Nowadays, we hear a lot about the noxious cocktail of chemicals that can be found in our food, furniture, cleaning products and even our cosmetics. Yet we never really hear about what might be included in some of the most intimate personal care products women use.

"Chem Fatale" — a report recently released by Women’s Voices for the Earth (WVE) — attempts to shed some light on this subject by taking aim at the $3-billion-a-year feminine care industry. In particular, the group examines products such as maxi pads, tampons and douches that contain potentially harmful ingredients including pesticides, dyes and dioxin, which has been identified by the World Health Organization as a Persistent Organic Pollutant, a toxic chemical that persists in environments for long periods of time. The report also includes a “Hall of Shame” appendix that features examples of feminine care brands that contain toxic chemicals.

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“I think the question of how toxic [feminine care products] might be is one of those things that is not talked about because there is a such a mystique around the vagina,” says Ogonnaya Dotson-Newman, Director of Environmental Health at WE ACT for Environmental Justice, and a WVE board member. “It’s highly taboo and something that’s not supposed to be discussed in polite company.”

Even those curious enough to put in the extra effort to find out what’s in these products would be hard-pressed to find any concrete answers. Since tampons and sanitary pads are regulated as “medical devices” the industry is not required to disclose any of their ingredients.

The WVE report highlights tampons as particularly problematic, as they are used by 85 percent of women and often contain chemicals linked to cancer, including dioxin.

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As dioxin is a byproduct of chlorine bleaching and most sanitary napkins and tampons contain chemically-bleached cotton and rayon, it's likely that most of these products on the market contain at least some levels of dioxin residue. A study published in Environmental Health Perspectives in 2002 found dioxin in four different brands of tampons, albeit at low levels. However, since the US Environmental Protection Agency released an in-depth report on dioxins in 2012 that concluded that dioxins could have “potentially serious [health] effects at ultra-low levels of exposure,” the presence of dioxins at any level in tampons can be a cause for concern.

Unlike pads and tampons, feminine wipes and washes are not considered medical devices and are instead categorized as cosmetics. This means they are subject to the Fair Packaging and Labeling Act (FPLA), which mandates that manufacturers disclose their ingredient list on the product. However, the FPLA contains a legal loophole that exempts “individual fragrance ingredients” from labeling requirements. With this in mind, many manufacturers can choose any chemical they do not wish to disclose to the public and simply list it as a “fragrance.”

“It is amazing how little information is out there about chemicals in products,” notes Robin Dodson, a research scientist with the Silent Spring Institute, based in Newton, Mass. “Without actually testing the products, it is not possible to know their actual chemical composition. So, while label reading can be helpful for some chemicals of concern, it is not comprehensive.”

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For example, according to the WVE report, many feminine hygiene products have been found to contain quaternium-15 and DMDM hydantoin, which in turn release formaldehyde — a known carcinogen. The report also notes that feminine wipes and washes have been found to be used in greater numbers by black and Latina women, meaning they may have disproportionate health impacts for women of color.

And yet, feminine care items aren't just conspicuously absent from the overall public dialogue about the health impacts of consumer products; they're also rarely discussed by the organizations and advocacy groups that work primarily on women's health and cosmetic safety. There are virtually no references to the possible toxicity of feminine care products on the websites of the Breast Cancer Fund, Breast Cancer Action or the Campaign for Safe Cosmetics. Even the Environmental Working Group’s Skin Deep Database, which offers detailed rating assessments for the toxic potential of more than 80,000 consumer products on the market, does not include a category for pads and/or tampons (though they do list quite a few feminine washes).

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“Virtually no one has been talking about [the possible health impacts] of feminine care products, even though most women use these products on a monthly basis, some demographics more than others,” says Dr. Ami Zota, an assistant professor at the School of Public Health and Health Services at George Washington University who worked as an independent scientific advisor on the WVE report. “Additionally, many of these products are coming into direct contact with the bloodstream and very sensitive tissue, which can make them potentially more dangerous.”

So what is a woman who wants to avoid putting toxic chemicals up and around her lady-parts to do?

Alexandra Scranton, the Director of Science and Research at WVE, suggests women forego feminine cleansers altogether, which she asserts often cause many of the very issues the manufacturers of these products claim they fix.

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Scranton’s suggestion is in line with recommendations of both the American Public Health Association and the American College of Obstetricians and Gynecologists, which warn against the use of douches, feminine sprays/powders and fragranced tampons and pads, as they often can cause allergic reactions and bacterial infections.

“A lot of the chemicals we are concerned about are listed as a fragrance,” says Scranton. “The market is really trying to expand into a whole range of fragranced products.”

For those other products that can’t be readily abandoned by the female consumer — namely, pads and tampons — the report urges women to not only choose “unscented” or “fragrance free” alternatives, but to opt for products that have not been bleached with chlorine and those that are made from organic cotton.

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Scranton hopes the WVE study will start a discourse about what message an industry that is supposed to be concerned with women’s comfort and health is sending when it aggressively markets fragranced products that could be harmful.

But the ultimate purpose of the report, says Scranton, is to pressure the industry to be more transparent and the federal government to offer greater oversight and regulation of the industry. In that vein, the report’s release kicks off the group’s new campaign calling on the public to push Procter & Gamble, the maker of Tampax and Always, to disclose the ingredients in these brands. (Procter & Gamble could not be reached for comment.)

“We want to create a movement where the public is holding the manufacturer of these products accountable,” says Scranton. “And we want the industry to conduct more evaluation on their health and safety.”