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Environment International
journal homepage: www.elsevier.com/locate/envint
Phthalates, bisphenols, parabens, and triclocarban in feminine hygiene
products from the United States and their implications for human exposure
Chong-Jing Gao
a
, Kurunthachalam Kannan
a,b,⁎
a
Wadsworth Center, New York State Department of Health, Empire State Plaza, P.O. Box 509, Albany, NY 12201-0509, United States
b
Department of Pediatrics, New York University School of Medicine, New York, New York 10016, United States
ARTICLE INFO
Handling Editor: Adrian Covaci
Keywords:
Phthalates
Bisphenols
Antimicrobials
Tampons
Napkins
Deodorant spray
ABSTRACT
Feminine hygiene products, a category of daily necessities, can be a source of exposure to plasticizers and
antimicrobial agents in women. Nevertheless, studies on the occurrence of chemicals in feminine hygiene pro-
ducts have received little attention. In this study, 24 endocrine-disrupting chemicals (EDCs), comprising nine
phthalates, six parabens, eight bisphenols, and triclocarban (TCC) were measured in seven categories of feminine
hygiene products (i.e., pads, panty liners, tampons, wipes, bactericidal creams and solutions, and deodorant
sprays and powders; N= 77) collected in the Albany area of New York State in the United States. Dimethyl
phthalate (DMP), diethyl phthalate (DEP), dibutyl phthalate (DBP), di-iso-butyl phthalate (DIBP), di(2-ethyl-
hexyl) phthalate (DEHP), methyl paraben (MeP), and ethyl paraben (EtP) were found in all pad, panty liner, and
tampon samples. Panty liners contained the highest concentrations of DMP (median: 249 ng/g), DEP (386 ng/g),
DBP (393 ng/g), and DIBP (299 ng/g) and tampons contained the highest concentrations of DEHP (267 ng/g).
MeP, EtP, and propyl paraben (PrP) were the major parabens found in feminine hygiene products. Bactericidal
creams and solutions contained median concentrations of MeP, EtP and PrP at 2840, 734, and 278 ng/g, re-
spectively. The estimated exposure doses of phthalates, parabens, and bisphenols through the dermal absorption
pathway from the use of pads, panty liners, and tampons were significant. In comparison with the exposure doses
reported previously from other sources and pathways, the significance of feminine hygiene products as sources
of EDC exposure was delineated. The dermal absorption doses from the use of feminine hygiene products, under
different exposure scenarios, were 0.19–27.9% and 0.01–6.2% of the total exposure doses of phthalates and
bisphenols, respectively. This is the first study to report the occurrence of phthalates, parabens, bisphenols, and
TCC in feminine hygiene products from the United States.
1. Introduction
Phthalates, bisphenols, parabens, and triclocarban (TCC) are high-
production-volume chemicals that have been reported to possess en-
docrine-disrupting potentials. These chemicals are widely used in a
variety of industrial and consumer products as plasticizers and anti-
microbials (e.g., PVC products, polycarbonate resins, epoxy resins,
medical supplies, detergents, lubricants, personal care products (PCPs),
foodstuffs, and pharmaceuticals) (Andersen, 2009; Carey and
Mcnamara, 2015; Eriksson et al., 2008; Halden and Paull, 2005; Hauser
and Calafat, 2005; Moreta et al., 2015; Soni et al., 2005; Wang et al.,
2019). Epidemiologic studies have linked exposure to phthalates,
parabens, bisphenols, and TCC to effects on endocrine system and fe-
male reproductive disorders (Benjamin et al., 2017; Jagne et al., 2016).
Elevated exposure to phthalates has been associated with precocious
puberty, endometriosis, female genital tumors, and ovulation disorders
(Cai et al., 2010; Jefferson et al., 2010; Miao et al., 2004; Reddy et al.,
2006; Smarr et al., 2016; Svechnikova et al., 2007). Parabens are es-
trogen agonists, and their exposure was linked to breast cancer (Jagne
et al., 2016). Bisphenol A (BPA) has been reported to decrease the
viability of oocytes (Ronit et al., 2013).
Human exposure pathways to phthalates, parabens, bisphenols, and
TCC have been widely studied. Foodstuffs, PCPs, indoor dust, and
pharmaceuticals have been identified as important sources of exposure
to these chemicals (Chen et al., 2016; Gao et al., 2017; Ma et al., 2016).
One study showed that baby wipes and diaper creams contained re-
markable concentrations of antimicrobials, such as parabens (Liao and
Kannan, 2014a). Similarly, high concentrations phthalates have been
measured in sanitary pads (Park et al., 2019). Despite the use of anti-
microbials and plasticizers in feminine hygiene products (e.g., pads,
https://doi.org/10.1016/j.envint.2020.105465
Received 13 September 2019; Received in revised form 23 December 2019; Accepted 3 January 2020
⁎
Corresponding author at: Wadsworth Center, Empire State Plaza, P.O. Box 509, Albany, NY 12201-0509, United States.
E-mail address: Kurunthachalam.kannan@health.ny.gov (K. Kannan).
Environment International 136 (2020) 105465
Available online 13 January 2020
0160-4120/ © 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).
T
panty liners, tampons, wipes, bactericidal creams and solutions, deo-
dorant sprays and powders, other vaginal lotions), exposure to EDCs
from the use of such products by women is not known. Feminine hy-
giene products are daily necessities catering women’s needs. Some
feminine hygiene products, such as pads and tampons, are used during
menstrual periods on a monthly basis, but throughout the entire re-
productive period in women. These products come in direct contact
with reproductive organs including vulvar skin and vaginal mucosa.
Considering the high absorption efficiency and permeability of vulvar
skin and vaginal mucosa, contaminants present in feminine hygiene
products can be easily absorbed into the circulation system (Ishii et al.,
2014; Kumamoto and Iwasaki, 2012; Shin and Ahn, 2007). One study
reported that vaginal douching can increase the exposure to phthalates
in reproductive-aged women (Branch et al., 2015). Therefore, feminine
hygiene products can be a potential source of chronic exposure to EDCs
in women.
Phthalates are widely used as humectants, emollients, or skin pe-
netration enhancers in PCPs such as perfumes, deodorants, cosmetics,
nail polishes, and skin and hair care products, and are incorporated into
feminine care products during production (Bao et al., 2015; Guo and
Kannan, 2013; Hubinger and Havery, 2006; Hyun and Byung, 2004;
Koniecki et al., 2011). Parabens are antimicrobials and are used as
preservatives in feminine care products (Guo and Kannan, 2013). TCC,
an antibacterial agent, is used in feminine care products, including bar
soaps, cleansing lotions, wipes, and feminine bactericidal creams and
solutions (HPV, 2012; Lewis, 2007). In addition, pads, panty liners, and
tampons are made from polypropylene (PP) and polyethylene (PE)
materials, which can contain plasticizers such as phthalates, to increase
the products’flexibility (Farage et al., 2007). Nevertheless, there are no
standards or regulations with regard to the use of phthalates, parabens,
bisphenols, and TCC in feminine hygiene products.
In this study, 24 EDCs, comprising nine phthalate diesters, six
parabens, eight bisphenols, and TCC, were determined in seven cate-
gories of feminine hygiene products collected from the Albany area of
New York State in the United States. The objectives of this study were to
(1) elucidate the occurrence and profiles of phthalates, parabens, bi-
sphenols, and TCC in feminine hygiene products; (2) determine the
dermal exposure doses of the chemicals from the use of products, and
(3) evaluate the significance of feminine hygiene products as a source of
EDC exposure in women.
