The European Union banned titanium dioxide in food earlier this year, according to the U.S. Department of Agriculture's Foreign Agriculture Service. OK, so what about titanium dioxide in tampons, which sit inside you for hours at a time? It can also be found in a variety of beauty products and lotions such as sunscreen. Some research, mostly conducted in animals, has found titanium dioxide to be harmful when inhaled and consumed, typically in large quantities. There is some In a previous blog post, Jayesh debunked the myth that non-organic pads can cause cancer since study after study has not proven this. "While most cosmetic products will disclose whether or not titanium dioxide is an ingredientsome states require itit is important to note that the FDA does not currently require brands to disclose this information.". I will share what I know about titanium dioxide in tampons! Ingestion: likely not harmful at the low levels we typically encounter it. Toxins released from rayon can also rarely cause tissue necrosis for people who regularly wear clothing made of this fabric. If a tampon shortage in the USA wasnt enough, theres now a terrifying TikTok about the effects of titanium dioxide in tampons with an emotional story that hits home for menstruators. Sunscreen, for example, can have up to 25% titanium dioxide nanoparticles, and both the FDA and EU consider it to be safe. This lack of data is incredibly frustrating, given that 26 percent of the global population are of reproductive age and presumably using pads and tampons on the regular to manage their cycles. To say this guy likes his scientific studies is an understatement. Because lets face it- we should not be putting toxic chemicals inside of our bodies on a regular basis. Because of the mixed evidence, it was classified as "possibly" carcinogenic. There have been studies in animals that have shown the carcinogenic effects of titanium dioxide when inhaled. As I mentioned earlier, vaginal pH imbalances can lead to different bacterial and fungal infections. Aug. 6, 2022, theSkimm, "What To Know About Titanium Dioxide In Tampons and Skittles," Aug. 4, 2022, The Vajenda, "Titanium dioxide isn't making tampons into toxic death sticks," Aug. 3, 2022, Kimberly-Clark, "U by Kotex Ingredients and Purposes," accessed Aug. 8, 2022, L. (tampon brand), "FAQs," accessed Aug. 9, 2022, Tampax, "What are tampons made of?" If you think of all the cosmetics and dyes and candy and food its everywhere, Dr. Jennifer Wu, an OB-GYN at Lenox Hill Hospital, told TODAY. It is the mostwidely used white pigment because of its brightness and very high refractive index meaning that its "brilliant whiteness" does not allow light to pass through. Lincoln said this led some to believe that the substance has been proven to be cancerous. But there is also no published research on vaginal Some country-level occupational health and safety organizations cite a lack of high-quality studies from which they can draw any concrete conclusions about the long-term risks of titanium dioxide exposure. How can this be? Titanium dioxide can also be in food, according to the National Library of Medicine. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); The International Agency for Research on Cancer (IARC), California Environmental Protection Agency, https://www.epa.gov/sites/production/files/2016-09/documents/carbon-disulfide.pdf, https://www.ccohs.ca/oshanswers/chemicals/chem_profiles/titanium_dioxide.html, https://www.healthline.com/health/is-polypropylene-safe, https://balmonds.co.uk/blogs/blog/the-problem-with-paraffin-in-emollients, https://en.wikipedia.org/wiki/Polypropylene#Health_concerns, https://cfda.com/resources/materials/detail/rayon-viscose, https://davidsuzuki.org/queen-of-green/dirty-dozen-peg-compounds-contaminants/, https://www.healthline.com/health/womens-health/vaginal-ph-balance. Environmental and reproductive health experts have mixed views on how safe titanium dioxide in menstrual products is, but there's no evidence the tampons cause reproductive health problems like ovarian cysts or cancer. Theres no evidence of cancer due to titanium dioxide in tampons but that may be because there simply arent any studies in this regard.. For example, when the substance is applied via sunscreen, sufficient data have found titanium dioxide to be "generally recognized as safe and effective," per the FDA. As an emergency roomdoctor, there would be many possible (and more likely) emergency room causes of excessive menstrual bleeding that I would evaluate a patient for. Sunscreen can safely contain up to 25% titanium dioxide. You cant just say just because you breathe something in and it causes cancer that its also going to cause cancer in a different route, Lincoln explained. Tampons are great. The amount of titanium dioxide in each tampon is minuscule. So now that you know why you should avoid conventional menstrual products at all costs, lets explore some healthier alternatives and brands! Before I wrote this blog, I knew tampons and pads contained harmful chemicals