Development of the reproductive system
The development of the reproductive system is a part of prenatal development, concerns the sex organs. It is a part of the stages of sexual differentiation; because its location, to a large extent, overlaps the urinary system, the development of them can be described together as the development of the urinary and reproductive organs. The reproductive organs are developed from the intermediate mesoderm; the permanent organs of the adult are preceded by a set of structures which are purely embryonic, which with the exception of the ducts disappear entirely before the end of fetal life. These embryonic structures are the paramesonephric ducts; the mesonephric duct remains as the duct in males, the paramesonephric duct as that of the female. The mesonephric duct originates from a part of the pronephric duct. In the outer part of the intermediate mesoderm under the ectoderm, in the region from the fifth cervical segment to the third thoracic segment, a series of short evaginations from each segment grows dorsally and extends caudally, fusing successively from before backward to form the pronephric duct.
This continues to grow caudally. Thus, the mesonephric duct remains after the atrophy of the pronephros duct. In the male the duct persists, forms the tube of the epididymis, the vas deferens and the ejaculatory duct, while the seminal vesicle arises during the third month as a lateral diverticulum from its hinder end. A large part of the head end of the mesonephros disappears. In the female the mesonephric bodies and ducts atrophy; the nonfunctional remains of the mesonephric tubules are represented by the epoophoron, the paroöphoron, two small collections of rudimentary blind tubules which are situated in the mesosalpinx. The lower part of the mesonephric duct disappears, while the upper part persists as the longitudinal duct of the epoöphoron, called Gartner's duct. There are developments of other tissues from the mesonephric duct that persist, e.g. the development of the suspensory ligament of the ovary. Shortly after the formation of the mesonephric ducts a second pair of ducts is developed.
Each arises on the lateral aspect of the corresponding mesonephric duct as a tubular invagination of the cells lining the abdominal cavity. The orifice of the invagination remains open, undergoes enlargement and modification to form the abdominal ostium of the fallopian tube; the ducts pass backward lateral to the mesonephric ducts, but toward the posterior end of the embryo they cross to the medial side of these ducts, thus come to lie side by side between and behind the latter—the four ducts forming what is termed the common genital cord, to distinguish it from the genital cords of the germinal epithelium seen in this article. The mesonephric ducts end in an epithelial elevation, the sinus tubercle, on the ventral part of the cloaca between the orifices of the mesonephric ducts. At a stage the sinus tubercle opens in the middle, connecting the paramesonephric ducts with the cloaca. In the male the paramesonephric ducts atrophy, but traces of their anterior ends are represented by the appendix of testis of the male), while their terminal fused portions form the prostatic utricle in the floor of the prostatic urethra.
This is due to the production of Anti-Müllerian hormone by the Sertoli cells of the testes. In the female the paramesonephric ducts undergo further development; the portions which lie in the genital cord fuse to form the vagina. This fusion of the paramesonephric ducts begins in the third month, the septum formed by their fused medial walls disappears from below upward; the parts outside this cord remain separate, each forms the corresponding Fallopian tube. The ostium of the fallopian tube remains from the anterior extremity of the original tubular invagination from the abdominal cavity. About the fifth month a ring-like constriction marks the position of the cervix of the uterus, after the sixth month the walls of the uterus begin to thicken. For a time the vagina is represented by a solid rod of epithelial cells. A ring-like outgrowth of this epithelium occurs at the lower end of the uterus and marks the future vaginal fornix. At about the fifth or sixth month the lumen of the vagina is produced by the breaking down of the central cells of the epithelium.
