Perspectives on engineering and biomaterials in tampon design: a review of device-tissue interactions and dysmenorrhea risk.

Background: Dysmenorrhea affects approximately 71% of menstruating individuals globally and is associated with substantial losses in quality of life, work and school participation, and healthcare utilization. Tampons are among the most widely used intravaginal menstrual devices, yet their design has evolved primarily around absorbency, structural integrity, and infection risk, not around comfort or pain minimization as a formal design or regulatory endpoint. No existing review has examined tampon design, materials, or biomechanical properties through the lens of menstrual pain or discomfort. Objectives: This review (1) synthesizes evidence on tampon-associated discomfort; (2) identifies plausible biomechanical and biological mechanisms linking device properties to pain; (3) characterizes tampon materials and biocompatibility; and (4) proposes an engineering framework for developing lower-discomfort products. Methods: Literature was searched across PubMed, Google Scholar, and regulatory databases. A PRISMA-informed screening process prioritized primary research and systematic reviews, identifying a core evidence base of 51 sources for narrative synthesis. Results: No randomized controlled trials or prospective clinical studies directly examining the effect of tampon use or tampon material type on menstrual cramp severity were identified. However, evidence from adjacent fields supports several plausible mechanisms: colposcopy studies of older superabsorbent tampon formulations documented mucosal desiccation and microulceration, though modern products have not been comparably characterized; tampon materials contain detectable chemical residues including metals, phthalates, and volatile organic compounds, though their bioavailability across vaginal mucosa and contribution to systemic exposure remain unquantified, and current regulatory reviews (FDA, American College of Medical Toxicology) have not identified an associated safety concern; tampon use may perturb the vaginal microbiome in ways that could increase pro-inflammatory bacterial activity; and removal dynamics plausibly generate friction and contact pressure against vaginal tissue, though this has not been directly measured. These mechanisms are mechanistically coherent hypotheses that may converge in populations with elevated pain sensitivity, not established causal pathways. Conclusion: A substantial evidence gap exists at the intersection of tampon design and menstrual pain. Biomedical engineering provides a pathway to close this gap