but I will admit that Im a bit shocked by the amount of information there is on this already. ", Dr. Eyvazzadeh and Flynn agree that it's okay to approach the ingredient with caution. Toxic shock syndrome (TSS) occurs when a super-absorbent tampons is inserted for longer than medically recommended, which may lead certain types of bacteria to grow. This greatly increases the risk of residues being present in your personal products and can throw off the natural pH balance within your vagina. "For example, inhaling it at high concentrations can irritate the nose and throat." As for the potential risks (or lack thereof!) Lincoln said this led some to believe that the substance has been proven to be cancerous. An additional two satellite groups underwent the same protocol for 45 days and for Your official excuse to add "OOD" (ahem, out of doors) to your cal. [TiO2] may cause cancer based on studies done on animals, and it Full disclosure: our ingredient list is simple and does not contain titanium dioxide or any other chemicals or fragrances. as well as other partner offers and accept our. Retrieved May 11, 2021, from https://www.epa.gov/sites/production/files/2016-09/documents/carbon-disulfide.pdf, Government of Canada, C. C. (2021, May 09). I also love that they use 100% organic cotton, are plastic & fragrance free, totally chlorine free and are biodegradable! Titanium dioxide has bubbled up to the top of our feed again, but this time it's not in Skittles, it's in tampons. More:Which supplements are most likely to land you in the ER? In fact, in 2021 the European Food Safety Authority (EFSA) declared titanium dioxide no longer safer as a food additive. "But it's the dose, it's the route that makes the 'poison,' and so just because something might cause lung cancer, for example, doesn't mean it's going to cause an issue in a tampon. debunked the myth that non-organic pads can cause cancer. TikTokers are raising concern about an ingredient in an organic tampon brand that they say is causing symptoms like heavy bleeding and ovarian cysts. But this is not the only report that is sparking concerns. Wang, J. J. "If you use these, STOP RIGHT NOW!! Retrieved May 11, 2021, from https://balmonds.co.uk/blogs/blog/the-problem-with-paraffin-in-emollients, Mancini, F., Bruggen, A. H., Jiggins, J. L., Ambatipudi, A. C., & Murphy, H. (2005). However, titanium dioxide isn't just a popular ingredient in food. We need your help. On supporting marriage rights for same-sex couples. (2021, May 01). As a result, it's not too difficult to shop for TiO2-free tampons if you're concernedand have the financial means to do so. There's not much information on how titanium dioxide could affect health when used in tampons. Once that social media seed is planted, it is extremely difficult to convince people otherwise. However, that is unfortunately not the case for pads and tampons. Rayon is a semi synthetic fabric made from recycled wood pulp. A few weeks ago, Dr. Jennifer Lincoln started receiving messages on social media from people worried about titanium dioxide Cancer is a complex phenomenon that can be correlated with many factors. (LogOut/ Its a compound that reflects light particles. So inhalation at higher concentrations may not be advisable, but inhalation clearly isnt a risk when tampons are used according to their intended purpose. Titanium dioxide tampons are made from a material that does not absorb fluid, which is great for those with anemia or other conditions that can lead to heavy menstrual bleeding. Organyc is also a safe and clean choice for menstrual products. And though tampons have not been linked to cancer or reproductive harm, experts say more research is needed. of using pads and tampons with titanium dioxidewe just don't know for certain. A few weeks ago, Dr. Jennifer Lincoln started receiving messages on social media from people worried about titanium dioxide in tampons. Despite a small percentage ofTiO2 present in the product, low toxicity risk and an unsupported cause-and-effect exampleare both factors that led me to debunk this claim. It's unclear exactly how many brands use TiO2 in their menstrual products. Myths about aluminum and deodorant, explained. There is some evidence to suggest that titanium dioxide may have a carcinogenic effect in some formats. " Is polypropylene a safe plastic to use in your home? Theyve got their ingredients listed on the box and on their website.. Its widely used in the fashion industry because of its ability to mimic the look and feel of other fabrics such as silk, cotton, wool and others. Acute Pesticide Poisoning among Female and Male Cotton Growers in India. In a previous blog post, Jayesh. "Our high-quality ingredients are rigorously tested and meet strict safety and government regulations around the world.". "Most tampons list their ingredients on the back of the package," Dr. Gohar says. Both TikTok users are falling prey to the correlation, not causation trap. Environmental and reproductive health experts have mixed views on how safe titanium dioxide