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Expert Analysis: What Happens If You Use Tissue as a Pad — 5 Critical Risks for 2026

Mar 30, 2026

Abstract

An examination of the practice of using household tissue as a substitute for a sanitary pad reveals significant health and hygiene-related concerns. This analysis, grounded in principles of dermatology, microbiology, and materials science, explores the consequences of this common emergency measure. The core issue stems from the fundamental mismatch between the design of tissue paper—engineered for rapid disintegration—and the requirements of a menstrual product, which must provide absorption, containment, and skin protection over several hours. Using tissue paper can lead to inadequate absorption, resulting in leakage and discomfort. More critically, it elevates the risk of vulvar skin irritation, contact dermatitis, and allergic reactions due to moisture, friction, and the potential presence of dyes or fragrances. The non-sterile nature and structural fragility of tissue also create a favorable environment for pathogenic bacterial growth, potentially increasing the incidence of infections such as bacterial vaginosis and urinary tract infections. This objective review concludes that while seemingly a harmless improvisation, using tissue as a pad poses tangible risks that underscore the necessity of purpose-designed menstrual hygiene products for safeguarding female health.

Key Takeaways

  • Tissue breaks down when wet, offering minimal absorption and causing leaks.
  • Constant moisture and friction from tissue can lead to painful skin irritation.
  • Using non-sterile tissue may increase your risk of developing vaginal infections.
  • Understand what happens if you use tissue as a pad to protect your health.
  • Purpose-built sanitary pads have layers designed for safety and absorbency.
  • Small pieces of tissue can break off, creating hygiene and removal issues.
  • Always prioritize using products specifically designed for menstrual care.

Table of Contents

A Common Predicament: The Rationale and the Reality

The sudden realization that a menstrual period has begun, unaccompanied by the necessary sanitary products, is a near-universal experience for those who menstruate. In this moment of quiet panic, a search for an immediate, temporary solution often leads to a single, readily available item: toilet tissue, facial tissue, or paper towels. The impulse is understandable, born from a desire to manage a biological reality with discretion and immediacy. The logic seems straightforward—tissue is absorbent, it is clean, and it is accessible. This act of improvisation, however, rests upon a series of assumptions about the material properties of tissue and the specific demands of menstrual hygiene. What happens if you use tissue as a pad is not a simple matter of inconvenience but a complex interplay of material science, human physiology, and potential health consequences.

To truly comprehend the implications, we must move beyond the immediate relief of a temporary fix and engage in a more profound inquiry. This requires us to adopt a perspective that is both empathetic to the predicament and rigorously scientific in its analysis. We must ask not just if tissue works, but how it works, and more critically, where its function fails. It is a question that invites us to consider the very nature of the materials we bring into contact with our bodies, particularly in areas as sensitive and physiologically complex as the vulvar region. The dialogue that follows seeks to deconstruct this common practice, not to induce shame or fear, but to foster a deeper understanding of our bodies and empower informed choices regarding menstrual health. It is an exploration into the hidden costs of a seemingly harmless substitute.

Comparing Material Realities: Sanitary Napkins vs. Tissue Paper

Before delving into the specific risks, it is illuminating to place the two materials side-by-side for a direct comparison. The difference is not merely one of degree but of fundamental purpose and design. One is engineered for transient use and rapid disposal, while the other is a multi-layered technological product designed for safety, comfort, and performance over time. Thinking about this comparison is like comparing a paper umbrella to a reinforced storm shelter in a hurricane; while both might offer a fleeting sense of protection, only one is truly designed for the conditions it will face.

Feature Tissue Paper (Toilet/Facial) Standard Sanitary Napkin
Primary Material Short-fiber wood pulp Non-woven fabrics, polymer films, wood pulp, Super Absorbent Polymer (SAP)
Core Function Light absorption, easy disintegration in water High-capacity fluid absorption, retention, and containment
Absorbency Rate Low to moderate; rapid saturation High; designed to pull fluid away from the surface quickly
Structural Integrity Very low when wet; prone to tearing and shredding High; maintains shape and structure even when saturated
Surface Layer Raw paper fibers; can be abrasive Soft, non-woven topsheet (e.g., polypropylene) designed for skin comfort
Adhesive Strip None Present to secure the product to undergarments, preventing shifting
Moisture Locking None; holds moisture directly against the skin Absorbent core with SAP gels fluid, keeping the surface layer dry
Sterility & Hygiene Not manufactured in a sterile environment; may contain dyes/fragrances Produced under hygienic conditions; often dermatologically tested

Risk 1: The Failure of Containment: Inadequate Absorption and Leakage

The primary function of any menstrual product is absorption. Menstrual fluid is not simply water; it is a complex combination of blood, endometrial tissue, and vaginal secretions. An effective product must not only absorb this fluid but also retain it under pressure (such as when sitting or moving) and prevent it from returning to the surface. Herein lies the first and most immediate failure of tissue paper.

