There are two basic types of period products: external protection and internal protection. External protection such as pads and panty liners attach to the crotch of underpants to absorb your menstrual flow after it leaves the body, while internal protection such as tampons are inserted into the vagina to catch or absorb menstrual flow before it leaves your body. Some people prefer internal protection because they can’t feel it and it is easier to use when playing sports. Tampons are the most common type of internal protection, but there are other choices available, too.

Are internal and external forms of period protection safe?

Both internal and external period products that are approved by the FDA (Federal Food and Drug Administration) are considered safe. There is a risk of Toxic Shock Syndrome with tampons, but the risk is very low. You should read the directions on the tampon package and change your tampon frequently (every few hours or more often if needed) and use intermittently, for example, tampons in the daytime and pads at night. Avoid super absorbent tampons. Make your decision about which type of period product to use based on whatever you feel most comfortable using! Talk about the different types of period products with an adult you trust. This will help you make your decision about which kind you will want to use.

How do I insert my first tampon?

Using a tampon or other form of internal protection can be scary the first time, but after that it gets much easier! It’s a good idea to read the instructions and to talk to your mom, older sister, or another adult that you trust about how to use tampons. You can also watch our video about using your first tampon.

Will tampons change my hymen or affect my virginity?

No. Some people worry that internal protection will change their hymen (a thin piece of tissue that partially blocks the entrance to the vagina), but this isn’t true. Most teens can easily insert the tampon through the opening in hymen into the vagina. If you cannot get the tampon into your vagina, you may be stressed and not putting it in at the correct angle or you may have been born with a very small opening into the vagina, called a “microperforate hymen.”  So, if insertion of a tampon is impossible after several attempts, make an appointment with your health care provider (HCP).

Even though using tampons does not change your hymen or your “virginity,” some cultures, religions, and families have different definitions of “virginity” and don’t approve of the use of tampons in females until they are married.

Can I swim and do normal activities when I have my period?

Yes. People used to think that you shouldn’t swim, play sports, or do other normal activities when you had your period. Now people know that this is not true. If you have the right type of menstrual protection, you can do anything! In fact, swimming and playing sports may make you feel better. Other teens prefer to be less active when they have a heavy flow or cramps. You will probably be most comfortable if you use a tampon rather than a pad when you swim or play sports.

Alternative and Environmentally Friendly Menstrual Products: If you’re concerned about the chemicals and synthetic materials used to make regular pads and tampons, or you’re looking for a more cost-effective way to deal with your periods, you may want to consider using alternative products that are available in most pharmacies and grocery stores. You can learn about Eco-Friendly Period Products here.

You may feel nervous about using a tampon for the first time. It’s normal to feel nervous, especially if you have any unanswered questions about tampons.

What are tampons and how do they work?

Tampons are products used to absorb your menstrual flow. They are made of soft cotton pressed together to form a cylinder-like shape, so that they can be easily inserted into the opening of the vagina. A tampon absorbs your menstrual flow, or blood, before it has a chance to leave the body so they are considered “internal” protection whereas pads are “external” period protection. Tampons come in all different sizes and absorbencies. You can buy them at most pharmacies and grocery stores.

What size tampon should I use?

It’s a good idea to use the “slender” size tampon when you are learning how to use them for the first time. It’s also easier to insert it when your menstrual flow is moderate to heavy as this allows the tampon to glide in more easily.

I’m nervous. What should I do to make inserting the tampon easier?

By following the simple guidelines below, as well as the instructions that come with the tampons, your first experience with tampons should be easy. Remember, the more you relax, the easier the insertion will be. When you are nervous, your muscles tense up, which can make inserting the tampon more difficult.

Getting ready: Before you insert the tampon, let’s review your anatomy so you know where to insert it.

It’s a good idea to use a mirror to look at your vulva or outside area, which is all of your female genitalia (parts) that you can see. The urethra is where your urine (pee) comes out, the anus is where feces (poop) come out and right in the middle is your vaginal opening. This is where you will insert the tampon into your vagina. It’s normal to feel nervous the first time you use a tampon. It does get easier though.

