses only; the other four

used them every day. The women were asked about menstrual-protection

methods, use of sanitary napkins for other reasons and episodes of menstrual or

postmenstrual vulvar itching or burning during the 6 months before the index

episode.

Thirteen women had symptoms with their first exposure to the product;

reactions in the others developed only on repeat exposure. Symptoms were

typically recurrent: 19 of the women had had four or more episodes of symptoms,

and 8 of the 20 women who had used the product for at least 6 months had had

symptoms every month during that time.

Symptoms were first noticed 1 to 9 days (median 3 days; interquartile range

[iQR] 2 to 4 days) after use of the sanitary napkins was started during each

menses and lasted for a median of 4.5 days (IQR 4 to 7 days). The four women who

used the napkins every day had constant irritation. Of the 28 women 13 also had

erythematous papular eruption.

Symptoms did not disappear immediately after the women stopped using the

sanitary napkns; rather, the itching and burning lasted for a median of 3 days

(IQR 2 to 5 days) afterward. In six of the women the symptoms began 1 to 2 days

after napkin use was stopped. All of these women experienced only postmenstrual

itching and burning of the vulva on at least three occasions.

Before the index visit none of the women had identified the sanitary napkins as

a possible cause of their symptoms: most reported " vaginal infection every

month. " We informed patients at the end of the index visit of the possible cause

of their

symptoms and advised them to suspend use of the product. Twenty-three of the 28

women switched to another product for the next 3 months and had no further

vulvar irritation.

Three women continued to use Always napkins and had

recurrent irritation at each menses until they discontinued its use, whereupon

symptoms disappeared. One woman continued to use Always napkins for 3 months

after the index visit without a problem, but when she used them again later

she experienced irritation. Another woman could not recall whether she had had

recurrent irritation during the 3 months after switching brands, but she did

later reuse. Always napkins and experienced irritation. Seven women later used

Always napkins again and experienced recurrent vulvar itching and burning.

C. albicans or bacterial vaginitis was present at the index visit in 5 of the 28

women. Although these women had a potential microbial cause of vulvitis, the

clinical picture was that of contact or irritant dermatitis. All five had at

least 3 months of exclusively menstrual or postmenstrual irritation. Cyclic

symptoms continued in one of the five patients after treatment for Candida and

resolved only after use of Always napkins was stopped.

Only 1 of the 28 women reported using scented napkins; 7 were unsure whether

they were scented. None used talcum powder, feminine hygiene spray or douches.

None had recently changed brands of soap, laundry detergent or fabric

softener. None had lichen sclerosis or vulvar epithelial hyperplasia.

Three had a history of nonvulvar eczema or psoriasis but had no active disease

at the time of the index visit. None of the women was using vulvar or vaginal

medications when the irritation began.

Six had a history of contact dermatitis not involving the vulvar area, and five

had a history of skin manifestations related to drug allergy. No patient had

diabetes. The vulvar symptoms were not related to obesity: the median body mass

index was 22.8 (IQR 20.9 to 24.2), which was within normal limits. None of the

women used spermicide; five were exposed to condoms without resulting

irritation.

In the comparison group of 29 patients from the same practice, 8 (28 percent)

were using Always napkins; 1 reported that they caused vulvar irritation but

that she liked the " wings " feature. Eleven (38 percent) were using another brand

of

napkin, and 10 (34 percent) were using tampons.

Discussion

The clinical picture of recurrent menstrual or postmenstrual vulvitis, described

by some of the patients as " repeated yeast infections " or " chronic vaginitis, "

was always associated with the same brand of sanitary napkin. It is improbable

that this

was a chance occurrence: the Canadian market share of Always napkins in 1993 was

about 30 percent (Ontario Consumer Information Office, Procter & Gamble,

Toronto: unpublished data), and the proportion of women in the

comparison group who used this brand was 28 percent.

Despite the rather striking pattern of recurrence, none of the women in the

study group had made the connection between their sanitary napkins and the

irritation. Few physicians are aware of this potential problem with Always

napkins, although

colleagues we have since alerted have confirmed our observations.

We suspect that this relatively common reaction has escaped notice for several

reasons. In our experience, it did not always occur with the initial use of the

product or immediately upon exposure, and symptoms tended to persist and to

worsen after the women stopped using the napkins.

