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Family Health Magazine - PHARMACY CARE

Feminine Hygiene
Unveiling the mysteries

At some point, it becomes necessary to venture into that mysterious sanctuary of womanhood: the feminine hygiene aisle at your local store or pharmacy. As a pharmacist, I regularly see shoppers staring dazedly at the wall of brightly colored packages. You pick up first one box, then another. You may be a first-timer, an experienced user wondering about new options, or even a bewildered boyfriend or husband doing your significant other a favour. In any case, the next few pages should provide you with a guide to the variety of products available in the feminine hygiene section.

Why they call those things ‘feminine protection’?

It’s universal. Every woman (barring certain medical problems) will menstruate. The average woman has her first menstrual period around age 12 and her last period when she is in her fifties. The average length of a menstrual cycle is about 28 days, but may vary greatly depending on the woman. Menstruation is the release of about 25 to 65 millilitres of blood, tissue fluid, mucus and cells that line the uterus (where a baby develops). It lasts for about the first five days (and nights!) of the menstrual cycle. Menstrual flow is often heaviest on the second day of menstruation and then tapers off over the next few days. Women protect their clothing from this flow, and so the term ‘feminine protection.’

External protection - pads

Pads consist of several layers: a top sheet, an absorbent core, a waterproof sheet and an adhesive beneath a protective paper strip. To use a pad, a woman removes the paper strip, exposes the adhesive and attaches the pad to her underwear. The pad may be left in place for up to several hours or overnight. Depending on the amount of flow, pads may need to be changed every couple of hours to prevent leakage. After use, pads should be discarded in the trash. Flushing them in the toilet will often clog the plumbing.

Pads come in all shapes and sizes, and include the following:

Panty liners. These are generally the smallest and thinnest of pads. Panty liners are often used with a tampon or at the end of the woman’s period when flow is minimal. Panty liners are often marketed for everyday use between periods, but it is not necessary to use any feminine protection product if there is no vaginal flow or discharge.

Mini pads. These pads are slightly bigger and thicker than panty liners and may be used for the same reasons as panty liners.

Maxi pads. These pads are bigger and longer than mini pads and can be used any day of menstruation. Maxi pads may come in several forms as well. ‘Overnight’ pads are longer and have one end that is wider than regular maxis. This provides extra protection during the many position changes that occur during sleep. ‘Long’ pads are longer to provide extra protection at the front and back. ‘Thin’ maxi pads have an extra absorbent core and are thinner than regular maxis, but provide the same protection.

Winged pads. These are pads with flaps attached to the sides. The ‘wings’ fold around the sides and underneath the woman’s underwear between the legs. Wings provide extra leakage protection.

Plus-size pads. These pads are being marketed to women who are size 14 or over. The pad is longer and wider than a regular maxi. They are about the same length as an overnight pad and have about the same width as the wide end of an overnight pad. The manufacturer claims they cover 30 per cent more panty than a regular maxi. It should be noted that plus-size maxi packages have fewer pads in them than the overnight and long maxi packages but cost the same.

Scented pads. Most pads are unscented but some scented or deodorant versions are available. These scented products are not recommended, as there is an increased risk of irritation or allergic reaction to the perfume.

Non-menstrual uses for pads. Maxi pads are also used for postpartum (after having a baby) bleeding. During this time, the flow is usually very heavy, and long or overnight maxi pads are most commonly used. Some women may also use pads to protect their clothing if they have trouble holding their urine (urinary incontinence). There are more effective products on the market for managing this concern. Ask your pharmacist for advice. As well, my three-year-old daughter assures me that maxi pads make great pillows for dolls.

Internal protection

In Canada there are two basic types of internal feminine protection products on the market: tampons and the Instead™ Softcup.

Tampons. Tampons are small, cylindrical bundles of absorbent cotton or cotton-like material that are inserted into the vagina to absorb the menstrual flow internally. Depending on the brand, the tampon may come with a plunger-type applicator made of cardboard or plastic to assist with insertion. Cardboard applicators are flushable. Plastic applicators are disposable but not flushable. Some brands of tampons are made for insertion without an applicator. A cord is attached to the tampon to assist with removal.

Tampons should be changed approximately every four to a maximum of eight hours. Tampons come in a range of absorbencies, from light to regular to super-absorbent. Some brands also make a slimmer version. These may be more comfortable to insert for some women, especially first-time tampon users.

As a general rule, the lowest absorbency tampon that meets the woman’s needs should be used. Regularly using a higher absorbency tampon on a day of light menstrual flow can increase the chance of vaginal irritation and dryness. It also increases the risk of toxic shock syndrome (TSS). Women who have recently given birth or had vaginal surgery should not use tampons until they have completely healed (usually six to eight weeks).

Instead™ Softcup. This product came on the market in 1996. It is a soft plastic cup that is inserted into the vagina and fits into the space just below the cervix (the narrow lower end of the uterus). When inserted correctly, the tip of the cervix is inside of the cup. Instead holds and collects the menstrual flow but does not absorb it. The cup is made from a non-irritating, non-latex, plastic material. This product can be used on any day of menstruation and can be left in place for up to 12 hours. It is disposable but not flushable. The manufacturer claims it does not interfere with physical activity, does not cause vaginal dryness, and can be even be used during sexual intercourse. Instead is not a method of birth control, even though it is similar in appearance to a diaphragm. Women should not use this product if they use an IUD or if they have had an episode of TSS. Women who have recently given birth, have recently had a miscarriage or abortion, or have been diagnosed with a tilted uterus, should consult their doctor before using this product.

Feminine deodorants and towelettes

Cleaning the area around the vagina is easy and simple. Regular genital hygiene requires no more than washing the external genitals regularly with mild soap and water. A mild genital odor is common and normal. Genital towelettes are disposable wipes marketed for feminine genital hygiene. These towelettes are no more effective than mild soap and water and may cause irritation in some women.

Aerosol feminine deodorant sprays are marketed to control genital odor, but may also cause irritation in some women. Deodorant sprays may also mask the odor from an infection in the vagina and cause the woman to delay seeking treatment. Use of these products is not recommended.

To douche or not to douche, the question answered

Vaginal douching means to put liquid into the vagina with an applicator like a syringe. Some women feel they need to douche to cleanse the vagina, control odor or reduce genital itching. However, the vagina is self-cleansing and usually does not require extra care. There is no benefit to regular douching. Douching may mask symptoms of infection in the vagina and cause a woman to delay seeking medical treatment. Douching may also disrupt the normal bacteria present in the vagina and lead to increased risk of irritation or infection. The vagina normally has a slightly acid environment. Douching may change the acid level of the vagina, which could lead to increased risk of certain types of vaginal infection. If a woman still feels it is necessary to douche, plain water is the safest liquid to use. Commercially prepared disposable douches are available but again, douching is not required or recommended for regular hygiene of the vagina. If a disposable product must be used, vinegar and water solution is the best alternative to plain water as it maintains the acidity of the vagina. Scented products should be avoided. Douching is not recommended in pregnancy and is not an effective means of birth control.

Mystery solved . . .

Whatever your needs may be, if you need help in this area please don't be embarrassed to ask the pharmacist. Hopefully the next time you're in the feminine hygiene aisle, it won't seem quite so mysterious.

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While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specifid medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physican promptly. Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1  [CH_FHd02]