2. Materials and methods
2.1. Standards and reagents
Nine phthalate diester standards (purity ≥99%), namely, dimethyl
phthalate (DMP), diethyl phthalate (DEP), dibutyl phthalate (DBP), di-
iso-butyl phthalate (DIBP), butyl benzyl phthalate (BBzP), dicyclohexyl
phthalate (DCHP), di-n-hexyl phthalate (DNHP), di(2-ethylhexyl)
phthalate (DEHP), and di-n-octyl phthalate (DOP), were purchased
from AccuStandard Inc (New Haven, CT, USA) and/or C/D/N isotopes
(Pointe-Claire, Quebec, Canada). Six paraben standards (purity ≥98%),
methyl- (MeP), ethyl- (EtP), propyl- (PrP), butyl- (BuP), benzyl- (BzP)
and heptyl- parabens (HeP) were purchased from Cambridge Isotope
Laboratories (Andover, MA, USA) and AccuStandard Inc. Seven bi-
sphenol analogues (purity ≥97%), bisphenol F (BPF), bisphenol A
Table 1
Concentrations (ng/g) and detection frequencies of phthalates in feminine hygiene products from Albany, New York, the United States.
Category DMP DEP DIBP DBP BBzP DEHP Σ
9
Phthalate
Pads (n= 18)
Mean 88.4 162 413 764 < LOD 97.7 1530
Median 81.5 82.0 73.0 83.3 < LOD 38.7 362
Range 56.0–174 50.9–1200 25.9–5400 22.0–3630 < LOD 14.9–858 205–11200
DF 100% 100% 100% 100% 0% 100%
Panty liners (n= 13)
Mean 234 394 817 1230 < LOD 2070 4740
Median 249 386 299 393 < LOD 164 1830
Range 57.2–522 45.6–1070 25.1–5500 21.3–6070 < LOD 11.1–23400 168–34500
DF 100% 100% 100% 100% 0% 100%
Tampons (n= 12)
Mean 412 192 128 378 < LOD 744 1850
Median 214 190 99.2 125 < LOD 267 1130
Range 141–1650 127–262 57.9–326 72.0–2240 < LOD 64.1–4680 621–6160
DF 100% 100% 100% 100% 0% 100%
Wipes (n= 12)
Mean 227 3490 75.6 74.8 < LOD 63.3 3930
Median 168 149 68.0 64.7 < LOD 61.4 546
Range 40.9–810 36.0–21300 18.9–138 16.5–165 < LOD 5.33–126 118–21700
DF 100% 100% 100% 100% 0% 100%
Bactericidal creams and solutions (n= 14)
Mean 1.45 1.18 2.92 1.22 < LOD 7.77 15.1
Median < LOD < LOD <LOD < LOD < LOD < LOD 9.33
Range < LOD–16.6 < LOD–10.9 < LOD–10.9 < LOD–7.85 < LOD < LOD–32.9 < LOD–47.9
DF 38% 31% 46% 46% 8% 46%
Deodorant sprays (n=4)
Mean < LOD < LOD < LOD < LOD < LOD < LOD < LOD
Median < LOD < LOD < LOD < LOD < LOD < LOD < LOD
Range < LOD < LOD < LOD < LOD < LOD < LOD < LOD
DF 0% 0% 0% 0% 0% 0%
Powders (n=4)
Mean 0.26 1.87 1.83 3.89 < LOD 3.88 12.3
Median < LOD 1.19 1.64 3.37 < LOD 3.92 11.2
Range < LOD–1.02 < LOD–5.10 < LOD–4.05 < LOD–8.83 < LOD < LOD–7.68 < LOD–26.7
DF 25% 75% 50% 75% 25% 75%
Note: DCHP, DNHP and DOP were not found in any sample.
C.-J. Gao and K. Kannan Environment International 136 (2020) 105465
2
(BPA), bisphenol P (BPP), bisphenol S (BPS), bisphenol Z (BPZ), bi-
sphenol AP (BPAP),bisphenol AF (BPAF), and bisphenol B (BPB) were
purchased from Sigma-Aldrich (St. Louis, MO, USA) and TCI America
(Portland, OR, USA). TCC (99%) was purchased from Sigma-Aldrich. A
total of 22 isotope-labeled standards, d4-DMP, d4-DEP, d4-DBP, d4-
DIBP, d4-BBzP, d4-DCHP, d4-DNHP, d4-DEHP, d4-DOP,
13
C
12
-BPF,
13
C
12
-BPA,
13
C
4
-BPP,
13
C
12
-BPS,
13
C
12
-BPZ,
13
C
12
-BPAF,
13
C
6
-MeP,
13
C
6
-EtP,
13
C
6
-PrP,
13
C
6
-BuP, d4-BzP, d4-HeP, and
13
C
6
-TCC, were used
as internal standards. Solvents used for extraction and instrumental
analysis included methanol (LC/MS grade; Fisher Chemical, Fair Lawn,
NJ, USA), hexane (J.T. Baker, Center Valley, PA, USA), methyl-tert-
butyl-ether (MTBE; Phillipsburg, NJ, USA), dichloromethane (DCM;
ACS, Macron Fine Chemical, Center Valley, PA, USA), acetone (J.T.
Baker), and water (HPLC grade; J.T. Baker).
2.2. Sample collection and analysis
From February to March 2019, a total of 77 feminine hygiene pro-
ducts (Fig. S1) were purchased in several supermarkets in and around
Albany, New York, USA. Feminine hygiene products were grouped into
seven categories, namely, pads (n= 18), panty liners (n= 13), tam-
pons (n= 12), wipes (n= 12), bactericidal creams and solutions
(n= 14), deodorant sprays (n= 4), and powders (n= 4). All feminine
hygiene products were from 47 popular brands of varying prices that
were widely marketed throughout the United States and used by
American women. Detailed information on feminine hygiene products
analyzed in this study is summarized in Table S1.
To avoid possible contamination during storage, samples were
analyzed within a week after collection. For pads and panty liners, only
the surface layer of the material that comes in direct contact with the
skin was analyzed. For others, the product in entirety was analyzed.
Depending on the target compounds and the composition of samples,
four different extraction methods were used. The details of the extrac-
tion methods are described in the supplementary materials.
Phthalates were determined using an Agilent Technologies 7890A
gas chromatography (GC) system coupled with an Agilent Technologies
5975C mass spectrometer (MS). Parabens, bisphenols, and TCC were
determined using a Shimadzu Prominence modular high-performance
liquid chromatography (HPLC) system (Shimadzu Corporation, Kyoto,
Japan) coupled with an API 3200 electrospray triple quadrupole mass
spectrometer (ESI-MS/MS; Applied Biosystems, Foster City, CA).
Further details of the instrumental analysis have been provided in our
previous publications (Guo and Kannan, 2011; Li and Kannan, 2008).
2.3. Quality assurance (QA)/quality control (QC)
For each batch of 20 samples, two method blanks and two matrix
spike samples were analyzed. The reported concentrations in products
are in nanograms per gram (ng/g) sample weight (pads, panty liners,
tampons, and wipes are dry products, whereas bactericidal creams,
deodorant sprays, and powders are wet products). In the analysis of
bactericidal creams, deodorant sprays, and feminine powders, mea-
surable concentrations of DMP (mean: 0.60 ng/g), DEP (0.51 ng/
g), DBP (0.52 ng/g), DIBP (1.03 ng/g), BBzP (0.21 ng/g), DCHP
(0.60 ng/g), DEHP (0.65 ng/g), MeP (0.15 ng/g), EtP (0.50 ng/g), and
PrP (0.05 ng/g) were found in procedural blanks. The mean recoveries
of target compounds spiked into the above sample matrices ranged from
67 ± 8% to 113 ± 12% (mean ± standard deviation). In the
Table 2
Concentrations (ng/g) and detection frequencies (%) of parabens in feminine hygiene products from Albany, New York, the United States.
