Perineal Powder and Pads May Cause Problems

Frederick R. Jelovsek MD

" I have read that using talcum powder in the genital area has been associated with increased cervical cancer risks. Does this also apply to cornstarch based powders? ". S.Z.

As far as I know, talcum powder has never been associated with cervical cancer. It has, in the past, been implicated as a possible cause of ovarian cancer, not cervical cancer.

In the early 1970's, concern was raised about the possibility of talcum powder (talc) use being a cause of ovarian cancer. The first case-control study I could find was in 1982 (1). In it, they found a overall use of dusting the perineum or menstrual pads with talc of 43% in women with ovarian cancer and 28% in a matched population of women without cancer. This gave a risk ratio of almost 2.0 for ovarian cancer associated with talc use. Another study in 1988 looked at talc use and found 52% of ovarian cancer patients and 46% of control women regularly used talc (2). This study also looked at tobacco use and coffee use and found that coffee use increased the risk for ovarian cancer by a factor of 3.4. Keep in mind that these are the hazards of assuming that agents associated with an increased risk are really the cause and effect. They may easily be associated with other habits which are actually the causative agents.

Other studies have also found a slightly increased risk of ovarian cancer with talc use even in China (3). A study in Greece looked at this but the incidence of talc use was small so they could not tell; they did however, find and increased risk (1.7-2.1) with use of hair dye (4). Another group of authors looked at whether exposure to talc in an occupation raised the risk and they found it did not, but exposure to polycarbon chemicals at work slightly raised the risk (5).

You ask about whether cornstarch might be a good substitute for talc if talc causes problems.The original hypothesis behind talc as a carcinogen is that the particles gradually migrate up the genital tract through the vagina, uterus and tubes and into the peritoneal cavity where the ovaries are. It has beEN postulated that talc, a magnesium silicate inorganic compound may act as an irritant to the cells covering the ovary. Also in the past, more so than now, cosmetic talc was more contaminated with asbestos which is an inorganic agent known to produce tumors. Cornstarch is an organic carbohydrate that is quickly broken down by natural body enzymes so it is unlikely to be a long tern cancer inducer. It is difficult to say for sure that talc is a causative agent for ovarian cancer but it does need to be considered a possibility.

It is possible. One Italian study looked at women who had been compensated for asbestos exposure in their occupation and found a higher incidence of both ovarian and uterine cancer in those women (6). Another study looked microscopically at the ovaries of women whose husbands were exposed to asbestos at work and compared them to women who had not history of exposure (7) They found evidence of asbestos in almost 70% of women whose husbands were exposed and 35% of the other women!

Thus if 35% of all women have asbestos exposure and there is only a 1.4% lifetime incidence of ovarian cancer, there must be additional factors to consider. On the other hand, asbestos must still be seriously considered as a possible ovarian cancer causing agent.

Contact dermatitis has definitely been reported from the use of certain brands of sanitary pads (8). Most pads and even disposable diapers are made with cellulose, an organic product from plant materials, but the absorbent gels they are using on pads to help reduce wetness are made of chemicals called polyacrylates. These have been shown to be very effective compared to cotton diapers at reducing skin irritation from wetness (9).

The question always comes up as to whether manufacturers include any asbestos fibers in their perineal pads or sanitary napkins. I could not find any information on this except that most of the disposable pads nowadays are predominantly cellulose. While I think it unlikely that pads and their fibers or chemicals cause either vulvar cancer or ovarian cancer, the data is just not there to say for sure.

There are several conditions known to be associated with a decreased incidence of ovarian cancer. Women who use oral contraceptives or who have had 5 or more children have a decreased risk. It is felt that both frequent pregnancies and oral contraceptives block ovulation which disrupts the ovarian capsule. Perhaps this makes the ovary less susceptible over time to noxious agents that may be carcinogenic. A history of breast feeding also seems to protect somewhat which is another instance of blocking ovulation.

Previous tubal ligation and hysterectomy have also been shown to reduce ovarian cancer (10, 11). This concept of blocking the pathway from the vagina to the ovaries in the peritoneal cavity, coupled with the decreased risk if ovulation is blocked, lends support to external agents as a cause for ovarian cancer if the ovary is exposed over a long time. Whether those agents are chemicals, inorganic fibers and particles or viruses is unknown. It could be all of them.

What can you do to reduce this risk? First of all, do not use any powders or sprays on the perineal area. There really should be no reason to use these. Secondly, if tubal ligation or oral contraceptives are reasonable options for your birth control, give them strong consideration.