What can be done to reduce body odor?

The source of your daughter’s body odor is her skin glands, especially under her arms. Beginning around the time they’re 8 years old, girls produce more sweat in this area. Initially, human sweat is odorless. (Honest!) But when it becomes mixed with the bacteria that are normally present on a person’s skin, and then you add in some body heat, watch out. The funky odor begins.

Once this biological process begins for your daughter, she may need to begin bathing daily in order to reduce the amount of bacteria on her skin. This doesn’t need to be an elaborate process of soaking in bubble bath and scrubbing her skin raw. (In fact, both of these steps would do more harm than good to her body.) Rather, a quick rinse in the shower with a mild soap on a regular basis should do the trick.

Another step you can take to help your daughter in this embarrassing situation is to buy her loose-fitting clothing made of natural fibers. These types of clothes allow air to circulate around your daughter’s body and let her sweat evaporate. And needless to say, she shouldn’t wear sweaty clothes two days in a row.

If regular showering and the appropriate clothing don’t fully address the problem, you may want to consider having your daughter use antibacterial soap. Also, you should take a look at her diet. As we all know as adults, people can take a shower every day and wear only freshly laundered clothes, but if they eat food with lots of garlic, onions, and spices, they’re undoubtedly going to produce a noticeable body odor. (And, undoubtedly, they’ll end up standing right next to you on a crowded elevator.)

Are there helpful tips for inserting tampons?

Now that you know all of this information about tampons, it’s time to tell you the secret to effortlessly inserting tampons so that you can pass it along to your daughter.

But guess what? The secret is that there really is no secret.We gynecologists don’t have any special insights or methods that we learned in medical school or elsewhere. (Sorry about that.) However, the tips and steps listed below can be quite helpful to you and your daughter.

• First, your daughter should read the instructions in the tampon package. The pictures that accompany the directions can be particularly helpful.
• You should tactfully ask your daughter whether she wants help inserting a tampon for the first time. It’s her decision.
• Your daughter should try her first tampon on one of the days that her menstrual flow is the heaviest. This helps to ensure that dryness is not an issue during insertion or removal.
• Your daughter should start out using “slim” or “slender” tampons because they tend to be more comfortable. Also, it would probably be wise for her to choose a tampon with a rounded, smooth applicator because they typically are more comfortable than applicators with blunt ends.
• She may want to apply a small amount of lubrication such as K-Y Jelly to the applicator tip because it can help ease the insertion.
• Your daughter should find a position that is comfortable for her to insert the tampon. Most women insert a tampon while sitting on the toilet, but other women, especially adolescents, may find it’s easier if they remain standing in the bathroom and place one foot up on the toilet seat.
• Your daughter should relax as she inserts the tampon. Tensing the vaginal muscles causes resistance to the tampon, thereby making insertion more uncomfortable.
• She should hold the applicator between her thumb and her middle finger. Her index finger should be kept free so that she can push in the tampon.
• Using her other hand, she should separate the labia (lips) of her vagina and insert the tampon applicator into the vaginal opening.
• Some adolescents find that a small hand mirror is initially helpful in locating the vaginal opening.
• Using her index finger, she should push the tampon all the way in while holding the applicator steady with her thumb and forefinger.
• She should then remove the applicator, being careful not to pull on the tampon string.
• Your daughter can remove the tampon at any time simply by pulling on the string.

It’s important for your daughter to know that once the tampon is inserted she shouldn’t feel it or even sense that it’s there. If it’s constantly making its presence known, it may be positioned incorrectly or not be inserted far enough. The best thing to do in that case is to remove the tampon and try again with a new one. Remind your daughter that practice makes perfect with tampon use, and with time it will become a comfortable routine during a rather uncomfortable time of the month.

What myths about tampons are circulating on the Internet?