The Illusion of Absorbency

Tissue paper feels absorbent to the touch. It can soak up a small spill or wipe away moisture effectively. This property, however, is deceptive when applied to the context of menstrual flow. Tissue is made from short, loosely bonded cellulose fibers. When these fibers encounter fluid, they quickly become saturated through capillary action. Imagine a dry sponge; it soaks up water instantly. Yet, once full, the slightest pressure will cause the water to pour back out. Tissue paper behaves in a similar manner. It has a low total holding capacity and virtually no ability to lock fluid away.

A modern sanitary napkin, by contrast, employs a sophisticated system. The absorbent core contains not just fluff pulp but also a remarkable material known as Super Absorbent Polymer (SAP). These are tiny granules that can absorb and retain hundreds of times their own weight in liquid, transforming the fluid into a stable gel. This gelling process effectively traps the menstrual fluid within the core of the pad, preventing it from re-emerging, a phenomenon known as "rewet." Using tissue is akin to building a dam with sand; it may hold back the first trickle, but it is destined to be overwhelmed. The result is leakage, a practical failure that carries with it the psychological burdens of potential embarrassment and the constant, stressful awareness of the inadequacy of one's protection.

The Dynamics of Flow and Failure

Menstrual flow is not a steady, slow drip. It can vary significantly throughout the day and from one day to the next, often involving gushes or clots. Tissue paper is singularly unequipped to handle such dynamics. A sudden flow will overwhelm the tissue's limited capacity almost instantly, leading to immediate strike-through and staining of clothing. Because it lacks a waterproof backing layer—a standard feature in all disposable pads—there is no secondary line of defense. The fluid passes directly through the wad of tissue and onto the underwear. This failure of containment is not just a matter of inconvenience; it is a fundamental breakdown of the product's primary purpose, leaving the user unprotected and in a state of continuous anxiety.

Risk 2: The Epidermal Assault: Skin Irritation and Dermatological Distress

The skin of the vulva is unique. It is more permeable than the skin on other parts of the body, has a high density of sweat and oil glands, and is often occluded by clothing. This delicate environment, known as the vulvar ecosystem, is exquisitely sensitive to changes in moisture, pH, and friction. Introducing tissue paper into this ecosystem is a form of epidermal assault, creating conditions ripe for irritation and dermatitis.

The Problem of Occlusion and Maceration

When tissue becomes saturated with menstrual fluid, it holds that moisture directly against the skin. Unlike a proper sanitary pad, which is designed to pull moisture away from the body and into an absorbent core, the tissue acts like a wet compress. This prolonged contact with moisture leads to a condition called maceration—the softening, whitening, and breaking down of the skin, similar to what happens to your fingers after a long bath. Macerated skin is significantly more fragile and its barrier function is compromised, making it susceptible to damage from even minor friction (American College of Obstetricians and Gynecologists, 2021). The simple acts of walking, sitting, or shifting one's position can cause the damp, rough fibers of the tissue to chafe against the delicate, macerated skin, leading to painful redness, chafing, and even microscopic abrasions.

Contact Dermatitis and Chemical Sensitivities

Beyond the physical effects of moisture and friction, tissue paper can introduce chemical irritants. Many facial and toilet tissues are not the pure, simple products they appear to be. They may be bleached with chlorine, which can leave behind trace amounts of dioxins, or treated with lotions, perfumes, and dyes to improve their softness, scent, and appearance. When these chemicals are held in prolonged, occluded contact with the highly permeable vulvar skin, they can trigger irritant contact dermatitis—a non-allergic inflammatory reaction. Symptoms include burning, stinging, itching, and a red rash.

For individuals with pre-existing sensitivities, the risk is even greater. An allergic contact dermatitis reaction may occur, where the body's immune system reacts to a specific chemical in the tissue. This can lead to a more severe and persistent rash, sometimes with blistering and weeping. Since these products are not designed or tested for prolonged vulvar contact, using them in this manner is a gamble with one's dermatological health. The potential for such reactions is one of the key reasons why individuals are often advised to seek out a wide range of sanitary napkins specifically designed for sensitive skin.