Category MeP EtP PrP BuP BzP HeP Σ
6
Paraben
Pads (n= 18)
Mean 45.5 47.1 10.8 0.97 < LOD < LOD 104
Median 19.2 21.1 1.70 0.09 < LOD < LOD 46.5
Range 4.30–245 5.89–207 < LOD–79.4 < LOD–14.7 < LOD < LOD 12.6–426
DF 100% 100% 99% 61% 0% 0%
Panty liners (n= 13)
Mean 152 77.2 17.8 2.15 0.60 < LOD 249
Median 51.8 62.0 3.86 < LOD < LOD < LOD 108
Range 18.6–1240 32.0–281 < LOD–160 < LOD–17.3 <LOD–5.17 < LOD 51.1–1700
DF 100% 100% 92% 31% 38% 0%
Tampons (n= 12)
Mean 18.2 27.6 2.01 0.06 < LOD < LOD 47.9
Median 15.3 25.2 0.46 < LOD < LOD < LOD 42.7
Range 0.01–5.85 0.02–89.9 < LOD–12.8 < LOD–0.48 <LOD < LOD 0.04–162
DF 100% 100% 67% 33% 0% 0%
Wipes (n= 12)
Mean 418 12,564 20.4 0.91 0.38 < LOD 13,004
Median 86.3 0.98 0.73 < LOD 0.06 < LOD 149
Range 0.37–3650 < LOD–15000 < LOD–136 < LOD–8.28 <LOD–1.94 < LOD 0.41–15400
DF 100% 75% 83% 33% 58% 8%
Bactericidal creams and solutions (n= 14)
Mean 67,100 70,200 27,700 5.89 8.62 < LOD 165,000
Median 2840 743 278 2.22 0.52 < LOD 5350
Range 357–278000 <LOD–564000 < LOD–143000 <LOD–48.8 < LOD–55.4 < LOD 363–946000
DF 100% 77% 85% 69% 54% 0%
Deodorant sprays (n=4)
Mean 1590 2100 188 0.26 324 < LOD 4200
Median 748 141 20.9 < LOD 147 < LOD 1060
Range 186–4680 39.9–8070 7.62–702 < LOD–1.05 <LOD–1000 < LOD 233–14400
DF 100% 100% 100 25% 50% 0%
Powders (n=4)
Mean 997 12.5 352 < LOD 6.76 < LOD 1370
Median 967 4.93 36.6 < LOD < LOD < LOD 1167
Range 137–1920 < LOD–40.0 1.03–1330 <LOD < LOD–27.0 < LOD 179–2960
DF 100% 50% 100% 0% 25% 0%
C.-J. Gao and K. Kannan Environment International 136 (2020) 105465
3
analysis of pads, panty liners, tampons, and wipes, measurable con-
centrations of DMP (0.55 ng/g, mean), DEP (1.35 ng/g), DBP (0.90 ng/
g), DIBP (0.45 ng/g), BBzP (0.40 ng/g), DCHP (0.70 ng/g), DEHP
(2.90 ng/g), MeP (0.15 ng/g), EtP (0.48 ng/g) and PrP (0.01 ng/g) were
found in procedural blanks. The mean recoveries of target compounds
spiked into the above sample matrices ranged from 67 ± 11% to
105 ± 8%. The reported concentrations in samples were corrected for
the recoveries of corresponding internal standards and were subtracted
from concentrations found in procedural blanks. The limits of quanti-
fication (LOQs) of phthalate diesters were in the range of 2–10 ng/g,
and the LOQs of parabens, bisphenols, and TCC were in the range of
0.1–0.4 ng/g. Concentrations below the LOQ were assigned a value of
zero for statistical analysis.
2.4. Data analysis
The daily exposure doses of phthalates, parabens, bisphenols, and
TCC via dermal absorption from the use of pads, panty liners, and
tampons were calculated as shown in Eq. (1) (Ishii et al., 2015):
=×××
DED CMNA
BW
11
(1)
where DED is the daily exposure dose (μg/kg-bw/day); C
1
is the mea-
sured concentration of phthalates, parabens, bisphenols, and TCC in
pads, panty liners, and tampons; M
1
is the weight (g) of the top layer of
pads and panty liners or the weight (g) of tampons; Nis the number of
pads, panty liners, and tampons used per day; Ais the transdermal
absorption rate; and BW is the average body weight of women (kg).
The DED of phthalates, parabens, bisphenols, and TCC through
dermal absorption from the use of wipes, bactericidal creams, deo-
dorant sprays, and powders were calculated as shown in Eq. (2) (Bao
et al., 2015):
=××××
DED CMFARF
BW
22
(2)
where DED is the daily exposure dose (μg/kg-bw/day); C
2
is the mea-
sured concentrations of target chemicals (μg/g); M
2
is the amount of
daily use of bactericidal creams, deodorant sprays, and powders; Fis
the daily use frequency (times/day), Ais the transdermal absorption
rate; RF is the retention factor; and BW is the average body weight of
women (kg).
For N, an average value of 6 was used. For BW, an average body
weight of 75 kg was used for adult females in the United States (Guo
and Kannan, 2013). The values of M
2
and Fwere calculated from the
recommended doses of use, as provided in the manufacturers' instruc-
tions. For RF, a value of 0.01 for phthalates (Bao et al., 2015) and 0.001
for parabens, bisphenols, and TCC were applied (Liao and Kannan,
2014b). The transdermal absorption rates (A) for phthalates, parabens,
bisphenols, and TCC through vulvar skin and vaginal mucosa are not
available. One study reported that vulvar skin exhibited higher ab-
sorption rates for hydrocortisone than did the normal skin (Farage and
Maibach, 2010). Considering the high transdermal absorption of che-
micals by vulvar skin and vaginal mucosa, a range of absorption rates
was used in this study to reflect different exposure scenarios for
phthalates, parabens, bisphenols, and TCC from the use of feminine
hygiene products. The absorption rates by normal skin of 10%, 5%,
Table 3
Concentrations (ng/g) and detection frequencies (%) of bisphenols and TCC in feminine hygiene products from Albany, New York, the United States.
Category BPF BPA BPP BPS BPZ Σ
6
Bisphenol TCC
Pads (n= 18)
Mean 0.63 12.7 < LOD < LOD < LOD 13.3 0.01
Median < LOD 2.77 < LOD < LOD < LOD 5.59 < LOD
Range < LOD–3.81 < LOD–55.9 <LOD < LOD < LOD < LOD–55.9 < LOD–0.10
DF 22% 72% 0% 0% 0% 17%
Panty liners (n= 13)
Mean 14.2 23.1 < LOD 0.12 < LOD 37.5 0.04
Median 8.44 5.12 < LOD < LOD < LOD 21.1 < LOD
Range < LOD–89.9 < LOD–157 < LOD < LOD–1.34 < LOD < LOD–160 < LOD–0.47
DF 69% 69% 0% 15% 0% 8%
Tampons (n= 12)
Mean 5.60 0.87 < LOD 0.02 < LOD 6.49 0.05
Median 4.82 0.70 < LOD < LOD < LOD 5.56 < LOD
Range < LOD–15.4 < LOD–2.46 <LOD < LOD–0.22 < LOD < LOD–15.6 < LOD–0.44
DF 92% 92% 0% 8% 0% 33%
Wipes (n= 12)
Mean 0.84 0.73 0.78 0.05 < LOD 2.41 0.02
Median < LOD 0.57 < LOD < LOD < LOD 1.24 < LOD
Range < LOD–5.89 < LOD–2.18 <LOD–7.96 < LOD–0.62 < LOD < LOD–8.91 <LOD–0.13
DF 17% 75% 17% 17% 0% 17%
Bactericidal creams and solutions (n= 14)
Mean 0.01 0.34 < LOD 0.18 < LOD 0.54 5.24
Median < LOD < LOD < LOD 0.06 < LOD 0.07 < LOD
Range < LOD–0.16 < LOD–3.11 <LOD < LOD–1.43 < LOD–0.08 < LOD–4.62 <LOD–40.2
DF 8% 15% 0% 62% 8% 46%
Deodorant sprays (n=4)
Mean 0.41 4.99 < LOD < LOD < LOD 5.41 2.40
Median < LOD 4.79 < LOD < LOD < LOD 5.20 1.91
Range < LOD–1.65 < LOD–10.4 <LOD < LOD < LOD < LOD–11.2 < LOD–5.79
DF 25% 50% 0% 0% 0% 50%
Powders (n=4)
Mean < LOD < LOD < LOD < LOD < LOD < LOD 3.44
Median < LOD < LOD < LOD < LOD < LOD < LOD < LOD
Range < LOD < LOD < LOD < LOD < LOD < LOD < LOD–13.8
DF 0% 0% 0% 0% 0% 25%
Note: BPAP, BPAF and BPB were not found in any sample.