In some cases the symptoms began after the end of their menses. If the

dermatitis is mistaken for Candida vulvitis, which is similar in appearance

although not in distribution, its resolution coincident with antifungal therapy

may mislead the patient

and her physician into believing that it was a yeast infection.

Indeed, we saw several patients who had been treated for " monthly recurring yeast

infection " that resolved after the correct diagnosis. <--- (NOTE THIS)

Clinicians are generally unaware of the possibility that unscented sanitary

napkins can cause contact dermatitis. Although Pincus [3] and others [6-8] have

mentioned the possibility of allergy to the rubber or perfumes used in sanitary

products,

contact dermatitis to sanitary napkins is not mentioned in major gynecology or

dermatology textbooks or in texts on diseases of the vulva. [1,2,7,9]

Since almost all of the women in our study used unscented napkins, the cause of

their symptoms was likely different from that in the previously reported

cases--irritant rather than allergic.

Many of our patients like Always sanitary napkins because of their length, the

" wings " that protect the underwear and the wicking of blood away from the

surface through the Dry Weave plastic.

This plastic, which lies directly in contact with the skin, may chafe and result

in irritant dermatitis in some women. However, the timing and duration of

symptoms suggest an allergic reaction to some component of the sanitary napkin.

From our study we cannot determine whether the reactions

were primarily an irritant or an allergic contact dermatitis. Further

investigation, including patch testing to various components of the Always

napkins, is under way to elucidate the mechanism responsible for the vulvitis.

Certain questions about the syndrome cannot be answered within the framework of

a case series. The spectrum of severity and the prevalence cannot be identified,

since women making their own diagnosis would simply change products

without consulting their physician, and the proportion of women using Always

napkins who have experienced vulvar irritation cannot be estimated.

Hanke-Baier and associates [10] observed skin irritation from Always Excel Plus

and

another sanitary pad in 256 women and reported " up to moderate erythema " of the

contact area during menstruation but did not provide data or analysis by type of

pad.

Because our case definition included Always use, we could not determine

the proportion of cases of menstrual or postmenstrual vulvitis attributable to

this brand. However, the novelty of this pattern alerted us to the diagnosis,

and in our experience the vulvitis has been associated with the use of this

product in

almost all cases.

Our findings reveal a potentially important cause of recurrent vulvitis that has

hitherto escaped notice. Because of the widespread use of Always sanitary

napkins in Canada, physician awareness of the association will enable effective

advice

and relief for a large number of women suffering from " chronic vaginitis. "

[Guest guest]

Anne,

Well, it's certainly something to aspire to!

I just want to tell you how wonderful it is to hear how much better you're doing now.

I remember very well how miserable and desperate you were just a few months ago.

Hollis

<That’s a good idea. Thanks for the tip. Now if only I could stand wearing underwear…..>

---

Another suggestion: Lately, i have been using a standard pad (CVS brand, which, for all i know, could be a generic Always. . .), but covering it with a nice cushy strip of & Red Cross Brand 100% Pure Absorbent Rolled Cotton

[Guest guest]

Natra Care products (pads and tampons) are made from 100% Organic

Cotton. You can get them at drugstore.com

[Guest guest]

I too use Natracare. I have used the pantiliners, pads and tampons. They are all great and breathable. They contain no bleach, rayon, plasticwss or synthetic materials which all cause vaginal problems. From my understanding Always are rated the worst pads for vaginal irritation. All the best maskedlioness wrote: Well, Its finally come to it and the brand of pads I have always used(Always) is now causing me crazy amounts of irritation and tenderness.I've been mildly irritated by them before, but usually I have toover-wear the pad or already be having a bad pain-day. Not so this time.Does anyone know a good product to use instead? I'm pretty set on thepads option as I'm currently on extended treatment for yeast

and Inever got the hang of tampons. Also I'm pretty pungent this time amonth, so I'd prefer not to be washing out anything.Thanks in advance.

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[Guest guest]

Thank you all for the suggestions. Taurusrcyoo, that is definately an

interesting article. I wonder if any more extensive studies have been

done as well. My hubby says " well they sure told you " , which is to

say I'll be shopping tomorrow.

I trust I can pick up some of these brands, such as seven generation,

at a health food store or such?

Too bad I'll have to toss that Cosco size box of Always that my inlaws

bought me. Mother-in-law's, go figure. :-)

Shade & Sweet Water all!