Potential Issue Description Common Symptoms
Maceration Softening and breakdown of the skin due to prolonged exposure to moisture. Skin appears white, wrinkled, and feels soggy; increased fragility.
Chafing Skin irritation caused by repetitive friction from the damp tissue. Redness, stinging, raw-feeling patches of skin.
Irritant Contact Dermatitis An inflammatory skin reaction to substances like dyes, fragrances, or bleach residues. Itching, burning, redness, inflammation.
Allergic Contact Dermatitis An immune system response to a specific allergen in the tissue. Intense itching, severe rash, possible blistering or weeping.
Folliculitis Inflammation of hair follicles, often caused by friction and trapped bacteria. Small, red, tender bumps, sometimes with a white head.

Risk 3: An Invitation to Infection: The Microbiological Fallout

A healthy vaginal and vulvar environment maintains a delicate balance of microorganisms, dominated by beneficial Lactobacillus species. This "microbiome" creates an acidic environment (a low pH) that naturally inhibits the growth of pathogenic, or disease-causing, organisms. The use of an improper menstrual product like tissue can disrupt this balance in several ways, effectively rolling out a welcome mat for infections.

Altering the Microenvironment

The constant moisture held against the skin by a saturated tissue paper does more than just cause irritation; it changes the local microenvironment. Healthy skin is typically dry and slightly acidic. A wet, macerated environment, however, becomes more neutral or even alkaline. This shift in pH can be detrimental to the resident Lactobacillus population and creates a more hospitable breeding ground for opportunistic pathogens.

Furthermore, menstrual blood itself is a rich nutrient medium for bacteria, and its pH is higher (around 7.4) than that of a healthy vagina (around 3.8 to 4.5). A proper sanitary pad is designed to absorb this fluid quickly and lock it away, minimizing its contact with the skin and limiting the time available for bacterial proliferation. A saturated tissue, on the other hand, essentially creates a petri dish—a warm, moist, nutrient-rich environment held directly against the entrances to the vagina and urethra. This significantly increases the risk for common and uncomfortable infections.

The Specter of BV and UTIs

Two of the most common infections associated with poor menstrual hygiene are bacterial vaginosis (BV) and urinary tract infections (UTIs).

  • Bacterial Vaginosis (BV): This condition is not a true infection but rather a dysbiosis—a disruption of the normal vaginal flora. It involves an overgrowth of certain anaerobic bacteria (like Gardnerella vaginalis) and a decrease in protective lactobacilli. The altered pH and moist conditions created by using tissue can favor this shift. BV is characterized by a thin, greyish discharge and a distinctive "fishy" odor, and while not typically dangerous, it can be distressing and may increase the risk of other sexually transmitted infections (Koumans et al., 2007).
  • Urinary Tract Infections (UTIs): A UTI occurs when bacteria, most commonly Escherichia coli (E. coli) from the gastrointestinal tract, enter the urethra and infect the urinary system. The close proximity of the anus, vagina, and urethra in the female anatomy makes this transference a constant risk. The structural breakdown of tissue paper (which will be discussed next) can facilitate this. Tiny, feces-contaminated particles from the perianal area can become trapped in the damp, shredded tissue and held near the urethral opening, dramatically increasing the chance of bacterial entry and subsequent infection.

In rarer, more extreme cases, poor menstrual hygiene practices have been linked to Toxic Shock Syndrome (TSS), a severe and life-threatening condition. While most commonly associated with high-absorbency tampons, any condition that allows certain strains of bacteria (Staphylococcus aureus or Streptococcus pyogenes) to proliferate in the vaginal environment can elevate the risk (Schlievert et al., 2020). The non-sterile, occlusive, and structurally unsound nature of a makeshift tissue pad creates a scenario that, while not a direct cause, certainly moves in the wrong direction from a risk-reduction standpoint.

Risk 4: The Peril of Disintegration: Structural Fragility and Contamination

The defining characteristic of toilet tissue and facial tissue is its designed fragility. It is engineered to dissolve quickly in water to prevent clogging plumbing systems. This very quality makes it a disastrous choice for a menstrual product, which must maintain its integrity for hours while saturated with a protein-rich fluid. What happens if you use tissue as a pad from a structural perspective is a complete and messy failure.