When your daughter starts using tampons, she’ll probably rely on the Internet or her friends to get information about them. You should know that tall tales abound when it comes to tampons, and questionable Web sites often add unfounded, unproven, and just plain wrong information. Therefore, it’s important for you to be able to set the record straight. In doing so, you should remember the following facts to combat common, but completely silly, rumors:

1. Tampons CANNOT be lost forever in a woman’s body. A tampon remains in the vagina no matter what. It cannot migrate anywhere else.
2. Tampons do NOT cause AIDS.
3. Manufacturers do NOT add asbestos or other materials to tampons to cause an increase in menstrual bleeding, which then boosts sales.
4. Tampons do NOT contain hazardous levels of dioxins which are cancer-causing agents and which are claimed to be produced through the tampon bleaching process. (The bleaching process is designed to clean and purify the raw materials used in tampons. In conjunction with the Environmental Protection Agency, tampon manufacturers tested their products for dioxin. The levels of dioxin in tampons ranged from undetectable to 1 part in 3 trillion, far below the level that occurs through daily environmental exposure and considerably below the level the FDA believes would put consumers at risk.)
5. Tampon use does NOT affect virginity.

What is my daughter’s risk of getting TSS and how can she avoid it?

Younger females, such as those under 30, may be at a higher risk for TSS because they have not yet formed antibodies to the staph toxin. Therefore, it’s important for you and your daughter to be vigilant for TSS. However, it’s also important to know that there now are actually very few TSS cases reported each year.

Toxic Shock Syndrome became a hot topic in 1980 when 813 cases of menstrual-related cases of TSS—and 38 deaths—were reported. Research ended up showing that use of a specific type of tampon that is no longer on the market put women at a higher risk of TSS than use of other tampons. This tampon was made with a new combination of materials including polyester foam  and a highly absorbent cellulose that enhanced absorption. Although not all TSS cases occurred in women who used this specific type of tampon, it clearly played an important role. Therefore, it was removed from the market, along with other new, highly absorbent tampons of similar substances.

Because of the discontinued use of these types of tampons, as well as the Food and Drug Administration’s regulation of tampon materials and absorbency, there has been a dramatic drop in the number of TSS cases. In 1997, only six cases were confirmed, and in 1998, only three cases. Nevertheless, the FDA recommends that women take the following steps to avoid tampon problems:

• Follow the package directions for insertion;
• Choose the lowest absorbency that will handle your menstrual flow;
• Change your tampon at least every 4 to 8 hours;
• Consider alternating pads with tampons;
• Don’t use tampons between periods; and
• Know the warning signs of Toxic Shock Syndrome.

What are the symptoms of TSS?

The symptoms of TSS include fever, vomiting, dizziness, diarrhea, fainting, a sunburn-like rash, muscle aches, sore throat, headache, joint pain, red eyes, and sensitivity to light. As the illness progresses, TSS can also lead to mental confusion, kidney failure, a drop in blood pressure, and collapse. One to two weeks after the initial symptoms, peeling patches of skin on the palms and soles can occur.

These symptoms typically appear during a woman’s period or a few days after. If a woman suspects she has TSS, she should remove her tampon immediately and call her doctor or go to the emergency room for immediate evaluation. Treatment requires hospital admission for intravenous antibiotics to kill the bacteria, intravenous fluids to treat the low blood pressure and dehydration, and observation and treatment for signs of kidney failure. With appropriate treatment, most patients will recover in 2 to 3 weeks.

What is Toxic Shock Syndrome?

Toxic Shock Syndrome (or TSS) is a rare but potentially life-threatening illness. Researchers believe it is caused by an infection resulting from certain staph and strep bacteria that often exist even in a healthy woman’s vagina. The exact process is unknown, but it’s thought that these bacteria multiply in the presence of a bloodsoaked tampon. It’s actually not the bacteria that cause the TSS directly. Rather, it’s the toxins that the bacteria produce that do the harm.

It’s important to note that staph bacteria are very common.We all have them on our skin and inside our noses. Usually they are harmless, but if they gain access to the bloodstream or deeper tissue, they can cause a serious infection.

For TSS to occur, certain strains of the bacteria have to overpopulate and produce large amounts of toxin. This toxin then has to gain access to the bloodstream. One generally accepted theory is that super-absorbent tampons that are left in the vagina for extended periods of time can encourage growth of the bacteria. And importantly, these super-absorbent tampons can also adhere to the vaginal wall if they are dry and the menstrual flow is light, thereby causing tiny abrasions when removed. These abrasions then provide access to deeper tissue or to the bloodstream for the bacteria and toxins.

How can my daughter choose the right tampon?