Instructions for inserting a tampon with a built-in applicator:

1. Wash your hands with soap and water. With dry hands, unwrap the tampon. If you drop the tampon on the floor, throw it away and begin again with a new tampon.
2. Sit or stand in a comfortable position. Some teens prefer to place one leg on the toilet seat or tub, while others prefer to squat down. After you find a position that is most comfortable for you, hold the tampon with the fingers that you write with. Hold the middle of the tampon, at the spot where the smaller, inner tube inserts into the larger, outer tube. Make sure the string is visible and pointing away from your body.
3. With your other hand, open the labia (the folds of skin around the vaginal opening) and position the tampon in the vaginal opening. (See picture 1)
4. Gently push the tampon into the opening, aiming for the small of your back. Stop when your fingers touch your body and the applicator, or outer tube, is completely inside the vagina. (See picture 2)
5. Once the applicator or outer tube is inside your vagina, use your index or “pointer” finger to push the inner tube (the tube where the removal string is visible) through the outer tube. This pushes the tampon into the vagina.
6. Once the inner tube is all the way in, use your thumb and middle finger to remove the applicator or outer tube. (See picture 3) Make sure that the string hangs outside of your vaginal opening. Later, when you are ready to remove the tampon, hold the string and gently pull it downward until the entire tampon is out.
7. Remember to wash your hands before and after you insert and remove a tampon.

Instructions on how to insert a non-applicator tampon:

1. 1. Wash your hands with soap and water. With dry hands, unwrap the tampon. If you drop the tampon on the floor, throw it away and begin again with a new tampon. The tampon should be completely sealed in plastic wrap. If not, select another tampon and unwrap it with clean hands.
   2. Read the directions on the tampon box.
   3. With clean hands, unwrap a tampon and tug on the string to make sure the string is firmly attached to the tampon.
   4. Sit or stand in a comfortable position. Some teens prefer to place one leg on the toilet seat or tub, while others prefer to squat down. After you find a position that is most comfortable for you, hold the end of the tampon, at the spot where the tampon dents in. Make sure the string is visible and pointing away from your body.
   5. With your other hand, open the labia (the folds of skin around the vaginal opening) and position the tampon in the vaginal opening. (See picture 1.)
   6. Gently push the tampon into the opening, aiming for the small of your back.
   7. Once the tampon is inside of your vagina, use your index or “pointer” finger to push the tampon in.
   8. Make sure that the string hangs outside of your vaginal opening. Later, when you are ready to remove the tampon, hold the string and gently pull it downward until the entire tampon is out.
   9. Remember to wash your hands before inserting a tampon and again after you take one out.

If the tampon is inserted correctly, you should not feel it. If you feel uncomfortable in any way, you may have inserted the tampon incorrectly or the tampon may not be placed far enough into your vagina. If this happens, just remove the tampon and start again with a new tampon. Remember that practice makes perfect. If you don’t get it on the first try, your second try will most likely be successful. Instead of getting frustrated and giving up, relax and try again!

What if I still don’t succeed?

If you’re not able to insert a tampon after several tries, make an appointment with your health care provider. One reason for this is that you may have been born with a very small opening in your hymen, which prevents you from inserting tampons. This is true in only about 2% of teens, but it could be a problem.

A mirror is often helpful when you’re trying to insert a tampon for the first time, so that you can see exactly where your vaginal opening is. You can also try using a small amount of vaginal lubricant (K-Y Jelly) on the end of the tampon to help it glide in.

What is TSS?

TSS stands for Toxic Shock Syndrome. It’s rare but a dangerous infection if you get it. It can occur in girls who wear tampons.

Tampons themselves do not cause TSS. TSS is caused by bacteria, usually called Staphylococcus aureus. When a tampon is in your vagina, it creates a perfect environment for different types of bacteria, including Staphylococcus aureus, to grow. The bacteria make a toxin that causes severe illness. Younger teens are less likely to have antibodies against the toxin made by these bacteria. You will probably never get TSS, but it’s good to know what the symptoms are and how to lessen your risk.