C.-J. Gao and K. Kannan Environment International 136 (2020) 105465
4
0.5% and 0.5% for DBP, BBzP, DEHP and DINP (phthalate diesters) as
proposed by the European Union were adopted (EU-RAR 2003; 2004;
2007; 2008). Considering the similar physicochemical properties to
DBP, BBzP and DINP, the dermal absorption rates of DMP, DEP, DIBP,
DCHP and DNOP were projected at 10%, 10%, 10%, 5% and 0.5%,
respectively. The dermal absorption rates of parabens, bisphenols and
TCC were assumed to be 5%. For high exposure scenarios, the ab-
sorption rates of 20% and 100% were considered (Hopf et al., 2014).
3. Results and discussion
3.1. Phthalate diesters
More than 90% of feminine hygiene products analyzed in this study
contained measurable concentrations of Σ
9
Phthalate (sum of nine
phthalates) (Table 1). The median (range) concentrations of
Σ
9
Phthalate in pads (top layer), panty liners (top layer), tampons, and
wipes were 362 (205–11200), 1830 (205–34500), 1130 (621–6160)
and 546 (118–21700) ng/g, respectively, which were two or three or-
ders of magnitude higher than those measured in bactericidal creams
and solutions (9.33; < LOD–47.9 ng/g), deodorant sprays (< LOD; <
LOD), and feminine powders (11.2; < LOD–26.7 ng/g) (p< 0.01).
DMP, DEP, DBP, DIBP, and DEHP were the major phthalate diesters
found in 100% of pads, panty liners, tampons, and wipes. Panty liners
contained the highest concentrations of DMP, DEP, DBP, and DIBP
(respective median: 249, 386, 393, and 299 ng/g), followed by tampons
(214, 190, 99.2, and 125 ng/g), wipes (168, 149, 68.0, and 64.7 ng/g)
and pads (81.5, 82.0, 73.0, and 83.3 ng/g). Tampons contained the
highest concentrations of DEHP (267 ng/g), followed by panty liners
(164 ng/g), wipes (61.4 ng/g), and pads (38.7 ng/g). The median
concentrations of DMP, DEP, DBP, DIBP, and DEHP found in bacter-
icidal cream and solutions, deodorant sprays, and powders
were < LOD, 1.19, 1.64, 3.37 and 3.92 ng/g, respectively, which were
significantly lower than those in pads, panty liners, tampons, and wipes
(p< 0.01). BBzP, DCHP, DNHP, and DNOP were rarely detected in
feminine hygiene products.
Very few studies have reported the occurrence of phthalates in
feminine hygiene products. One study reported that the use of vaginal
douching products may increase phthalate exposure in women (Branch
et al., 2015). Median concentration of 16 phthalates in Chinese sanitary
pads was reported to be 4970 ng/g (Chai et al., 2017), which was much
higher than the concentrations of Σ
9
phthalate measured in pads in our
Fig. 1. Concentrations of phthalates, parabens, bisphenols and TCC in feminine hygiene products collected from the Albany area of New York State, the United States
(Each vertical bar represents one feminine hygiene product category. Different colors on the vertical bar represent different compounds and the corresponding values
represent the median concentrations). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
C.-J. Gao and K. Kannan Environment International 136 (2020) 105465
5
study (362 ng/g). Another study reported the concentrations of several
phthalates (DEP, DBP and DEHP) in sanitary pads from six countries
(Korea, Japan, Finland, France, Greece and the United States) (Park
et al., 2019). The measured concentrations of DBP in sanitary pads from
these countries (52.1–7820 ng/g) were similar to those found in our
study (22.0–3630 ng/g); however, the reported concentrations of DEP
and DEHP in sanitary pads from these countries (below detection
limit–134 ng/g and 5.5–194 ng/g) were an order of magnitude lower
than the values found in our study (50.9–1200 ng/g and 14.9–858 ng/
g). DBP and DEHP were also reported to occur in newborn diapers from
Japan, at concentrations in the ranges of 100 to 200 ng/g and 100 to
600 ng/g, respectively (Ishii et al., 2015). DBP and DEHP concentra-
tions reported in newborn diapers were comparable to those found in
wipes but much lower than those found in pads, panty liners, and
tampons (Ishii et al., 2015). Panty liners, tampons and feminine wipes
are frequently used by women similar to that of sanitary pads.
However, information on the occurrence of phthalates in these products
is scarce. The concentrations of DEP in panty liners (45.6–1070 ng/g)
and wipes (36.0–21300 ng/g) and the concentrations of DEHP in panty
liners (11.1–23400 ng/g) and tampons (64.1–4680 ng/g) found in our
study were one or two orders of magnitude higher than the values re-
ported in sanitary pads by Park et al. (2019).
The high concentrations of phthalates in pads, panty liners, and
tampons could be explained by PP- and PE-based materials used in the
production of these daily necessities. Phthalates may be present in these
plastics as additives to increase the flexibility of the material (Farage
et al., 2007). Hot-melt adhesive, which is used to cement different
layers of pads and panty liners, is another source of phthalates in these
products. During the production of hot-melt adhesives, phthalates are
added to enhance the ductility and gel properties (Lian et al., 2011).
The high temperature processes used in the production of pads, panty
liners, and tampons can release phthalates from hot-melt adhesives to
Fig. 2. Concentration profiles of phthalates, parabens, bisphenols and TCC in feminine hygiene products collected from the Albany area of New York State, the
United States (Each vertical bar represents one feminine hygiene product category. Different colors on the vertical bar represent different compounds and the
corresponding values represent the average concentration ratios of the compound to the total concentrations of all compounds. Blank column represents lack of
occurrence). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
C.-J. Gao and K. Kannan Environment International 136 (2020) 105465
6
Table 4
Dermal absorption doses (ng/kg-bw/day) of phthalates, parabens, bisphenols and TCC through the use of feminine hygiene products in the United States.