in menstrual products is, but there's no evidence the tampons cause Aside from the negative health effects associated with GM cotton, thousands of cotton farmers and their families suffer from pesticide poisoning every year. The ban was related to really concern and hypothetical risks, she stressed. joni's non-applicator tampons are made with 100% organic cotton and nothing else. In other words, over the billions of tampons used, a handful of cases have found that tampons contributed to cancer but did not cause cancer. Less than 0.1% of titanium dioxide is used in the total ingredients of tampons. Below, Dr. Eyvazzadeh and Erin Flynn, MPH, DNP/FNP, an LGBTQ+ care expert with birth control startup Favor, share the complicated truth behind this question. If you Google titanium dioxide and cancer, you are going to see studies that show it has been linked with cancer. Whats lost in translation is that its really related to the inhalation of titanium dioxide, not (when it's) used internally, such as a tampon," she explained, adding that the research is in rats. The second reason? And its equally important to question the motivations behind trending conspiracies that prey on emotions (and boost social virality), adds Jayesh. And as of March 2022, the FDA maintains its position that titanium dioxide may be safely used as a food coloring. ", "Titanium dioxide is not an issue," she said, adding that "titanium dioxide doesn't cause reproductive harm when it's on a tampon string.". Fortunately, many new wave period-care companies are extremely transparent about their ingredients lists. And in 2020, The European Unions Scientific Committee on Consumer Safety advised against aerosol and spray products that contain more than 1.4% titanium dioxide due to concerns about inhalation. We recommend looking at the whole picture by looking for certifications and asking what those certifications entail. Titanium dioxide is chemical substance used in many products to make them look whiter, according to ChemicalSafetyFacts.org. Myths about aluminum and deodorant, explained, Ive written multiple times in this column. No added chemicals. Theyre really tightly regulated. However, trouble arose for the ingredient in 2021 when the European Food Safety Authority (EFSA) issued a statement that titanium dioxide "could no longer be considered safe" as a food additive. For instance, certain plastics and artificial adhesives have been shown to increase the risk of vulva-vaginal infections and contact dermatitis. USDA Organic certification may only be displayed on products that are 100% organic. A cure for cancer, known as a Rife machine, was found in 1934. Fear of tampons may persist because of their association with toxic shock syndrome, Greves and Lincoln theorized. What to Know About Food Additive Titanium Dioxide, Release of Titanium Dioxide from Textiles during Washing, Tampon wars: the battle to overthrow the Tampax empire. Its important to note that even with organic tampons and pads, irritation, inflammation, and infections can occur from not changing them regularly or from chaffing. The compound is used safely in many foods and cosmetics, but it's still banned in foods in the UK. As you can see, there is not much regulation that goes into the manufacturing of menstrual products. Our only agenda is to publish the truth so you can be an informed participant in democracy. according to the U.S. Department of Agriculture's Foreign Agriculture Service, Periods happen: Heres how 2 sisters are normalizing the taboo, Lauren Wasser, model who lost leg to toxic shock syndrome, speaks out, according to the Centers for Disease Control and Prevention. There are several health concerns regarding TiO2. There are many substances, including medications, that we safely encounter or consume on a regular basis. We definitely need more activism and awareness around this issue! You would think that with all of the evidence behind the dangers related to this ingredient that it would not be used in menstrual products, however there is very little regulation as you can see! This ingredient is used by Tampax as a wax to keep the [tampon] string clean. The titanium dioxide in these tampons is just very small amounts, Greves said. Examples of this include the follicular phase, ovulatory phase and the luteal phase. There is no published research available currently that has examined the impacts of vaginal or vulvar exposure to titanium dioxide. Aimee Eyvazzadeh, MD. They are about the same price as regular pads and tampons, but contain much cleaner ingredients! Its use as a food additive was banned in the European Union. Non-organic period care may also have fragrances or use bleach that can cause irritation, so its important to find the product that works for you individually and use it as directed. There's also a little bit of evidence to suggest that the common ingredient may be an endocrine disruptor, says Flynnmeaning it may affect a person's hormonal system. Throughout the week of our actual menstrual cycle, it is so important to allow