To lessen your risk of developing TSS, follow these tips when using tampons:

• Use care in inserting tampons. Wash your hands before inserting or removing your tampon. (Make sure your fingernails are not sharp or jagged to avoid tearing your skin).
• Change your tampons at least every 4-6 hours or more often if necessary.
• Choose the correct tampon absorbency. Use smaller sized tampons when your flow is lighter. TSS is very rare but more likely with super-absorbent tampons only when you have a heavy flow. Don’t use these unless your menstrual flow is heavy.
• Alternate between pad and tampon use. Try using pads at night, and tampons in the daytime.
• Don’t use tampons to absorb anything other than your menstrual flow. Only insert a tampon once menstrual blood is present.

Symptoms of TSS-Toxic Shock Syndrome usually come on quickly and may include:

• Flu-like symptoms (muscle aches, headache, redness of your eyes, mouth, and throat
• Sudden high fever
• Dizziness, fainting, or lightheadedness
• Vomiting
• A sunburn-like rash
• Diarrhea

Are there other period products available besides tampons and pads?

Yes. If you are looking for a reusable period product, you may want to consider period cups. Unlike tampons and pads that can only be worn once, period cups can be washed and used over and over again.

What is a period cup?

A period cup is a small, soft, flexible cup made of silicone or rubber. It is placed inside the vagina (close to the cervix) during her period. As blood leaves the uterus, it gets trapped inside the cup. Similar to tampons, there are different size cups that hold different amounts of blood, and there are also different brands and styles of period cups. Just like tampons, menstrual cups do not change your hymen or your “virginity.” If you have a small opening in your hymen, you may not be able to put the cup in and out easily. Some may be more comfortable than others.

• Period cups should only be used to collect menstrual blood.
• Menstrual cups will not change your virginity, nor will a tampon.
• You should NEVER leave the cup in for longer than 12 hours.
• Period cups are not a form of birth control. If you are sexually active, talk to your health care provider about the best birth control method for you. Barrier methods such as condoms greatly decrease the risk of sexually transmitted diseases.

How do I know which size period cup is right for me?

Period cup sizes vary by brands and can depend on several things, such as how much blood the cup can hold, and your cervix size (length of cervix). Talk with your health care provider (HCP) about which period cup is best for you. Some are more rigid (stiff) so they may be better when you plan on being very active, with sports, etc. In the beginning, it’s a good idea to buy a couple of different styles to find the right fit. Unfortunately, you cannot return them to the store if they do not fit because they are personal hygiene product.

How do I insert a period cup?

1. Read and follow the instructions that come with your period cup.
2. Before you insert the period cup, empty your bladder (pee) and wash your hands well. You may stand, squat, lay down, or sit at the edge of the toilet or chair.

Basic instructions

1. Take the cup and fold it so that the top is small and compressed (fold it into a “C” shape or push the lid into the center of the cup).
2. Once you have a good grip on the cup and you’re in a comfortable position, use the other hand to separate your labia (skin folds of your vagina) and slowly insert the opening side of the cup first (while keeping it ) into your vagina with your other hand. Try to keep the cup folded as long as you can while you insert it, so it doesn’t open until it’s all the way inside.
3. When you can’t hold the folded cup any longer, let it unfold and open. Use your fingers to push the base of the cup so it moves into position. Be sure you don’t push the cup too far back so that you can still grab the base when it’s time to empty it.
4. If your cup came with instructions to twist it to confirm placement, you should do this now. You’ll want to twist it one full rotation at the base.
5. To make sure it’s inserted correctly, take a finger and circle the opening of your vagina. If you are able to get a finger passed the top of the cup, you need to make an adjustment (revisit step 3).
6. You can also gently pull on the stem of the cup to confirm placement. If you feel a bit of resistance that means the suction is working and the cups in the right place!
7. Never leave your period cup in your vagina for longer than 12 hours at a time.

How do I remove the period cup?

Removing the cup is easy. Simply follow the following instructions below:

1. Begin by washing your hands well with soap and water.
2. Removing the cup is easy, as long as you’re applying pressure and in the correct position. You can do this by squatting and bearing down like you’re having a bowel movement (pooping).
3. While in the squatting position, pinch the bottom of the cup (to release suction) and pull downwards, making sure you continue to pinch the cups base to prevent any blood from spilling out.
4. Once the cup is out, pour the blood into the toilet.
5. Next, wash your cup well with soap and water, before reinserting it or storing it.
6. Once you are completely finished, be sure to wash your hands again with soap and water.