The "Shedding" Problem

As tissue absorbs menstrual fluid, its short fibers lose their tenuous bonds. With the added stresses of body heat, moisture, and the friction of movement, the wad of tissue begins to shred, tear, and disintegrate. This process, sometimes called "shedding" or "pilling," results in small, damp clumps of paper being left behind on the skin and hair of the vulvar area. These fragments can become lodged in the intricate folds of the labia, creating a significant hygiene challenge.

Removing these clinging remnants can be difficult and may require vigorous wiping, further irritating the already sensitive skin. If not removed completely, these particles can act as foreign bodies, causing inflammation and providing a persistent nidus for bacterial growth. Imagine trying to clean a sticky spill with a low-quality paper towel that falls apart, leaving more of a mess than it cleans up; this is an apt analogy for the situation created within one's underwear.

The Risk of Internal Contamination

Perhaps the most concerning aspect of tissue disintegration is the potential for fragments to travel. Small pieces can migrate towards and even into the vaginal opening. While the vagina is a self-cleaning organ, the introduction of non-sterile, fibrous foreign material is highly undesirable. These fragments can disrupt the vaginal microbiome, cause physical irritation to the vaginal walls, and may contribute to an abnormal discharge as the body attempts to expel them.

In a worst-case scenario, a piece of tissue could be retained for a longer period, becoming a focal point for a serious infection. This is not a hypothetical fear; gynecologists occasionally have to remove forgotten foreign objects from the vagina, which are often associated with foul-smelling discharge and signs of infection. While a tampon is the most common culprit, any disintegrating material used in a similar fashion poses a theoretical risk. The structural integrity of a purpose-built sanitary napkin, which is designed to be removed as a single, intact unit, eliminates this entire category of risk. Reputable hygiene product manufacturers invest heavily in research and development to ensure their products are both effective and structurally sound.

Risk 5: The Psychological Weight: Anxiety, Discomfort, and Dignity

The consequences of using tissue as a pad are not confined to the physical realm. The human experience of menstruation is deeply intertwined with emotions, self-perception, and social context. An inadequate menstrual product can exact a significant psychological toll, eroding confidence and creating a pervasive sense of anxiety.

The Constant Hum of Worry

When a person knows their menstrual protection is unreliable, a part of their mental energy is constantly diverted to managing this vulnerability. Every movement is second-guessed. The act of standing up after sitting for a while is fraught with the fear of leakage. Public spaces become arenas of potential embarrassment. This state of low-grade, persistent anxiety is draining. It can interfere with concentration at work or school, detract from social enjoyment, and create a barrier to full participation in daily life.

This experience is a microcosm of what is often discussed in the context of "period poverty"—the lack of access to adequate menstrual hygiene products. Even when temporary and self-imposed, the use of a makeshift solution like tissue introduces the same feelings of insecurity and indignity. The user is forced into a state of hyper-vigilance, constantly performing mental checks: "Is it still in place? Has it leaked? Can anyone tell?" This mental burden is a heavy one to carry.

The Sensory Offense and Loss of Dignity

The experience of using a saturated, disintegrating tissue pad is deeply unpleasant from a sensory standpoint. It feels damp, lumpy, and insecure. There may be an associated odor as the menstrual fluid is exposed to air and bacteria, unlike in a modern pad where it is gelled and contained. This constant sensory reminder of inadequacy can impact one's sense of cleanliness, well-being, and personal dignity.

Menstruation is a normal physiological process, not something to be ashamed of. However, the experience of being unable to manage it cleanly and effectively can evoke feelings of shame and self-consciousness. The ability to go about one's day without being constantly and unpleasantly reminded of one's period is a key benefit of effective menstrual products. It allows for a sense of normalcy and bodily autonomy. To be forced into a situation where one feels "unclean" or is worried about odor or leaks is a direct assault on this sense of dignity. The psychological comfort and confidence provided by a reliable sanitary napkin are as important a feature as its absorbency.

The Architecture of Protection: Understanding the Science of Sanitary Napkins

To fully appreciate the risks of using tissue, it is crucial to understand what makes a purpose-built sanitary napkin so effective. These are not simple products; they are feats of material science and engineering, with each component playing a specific role in maintaining health, comfort, and confidence. Exploring further reading on the risks of makeshift pads can highlight the stark contrast between improvised solutions and professionally engineered products.