Category DMP DEP DIBP DBP BBzP DEHP Total
Pads
Median 1.129 1.136 1.010 1.154 < 0.001 0.027 0.250
Maximum 2.413 16.58 74.71 50.21 < 0.001 0.594 7.723
Panty liners
Median 2.294 3.559 2.764 3.631 < 0.001 0.076 0.844
Maximum 4.819 9.874 50.74 56.01 < 0.001 10.80 15.90
Tampons
Median 4.940 4.384 2.288 2.885 < 0.001 0.308 1.309
Maximum 38.03 6.051 7.518 51.67 < 0.001 5.400 7.105
Wipes
Median 0.001 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.000
Maximum 0.005 0.142 0.001 0.001 < 0.001 < 0.001 0.007
Bactericidal creams and solutions
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.002 0.002
Deodorant sprays
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Powders
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Category MeP EtP PrP BuP BzP HeP Total
Pads
Median 0.133 0.146 0.012 0.001 < 0.001 < 0.001 0.322
Maximum 1.697 1.436 0.550 0.102 < 0.001 < 0.001 2.951
Panty liners
Median 0.239 0.286 0.018 < 0.001 < 0.001 < 0.001 0.499
Maximum 5.709 1.297 0.739 0.080 0.024 < 0.001 7.848
Tampons
Median 0.176 0.291 0.005 < 0.001 < 0.001 < 0.001 0.493
Maximum 0.676 1.037 0.148 0.006 < 0.001 < 0.001 1.866
Wipes
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum 0.001 0.050 < 0.001 < 0.001 < 0.001 < 0.001 0.052
Bactericidal creams and solutions
Median 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.002
Maximum 0.093 0.188 0.048 < 0.001 < 0.001 < 0.001 0.316
Deodorant sprays
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum 0.002 0.003 < 0.001 < 0.001 < 0.001 < 0.001 0.005
Powders
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 0.001
0.133 0.146 0.012 0.001 < 0.001 < 0.001 0.322
Category BPF BPA BPB BPS BPZ Total TCC
Pads
Median < 0.001 0.019 < 0.001 < 0.001 < 0.001 0.039 < 0.001
Maximum 0.026 0.387 < 0.001 < 0.001 < 0.001 0.387 < 0.001
Panty liners
Median 0.039 0.024 < 0.001 < 0.001 < 0.001 0.097 < 0.001
Maximum 0.415 0.724 < 0.001 0.006 < 0.001 0.736 < 0.001
Tampons
Median 0.056 0.008 < 0.001 < 0.001 < 0.001 0.064 < 0.001
Maximum 0.177 0.028 < 0.001 0.003 < 0.001 0.180 < 0.001
Wipes
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Bactericidal creams and solutions
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Deodorant sprays
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
(continued on next page)
C.-J. Gao and K. Kannan Environment International 136 (2020) 105465
7
other layers of the product. The outer polymeric layers of pads and
panty liners that we analyzed in this study are hydrophobic to prevent
the leakage of liquids (Fierens et al., 2012; Zheng et al., 2006).
Phthalates have been reported to occur in PCPs in the United States
(EWG, 2002; Guo and Kannan, 2013), Canada (Koniecki et al., 2011),
China (Bao et al., 2015; Guo et al., 2014), and Korea (Hyun and Byung,
2004). The concentrations of individual phthalate diester in bacter-
icidal creams and solutions, deodorant sprays, and powders measured
in this study were below 0.005% of the sample weight. The low con-
centrations of phthalates found in bactericidal creams and solutions,
deodorant sprays, and powders may be derived from plastic packing
materials (Guo and Kannan, 2013).
3.2. Parabens
More than one paraben was found in all feminine hygiene products
(Table 2). Bactericidal creams and solutions contained the highest
concentrations of Σ
6
Paraben, with a median value of 5350 ng/g (range:
363–946000 ng/g). The median concentrations of Σ
6
Paraben in pads,
panty liners, tampons, wipes, deodorant sprays, and powders were 46.5
(range: 12.6–426), 108 (51.1–1700), 42.7 (0.04–162), 149
(0.41–154000), 1060 (233–14500), and 1170 (179–2960) ng/g, re-
spectively. Bactericidal creams and solutions, deodorant sprays, and
powders contained one to two orders of magnitude higher concentra-
tions of Σ
6
Paraben than those of pads, panty liners, tampons and wipes.
MeP, EtP, and PrP were the major paraben compounds found in
feminine hygiene products, with detection frequencies of 75–100%,
which is consistent with the pattern found in foodstuffs, non-feminine
hygiene related PCPs, indoor dust, and pharmaceuticals in the United
States (Guo et al., 2014; Liao and Kannan, 2013; Moreta et al., 2015;
Wang et al., 2012). The concentrations of MeP (2840 ng/g), EtP
(734 ng/g) and PrP (278 ng/g) in bactericidal creams and solutions
were at least three times higher than those found in deodorant sprays
(748, 141, and 20.9 ng/g, respectively) and powders (967, 4.93, and
36.6 ng/g, respectively) and at least two orders of magnitude higher
than those found in pads (19.2, 21.1, and 1.7 ng/g), panty liners (51.8,
62.0, and 3.86 ng/g), tampons (15.3, 25.2, and 0.46 ng/g), and wipes
(86.3, 0.98 and 0.73 ng/g).
The occurrence of parabens in non-feminine hygiene related PCPs,
including cosmetics, fragrances, scents, and skin and hair care products
has been reported previously (Guo and Kannan, 2013; Guo et al., 2014;
Yazar et al., 2011). The measured concentrations of MeP in bactericidal
creams and solutions (mean: 67100 ng/g) were higher than those re-
ported for face cream (400 ng/g), skin toner (180 ng/g), eyeliner cream
(640 ng/g), hand cream (450 ng/g), and hair care products (120 ng/g)
from the United States. The concentrations of EtP in bactericidal creams
and solutions (mean: 70200 ng/g) were higher than those reported for
many non-feminine hygiene related PCPs, except for face creams
(246000 ng/g), body wash (94500 ng/g), skin lotions (81300 ng/g),
and sunscreens (419000 ng/g), from the United States (Guo and
Kannan, 2013). Similarly, median concentrations of MeP measured in
bactericidal creams and solutions, deodorant sprays, and powders were
higher than those reported for face cleanser (28700 ng/g), shampoo
(10 ng/g), and body wash (10 ng/g) but lower than those reported for
face creams (1040000 ng/g) and body lotions (1170000 ng/g) from
China (Guo et al., 2014).
3.3. Bisphenols and TCC
Σ
8
Bisphenol (sum of eight bisphenols) was found in more than 95%
of feminine hygiene products analyzed (Table 3). The concentrations of
Σ
8
Bisphenol in feminine hygiene products were lower than those of
phthalates and parabens. Among the products analyzed, panty liners
contained the highest concentrations of Σ
8
Bisphenol, with a median
value of 21.1 ng/g (< LOD–160 ng/g). The concentrations of
Σ
8
Bisphenol in pads (5.59; < LOD–55.9 ng/g), tampons
(5.56; < LOD–15.6 ng/g), and deodorant sprays
(5.20; < LOD–11.2 ng/g) were one-third of the concentrations found in
panty liners.
BPF, BPA, and BPS were the major bisphenols found in feminine
hygiene products. BPF was widely found in tampons (92%) and panty
liners (69%) at median concentrations of 8.44 and 4.82 ng/g, respec-
tively. BPA was widely found in pads (72%), panty liners (69%), tam-
pons (92%), and wipes (75%). Panty liners (5.12 ng/g) contained the
highest concentration of BPA, followed by pads (2.77 ng/g), tampons
(0.70 ng/g), and wipes (0.57 ng/g). BPS was found in bactericidal
creams and solutions (62%), but was rarely (< 20%) found in other
categories of samples. BPP, BPZ, BPAP, BPAF, and BPB were seldom
found in feminine hygiene products (< 20%). BPA and BPF were re-
ported to be present in < 50% of non-feminine hygiene related PCPs
from the United States (Liao and Kannan 2014b). Toilet soaps in the
United States contained BPA at a mean concentration of 4.05 ng/g,
which was lower than that found in panty liners (8.44 ng/g) and
tampons (4.82 ng/g). The source of bisphenols in tampons and panty
liners could be the plastic polymers that may contain these chemicals as
additives or impurities.
TCC was found in 8–50% of the feminine hygiene products analyzed
in this study (Table 3). The concentrations of TCC in all feminine hy-
giene products ranged from < LOD to 40.2 ng/g. Bactericidal creams
and solutions (46%) and deodorant sprays (50%) showed higher de-
tection frequencies for TCC than did the other product categories ana-
lyzed.