your body to do a full cleanse! Spending time in the sun increases your risk of skin cancer and early skin aging. In my opinion, if all site owners and bloggers made good content as you did, the net will be a lot more useful than ever before. TiO2 was nevertheless banned as a food additive in the EU as of this month. Massachusetts events honor legacy of Martin Luther King Jr. Fire breaks out at Wolfeboro grocery store. But titanium dioxide's possible deleterious effects extend beyond ingesting it. A post shared by Jen Gunter (@drjengunter), But not all doctors agree. And it would be a stretch to correlate a possible connection in rats to a true cause-and-effect in humans. Theres no evidence of cancer due to titanium dioxide in tampons but that may be because there simply arent any studies in this regard. In an interview with Popsugar, ob The experts agree that myths about tampons have long existed, and this is just the latest misconception. oft-cited study that shows that chronic high-level exposure of inhaled TiO2 could be linked to lung cancer in rats, expressed concern that TiO2 particles in food additives could accumulate over time in the body, the FDA continues to allow for safe use of TiO2 as a food additive, Why Epsom salt should be a staple in your home medicine cabinet, Your California Privacy Rights/Privacy Policy, Inhalation: can cause irritation of nose and throat at high concentrations, Eyes: can cause mild irritation as a foreign body sensation but tearing and blinking can safely remove the particles. I believe we all have a responsibility to better and more critically appraise social media content, particularly with regard to health and medical information. Sign up for notifications from Insider! As far as hypothetical exposure risk, the tampon would pose a more significant exposure as it is worn internally. But there's not much research to tell us what the potential effects are of TiO2 in certain other formats, like if you eat a little bit of it in food, or regularly insert small amounts of it in your body via a tampon for a few days each month. In Canada and the USA, organic claims must be verifiable but only a percentage of the product needs to be organic, and that percentage must be displayed. Yet Jayesh clarifies that simply because a brand uses materials that have been pre-assessed for health safety does not mean how theyre being used does not cause problems. But we dont know anything about how much is safe in tampons or if it accumulates in the body. "They use it to make the string look whiter.. Most people assume that menstrual products contain safe, non-toxic ingredients. "According to the U.S. Food and Drug Administration (FDA), regulated doses of titanium dioxide are not harmful, but this also varies based on use," Dr. Gohar says. The Beach Is My Happy Placeand Here Are 3 Science-Backed Reasons It Should Be Yours, Too. ", The post was flagged as part of Facebooks efforts to combat false news and misinformation on its News Feed. Manufacturers are expected to conduct "biocompatibility" tests, assess chemical residues in the device and determine how the tampon affects the vaginal microbiome, the collection of microbes that live naturally on and inside ones body. The classification as bio-inert material has given the possibility to normal-sized (>100 nm) titanium dioxide particles (TiO2-NPs) to be extensively used in food products and as ingredients in a wide range of pharmaceutical products and cosmetics, such The research from the IARC did however acknowledge that its lacking the connection to a human study that would confirm long-term effects. "As an oxide, titanium is found in minerals in the earth's crust and is also found with other elements, including calcium and iron. The doctors all praised how tampons make a lot of activities, like swimming, more accessible when you have your period, and stressed that people should feel comfortable using whatever menstrual products they like best. Full disclosure: our ingredient list is simple and. But the same 2010 assessment by the International Agency for Research on Cancer did not find adequate evidence that the same was true for humans. But no matter what your period product preference, you shouldn't be worried about whether it can harm your health. "Titanium dioxide is the naturally occurring compound created when titanium reacts with oxygen in the air," explains endocrinologist and advisor at reproductive-health company Natalist Aimee Eyvazzadeh, MD. The International Agency for Research on Cancer (IARC) classifies titanium dioxide as possibly carcinogenic to humans. Most big companies will do anything to make a bit of profit. They also have a longer lasting tampon than other types and can be inserted deep into the vagina without having to worry about them coming out. And as of March 2022, the FDA maintains its position that titanium dioxide may be safely used as a food coloring.. It's also is often used to make things like paint, and most relevant for our purposes, it's used to make pads and tampons appear whiter. If