[Tampon use during menstruation among Japanese females]

Objectives　In Japan, many females primarily use sanitary napkins during menstruation. However, growing awareness of environmental concerns and increasingly diverse lifestyles has led to the introduction of various menstrual products. Particularly, tampons, which are inserted intravaginally, are becoming more common; however, the prevalence of tampon use among Japanese females, the psychological and social factors influencing their use, and awareness of tampon-related adverse events remain unclear. Therefore, this study used an internet survey to examine tampon use among Japanese females.Methods　An internet survey was conducted in March 2024 through an online platform targeting 14,000 females aged 18-54 years in Japan. The primary survey assessed tampon use with the options "currently using," "previously used," or "never used," and explored the reasons underlying these responses. Additionally, 1,000 females from each usage category were randomly selected for a secondary survey that assessed menstrual symptoms and economic status. Among current tampon users, we also evaluated tampon-use practices and awareness of toxic shock syndrome (TSS), an adverse event linked to tampon use.Results　A total of 13,983 participants were included in the primary survey analysis after excluding inappropriate respondents. Among the respondents, 13.0% (95% CI: 12.4-13.5) were currently using tampons, 28.8% (95% CI: 27.7-29.2) had previously used tampons, and 58.2% (95% CI: 57.8-59.5) had never used tampons. The most common reason for current use was reduced risk of blood staining on underwear (51.7%). Among current users, 25.4% did not practice hand hygiene before tampon insertion, and 16.3% were aware of TSS. The current-use group reported more menstrual symptoms than the other two groups (Mean: 3.58, 3.26, 2.96; P < 0.001). The current-use group was more likely to have experienced economic difficulties that prevented purchasing menstrual products (16.9%, 6.8%, 3.6%; P < 0.001).Conclusion　Although the proportion of current tampon users in Japan remains lower than that in Western countries, these findings indicate the need to consider motivations for tampon use and related social factors to promote awareness of safe tampon practices in Japan.