How often do I have to empty my period cup?

In the beginning it will take a little while to figure out how often to remove and empty the cup. On your heavier flow days (usually Day 1 & 2), you may need to empty the cup more often. However, on your lighter flow days, you will likely need to empty it less often. Since everyone’s menstrual cycle is different, the length of time the cup can stay in is determined by your flow. However: NEVER leave your period cup in your vagina for longer than 12 hours.

Can I leave the period cup in my vagina while I sleep?

As long as it’s not more than 12 hours it’s ok to wear while you sleep. However if you aren’t sure how long you sleep for, it’s better to be safe and use a pad or other period product.

How can I tell how much I am bleeding (when I’m using the period cup)?

Sometimes, your health care provider (HCP) may ask you how often you need to change your pad or tampon.  This helps your HCP figure out how much you are bleeding.  If you are using a period cup, simply tell your HCP the number of times you need to empty the cup and how full it is when you do. Some cups have measuring lines that makes measuring the amount easier.

Can I wash my period cup?

Yes. It’s super important to wash your period cup with soap and water before you use it for the first time and every time you empty it. Be sure to read the care instructions that come with your cup to make sure you’re cleaning it properly.

What are the tiny holes in the period cup for?

The tiny holes help keep the cup in place by using gentle suction If you clean the tiny holes properly it’s unlikely that your cup will leak, so be sure to clean the cup thoroughly.

Can I use someone else’s period cup?

No. It’s best to buy your own period cup and not share it with anyone. Although the cup is reusable, it is meant to be used by one person. Sharing the cup with others, could lead to the spread of infections.

Can I use a tampon with the period cup?

No. Tampons cannot be used with period cups; however, you can wear a panty liner if you are worried about leakage.

Can I make my own period cup?

No. Doctors do NOT recommend homemade period cups. Using household items as a period cup put you at risk for losing the item (inside your vagina) and/or developing an infection. DIY (do-it-yourself) or homemade period cups are NOT safe.

Where can I buy a period cup?

You can buy a period cup at most pharmacies and online. Here are some period cup brands:

• MeLuna®
• Ruby Cup®
• DivaCup®
• OrganiCup®

Are there other period products available besides tampons and pads?

Yes. If you are looking for a reusable period product, you may want to consider period underwear. Unlike tampons and pads that can only be worn once, most period underwear can be washed and used over and over again.

What is period underwear? 

Period underwear are a new eco-friendly period product that is both reusable and absorbable. The idea behind the underwear is similar to that of a pad, but one that is more comfortable. In the lining of the underwear, there are many thin layers of material, which traps blood, while preventing moisture from coming in contact with your skin and vagina. The amount of the blood the underwear can hold depends on the type you buy. Typically, period underwear absorbs a light to moderate flow (or as much as 1-2 tampons); however, it all depends on the type you choose and the amount of your flow. Period underwear looks exactly like a regular pair, and they are available in a variety of colors, patterns, and styles. One company has even designed a pair of period athletic shorts.  Many people are swapping out their one-time use pad or tampon for a pair of stylish period underwear for the convenience and the fact they are reusable.

Can I wear a tampon or cup with period underwear?

Yes, you can absolutely wear a tampon or cup with them. Many people may wear the underwear for added protection from possible leakage.

Can I wear a pad on top of my period underwear?

Technically, you can wear a pad on top of your underwear; however, period underwear were designed to replace the use of a pad. The pad may also prevent the underwear from working properly to trap blood.

Will there be an odor (smell)?

Be sure to change and clean your period underwear at least every 12 hours or sooner. The longer you wear them, the more blood they collect, and the more likely there is going to be an odor. Many of the brands come with an antimicrobial layer to help minimize any odor. Changing them more regularly and wearing cotton/breathable clothing can help as well. It’s important to shower and clean your vulva (outside of vagina) at least once a day, especially during your period. Do not use feminine hygiene deodorants as they can cause irritation of the vulva.  It’s completely normal for periods to have a slight smell; however, it’s important to remember that if you have an unusual odor coming from your vagina that’s different for you, you should call your health care provider (HCP).

