A descriptive, cross-sectional questionnaire based survey amongst the women regarding the adverse effects of sanitary pads

INTRODUCTION

Menstrual health is an important component of women’s well-being. Across the globe, individuals manage menstruation using various products – including disposable sanitary pads, reusable cloth pads, tampons, menstrual cups, and period underwear – each with distinct implications for comfort, hygiene, and safety.^[1]

In India, the use of hygienic menstrual products has risen significantly – from 41.8% in 2015–2016 to 64.1% in 2019–2021 among adolescent girls and young women – yet access remains uneven, with socioeconomically disadvantaged groups still relying on unhygienic alternatives such as cloth, increasing their risk of dermatological and reproductive health issues.^[2] Menstrual hygiene practices play a key role in preventing urogenital complications. Inadequate hygiene has been linked to increased risk of reproductive tract infections, urinary tract infections, and vulvovaginal discomfort.^[3] One common concern is the prolonged use of sanitary pads beyond recommended durations (typically 4–6 h), which can lead to excessive moisture retention, friction, and microbial growth – factors that contribute to skin irritation and infection.^[4]

Contact dermatitis is one of the most significant negative effects linked to the usage of sanitary pads. It is triggered by exposure to irritants such as adhesives, synthetic fibers, and fragrances found in menstrual products. Symptoms include vulvar itching, erythema, edema, and soreness, which can significantly impair quality of life.^[5] This study aims to assess the prevalence and severity of sanitary pad-induced contact dermatitis among menstruating individuals and to identify contributing factors related to product type, usage patterns, and hygiene practices.

MATERIALS AND METHODS

This descriptive, cross-sectional survey was conducted across India, over 2 weeks (June 20–July 04, 2025), to raise awareness about the adverse effects of sanitary pads and explore their impact on women’s quality of life. A total of 110 menstruating women aged 18–55 years participated, representing diverse age groups, occupations, and socioeconomic backgrounds. Subjects were surveyed from different parts of Kerala, Karnataka, and Maharashtra, including colleagues, natives from our localities, friends, and family. Data were summarized using descriptive statistics.

RESULTS

A total of 110 responses were collected through Google Forms, out of which 37.4% of respondents were between 18 and 25 years old, and 32.6% between 26 and 35 years old, with 47.7% of employed women [Figure 1]. Despite the availability of a diverse range of menstrual products, our survey revealed that a significant majority, 87.3% (n = 96), primarily use sanitary pads, with 77.3% (n = 85) of women using them for more than 10 years [Figure 2].The survey highlights key insights into sanitary pad usage. Respondents change sanitary pads at varying frequencies. With 39.1% (n = 43) of the respondents changing their pads every 4–6 h and 33.6% (n = 37) depending on the flow. Whisper is the most popular brand at 47.3% (n = 52), followed by Always at 11.8% (n = 13) and Kotex at 11.8% (n = 13).

Close

Figure 1:

Age demographics of the study respondents.

Export to PPT

Close

Figure 2:

Product primarily used by the study population.

Export to PPT

One hundred nine responses were received to the question about factors influencing the choice of sanitary pads. Comfort is the primary factor influencing the choice of sanitary pads, with 87.2% of respondents (n = 95) prioritizing it. Availability (26.6%, n = 29) and price (16.5%, n = 18) are also significant considerations. Brand reputations, eco-friendliness, and recommendations play a lesser role.

62.7% (n = 69) have experienced skin irritation while using sanitary pads, out of which nearly half of the respondents rarely (n = 39, 55.1%) experience irritation or rashes rarely, while 26.1% (n = 18) experience them occasionally. A smaller percentage, 8.7% (n = 6), experiences irritation or rash every menstrual cycle.About 108 responses were received regarding allergic reactions and infections (bacterial/fungal) related to sanitary pads, with 6.5% (n = 7) confirming they had allergic reactions and 11.1% (n = 12) having experienced bacterial/fungal infections. In addition, 11.1% (n = 12) may have had an allergic reaction to sanitary pads [Figure 3].

Close

Figure 3:

Rashes or irritation experienced by the study population.

Export to PPT

The survey revealed that out of 85 respondents, 13.5% (n = 12) were prescribed topical creams or ointments for sanitary pad-related issues. At the same time, the remaining respondents opted for self-management strategies, such as allowing them to cure naturally within a week or shifting to alternative products like cups and cotton liners. These findings highlight the varying approaches to addressing health concerns related to sanitary pad use.