3.4. Profiles of phthalates, parabens, bisphenols, and TCC
Among the four classes of chemicals analyzed, phthalates were the
major compounds found in pads, panty liners, tampons, and wipes,
accounting for 85%, 85%, 96%, and 73%, respectively, of the total
concentrations of all compounds analyzed (Figs. 1 and 2). Parabens
were the major compounds in bactericidal creams and solutions, deo-
dorant sprays, and powders, accounting for 95%, 98%, and 95%, re-
spectively, of the total concentrations. Bisphenols and TCC accounted
for less than 5% of the total concentrations in all categories of products.
The concentrations of individual compounds within each chemical
class varied among products. DMP, DEP, DBP, DIBP, and DEHP col-
lectively accounted for > 90% of Σ
8
Phthalate in all feminine hygiene
products. The proportion of DMP, DEP, and DBP to Σ
8
Phthalate con-
centrations in pads, panty liners, and wipes were significantly higher
than those in bactericidal creams and solutions (p< 0.05). Among
parabens, MeP and EtP accounted for > 80% of Σ
6
Paraben in all fem-
inine hygiene product categories. The proportion of MeP to Σ
6
Paraben
in wipes, bactericidal creams and solutions, deodorant sprays, and
powders was higher than that in pads, panty liners, and tampons,
Table 4 (continued)
Category DMP DEP DIBP DBP BBzP DEHP Total
Powders
Median < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Maximum < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
Note: The transdermal absorption rates of DMP, DEP, DIBP, DBP, BBzP and DEHP were set at 10%, 10%, 10%, 10%, 5%, and 0.5%. The transdermal absorption rates
of all of paraben, bisphenol and TCC compounds were set at 5%.
C.-J. Gao and K. Kannan Environment International 136 (2020) 105465
8
whereas the proportion of EtP to Σ
6
Paraben in pads, panty liners, and
tampons was higher than that in wipes, bactericidal creams and solu-
tions, deodorant sprays, and powders (p< 0.05). MeP and EtP are
used as antimicrobial preservatives in a variety of consumer goods (Guo
and Kannan, 2013; Ma et al., 2016; Soni et al., 2005). Almost all pre-
vious studies reported MeP as the predominant preservative in foods
and pharmaceuticals. The elevated proportion of EtP (relative to MeP)
in pads, panty liners, and tampons was distinctive. BPF and BPA were
the major bisphenols, accounting for > 85% of Σ
8
Bisphenol in all
feminine hygiene categories, except for bactericidal creams and solu-
tions (26%). Panty liners and tampons contained a notable proportion
of BPF.
3.5. Dermal exposure assessment
The daily exposure doses of phthalates, parabens, bisphenols and
TCC through dermal absorption from the use of feminine hygiene
products are summarized in Table 4. Pads, panty liners, and tampons
accounted for a major share of phthalate, paraben, and bisphenol ex-
posures in American women. The respective exposure doses of phtha-
lates, parabens, and bisphenols through dermal absorption from the use
of pads (0.250, 0.322 and 0.039 ng/kg-bw/day), panty liners (0.844,
0.499 and 0.097 ng/kg-bw/day) and tampons (1.31, 0.493 and
0.064 ng/kg-bw/day) were two to three orders of magnitude higher
than those calculated from the use of other feminine hygiene products.
The data from high exposure scenarios of phthalates, parabens, bi-
sphenols and TCC from the use of feminine care products are sum-
marized in Tables S2–S4. With the absorption rate of 100%, the ex-
posure doses of phthalates, parabens, and bisphenols from the use of
pads (50.1, 169, and 262 ng/kg-bw/day), panty liners (6.43, 9.97, and
9.85 ng/kg-bw/day) and tampons (0.775, 1.94, and 1.28 ng/kg-bw/
day) were at least ten times higher than those estimated for the ab-
sorption rates of the normal skin.
Currently, no-observed-adverse-effect levels (NOAELs) for phtha-
lates, parabens, bisphenols, and TCC are not available. Therefore,
NOAELs from animal studies based on oral or gavage exposure routes
were used to evaluate the transdermal exposure risks of phthalates,
parabens, bisphenols, and TCC. The NOAELs of DEP (800 µg/kg-bw/
day), DBP (200 µg/kg-bw /day), DIBP (300 mg/kg-bw /day), BBzP
(20 mg/kg-bw /day), DEHP (3.7 mg/kg-bw /day), DOP (37 mg/kg/
day), MeP + EtP (10 mg/kg-bw /day), PrP (0.1 mg/kg-bw /day), and
BPA (400–1400 ng/kg-bw /day) have been reported earlier (FAO/
WHO, 2010; Honda et al., 2018; Lesa et al., 2009). The calculated daily
exposure doses of the target chemicals from the use of feminine hygiene
products were all below the threshold for toxic effects.
3.6. Significance of feminine hygiene products as a source of chemical
exposure in women
The exposure doses of phthalates, parabens, and bisphenols through
foodstuffs(Liao and Kannan, 2013; Schecter et al., 2013), PCPs (Guo
and Kannan, 2013; Liao and Kannan, 2014b), and indoor dust (Guo and
Kannan, 2011; Liao et al., 2012; Wang et al., 2012) in the United States
have been reported in our previous studies. Based on the exposure doses
reported previously from other sources and pathways as well as those
calculated in this study, the significance of feminine hygiene products
in contributing to exposures was delineated. When exposure doses from
feminine hygiene products were calculated based on an absorption rate
recommended for the normal skin, these products accounted for 0.2%
of the total phthalate exposure doses, in comparison to 40.7% from
foodstuffs, 40.4% from PCPs, and 18.7% from indoor dust. However, at
an absorption rate of 100%, the contribution of feminine hygiene
products to total phthalate exposure was 27.9%, in comparison to
29.4% from foodstuffs, 29.2% from PCPs, and 13.5% from indoor dust;
the dermal absorption from the use of tampons, panty liners, and pads
accounted for 15.2%, 9.8%, and 2.9% of the total exposure doses of
phthalates. For parabens, dermal absorption from the use of PCPs ac-
counted for 97.2% of the total exposure doses, which was consistent
with those reported in our previous study (Guo and Kannan, 2013).
Feminine hygiene products contributed only < 0.1% of the total ex-
posure doses of parabens. Dietary ingestion was the major exposure
pathway for bisphenols, accounting for 95.0% of the total exposure
doses. Feminine hygiene products accounted for 0.01% of the total
exposure doses of bisphenols at an absorption rate of 5%.
4. Conclusions
We report the occurrence of phthalates, parabens, bisphenols, and
TCC in feminine hygiene products in the United States for the first time,
signifying a new source of women’s exposure to EDCs. Use of these
products in close contact with women’s reproductive system needs
consideration from the perspective of EDC exposures. Our study high-
lights the significance of feminine hygiene products in phthalate ex-
posure among American women. Nevertheless, this study has some
limitations which requires cautious interpretation. First, our samples
are limited to one geographic location and therefore representativeness
of the samples for the entire country as well as for all feminine hygiene
products may have been tempered. Second, the calculated exposure
doses involve uncertainties. It has been reported that human skin ex-
hibits high variability in absorption rates for phthalates, but data for
several phthalates, parabens, bisphenols, and TCC are not available
(Ishii et al., 2015). Considering the high transdermal absorption prop-
erties of the vulvar skin and vaginal mucosa, values of 20% and 100%
were used to estimate high exposure scenarios in this study, which may
be an overestimate of the actual exposure doses. Furthermore, the
transfer rates of phthalates, parabens, bisphenols, and TCC from pads,
panty liners, and tampons are not known. The transfer rates of DBP,
BBzP, DEHP, and DOP from baby diapers to artificial urine and artificial
sweat varied from 0.0006% to 2.4% (Ishii et al., 2015). Considering
that chemicals present in sanitary pads, panty liners and tampons can
be extracted by blood and other menstrual fluids, the transfer rates of
chemicals can be higher than the values used in this study. Further
studies determining transdermal absorption rates of these chemicals by
vaginal mucosa and vulva as well as transfer rates of chemicals from
products (under various real-world scenarios) are needed. Third, the
types of feminine hygiene products analyzed in this study are not ex-
haustive. For example, vaginal douches, menstrual cup, and lubricants,
which are widely used in the United States, were not analyzed in this
study. These products can further increase the risk of EDC exposure in
women. Women often use multiple feminine hygiene products at the
same time. This may also increase the total exposure burden of che-
micals from feminine hygiene products. Moreover, other potential EDCs
(e.g., terephthalates) that may be present in feminine hygiene products
were not analyzed in this study. Finally, studies on long-term biological
and health risks from the use of products that are used on or close to
sexual and reproductive organs are needed. It has been reported that
some EDCs, such as phthalates, are potential risk factors for bacterial
vaginosis (Geller et al., 2018).