you Google titanium dioxide and cancer, you are going to see studies that show it has been linked with cancer. In the study, 48 regions were surveyed to estimate the global exposure to infants up to 12 months. This greatly increases the risk of residues being present in your personal products and can throw off the natural pH balance within your vagina. Chemicals and ingredients found in conventional tampons have many unadvertised side effects and dangers so lets get into it and explore healthier alternatives! Have an idea for an article? That said, with all the scientific evidence accumulating in other areas, consumers should be more aware of titanium dioxide's potential effect on reproductive health, Dr. Gohar says. This finding prompted the European Union to ban TiO2 as a food additive earlier this year, but in the U.S., the ingredient is still considered to be safe in food at the limits set by the FDA. The TikTok user who posted the video makes theclaim that TiO2 has been linked to cancer and multiple gynecological issues. They found values ranging from 14,600-4,550,000 particles per capita per day, depending on the region. "To date, there is no published research that has researched the impacts of vaginal or vulvar exposure to titanium dioxide," Eyvazzadeh said. Which supplements are most likely to land you in the ER? The European Union banned titanium dioxide in food earlier this year, according to the U.S. Department of Agriculture's Foreign Agriculture Service. We see tampons as something that could potentially harm us, Lincoln said. ". If you Google titanium dioxide and cancer, you are going to see studies that show it has been linked with cancer. And thats it. Lets look at what can happen with an acute TiO2 exposure: The last route absorption is the route of question when it comes to the TiO2 in tampons. L. brand tampons use titanium dioxide as pigment in the thread that attaches the stringto the absorbent part of the tampon. "But while no study has positively linked titanium dioxide exposure to ovarian cancer, miscarriages, or UTIs, we also dont have the science to assure us that this kind of exposure is perfectly safe either." Feminine hygiene products are seen as an employee restocks a shelf at Compton's Market, Wednesday, June 22, 2016, in Sacramento, Calif. (AP). Indeed, this white pigment lightens everything from paints, paper coatings and plastics to sunscreen, pharmaceutical tablets, flours and dairy products, according to the National Library of Medicine. What I want to get at here is that its so important to not add toxic chemicals to your cycle because this can later cause hormonal imbalances, bacterial infections or even a heavier flow. Theyve got their ingredients listed on the box and on their website.. (1992, April 11). The FDA also lists titanium dioxide as a safe ingredient for use in cosmetics. To decrease this risk, regularly use a sunscreen with a Broad-Spectrum SPF value of 15 or higher and other sun protection measures including: limit time in the sun, especially from 10 a.m. 2 p.m. wear long-sleeved shirts, pants, hats, and sunglasses Its really pervasive because its a whitening agent. Its very commonly used as a natural mineral and has been studied in rodents.. 20006, Florida The widespread use of titanium dioxide nanoparticles (TiO 2 NPs) in the food industry has brought about human safety risks related to nanotoxicity. A recent viral TikTok had social media users alarmed about the idea of tampons causing cancer because they contain titanium dioxide, but OB-GYNs say there's no data to Meanwhile, in the US, the FDA continues to allow for safe use of TiO2 as a food additive as long as manufacturers provide evidence that it is safe at its intended level of use. He studied Global Health at Georgetown University and has a Medical Degree from Ben-Gurion University. NASA photos of the moon and Earth show that space is fake., A small area in western Texas and southeastern New Mexico has enough oil to fuel America for the next 200 years., Florida Gov. Needless to say, we need to start voting with our money and stop buying products that we know are not good for us. We know its very important to remove the tampon, not to leave it in., Added Lincoln: I also think this is just my theory that anything that goes in the vagina, in this country, were somewhat scared of it. This greatly demonstrates that propylene plastics release micro plastics into our bodies and can have damaging health effects. He added that the vaginal mucosa has lots of blood vessels, which allow it to absorb what's in tampons, leading to complications like toxic shock syndrome. Yes, I know there are scary videos circulating on TikTok, but this is chemophobia. So while there is no evidence of danger, "we also dont have the science to assure us that this kind of exposure is safe either. A recent TikTok video went viral with thefalse claim that the titanium dioxide used in L. brand organic tampons is responsible for miscarriages, cancerand a host of other medical problems. "Titanium dioxide doesnt