The type of tampon that is right for your daughter depends on her menstrual flow. Simply stated, she should match the absorbency of the tampon to her flow. If she has a light flow, then she should try the junior or regular tampon. If her tampon is completely soaked before 4 hours, she should try one with higher absorbency.

However, you should caution your daughter that if a tampon is too absorbent for her flow, vaginal dryness and even vaginal ulcerations can occur. If a tampon is dry and hard to remove, shreds, or doesn’t need to be changed for many hours, she should switch to a less absorbent tampon. Why is this important? Because research suggests that the risk of Toxic Shock Syndrome may increase with tampon absorbency. However, please note this doesn’t mean your daughter should shy away from using higher absorbency tampons if she really needs them.

What are the different types of tampons?

The Food and Drug Administration now regulates tampon absorbency, which is defined as the rate at which a tampon soaks up menstrual blood. Absorbency is measured in grams of fluid, and you will find absorbency ratings on all tampon boxes. Specifically, the following tampons are readily available:

• Light or Junior Absorbency: 6 grams of blood or less. This tampon is good for the end of a woman’s period when she has the lightest flow.
• Regular Absorbency: 6 to 9 grams of blood. As the name suggests, this tampon is good for many women on most days of their periods.
• Super Absorbency: 9 to 12 grams of blood. This tampon will provide the extra absorption that some women need on their first 1 to 2 days of heavier bleeding.
• Super-Plus Absorbency: 12 to 15 grams of blood. Some women experience especially heavy bleeding on their period and may require this tampon.
• Ultra-Absorbency: 15 to 18 grams of blood. Most women will never need to use this tampon. If this tampon is necessary, a visit to the gynecologist may be wise in order to evaluate the cause of this extremely heavy menstruation.

When should my daughter use tampons?

After using sanitary pads for a while, it’s likely that your daughter will tell you one day that she’d like to try tampons. That means it’s time for you to go to the store and stare at the many options on the shelf. (And when I say “you,” I mean that in the singular rather than the plural form. Unless you’re willing to travel to a different state and perform your task in disguise, don’t count on your adolescent daughter being willing to stand in a store aisle next to you as you both publicly survey the menstrual products they have available.)

What are reusable menstrual pads?

One product that seems to be gaining increased attention is reusable menstrual pads. These are washable, highly-absorbent cloths that are usually secured by wings around the underwear. In many ways they are a modern version of what was used by women in “the old days” during their menstrual cycles. (In fact, it’s from this practice that the demeaning and archaic phrase “on the rag” comes from.)

Although relatively few women use reusable menstrual pads, they do have certain advantages:

• They are allergen-free, chemical-free, and perfume free and are thus less likely to cause irritation and contact dermatitis on the vulva and the vagina, and they are generally more comfortable for women with sensitive skin.
• They are less expensive than disposable pads over the long term.
• They carry less menstrual odor and are more breathable.
• They are environmentally friendly because they are made of natural materials rather than plastic and do not contribute to growing landfill problems.

Reusable pads do have disadvantages, however. For instance:

• They are more time consuming due to the need to wash and dry them.
• Washing them is not particularly easy because the
water with the menstrual blood needs to be disposed of properly.
• If the user has a yeast infection the pad must be sanitized in order to prevent re-infection.
• Their initial cost is higher, although over time they become more economical.

Reusable menstrual pads are certainly not for everyone, but they are worth considering if they fit your lifestyle.

What should my daughter know about sanitary pads?

Sanitary pads are the mainstay for adolescent girls as they adjust to the new phenomenon of menstruating. As I think back to the days when you had to fiddle with the old sanitary napkin belt and the bulky, leaky pads of the 1970s, I realize just how much easier girls have it now. Pads nowadays are more absorbent, more comfortable, and have better features such as side wings and increased length to prevent leakage.

These aren’t the only changes when it comes to sanitary pads. When disposable pads first became available, in many stores women placed their money in a box and then took a package of sanitary napkins from the counter so that they wouldn’t have to undergo the embarrassment of dealing with the male sales clerk. But today, you’re likely to end up viewing a multitude of commercials for sanitary pads while you’re just trying to watch a little TV with your teenaged son.

What menstrual issues should prompt me to take my daughter to a doctor?