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influ-
ence the work reported in this paper.
Appendix A. Supplementary material
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.envint.2020.105465.
C.-J. Gao and K. Kannan Environment International 136 (2020) 105465
9
References
Andersen, F.A., 2009. Final amended report on the safety assessment of methylparaben,
ethylparaben, propylparaben, isopropylparaben, butylparaben, isobutylparaben, and
benzylparaben as used in cosmetic products1. Int. J. Toxicol. 27, 1–82.
Bao, J., Wang, M., Ning, X., Zhou, Y., He, Y., Yang, J., Gao, X., Li, S., Ding, Z., Chen, B.,
2015. Phthalate concentrations in personal care products and the cumulative ex-
posure to female adults and infants in Shanghai. Journal of Toxicol. Environ. Health-
Part A: Current Issues 78, 325–341.
Benjamin, S., Masai, E., Kamimura, N., Takahashi, K., Anderson, R.C., Faisal, P.A., 2017.
Phthalates impact human health: Epidemiological evidences and plausible me-
chanism of action. J. Hazard. Mater. 340, 360–383.
Branch, F., Woodruff, T.J., Mitro, S.D., Zota, A.R., 2015. Vaginal douching and racial/
ethnic disparities in phthalates exposures among reproductive-aged women: National
Health and Nutrition Examination Survey 2001–2004. Environ. Health-GLOB 14, 57.
Cai, X., Shen, H., Lu, Q., Jing, H.H., Shi, C., Yu, W., Wang, Y., Wei, L., 2010. The effect of
mono-(2-ethylhexyl)phthalate on human granulosa cells viability and steroid pro-
duction. Chin. J. Clin. Obstetr. Gynecol. 11, 335–338 (in Chinese).
Carey, D.E., Mcnamara, P.J., 2015. The impact of triclosan on the spread of antibiotic
resistance in the environment. Front. Microbiol. 5, 780.
Chai, M., Han, X., Zhong, F.Y., Wang, Y.W., Tang, Z.W., 2017. Contamination and health
risk of phthalate esters in marketed sanitary napkins from China. China Environ. Sci.
37, 1954–1960.
Chen, D., Kannan, K., Tan, H., Zheng, Z., Feng, Y.L., Wu, Y., Widelka, M., 2016. Bisphenol
analogues other Than BPA: Environmental occurrence, human exposure, and toxicity-
A review. Environ. Sci. Technol. 50, 5438–5453.
Eriksson, E., Andersen, H.R., Ledin, A., 2008. Substance flow analysis of parabens in
Denmark complemented with a survey of presence and frequency in various com-
modities. J. Hazard Mater. 156, 240–259.
EU-RAR (European Union Risk Assessment Report), 2003. Existing Substances 2nd
Priority List. In: 1,2-benzenedicarboxylic acid, di-C8-10-branched alkyl esters, C9-
rich and di-“isodecyl”phthalate (DINP) dibutyl phthalate, vol. 35. https://ec.europa.
eu/jrc/en/publication/eur-scientific-and-technical-research-reports/european-
union-risk-assessment-report-dinp-cas-no-68515-48-0-and-28553-12-0-einecs-no-
271. (accessed October 2019).
EU-RAR (European Union Risk Assessment Report), 2004. Existing Substances 1st Priority
List. In: Dibutyl Phthalate, vol. 29. https://publications.europa.eu/en/publication-
detail/-/publication/9d752877-f9eb-44e1-a3e3-43294469330b. (accessed October
2019).
EU-RAR (European Union Risk Assessment Report), 2007. Existing Substances 3rd
Priority List. In: Benzyl Butyl Phthalate (BBP), vol. 76. http://echa.europa.eu/
documents/10162/bad5c928-93a5-4592-a4f6-e02c5e89c299. (accessed October
2019).
EU-RAR (European Union Risk Assessment Report), 2008. Existing Substances 2nd
Priority List. In: bis(2-ethylhexyl)phthalate (DEHP), vol. 80. https://publications.
europa.eu/en/publication-detail/-/publication/80eaeafa-5985-4481-9b83-
7b5d39241d52. (accessed October 2019).
EWG (Environmental Working Group), 2002. Not Too Pretty: Phthalates, beauty products
and the FDA. http://www.safecosmetics.org/downloads/NotTooPretty_report.pdf.
FAO/WHO (Food and Agriculture Organization/World Health Organization), 2010. Joint
FAO/WHO Expert Meeting to Review Toxicological and Health Aspects of Bisphenol
A. available from http://www.who.int/foodsafety/chem/chemicals/BPA_
Summary2010.pdf (accessed Dec 16, 2012).
Farage, M., Elsner, P., Maibach, H., 2007. Influence of usage practices, ethnicity and
climate on the skin compatibility of sanitary pads. Arch. Gynecol. Obstet. 275,
415–427.
Farage, M., Maibach, H.I., 2010. The vulvar epithelium differs from the skin: implications
for cutaneous testing to address topical vulvar exposures. Contact. Dermatitis. 51,
201–209.
Fierens, T., Servaes, K., Van Holderbeke, M., Geerts, L., De Henauw, S., Sioen, I.,
Vanermen, G., 2012. Analysis of phthalates in food products and packaging materials
sold on the Belgian market. Food Chem. Toxicol. 50, 2575–2583.
Gao, C., Jia, L., Pengran, W.U., Hong, W.U., Guo, Y., 2017. Chinese population exposuring
to phthalate esters: a review. J. Jinan Univ. 38, 93–103.
Geller, R.J., Brotman, R.M., O’Brien, K.M., Fine, D.M., Zota, A.R., 2018. Phthalate ex-
posure and odds of bacterial vaginosis among U.S. reproductive-aged women,
NHANES 2001–2004. Reprod. Toxicol. 82, 1–9.
Guo, Y., Kannan, K., 2011. Comparative assessment of human exposure to phthalate
ethers from house dust in China and the United States. Environ. Sci. Technol. 45,
3788–3794.
Guo, Y., Kannan, K., 2013. A survey of phthalates and parabens in personal care products
from the United States and its implications for human exposure. Environ. Sci.
Technol. 47, 14442–14449.
Guo, Y., Wang, L., Kannan, K., 2014. Phthalates and parabens in personal care products
from China: concentrations and human exposure. Arch. Environ. Contam. Toxicol.
66, 113–119.
Halden, R.U., Paull, D.H., 2005. Co-occurrence of triclocarban and triclosan in U.S. water
resources. Environ. Sci. Technol. 39 6335–5336.
Hauser, R., Calafat, A., 2005. Phthalate and human health. Occup. Environ. Med. 62,
806–818.
Honda, M., Robinson, M., Kannan, K., 2018. Parabens in human urine from several Asian
countries, Greece, and the United States. Chemosphere 201, 13–19.
