A few weeks ago, Dr. Jennifer Lincoln started receiving messages on social media from people worried about titanium dioxide in tampons. Someone had posted a TikTok about the dangers of the additive, claiming it caused cysts and cancers, and it went viral. While it sounds scary, the experts stress there’s little truth behind these worries.
“There’s really two reasons why people think that it could cause cancer, and I can understand why because it’s confusing,” Lincoln, an OB-GYN and author of the book, “Let’s Talk about Down There: An OB-GYN Answers all Your Burning Questions … Without Making You Feel Embarrassed for Asking,” told TODAY.
“If you Google titanium dioxide and cancer, you are going to see studies that show it has been linked with cancer. What’s lost in translation is that it’s 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? The European Union banned titanium dioxide in food earlier this year, according to the U.S. Department of Agriculture's Foreign Agriculture Service. Lincoln said this led some to believe that the substance has been proven to be cancerous.
“The ban was related to really concern and hypothetical risks,” she stressed.
What is titanium dioxide?
Titanium dioxide is chemical substance used in many products to make them look whiter, according to ChemicalSafetyFacts.org.
“It’s a compound that reflects light particles. It’s on the string — so it’s not even in the part of the tampon that’s inside the vagina," Lincoln said. "They use it to make the string look whiter.”
It's also used in sunscreen because its whitening property helps it reflect sunlight. "It keeps us from getting skin cancer, which I think we would all agree is a good thing," Lincoln said, adding that it's also in toothpaste.
Titanium dioxide can also be in food, according to the National Library of Medicine.
“It’s really pervasive because it’s a whitening agent. If you think of all the cosmetics and dyes and candy and food — it’s everywhere,” Dr. Jennifer Wu, an OB-GYN at Lenox Hill Hospital, told TODAY.
Titanium dioxide and cancer
But what about its relationship to cancer? The National Library of Medicine noted that there's "inadequate evidence in humans" that the additive contributes to cancer.
“There’s nothing linked in the data that says that tampon use is linked to cancer or harm in the reproductive system,” Dr. Christine Greves, an OB-GYN in Orlando, Florida, told TODAY. “It’s very commonly used as a natural mineral and has been studied in rodents.”
In studies examining cancer and titanium dioxide in animals, the animals inhaled it and did not ingest it or insert it, Lincoln said.
“You can’t just say just because you breathe something in and it causes cancer that it’s also going to cause cancer in a different route,” Lincoln explained. “If people just do a quick Google search, it can be a bit confusing.”
The Food and Drug Administration considers tampons “medical devices,” which means the agency has oversight on what’s in them.
“They’re really tightly regulated. It’s not like a company can throw anything in there,” Lincoln said. “They’ve got their ingredients listed on the box and on their website.”
Tampon myths persist
The experts agree that myths about tampons have long existed, and this is just the latest misconception. Fear of tampons may persist because of their association with toxic shock syndrome, Greves and Lincoln theorized.
“We see tampons as something that could potentially harm us,” Lincoln said.
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. In 1980, 812 cases of TSS associated with menstruation were reported, but over the course of the following decade, cases dropped significantly due to companies making less absorbent tampons and increased public awareness of TSS, according to the Centers for Disease Control and Prevention.
These days, in the United States, there are fewer than 20,000 cases of TSS a year, Greves said: “Toxic shock syndrome is definitely less common simply because now we’re educated. We know it’s 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, we’re somewhat scared of it. We see tampons as this idea of ‘taking your virginity,’ which is, of course, BS,” she said. “I do think that they have an image problem because of that.”
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.
“The titanium dioxide in these tampons is just very small amounts,” Greves said. “Tampons are great. They give women freedom.”