The hymen represents the remains of the sinus tubercle. The gonads are the precursors of the testes in ovaries in females, they develop from the mesothelial layer of the peritoneum. The ovary is differentiated into a central part, the medulla of ovary, covered by a surface layer, the germinal epithelium; the immature ova originate from cells from the dorsal endoderm of the yolk sac. Once they have reached the gonadal ridge they are called oogonia. Development proceeds and the oogonia become surrounded by a layer of connective tissue cells. In this way, the rudiments of the ovarian follicles are formed; the embryological origin of granulosa cells, on the other hand, remains controversial. Just as in the male, there is a gubernaculum in the female, which pulls it downward, albeit not as much as in males; the gubernaculum becomes the proper ovarian ligament and the round ligament of the uterus. The periphery of the testes are converted into the tunica albuginea. Cords of the
A pelvic examination is the physical examination of the external and internal female pelvic organs. It is called "bimanual exam" when two hands are used and "manual uterine palpation", it is used in gynecology. It can be done under general anesthesia; the examination can be uncomfortable. During the pelvic exam the vaginal wall is assessed for rugae and weak spots. In addition to a thorough pelvic exam, other tests may ordered to further determine the cause of symptoms that are concerning. During the pelvic exam, samples of vaginal fluids may be taken to screen for sexually transmitted infections or other infections; some clinicians combine a routine pelvic exam along with other preventative procedures like a breast examination and pap smear. The American College of Physicians published guidelines against routine pelvic examination in adult women who are not pregnant and lack symptoms in 2014. One exception being pelvic exams done as part of cervical cancer screening. A pelvic examination can be part of the assessment of sexual assault.
Previous to July 2014 the benefits of routine pelvic examinations were not clear and there was no consensus. Since American College of Physicians issued a guideline recommending against performing this examination to screen for conditions in asymptomatic, adult women; the ACP said that there was no evidence of benefit in support of the examination, but there was evidence of harm, including distress and unnecessary surgery. This was a strong recommendation, based on moderate-quality evidence. In 2018, the American College of Obstetricians and Gynecologists issued a committee opinion that pelvic exams should be performed for 1) symptoms of gynecologic disease, 2) screening for cervical dysplasia, or 3) management of gynecologic disorders or malignancy, using shared decision-making with the patient. ACOG concluded there is inadequate data to support recommendations for or against routine screening pelvic examination for asymptomatic, non-pregnant women with average risk for gynecologic disease.
Annual well-woman exams are an occasion for gynecologists to recognize issues like incontinence and sexual dysfunction, discuss patient concerns. The pelvic exam begins with an explanation of the procedure; the woman is asked to put on an examination gown, get on the examination table, lay on her back with her feet in stirrups. Sliding down toward the end of the table is the best position for the clinician to do a visual examination. A pelvic exam begins with an assessment of the reproductive organs that can be seen without the use of a speculum. Many women may want to'prepare' for the procedure. Douching before the exam is discouraged because cells needed from the cervix to assess for cervical cell abnormalities may be washed out. One possible reason for delaying an exam is if it is to be done during menstruation, but this is a preference of some women and not a requirement of the clinician; the woman will will be asked to put on an examination gown and lay down on the examination table. A girl or woman may ask to have another woman in the examination room during the exam.
The clinician may want to perform pelvic examination and assessment of the vagina because there are unexplained symptoms of vaginal discharge, pelvic pain, unexpected bleeding, or urinary problems. The typical external examination begins with making sure that a woman is in a comfortable position and her privacy respected. If a woman is obese, different positioning and assistance may be required to keep tissue from blocking the view of the perineal area; the pubic hair is inspected for pubic hair growth patterns. Sparse hair patterns can exist in older and in some Asian women; the labia majora are evaluated. Their position and symmetry are assessed; the expected finding in older women is that the labia majora can be smaller. The examiner is looking for ulcers, inflammation and rashes. If drainage is present from these structures, its color and other characteristics are noted. Infection control is accomplished by frequent glove changes; the labia minora are evaluated. They should appear smooth in texture and pink.
The presence of tearing and swelling is noted. Thinner and smaller labia minora are an expected finding in older women; the clitoris is assessed for size, position and inflammation. The urethral opening is inspected. No urine should leak. Urine leakage may indicate the weakening of pelvic structures; the opening should be midline and smooth. The presence of inflammation, or discharge which may indicate an infection. Excoriation can be present in obese women due to urinary incontinence; the vaginal opening is inspected for position, presence of the hymen, shape. The presence of bruising, tearing and discharge. Pelvic examinations are procedures that are designed to obtain objective, measurable descriptions of what is observed. If sexual abuse is suspected, questions regarding this is discussed after the examination and not during it; when the woman is requested to'bear down', the presence of prolapsed structures such as the bladder, rectum or uterus are documented. Prolapsed structures can appear when abdominal pressure increases or they can protrude without bearing down.