Can I wear period underwear while playing sports (i.e. running, swimming, dancing, etc.)?

Yes, there are several companies that have created period athletic shorts, swimwear, and leotards. When you are swimming you can either wear period underwear under a bathing suit or buy special period swimwear. If you choose to wear a period leotard for dance or gymnastics, remember to wear your tights over your leotard, so it works properly.

Can I wash my period underwear?

Washing instructions may vary depending on the brand of period underwear. Be sure to read the instructions before you wash them. However, most say it’s ok to wash them either separately or with other clothes in cold water, then hang dry. There are also some brands that are disposable, so again be sure to read up!

What else do I need to know about period underwear?

You can buy period underwear online or at most department stores. Unfortunately, period underwear can be pricey. Each pair can cost between $10-$65 depending on the brand and style. Usually, the disposable underwear is the more affordable option, but that can defeat one of their benefits of being eco-friendly and reusable. However, investing in a couple of pair of reusable period underwear may end up being cheaper than buying 1-2 boxes of tampons or pads each month.

What if period cups or underwear don’t fit my lifestyle?

It’s OK if period cups and underwear don’t fit your budget or your lifestyle; they are not for everyone. There are still several eco-friendly options available on the market.

You have options! Check out your local natural food store or larger supermarket chain, as many will carry non-chlorine bleached all-cotton pads and tampons. It’s important to mention that these products may be a bit more expensive than regular pads and tampons. They are disposable, so they aren’t as environmentally friendly as reusable products, but they’re not made using chemicals. However, even 100% natural cotton can contain pesticides, so if you want to be sure that the product you’re buying has no chemicals, it’s best to choose a brand made with organic cotton.

I’m looking for a tampon that will last longer like the cup or the underwear, do they exist?

Yes, Sea sponge tampons are an alternative to synthetic tampons that come in different sizes to absorb varying amounts of menstrual flow. The FDA in the United States has recommended that all menstrual sea sponges available seek FDA approval. Currently none are approved by the FDA. We recommend you talk to your clinician to learn more if you are interested in this product. The below content is general information about sea sponges.

These are not the same sponges that you might buy in a grocery store to wash dishes with. Sea sponges are from the ocean floor, and contain no synthetic materials. They are cleaned after harvesting (bleached with hydrogen peroxide) but are not sterile (free from bacteria or other living microorganisms) like synthetic tampons.

Sea sponges can be used multiple times for menses and washed between uses. To use the sponges you should follow the instructions that come with the product including specific instructions on how to place, remove, disinfect, and store the tampon and how often the specific tampon should be changed based on manufacturers recommendations. Menstrual sea sponges on average cost between $12-20 (for a package of two).

In general, before using a sea sponge tampon, you’ll have to dampen it, squeeze it tightly in your hand, and then gently insert it into your vagina. When the sponge is dry it’s surprisingly hard, but once dampened it softens up immediately. Once in place, it works like a tampon to absorb menstrual flow. A sea sponge needs to be rinsed out about every 3 hours and thoroughly cleaned, dried, and properly stored at the end of each menstrual cycle. Care must be taken to remove the sea sponge to avoid tearing it. One sea sponge will last about 6 months, but some may not last as long. A menstrual sea sponge should be thrown away and replaced if you notice that it rips apart while you’re inserting or removing it from your vagina (if this happens you should also speak to a clinician as you want to ensure all parts of a sponge have been removed from the vagina).

As with tampons, it is possible to get toxic shock syndrome from sea sponges.

What if I am not comfortable inserting anything into my vagina?

A great solution for you may be reusable, washable, cloth pads. They work just like regular disposable pads, but instead of throwing them away after use, you rinse them out, wash them, and use them again. Reusable pads usually come in two parts: a liner and a liner holder. The liner goes inside the holder, which has wings that snap around the crotch of your underwear to keep it in place. They come in different sizes and absorbencies and are usually less irritating because they are made of cotton, not plastic. Cloth pads are more expensive than disposables (when you first buy them) but they will save you money over time because they last for years. You change reusable pads as often as you would change disposable pads, except with reusable pads you hand or machine-wash them instead of throwing them away. Girls with sensitive skin or allergies may prefer cloth pads made with organic cotton.