When asked about the measures tried to reduce symptoms, the survey revealed the following results [Figure 4].From the survey, changing pad frequency (48.2%) and changing pad brand/type (39.1%) were among the most effective measures in reducing symptoms, along with switching to unscented products (19.1%). These findings suggest that adjusting pad use habits and product choices can significantly alleviate symptoms for many individuals.

Close

Figure 4:

Measures taken by the respondents to alleviate the symptoms.

Export to PPT

The survey inquired about the utilization of alternative menstrual products, and 35.4% (n = 39) reported having used other menstrual products. Among these individuals, 70.7% (n = 29) opted for menstrual cups, 17.1% (n = 7) chose reusable cloths, and 7.3% (n = 3) selected tampons.

A significant majority have concerns about chemicals used in sanitary pads, 60.7% (n = 65).

64.8% (n = 68) out of 105 respondents noticed a foul odor while using sanitary pads for an extended period.

When asked about toxic shock syndrome, 3.8% (n = 4) of 106 respondents reported experiencing symptoms.

In addition, 19.4% (n = 21) out of 108 respondents reported experiencing psychological or social stress related to the adverse effects of sanitary pads.

Despite concerns about chemical exposure and odor, a substantial 79.1% (n = 87) of 110 respondents still find sanitary pads to be the most comfortable and least problematic menstrual product option.

The survey results reveal that out of 107 responses, respondents prioritize improvements in sanitary pads, with 74.8% (n = 80) opting for chemical-free options, 46.7% (n = 50) for more absorbent materials, and 46.7% (n = 50) for hypoallergenic options. In addition, 4.7% of respondents chose the “other” category, suggesting alternatives such as moisturizing types, options for sensitive skin, and even advocating for the discontinuation of pads or making them biodegradable.

A significant majority, 50.5% (n = 53), of 105 respondents are willing to switch to a different menstrual product if it significantly reduces the adverse effects.

Respondents shared concerns and suggestions about sanitary pads, including allergic reactions, comfort issues, and chemical composition. Some of them recommended alternative products such as menstrual cups, citing convenience and hygiene benefits. Others suggested improving sanitary pad design and materials to reduce adverse effects. Research outcomes have been summarized after dividing into primary and secondary outcomes in Tables 1 and 2.

DISCUSSION

Clinical manifestations of sanitary pad dermatitis range from irritant and allergic contact dermatitis to secondary infections and psychological distress. This multifactorial condition is fueled by mechanical friction, extended exposure, chemical irritants, and personal vulnerability.^[6] This study supports the theory that vulvar skin health is greatly influenced by pad-related materials and usage habits, with allergens such as phthalates, colophonium, and unlisted fragrance chemicals exacerbating symptoms.^[7] Our results provide a more comprehensive viewpoint than previous research that only looked at chemical or microbiological triggers, and they are consistent with new studies that support hypoallergenic substitutes such as bamboo-based pads.^[8] Our primary and secondary outcomes support the initial hypothesis that pad-related materials and usage habits are contributing factors to poor vulvar health outcomes. Compared to previous studies that focus narrowly on either microbial or chemical irritants, our research integrates those findings along with documentation of user-reported symptom patterns and treatment behaviors [Figure 5].

Close

Figure 5:

Causes and risk factors illustrated by P. prasamsa

Export to PPT

Strengths of our study include a diverse sample, detailed symptom profiling as well as exploration of behavioral outcomes, but it is limited by the fact that we were not able to do diagnostic procedures such as vulva specific patch testing. We also had to rely upon self-reported data without clinical confirmation. Manufacturers’ failure to disclose complete ingredients and allergen information prevented us from pinpointing the specific allergenic compounds in any of the sanitary pad brands.

CONCLUSION

Despite the availability of diverse menstrual products, sanitary pads remain the predominant menstrual product, with most respondents reporting long-term, continuous use. However, this reliance is accompanied by frequent adverse effects, including skin irritation, infections, and psychosocial distress. Despite these symptoms, clinical intervention was rare, and most women managed reactions independently by adjusting pad usage or switching brands. Concerns about chemical exposure and unpleasant odors were common, prompting individuals to explore alternatives such as menstrual cups and reusable cloths. These findings highlight the need for transparent ingredient labeling, routine clinical recognition of pad-related dermatitis, and the development of safer, hypoallergenic menstrual products. We suggest further research to investigate the mechanisms underlying pad-induced skin reactions, evaluate the safety of commonly used materials, and guide innovation toward more biocompatible and sustainable menstrual solutions.