The perineum, the space between the vagina and the anus is inspected. It should be smooth and free of disease. Scars from episiotomies are visible on women; the anus is assessed for lesions, trauma. It should appear dark and moist. In an obese women, excoriation may be present due to fecal incontinence. B
A crescent shape is a symbol or emblem used to represent the lunar phase in the first quarter, or by extension a symbol representing the Moon itself. It is used as the astrological symbol for the Moon, hence as the alchemical symbol for silver, it was the emblem of Diana/Artemis, hence represented virginity. In Roman Catholic Marian veneration, it is associated with the Virgin Mary. From its use as roof finial in Ottoman era mosques, it has become associated with Islam, the crescent was introduced as chaplain badge for Muslim chaplains in the US military in 1993; the crescent symbol is used to represent the Moon, not in a particular lunar phase. When used to represent a waxing or waning lunar phase, "crescent" or "increscent" refers to the waxing first quarter, while the symbol representing the waning final quarter is called "decrescent"; the crescent symbol was long used as a symbol of the Moon in astrology, by extension of Silver in alchemy. The astrological use of the symbol is attested in early Greek papyri containing horoscopes.
In the 2nd-century Bianchini's planisphere, the personification of the Moon is shown with a crescent attached to her headdress. Its ancient association with Ishtar/Astarte and Diana is preserved in the Moon representing the female principle, virginity and female chastity. In Roman Catholic tradition, the crescent entered Marian iconography, by the association of Mary with the Woman of the Apocalypse The most well known representation of Mary as the Woman of the Apocalypse is the Virgin of Guadalupe; the crescent shape consists of a circular disk with a segment of another circle removed from its edge, so that what remains is a shape enclosed by two circular arcs of different diameters which intersect at two points. As such, it belongs to the class of figures known as lune in planar geometry; the tapering towards the points of intersection of the two arcs are known as the "horns" of the crescent. The classical crescent shape has its horns pointing upward (and is worn as horns when worn as a crown or diadem, e.g. in depictions of the lunar goddess, or in the headdress of Persian kings, etc.
The word crescent is derived etymologically from the present participle of the Latin verb crescere "to grow", technically denoting the waxing moon. As seen from the northern hemisphere, the waxing Moon tends to appear with its horns pointing towards the left, conversely the waning Moon with its horns pointing towards the right; the shape of the lit side of a spherical body that appears to be less than half illuminated by the Sun as seen by the viewer appears in a different shape from what is termed a crescent in planar geometry: Assuming the terminator lies on a great circle, the crescent Moon will appear as the figure bounded by a half-ellipse and a half-circle, with the major axis of the ellipse coinciding with a diameter of the semicircle. Unicode encodes a crescent at U+263D and a decrescent at U+263E; the Miscellaneous Symbols and Pictographs block provides variants with faces: U+1F31B FIRST QUARTER MOON WITH FACE and U+1F31C LAST QUARTER MOON WITH FACE. The crescent shape is used to represent the Moon, the Moon deity Nanna/Sin from an early time, visible in Akkadian cylinder seals as early as 2300 BC.
The crescent was well used in the iconography of the ancient Near East and was used transplanted by the Phoenicians in the 8th century BC as far as Carthage in modern Tunisia. The crescent and star appears on pre-Islamic coins of South Arabia; the combination of star and crescent arises in the ancient Near East, representing the Moon and Ishtar combined into a triad with the solar disk. It was inherited both in Hellenistic iconography. In the iconography of the Hellenistic period, the crescent became the symbol of Artemis-Diana, the virgin hunter goddess associated with the Moon. Numerous depictions show Artemis-Diana wearing the crescent Moon as part of her headdress; the related symbol of the star and crescent was the emblem of the Mithradates dynasty in the Kingdom of Pontus and was used as the emblem of Byzantium. The crescent remained in use as an emblem in Sassanid Persia, used as a Zoroastrian regal or astrological symbol. In the Crusades it came to be associated with the Orient and was used in Crusader seals and coins.
