Maternal health experts have warned women and girls against using tissue paper, cotton wool or scraps of cloth as substitutes for sanitary pads during menstruation, stressing that they could cause skin irritation, vaginal infections and, in the long term, blocked fallopian tubes and infertility.
The gynaecologists said tissue paper was particularly problematic because it disintegrates when wet, adding that the left-behind paper fragments could act as a retained foreign body inside the vagina, leading to offensive vaginal discharge, inflammation and secondary bacterial infection.
In exclusive interviews with PUNCH Healthwise, they stressed that while itching, burning or rash during menstruation was not a sign of infection, these symptoms should never be ignored or assumed to be caused by the sanitary product alone, as genuine vaginal infections could produce similar symptoms and require proper clinical examination to distinguish from irritant or allergic contact dermatitis.
The gynaecologists called on women experiencing repeated reactions to sanitary products to switch to fragrance-free alternatives from different manufacturers rather than turning to cotton wool or tissue, and said there were several purpose-designed menstrual alternatives available including reusable cloth pads, menstrual underwear and menstrual cups.
They warned that girls who used tissue papers and pieces of cloth for menstruation faced a risk of infection that, if left untreated and allowed to ascend the reproductive tract, could block the fallopian tubes and cause infertility in adulthood — making access to proper menstrual hygiene products a matter of reproductive health, not just comfort.
In an exclusive interview with PUNCH Healthwise, a Professor of Obstetrics and Gynaecology, Usmanu Danfodiyo University, Sokoto, Abubakar Panti said the first thing to understand was that itching, burning or rash during menstruation was not automatically a sign of infection.
The Consultant Obstetric Gynaecologist at the Usmanu Danfodiyo University Teaching Hospital in Sokoto added, “Itching, burning or rash during menstruation is not automatically an infection. The sanitary products can actually cause irritation or allergic contact dermatitis to some individuals,” he said.
He said that when a person reacted to a particular sanitary product, the immediate step was to stop using it and switch to a different one, as individuals could react to the components of one product and not another.
On the question of whether cotton wool or tissue paper was safe in place of sanitary pads, Panti was clear that neither was equivalent to a purpose-designed menstrual product.
“Cotton wool, among materials people use for menstruation, is not an established clinical option for menstrual products. It is not a recommended menstrual product to be used,” he said.
He said tissue paper was even more problematic.
“Tissue paper can be a problematic substitute because it is designed to disintegrate when wet. It can become saturated quickly, it breaks apart, and sometimes, if it does not have much water, it adheres to moist skin and leaves some paper fragments,” he said.
On what happened when cotton fibers or paper fragments touched the vulva, Panti said nothing immediately dangerous occurred simply from contact with the external vulva skin, but cautioned that the risks accumulated with continued use.
“These fibers can stick to moist, inflamed skin. Friction can produce tiny abrasions — tiny cuts in the vulva. The retained moisture can worsen the irritation, and fragmented materials can become uncomfortable or difficult to remove. This already damaged skin barrier is the one that is more susceptible to secondary infection,” he said.
He said small fibers or paper fragments could potentially enter the opening of the vagina, particularly when material was placed directly against the vaginal opening.
“A small retained foreign material is more likely to remain in the vagina than to migrate elsewhere. It can cause vaginal discharge, local irritation, or inflammation — vaginitis — which can occur due to this foreign object in the vagina,” he said.
He warned firmly against pushing cotton wool or tissue paper into the vagina as a menstrual absorber.
“Cotton wool or tissue should never be intentionally pushed into the vagina as a menstrual absorber. It will go and act as a foreign body in the vagina. If somebody is not sexually active, it will remain there as a foreign body and you start having offensive vaginal discharge,” he said.
On the organisms likely to proliferate, Panti said cotton wool or tissue paper did not automatically cause bacterial or fungal infection, but explained that once actual vaginitis occurred, the most common organism was candida albicans — a commensal that normally existed in the vagina and caused the characteristic whitish, itchy, burning discharge.
“It is not as if cotton wool causes candida. The relationship is more complicated,” he said.