Hopf, N.B., Berthet, A., Vernez, D., Langard, E., Spring, P., Gaudin, R., 2014. Skin per-
meation and metabolism of di(2-ethylhexyl) phthalate (DEHP); Comparison of per-
cutaneous absorption and metabolism of di-n-butylphthalate in various species.
Toxicol. Lett. 224, 47–53.
HPV. 2012. High production volume (HPV) chemical challenge program data availability
and screening level assessment for triclocarban (101-20-2) http://wwwepagov/hpv/
pubs/summaries/viewsrchhtm, 2012).
Hubinger, J.C., Havery, D.C., 2006. Analysis of consumer cosmetic products for phthalate
esters. J. Cosmet. Sci. 57, 127–137.
Hyun, J.K., Byung, M.L., 2004. Estimated exposure to phthalates in cosmetics and risk
assessment. J. Toxicol. Environ. Health –Part A. 67, 1901–1914.
Ishii, S., Katagiri, R., Kataoka, T., Wada, M., Imai, S., Yamasaki, K., 2014. Risk assessment
study of dioxins in sanitary napkins produced in Japan. Regul. Toxicol. Pharm. 70,
357–362.
Ishii, S., Katagiri, R., Minobe, Y., Kuribara, I., Wada, T., Wada, M., Imai, S., 2015.
Investigation of the amount of transdermal exposure of newborn babies to phthalates
in paper diapers and certification of the safety of paper diapers. Regul. Toxicol.
Pharm. 73, 85–92.
Jagne, J., White, D., Jefferson, F., 2016. Endocrine-disrupting chemicals: adverse effects
of bisphenol A and parabens to Womens health. Water Air Soil Pollution 227, 182.
Lomenick, J.P., Calafat, A.M., Castro, M.S., Mier, R., Stenger, P., Foster, M.B.,
Wintergerst, K.A., 2010. Phthalate exposure and precocious puberty in females. J.
Pediart-US. 56, 221.
Koniecki, D., Wang, R., Moody, R.P., Zhu, J., 2011. Phthalates in cosmetic and personal
care products: Concentrations and possible dermal exposure. Environ. Res. 111,
329–336.
Kumamoto, Y., Iwasaki, A., 2012. Unique features of antiviral immune system of the
vaginal mucosa. Curr. Opin. Immunol. 24, 411–416.
Lesa, L.A., Sean, M.H., Michelle, G., Kannan, K., 2009. Derivation of Biomonitoring
Equivalents for di-n-butyl phthalate (DBP), benzylbutyl phthalate (BzBP), and diethyl
phthalate (DEP). Regul. Toxicol. Pharm. 55, 259–267.
Lewis, R.J., 2007. Hawley’s Condensed Chemical Dictionary, 15th ed. John Wiley & Sons
Inc, New York, NY, USA.
Li, A.J., Kannan, K., 2008. Elevated concentrations of bisphenols, benzophenonenes, and
antimicrobials in pantyhose collected from six countries. Environ. Sci. Technol. 52,
10812–10819.
Lian, W., Xiao, F., Xie, X., 2011. Application of hot melt adhesive in absorbent disposable
products industry Guangzhou Chemical Industry. 39, 20–24 (in Chinese).
Liao, C., Kannan, K., 2013. Concentrations and profiles of bisphenol A and other bi-
sphenol analogues in foodstuffs from the United States and their implications for
human exposure. J. Agric. Food Chem. 61, 4655–4662.
Liao, C., Kannan, K., 2014a. Concentrations and composition profiles of parabens in
currency bills and paper products including sanitary wipes. Sci. Total. Environ. 475,
8–15.
Liao, C., Kannan, K., 2014b. A survey of alkylphenols, bisphenols, and triclosan in per-
sonal care products from China and the United States. Arch. Environ. Con. Toxicol.
67, 50–59.
Liao, C., Liu, F., Guo, Y., Moon, H.-B., Nakata, H., Wu, Q., Kannan, K., 2012. Occurrence
of eight bisphenol analogues in indoor dust from the United States and several Asian
countries: implications for human exposure. Environ. Sci. Technol. 46, 9138–9145.
Ma, W.L., Zhao, X., Lin, Z.Y., Mohammed, M.O.A., Zhang, Z.F., Liu, L.Y., Song, W.W., Li,
Y.F., 2016. A survey of parabens in commercial pharmaceuticals from China and its
implications for human exposure. Environ. Int. 95, 30–35.
Miao, Q., Yu, Z., Zhang, L., Wu, D., 2004. Influence of environmental estrogens on cell
proliferation and apoptosis in T47D cells. J. Environ. Occupat. Med. 21, 251–253 (in
Chinese).
Moreta, C., Tena, M.T., Kannan, K., 2015. Analytical method for the determination and a
survey of parabens and their derivatives in pharmaceuticals. Environ. Res. 142,
452–460.
Park, C.J., Barakat, R., Ulanov, A., Li, Z., Lin, P.C., Chiu, K., Zhou, S., Perez, P., Lee, J.,
Flaws, J., Ko, C.J., 2019. Sanitary pads and diapers contain higher phthalate contents
than those in common commercial plastic products. Reprod. Toxicol. 84, 114–121.
Reddy, B.S., Rozati, R., Reddy, B., Raman, N., 2006. General gynaecology: association of
phthalate esters with endometriosis in Indian women. BJOG: Int J. Obstetr. Gynaecol.
113, 515–520.
Ronit, M., Combelles, C.M.H., Missmer, S.A., Correia, K.F., Paige, W., Russ, H., Catherine,
R., 2013. Bisphenol-A and human oocyte maturation in vitro. Hum. Reprod. 28,
2735–2745.
Schecter, A., Lorber, M., Guo, Y., Wu, Q., Yun, S.H., Kannan, K., Hommel, M., Imran, N.,
Hynan, L.S., Cheng, D., 2013. Phthalate concentrations and dietary exposure from
food purchased in New York State. Environ. Health. Persp. 1, 473–479.
Shin, J., Ahn, Y., 2007. Analysis of polychlorinated dibenzo-p-dioxins and dibenzo-furans
in sanitary products of women. Text. Res. J. 77, 597–603.
Smarr, M.M., Kannan, K., Buck Louis, G.M., 2016. Endocrine disrupting chemicals and
endometriosis. Fertil. Steril. 106, 959–966.
Soni, M.G., Carabin, I.G., Burdock, G.A., 2005. Safety assessment of esters of p-hydro-
xybenzoic acid (Parabens). Food Chem. Toxicol. 43, 985–1015.
Svechnikova, I., Svechnikov, K., Söder, O., 2007. The influence of di-(2-ethylhexyl)
phthalate on steroidogenesis by the ovarian granulosa cells of immature female rats.
J. Endocrinol. 194, 603–609.
Wang, L., Liao, C., Liu, F., Wu, Q., Guo, Y., Moon, H.-B., Nakata, H., Kannan, K., 2012.
Occurrence and human exposure of p-hydroxybenzoic acid esters (parabens), bi-
sphenol A diglycidyl ether (BADGE), and their hydrolysis products in indoor dust
from the United States and three East Asian countries. Environ. Sci. Technol. 46,
11584–11593.
Wang, Y., Zhu, H., Kannan, K., 2019. A review of biomonitoring of phthalate exposures.
Toxics 7, 21. https://doi.org/10.3390/toxics7020021.
Yazar, K., Johnsson, S., Lind, M.-L., Boman, A., Lidén, C., 2011. Preservatives and fra-
grances in selected consumer-available cosmetics and detergents. Contact.
Dermatitis. 64, 265–272.
Zheng, Z., He, P.-J., Shao, L.M., 2006. Statistic analysis on distribution of phthalic acid
esters in plastic packages. China Environ. Sci. 26, 637–640.
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