It was used as a heraldic charge by the 13th century. Anna Notaras, daughter of the last megas doux of the Byzantine Empire Loukas Notaras, after the fall of Constantinople and her emigration to Italy, made a seal with her coat of arms which included "two lions holding above the crescent a cross or a sword". From its use in Sassanid Persia, the crescent found its way into Islamic iconography after the Muslim conquest of Persia. Umar is said to have hung two crescent-shaped ornaments captured from the Sassanid capital Ctesiphon in the Kaaba; the crescent appears t
A menstrual cup is a feminine hygiene product, inserted into the vagina during menstruation. Its purpose is to prevent menstrual fluid from leaking onto clothes. Menstrual cups are made of flexible medical grade silicone and shaped like a bell with a stem; the stem is used for removal. The bell-shaped cup seals against the vaginal wall just below the cervix; every 4–12 hours, the cup is removed, emptied and reinserted. After each period, the cup should be boiled for at least 5 minutes and stored for use the next month. Unlike tampons and pads, cups collect menstrual fluid rather than absorbing it. One cup is reusable for up to five years or more; this makes their long-term cost lower than that of disposable tampons or pads, though the initial cost is higher. Menstrual cups are promoted as more practical and eco-friendly than pads and tampons. Given that the menstrual cup is reusable, its use decreases the amount of waste generated from menstrual cycles, as there is no daily waste and the amount of discarded packaging decreases as well.
Most menstrual cup brands sell a larger size. Menstrual cups are sold colorless and translucent, but several brands offer colored cups, such as pink or purple; the use of menstrual cups is considered a safe option relative to other forms of menstrual hygiene. The menstrual cup is first folded or pinched and inserted into the vagina, it will unfold automatically and create a light seal against the vaginal walls. In some cases, the user may need to twist the cup or flex the vaginal muscles to ensure the cup is open; the cup should sit around the cervix. If inserted, the cup shouldn't leak or cause any discomfort. In comparison with a tampon, the menstrual cup should be placed lower in the vaginal canal; the stem should be inside the vagina. There are various folding techniques for insertion. If lubrication is necessary for insertion, it should be water-based, as silicone lubricant can be damaging to the silicone. After 4–12 hours of use, the cup is removed by reaching up to its stem to find the base.
Pulling on the stem is not recommended to remove the cup, as that can create suction. The base of the cup is pinched to release the seal, the cup is removed. After emptying, a menstrual cup should be wiped and reinserted, it can be washed with a mild soap, sterilized in boiling water for a few minutes at the end of the cycle. Alternatively, sterilizing solutions may be used to soak the cup. Specific cleaning instructions vary by brand; when using a menstrual cup, the menstrual fluid is collected after it flows from the cervix and is held in liquid form. With tampons, liquid is held in semi-coagulated form against the cervix; this reduces odors. Menstrual cups collect menstrual fluid inside the vagina and do not leak; some women have experienced leakage due to improper cup size. For example, a menstrual cup may leak if it is not inserted and does not pop open and seal against the walls of the vagina. If a user needs to track the amount of menses produced, a menstrual cup allows one to do so accurately.
Some cups have measuring marks on them. A 2011 randomized controlled trial in Canada investigated whether silicone menstrual cups are a viable alternative to tampons and found that 91% of women in the menstrual cup group said they would continue to use the cup and recommend it to others. In a 1991 clinical study involving 51 women, 23 of the participants found rubber menstrual cups to be an acceptable way of managing menstrual flow. In a randomized controlled feasibility study in rural western Kenya, adolescent primary school girls were provided with menstrual cups or sanitary pads instead of traditional menstrual care items of cloth or tissue. Girls provided with menstrual cups had a lower prevalence of sexually transmitted infections than control groups; the prevalence of bacterial vaginosis was lower among cup users compared with sanitary pad users or those continuing other usual practice. After six months, menstrual cup users were free from embarrassing leakage or odor, could engage in class activities and sport without humiliation or being teased.
Cleaning a menstrual cup in a public toilet can pose problems as the handwashing sinks are though not always, in a public space rather than in the toilet cubicle. Some manufacturers suggest wiping out the cup with a clean tissue and cleaning the cup at the next private opportunity; the user could carry a small bottle of water to rinse the cup over the toilet. Another option is to use wet wipes. Since menstrual cups may only need to be emptied every 6–24 hours, many users do not have to empty them in public restrooms but rather in the comfort of their own home. A lack of clean water and soap for handwashing, needed before inserting the cup, presents a problem to women in developing countries. Insertion requires thorough washing of the cup and hands to avoid introducing new bacteria into the vagina, which may heighten the risk of UTIs and other infections. Disposable and reusable pads do not demand the same hand hygiene, though reusable pads require access to water for washing out pads. Due to the fact that menstrual cups require boiling once a month, this can be a problem in developing countries if there is a lack of water, fire wood and good hygiene practices.