He listed the clinical problems most commonly associated with using cotton wool or tissue paper as: irritant contact dermatitis; friction and vulvar soreness; moisture-associated skin irritation; allergic reaction to substances in the menstrual product; retained cotton or paper fragments causing local irritation and vaginitis; worsening of pre-existing eczema or vulvar skin diseases; and delayed diagnosis of an actual vaginal infection because symptoms were wrongly attributed to the menstrual material.
On how to distinguish contact dermatitis from infection, Panti offered several clinical clues. He said that with dermatitis, symptoms coincided with the use of a particular product and improved when the product was stopped, while infection could occur independently of any product.
He said dermatitis affected the external vulva where the product touched, while infection typically involved the vagina as well. He noted that abnormal discharge was usually absent with dermatitis but present with infection, and that odour — particularly the fishy smell characteristic of bacterial vaginosis — pointed strongly toward infection rather than dermatitis.
“These are clues, not diagnostic criteria. They are just clues that you can use to differentiate if it is dermatitis or if it is infection,” he said.
For women with sensitive skin, he recommended purpose-designed menstrual products with minimal potential irritants, fragrance-free pads from different manufacturers, well-made reusable cloth menstrual pads designed specifically for menstruation, menstrual underwear or, in appropriate cases, menstrual cups.
He advised that the vulva could be washed gently with water and dried, while the vagina itself should not be washed internally, and warned against scented pads, deodorising products, vaginal washes, antiseptic washes, douching and perfumed soaps around the vulva.
“The bottom line is that a woman who reacts to a sanitary pad does not have to choose between an irritating commercial pad and tissue or cotton wool. There are several purpose-designed menstrual alternatives. The priority is to protect the vulva skin barrier, keep the area reasonably dry and clean, and change menstrual material regularly,” he said.
He also warned against leaving saturated material in place for too long, noting that some women delayed changing their pad for financial reasons, which worsened irritation and increased infection risk.
He said recurring symptoms including itching, burning, abnormal discharge, pelvic pain, significant swelling or fever required proper investigation — including vulva examination, vaginal pH testing, microscopy, culture and sensitivity, and STI screening where appropriate.
On urinary tract infections, Panti said they should not recur if properly treated, and that apparent recurrence was usually the result of suboptimal or incomplete treatment.
“Treatment of UTIs is never suboptimal. When you give somebody antibiotics for urinary tract infection and that infection is susceptible to the antibiotic, of course it will calm it down; it will subdue it. But because the duration of treatment is suboptimal, the thing will bounce back, and you say it has recurred,” he said.
In an earlier interview with PUNCH Healthwise, a renowned Professor of Obstetrics and Gynaecology with over 40 years of experience in healthcare delivery and development work, Prof Oladapo Ladipo said girls using clothes and tissue papers for menstruation were at risk of infections that could lead to infertility later in life.
Ladipo, who is the co-founder of the Association for Reproductive and Family Health, said, “The use of tissue papers and pieces of clothes is not ideal because of the risk of infection. Girls should not be using tissue papers for menstruation. How much will it absorb, and are they not clean enough like tampons? It may absorb, but the risk of infection is there.”
He warned that infections acquired through poor menstrual hygiene could travel upward through the reproductive tract with devastating consequences.
“When they get infected in the genital tract, if it gets to the upper reproductive tract, they may have pelvic infection. And if that happens, the two fallopian tubes may be blocked, and later on, they will face infertility problems when they get older and are married. So, we need to avoid that,” he said.
Ladipo stressed that using sanitary pads was the ideal approach to menstrual hygiene.
Also, a previous report by PUNCH Healthwise had an Obstetrics Gynaecologist at the Federal Medical Centre, Asaba, Dr Daniel Adegbulu, advising women against using tissue paper in place of sanitary pads, warning that it could cause severe infections.
He said the use of tissue paper as a sanitary pad could lead to severe health complications, as infections passing through the vaginal cavity could ascend to other parts of the genital tract.
“Some of these tissue papers are products of waste paper. If tissue paper must be used, it should be as a makeshift one to two hours before a proper sanitary pad is used and should never be inserted into the vagina,” he said.
Adegbulu also warned against other unhygienic menstrual practices, stating that they too provided pathways through which a woman could acquire infections.
Credit: healthwise.punchng.com