In addition to routine preventive health visits, there are certain signs related to menstruation that should prompt you to contact a doctor about your daughter’s health. Specifically, you should schedule an appointment if your daughter’s menstrual period:

• has not started within 3 years of her breast development;
• has not started by age 13 and there are no other signs of the onset of puberty;
• has not started by age 14 and she is experiencing excessive hair growth on her body;
• has not started by age 14 and you suspect that she is engaging in excessive exercise or may have an eating disorder:
• has not started by age 15;
• became regular, but then became noticeably irregular;
• occurs more frequently than every 21 days or less frequently than every 45 days;
• occurs more than 90 days apart, even for just 1 cycle;
• lasts more than 7 days;
• requires frequent pad or tampon changes (such as soaking more than one pad or tampon every 1 to 2 hours).

In many cases, even with these signs and symptoms, a doctor will conclude that an adolescent girl is just fine. But in other cases, medical treatment will be required. That’s why medical evaluations are so helpful. They’re indispensable to us as we fulfill our sacred responsibility as mothers.

What body changes accompany menstruation?

Once your daughter’s menstrual cycle begins, she’s going to notice some other bodily changes as well. Because of a rise in estrogen levels, which stimulates the vaginal tissue and the glands in the vagina, she is going to experience more secretions and lubrication. In fact, a small amount of non-odorous vaginal discharge is normal.

During this time frame, a girl’s vagina also becomes colonized by “good” bacteria. These are known as lactobacillus bacteria, and they are essential in balancing the environment in the vagina and warding off infections.

Why are preventive health visits important?

The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists both recommend routine preventive health visits for adolescent girls. I strongly encourage you to follow their guidance. These visits not only provide an opportunity for a doctor to evaluate your daughter’s health, but they also provide both you and your daughter with an opportunity to answer any questions you may have.

These check-ups can be part of a routine appointment with a family doctor. Similarly, a pediatrician can evaluate your daughter’s health, and they typically are an excellent source of information. As an alternative, you should feel free to schedule an appointment for your daughter with a gynecologist. I can assure you that in most cases there will be no need for the gynecologist to conduct a pelvic exam.

What symptoms will my daughter experience during her periods?

Many girls and women notice a change in their bowel habits around the time of their period. This is caused by prostaglandins, which are hormones released by the uterus during a menstrual cycle. These prostaglandins can cause nausea, intestinal cramping, and diarrhea. These unpleasant symptoms can occur to such a degree that otherwise healthy women and girls find it necessary to stay home from work or school during “that time of the month.”

When my patients tell me they’re experiencing these problems, I recommend that they take ibuprofen or Naprosyn. These medications are known as antip rostaglandins. As such, they can alleviate the nausea, cramping, and diarrhea. Similarly, oral contraceptives can greatly reduce these symptoms because they, too, have an antiprostaglandin effect.

When will my daughter enter puberty?

Interestingly, there are a number of factors that can influence when a girl enters puberty. Of course, as we’ve seen, genetics plays a very important role. However, there are other variables as well, some of which are rather surprising. For instance, not only does nutrition have an impact on when a girl first begins menstruating, but so too does the altitude at which the girl lives, how close she lives to the equator, and how heavy she is; some researchers even claim it can be affected by whether there is a father-figure in the household.

In general, during the past few decades there has been a noticeable decrease in the age at which girls in the United States enter puberty. Some people believe that this is a direct result of the hormones that are administered to cows. Their concern is that these hormones eventually end up in the cows’ milk, and then, in turn, they end up in our daughters’ bodies when they drink this milk. This hypothesis has been hotly debated over the years, but as of now, it is not generally accepted by the medical community. The more accepted theory regarding the declining age for the onset of periods relates to the increased prevalence of childhood obesity. Simply stated, the heavier the adolescent girl, the earlier she will menstruate.

How frequently will my daughter have periods?

Once your daughter’s menstrual cycle becomes more regular, she should expect to have a period every 25 to 30 days. However, it’s not uncommon for girls to have periods as frequently as every 21 days, or as spread out as every 45 days.

The time lapse between periods is highly dependent upon genetics, stress, and weight. You should also know that there are many documented cases where girls have essentially stopped having periods during times of grueling physical exertion, such as long-term training to run in marathons, or if they are anorexic. The American College of Obstetricians and Gynecologists recommends that adolescent females seek a medical evaluation if they have irregular menstrual cycles that occur less than every 90 days.