However, other options in use, such as rags that are washed, may be less hygienic. Removing a menstrual cup
Puberty is the process of physical changes through which a child's body matures into an adult body capable of sexual reproduction. It is initiated by hormonal signals from the brain to the gonads: the ovaries in a girl, the testes in a boy. In response to the signals, the gonads produce hormones that stimulate libido and the growth and transformation of the brain, muscle, skin, hair and sex organs. Physical growth—height and weight—accelerates in the first half of puberty and is completed when an adult body has been developed; until the maturation of their reproductive capabilities, the pre-pubertal physical differences between boys and girls are the external sex organs. On average, girls begin puberty around ages 10–11 and end puberty around 15–17; the major landmark of puberty for females is menarche, the onset of menstruation, which occurs on average between ages 12 and 13. In the 21st century, the average age at which children girls, reach puberty is lower compared to the 19th century, when it was 15 for girls and 16 for boys.
This can be due to any number of factors, including improved nutrition resulting in rapid body growth, increased weight and fat deposition, or exposure to endocrine disruptors such as xenoestrogens, which can at times be due to food consumption or other environmental factors. Puberty which starts earlier than usual is known as precocious puberty, puberty which starts than usual is known as delayed puberty. Notable among the morphologic changes in size, shape and functioning of the pubertal body, is the development of secondary sex characteristics, the "filling in" of the child's body. Derived from the Latin puberatum, the word puberty describes the physical changes to sexual maturation, not the psychosocial and cultural maturation denoted by the term adolescent development in Western culture, wherein adolescence is the period of mental transition from childhood to adulthood, which overlaps much of the body's period of puberty. Comprehensive sexuality education can contribute to teenagers' better understanding of this process.
Two of the most significant differences between puberty in girls and puberty in boys are the age at which it begins, the major sex steroids involved, the androgens and the estrogens. Although there is a wide range of normal ages, girls begin the process of puberty at age 10 or 11. Girls complete puberty by ages 15–17, while boys complete puberty by ages 16–17. Girls attain reproductive maturity about four years after the first physical changes of puberty appear. In contrast, boys accelerate more but continue to grow for about six years after the first visible pubertal changes. Any increase in height beyond the post-pubertal age is uncommon. For boys, the androgen testosterone is the principal sex hormone. A substantial product of testosterone metabolism in males is estradiol; the conversion of testosterone to estradiol depends on the amount of body fat and estradiol levels in boys are much lower than in girls. The male "growth spurt" begins accelerates more and lasts longer before the epiphyses fuse.
Although boys are on average 2 centimetres shorter than girls before puberty begins, adult men are on average about 13 centimetres taller than women. Most of this sex difference in adult heights is attributable to a onset of the growth spurt and a slower progression to completion, a direct result of the rise and lower adult male levels of estradiol; the hormone that dominates female development is an estrogen called estradiol. While estradiol promotes growth of the breasts and uterus, it is the principal hormone driving the pubertal growth spurt and epiphyseal maturation and closure. Estradiol levels reach higher levels in women than in men; the hormonal maturation of females is more complicated than in boys. The main steroid hormones, testosterone and progesterone as well as prolactin play important physiological functions in puberty. Gonadal steroidgenesis in girls starts with production of testosterone, quickly converted to estradiol inside the ovaries; however the rate of conversion from testosterone to estradiol during early puberty is individual, resulting in diverse development patterns of secondary sexual characteristics.
Production of progesterone in the ovaries begins with the development of ovulatory cycles in girls, before puberty low levels of progesterone are produced in the adrenal glands of both boys and girls. Puberty is preceded by adrenarche, marking an increase of adrenal androgen production between ages 6–10. Adrenarche is sometimes accompanied by the early appearance of pubic hair; the first androgenic hair resulting from adrenarche can be transient and disappear before the onset of true puberty. The onset of puberty is associated with high GnRH pulsing, which precedes the rise in sex hormones, LH and FSH. Exogenous GnRH pulses cause the onset of puberty. Brain tumors which increase GnRH output may lead to premature puberty; the cause of the GnRH rise is unknown. Leptin might be the cause of the GnRH rise. Leptin has receptors in the hypothalamus which synthesizes GnRH. Individuals who are deficient in leptin fail to initiate puberty; the levels of leptin increase with the onset of puberty, decline to adult levels when puberty is completed.