dissolve in water, meaning the nanoparticles arent going to dissolve from the tampon string and get into the blood that might be pooling in the vagina and then get absorbed by the body." According to Safe Cosmetics.org, titanium dioxide does not penetrate healthy or even unhealthy, burnt skin, and so "poses no local or systemic risk to human health" when used topically. However, these studies were conducted on mice who orally consumed titanium dioxide, so we'll still need extensive clinical research on humans before we can definitively link TiO2 with reproductive disruptionor assume those risks definitely come from other intakes of the ingredient. Whats lost in translation is that its really related to the inhalation of titanium dioxide, not (when it's) used internally, such as a tampon," she explained, adding that the research is in rats. Some country-level occupational health and safety organizations cite a lack of high-quality studiesfrom which they can draw any concrete conclusions about the long-term risks of Titanium dioxide is used in all kinds of products as a whitener, including toothpaste, sunscreen, and yes, period care. There's not much information on how titanium dioxide could affect health when used in tampons. Because exposure levels are very low, it is likely this is a very low carcinogenic risk. That said, well-known brands like Tampax and L. include TiO2 in their products, while brands like Rael, Cora, and The Honey Pot currently do not have this ingredient in their pads or tampons. July 29, 2022, European Commission, "Sunscreens with titanium dioxide as nanoparticles," accessed Aug. 9, 2022, The Journal of the European Academy of Dermatology and Venereology, "Safety of titanium dioxide nanoparticles in cosmetics," Nov. 2019, The Skin Cancer Foundation, "Sunscreen Safety," June 6, 2018, Today, "New York becomes first state to require ingredients list on pads, tampons," Oct. 12, 2019, The Atlantic, "The Tampon: A History," (archived) June 2015, The New York Times, "Are Skittles Toxic? Zero.. Titanium dioxide is a common ingredient in tampons, and tampon use has not been linked to cancer or reproductive harm. Dr. Sabrina offers ways to honor Martin Luther King Jr. and implement lessons in our lives. The video has 630,000 views and nearly 14,00 comments. accessed Aug. 9, 2022, Chemical Safety Facts, "Titanium Dioxide | Use, Benefits, and Chemical Safety Facts," accessed Aug. 8, 2022, International Agency for Research on Cancer, "Monographs on the Evaluation of Carcinogenic Risks to Humans VOLUME 93 Carbon Black, Titanium Dioxide, and Talc," 2010, International Agency for Research on Cancer, "Studies of Cancer in Experimental Animals - Carbon Black, Titanium Dioxide, and Talc," 2010, Healthline, "Titanium dioxide in food Should you be concerned?" For us, choosing organic is a proactive choice. "The potential risks of titanium dioxide vary depending on the method of exposure," said Dr. Aimee Eyvazzadeh, a gynecologist who runs a fertility clinic in California. Washington, DC Microplastic release from the degradation of Polypropylene feeding bottles during infant Formula Preparation. There is no evidence that tampon use (generally) causes cancer, reproductive damage or ectopic pregnancy according to the American College of Obstetricians and Gynecologists. 4 Mistakes That Are Causing You to Waste Money on Skin-Care Serums, According to an Esthetician, These Are the Best Anti-Chafing Denim ShortsAccording to Some Very Happy Reviewers. PEGS or polyethylene glycols are petroleum-based compounds that are widely used in the cosmetic industry as thickeners, solvents and softeners. And just as titanium dioxide has not been tested for use with tampons, certified organic tampons have not been tested for any negative or positive medical results. We go through many phases both before and after our monthly cycles based on the hormones being released. And linked it to cancer and damage to (LogOut/ So are organic tampons better? Plus, Gunter explained that titanium dioxide tends to stick to whatever fabric it is on, and is not easily washed out. ", In a statement provided by a spokesperson, the FDA said the agency regulates tampons as a medical device and "continues to allow for the safe use of titanium dioxide as a color additive when used according to the specifications requirements, including usage in amounts not to exceed the minimum reasonably required to accomplish the intended coloring effect.". I really appreciate your positive feedback . Passionate about periods? Its very commonly used as a natural mineral and has been studied in rodents.. One of our founding values at joni is radical transparency. 'S not much information on how titanium dioxide may be safely used a... National Library of Medicine can harm your health explained, Ive written times... Still banned in the EU as of March 2022, the FDA maintains its that. Plastic & fragrance free, totally chlorine free and are biodegradable each tampon is minuscule list is and... 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