A typical modern sanitary napkin consists of several distinct layers:

  1. The Topsheet: This is the layer that comes into direct contact with the skin. It is not made of paper but of a soft, non-woven fabric, usually polypropylene. It is designed to be hydrophobic, meaning it resists moisture. It has small apertures or pores that allow fluid to pass through it quickly into the layers below, but its hydrophobic nature helps it to stay dry to the touch, minimizing skin maceration and irritation.
  2. The Acquisition-Distribution Layer (ADL): Located directly beneath the topsheet, the ADL's job is to rapidly pull fluid away from the topsheet and spread it out over the wider area of the absorbent core. This prevents fluid from pooling in one spot and overwhelming the core, and it is especially important for handling sudden gushes.
  3. The Absorbent Core: This is the heart of the pad. It is typically a mixture of cellulose fluff pulp (for structure and initial absorption) and the aforementioned Super Absorbent Polymer (SAP). When menstrual fluid reaches the core, the SAP granules rapidly absorb it, swelling to form a stable gel. This process locks the fluid away, prevents rewet, and helps to control odor by trapping bacteria and fluids.
  4. The Backsheet: The bottom layer is a thin, flexible film, usually made of polyethylene. It is completely waterproof, acting as the final barrier to prevent any fluid from leaking through onto undergarments and clothing. Many modern backsheets are also engineered to be breathable, allowing water vapor (but not liquid) to escape, which helps to reduce heat and moisture buildup, further enhancing skin comfort.
  5. Adhesives: The back of the pad features a strip of pressure-sensitive adhesive to secure it to underwear, while many pads also have "wings" with adhesive that wrap around the sides of the underwear. This is a critical design feature that prevents the pad from shifting, bunching, or twisting during movement, ensuring it stays exactly where it is needed to provide protection.

When we consider this intricate, multi-layered system, the answer to "what happens if you use tissue as a pad" becomes starkly clear. Tissue paper attempts to perform all these functions with a single, ill-suited material, and it fails on every count. It fails as a topsheet by holding moisture against the skin. It fails as a core by lacking the capacity and mechanism to lock fluid away. It fails as a backsheet by offering no waterproof barrier. And it fails structurally by lacking any means of staying in place.

Understanding the risks associated with makeshift solutions is the first step toward prioritizing menstrual health. The second step is proactive preparation. The panic that leads to using tissue as a pad is almost always a result of being caught unprepared. Creating a small "period emergency kit" to keep in a backpack, purse, car, or office drawer is a simple yet powerful strategy. This kit need only contain a couple of sanitary napkins or tampons and perhaps a pain reliever and a pair of clean underwear. This small act of preparation can transform a potential crisis into a manageable inconvenience.

When selecting products, it is beneficial to consider one's own body and needs. Menstrual flow is not uniform. A person might need a highly absorbent pad for overnight use or the first heavy days of their cycle, and a much lighter, thinner liner for the last days. Activity levels also matter; pads designed for sports are often shaped differently and have enhanced adhesion to cope with vigorous movement. For those with sensitive skin, seeking out products that are hypoallergenic, fragrance-free, and dye-free can make a significant difference in comfort. Many manufacturers, such as Childsea, offer a diverse portfolio of products to meet these varied needs.

The conversation around menstruation is, thankfully, becoming more open. This allows for a greater sharing of knowledge and a reduction in the stigma that can lead people to suffer in silence. Understanding the science behind why one product is safe and effective while another is risky is a form of bodily literacy that empowers individuals to be advocates for their own health and well-being.

Frequently Asked Questions

1. Is it okay to use tissue as a pad for just a few minutes until I can get a real one? For a very short duration, such as the time it takes to walk from a public restroom to your car to get a pad, using tissue is unlikely to cause significant harm. However, the primary risks—leakage and disintegration—can happen very quickly. It is a stopgap measure that should be replaced with a proper product at the absolute earliest opportunity. Think of it as a temporary patch, not a solution.

2. What about paper towels? Are they better than toilet tissue? Paper towels are generally more durable and absorbent than toilet tissue, but they share many of the same fundamental flaws. They are not sterile, they lack a moisture-locking core and a waterproof backing, and their rougher texture can be even more irritating to sensitive vulvar skin. While perhaps marginally better than toilet tissue in terms of structural integrity, they still pose risks of irritation, inadequate protection, and hygiene issues.