The rise in GnRH might be caused by genetics. A study disco
United Nations Human Rights Council
The United Nations Human Rights Council is a United Nations body whose mission is to promote and protect human rights around the world. The UNHRC has 47 members elected for staggered three-year terms on a regional group basis; the 38th session of the UNHRC began June 18, 2018. It ended on July 7, 2018; the headquarters of UNHRC is in Switzerland. The UNHRC investigates allegations of breaches of human rights in UN member states, addresses important thematic human rights issues such as freedom of association and assembly, freedom of expression, freedom of belief and religion, women's rights, LGBT rights, the rights of racial and ethnic minorities; the UNHRC was established by the UN General Assembly on March 15, 2006 to replace the UN Commission on Human Rights, criticised for allowing countries with poor human rights records to be members. UN Secretaries General Kofi Annan and Ban Ki-moon, former president of the council Doru Costea, the European Union and the United States have accused the UNHRC of focusing disproportionately on the Israeli–Palestinian conflict, many allege an anti-Israel bias – the Council has resolved more resolutions condemning Israel than the rest of the world combined.
The UNHRC works with the Office of the High Commissioner for Human Rights and engages the UN’s special procedures. The members of the General Assembly elect the members; the term of each seat is three years, no member may occupy a seat for more than two consecutive terms. The seats are distributed among the UN's regional groups as follows: 13 for Africa, 13 for Asia, six for Eastern Europe, eight for Latin America and the Caribbean, seven for the Western European and Others Group; the previous CHR had a membership of 53 elected by the Economic and Social Council through a majority of those present and voting. The General Assembly can suspend the rights and privileges of any Council member that it decides has persistently committed gross and systematic violations of human rights during its term of membership; the suspension process requires a two-thirds majority vote by the General Assembly. The resolution establishing the UNHRC states that "when electing members of the Council, Member States shall take into account the contribution of candidates to the promotion and protection of human rights and their voluntary pledges and commitments made thereto", that "members elected to the Council shall uphold the highest standards in the promotion and protection of human rights".
The UNHRC holds regular sessions three times a year, in March and September. The UNHRC can decide at any time to hold a special session to address human rights violations and emergencies, at the request of one-third of the member states. To date there have been 28 special sessions; the Council consists of 47 members, elected yearly by the General Assembly for staggered three-year terms. Members are selected via the basis of equitable geographic rotation using the United Nations regional grouping system. Members are eligible for re-election for one additional term, after which they must relinquish their seat; the seats are distributed along the following lines: 13 for the African Group 13 for the Asia-Pacific Group 6 for the Eastern European Group 8 for the Latin American and Caribbean Group 7 for the Western European and Others Group An important component of the Council consists in a periodic review of all 193 UN member states, called the Universal Periodic Review. The new mechanism is based on reports coming from different sources, one of them being contributions from NGOs.
Each country's situation will be examined during a three-and-a-half-hour debate. The first cycle of the UPR took place between 2008 and 2012, the second cycle of reviews started in 2012 and is expected to be completed in 2016; the General Assembly resolution establishing the Council, provided that "the Council shall review its work and functioning five years after its establishment”. The main work of the review was undertaken in an Intergovernmental Working Group established by the Council in its Resolution 12/1 of October 1, 2009 The review was finalized in March 2011, by the adoption of an "Outcome" at the Council’s sixteenth session, annexed to Resolution 16/21. First cycle: The following terms and procedures were set out in General Assembly Resolution 60/251: Reviews are to occur over a four-year period. Accordingly, the 193 countries that are members of the United Nations shall all have such a Review between 2008 and 2011. Reviews shall be conducted alphabetically. Second cycle: HRC Resolution 16/21 brought the following changes: Reviews are to occur over a four-and-a-half-year period.
