For many years, women used rags to contain menstrual flow. These were not very reliable and had to be soaked and laundered after use. The first disposable sanitary pad was created in 1896 by Johnson & Johnson (New Brunswick, New Jersey, U.S.A.) (Lister's Towels) but failed to catch on. In World War I, nurses found bandages to be an excellent absorbing material for menstrual flow. Soon thereafter, Kimberly-Clark introduced Kotex® in 1921, and Johnson & Johnson introduced Modess®, the first successful disposable pads. Disposable pads were definitely more effective and convenient than rags. However, they were a long way from current products. They had to be held in place with pins or special belts worn around the waist and a range of protective gear were available to compensate when the pads failed, such as special panties or "sanitary aprons" (made of cloth-coated rubber, and worn backwards over the buttocks) (33,45).
The first major improvement in disposable pads came about 50 years after their initial introduction, when adhesive backing was introduced, enabling use of the pads without pins or special belts. The quality and effectiveness of pads have continued to improve in the last few decades. Performance improved substantially with the development of superabsorbent materials, i.e., polymeric gelling compounds developed to lock the moisture in the core of the pad and not release it under pressure. Procter & Gamble introduced ultrathin pads based on superabsorbent materials, which were seven times thinner than the early pads, making them more comfortable and less noticeable in tighter-fitting fashions. In addition, many modern pads incorporate a top sheet designed to wick moisture into the core and away from the wearer's skin for a drier feeling.
Modern pads offer women a wide variety of products designed specifically to meet their needs. Procter & Gamble introduced "wings" or flexible side extensions of the pad that wrap over the edge of the panty to prevent panty soiling and to hold the pad securely in place. Pads are available in a number of sizes and lengths, ranging from small, thin panty liners for managing discharges between periods or to use in combination with tampons, to larger, longer pads that offer maximum protection overnight. Most brands come in scented or unscented varieties. Some are packaged with wrappers for discrete disposal (46).
Major manufacturers of pads and panty liners have developed and published methods of evaluating the safety of these products. In-use clinical assessments of irritation and the impact of product use on the microflora of the vulva are important parts of this evaluation (47-49). However, new protocols have been developed that are designed specifically to evaluate the contribution of both the chemical composition of these products and the potential for mechanical irritation through friction (50,51).
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