3. I have a very light flow. Is it still risky to use tissue? Even with a very light flow or for spotting, using tissue is not ideal. While the risk of dramatic leakage is lower, the risks of skin irritation from moisture and friction, as well as the potential for disintegration and bacterial growth, remain. For light days, a thin panty liner is a far superior choice. Panty liners are specifically designed for this purpose: they are breathable, have an adhesive strip, and provide a comfortable, hygienic barrier.

4. What are some safe alternatives if I'm truly stuck without a pad or tampon? If you are in a situation with absolutely no access to commercial menstrual products, the next best option is to create a makeshift pad from the cleanest, softest, most absorbent cloth available. A folded, clean cotton handkerchief, a piece of a t-shirt, or multiple layers of gauze from a first-aid kit would be preferable to paper products. Cloth is more durable, less likely to disintegrate, and often softer on the skin. This should still be considered an emergency measure to be replaced as soon as possible.

5. Can using tissue as a pad cause Toxic Shock Syndrome (TSS)? The direct link between using tissue as a pad and TSS is not established, as TSS is caused by specific bacterial toxins. However, any practice that compromises menstrual hygiene can theoretically alter the vaginal environment in a way that might favor the growth of the bacteria responsible for TSS (Staphylococcus aureus or Streptococcus pyogenes). The non-sterile nature of tissue, its tendency to trap bacteria in a moist environment, and the potential for it to cause micro-abrasions on the skin all create a less-than-ideal hygienic situation. While the risk is likely very low, it is not zero. Using products designed and tested for menstrual hygiene is the safest course of action.

6. Does the type of tissue (e.g., facial tissue vs. toilet paper) make a difference? Facial tissue is often softer and may be slightly stronger than toilet paper, but it frequently contains added lotions, perfumes, or other chemicals that can be highly irritating to the vulvar area. Toilet paper is designed to break down most quickly. Neither is a good option. The fundamental problem is that they are paper products designed for disposal, not for prolonged, intimate contact with the body as a fluid-collection device.

7. How does using tissue compare to period poverty solutions in history? Throughout history, before the invention of commercial pads, menstruating individuals used various materials like moss, rags, wool, or grass. While these were the best options available at the time, they came with significant hygiene and health challenges. Using tissue today is, in a way, a regression. We have access to advanced, safe, and effective technology. Choosing to use tissue instead of a modern pad means forgoing decades of scientific advancement in materials and health, and re-introducing risks that these innovations were specifically designed to eliminate.

Conclusion

The impulse to reach for tissue paper in a moment of menstrual need is a testament to human ingenuity in the face of a common predicament. It is a practical, on-the-spot response. Yet, as this exploration has demonstrated, the gap between this improvised solution and a purpose-designed sanitary product is vast, with implications that extend far beyond mere inconvenience. The analysis of what happens if you use tissue as a pad reveals a cascade of interconnected risks, moving from the immediate physical failure of leakage to the microscopic battles being waged on the skin's surface and within the vaginal ecosystem, and culminating in a psychological toll of anxiety and discomfort.

The architecture of a modern sanitary napkin is a quiet marvel of engineering, a multi-layered defense system designed in harmony with female physiology. It seeks to manage moisture, protect skin, prevent infection, and provide a secure foundation for confidence and dignity. To substitute this with a material engineered for the opposite purpose—to fall apart quickly—is to ignore the profound importance of specialized care for a unique and sensitive part of the body. The choice is not merely between a good product and a bad one; it is between a system that supports health and one that potentially undermines it. Fostering a deeper understanding of these dynamics is not about creating fear, but about cultivating respect—respect for our bodies, for the science of health, and for the importance of making choices that affirm our well-being.

References

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Koumans, E. H., Sternberg, M., Bruce, C., McQuillan, G., Kendrick, J., Sutton, M., & Markowitz, L. E. (2007). The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sexually Transmitted Diseases, 34(11), 864–869. https://doi.org/10.1097/OLQ.0b013e318074e565

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Schlievert, P. M., Brosnahan, A. J., & The GALE Group. (2020). Menstrual toxic shock syndrome. The American Journal of Medicine, 133(4), 425–426.

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van der Wouden, J. C., van der Sande, M. A. B., & van Suijlekom-Smit, L. W. A. (1997). The relationship between personal hygiene and vaginal complaints. Family Practice, 14(3), 209-213.

World Health Organization. (2024). Menstrual health. WHO.