Accordingly, the 193 countries that are members of the United Nations shall all have such a Review between 2012 and 2016. Similar mechanisms exist in other organizations: Int
A tampon is a feminine hygiene product designed to absorb the menstrual flow by insertion into the vagina during menstruation. Once inserted a tampon is held in place by the vagina and expands as it soaks up menstrual blood; the majority of tampons sold are made of a blend of rayon and cotton. Tampons are available in several absorbency ratings; the average woman may use 11,400 tampons in her lifetime. Several countries regulate tampons as medical devices. In the United States, they are considered to be a Class II medical device by the Food and Drug Administration, they are sometimes used for hemostasis in surgery. Tampon design varies between companies and across product lines in order to offer a variety of applicators and absorbencies. There are two main categories of tampons based on the way of insertion - digital tampons inserted by finger and applicator tampons. Tampon applicators may be made of plastic or cardboard, are similar in design to a syringe; the applicator consists of two tubes, an "outer", or barrel, "inner", or plunger.
The outer tube has a smooth surface to aid insertion and sometimes comes with a rounded end, petaled. The two main differences are in the way. Most tampons have a string for removal; the majority of tampons sold are made of a blend of rayon and cotton. Organic cotton tampons are made from only 100% cotton. Tampons are available in several absorbency ratings, which are consistent across manufacturers in the U. S.: Junior/Light absorbency: 6 g and under Regular absorbency: 6–9 g Super absorbency: 9–12 g Super Plus absorbency 12–15 g Ultra absorbency 15–18 gAbsorbency ratings outside the US may be different. The majority of non-US manufacturers use absorbency rating and Code of Practice recommended by EDANA. A piece of test equipment referred to as a Syngina is used to test absorbency; the machine uses a condom into which the tampon is inserted, synthetic menstrual fluid is fed into the test chamber. Toxic shock syndrome was named by Dr. James K. Todd in 1978. Dr. Philip M. Tierno Jr. Director of Clinical Microbiology and Immunology at the NYU Langone Medical Center, helped determine that tampons were behind toxic shock syndrome cases in the early 1980s.
Tierno blames the introduction of higher-absorbency tampons in 1978, as well as the recent decision by manufacturers to recommend that tampons can be worn overnight, for increased incidences of toxic shock syndrome. However, a meta-analysis found that the absorbency and chemical composition of tampons are not directly correlated to the incidence of toxic shock syndrome, whereas oxygen and carbon dioxide content is associated more strongly; the U. S. Food and Drug Administration suggests the following guidelines for decreasing the risk of contracting TSS when using tampons: Follow package directions for insertion Choose the lowest absorbency needed for one's flow Follow guidelines and directions of tampon usage Consider using cotton or cloth tampons rather than rayon Change the tampon at least every 6 to 8 hours or more if needed Alternate usage between tampons and pads Avoid tampon usage overnight or when sleeping Increase awareness of the warning signs of Toxic Shock Syndrome and other tampon-associated health risks Cases of tampon-connected TSS are rare in the United States..
A study by Tierno determined that all cotton tampons were less to produce the conditions in which TSS can grow, this was done using a direct comparison of 20 brands of tampons including conventional cotton/rayon tampons and 100% organic cotton tampons from Natracare. In fact Dr Tierno goes as far to state that "The bottom line is that you can get TSS with synthetic tampons but not with an all-cotton tampon." Sea sponges are marketed as menstrual hygiene products. A 1980 study by the University of Iowa found that commercially sold sea sponges contained sand and bacteria. Hence, sea sponges could potentially cause toxic shock syndrome. Tampons are being used and tested to restore and/or maintain the normal microbiota of the vagina to treat bacterial vaginosis; some of these are available to the public but come with disclaimers. The efficacy of the use of these probiotic tampons has not been established. Ecological impact varies according to disposal method. Factors such as tampon composition will impact sewage treatment plants or waste processing.
The average woman may use 11,400 tampons in her lifetime. Tampons are made of cotton, polyester, polyethylene and fiber finishes. Aside from the cotton and fiber finishes, these materials are not bio-degradable. Organic cotton tampons are biodegradable, but must be composted to ensure they break down in a reasonable amount of time. Rayon was found to be more biodegradable than cotton. Environmentally friendly alternatives to using tampons are the menstrual cup, reusable sanitary pads, menstrual sponges, reusable tampons, reusable absorbent underwear; the Royal Institute of Technology in Stockholm carried out a life cycle assessment comparison of the environmental impact of tampons and sanitary pads. They found that the main environmental impact of the products was in fact caused by the pro