Because modern feminine hygiene products help reduce the physical and social costs associated with the menstrual cycle, women and scholars alike have hailed them as an important means of liberating the female body from patriarchal control.

But while Chinese women have embraced the convenience and comfort of the modern, disposable sanitary pad since its introduction to the Chinese mainland in the 1980s, tampons — which by nature allow women to participate in more strenuous activities than pads — have yet to catch on. According to a 2017 report from Period Helper — a Chinese period-tracking app — and CBNData, tampons accounted for just 2.9% of China’s feminine hygiene product market, compared with 26.7% in the United States. And while the market research firm Euromonitor found that China’s tampon market grew 342% between 2014 and 2018, it was still only worth 408 million yuan ($59.2 million) that year, compared with 78.32 billion yuan for sanitary pads.

Why don’t more Chinese women use tampons? So-called period poverty is one reason — with the price of a single tampon usually being two to five times higher than that of a sanitary pad — but it’s not the only one. To better understand this phenomenon, in October 2018 I conducted an online survey of men and women’s perceptions of, and experiences with feminine hygiene products. I received more than 900 valid responses, though the average respondent tended to be younger, better educated, and more urban than the national average. I found that tampons remain hampered by a combination of low public awareness, poor access to sex education, and traditional taboos regarding women’s bodies.

In 1989, American company Tampax sought to break into the Chinese market, buying newspaper and television advertisements and even opening its own domestic production facility. However, a product requiring vaginal insertion may have been too avant-garde for Chinese consumers, and poor sales soon caused the company to withdraw. Johnson & Johnson had better luck with o.b. Tampons in 1993, but Tampax’s next attempt in 1999 lasted only a year. Finally, in 2017, the company returned for another round. Three decades after their introduction, however, tampon manufacturers still find themselves having to educate consumers in order to familiarize them with the products.

According to my survey, both men and women said they relied on books, television, and the internet for information about menstruation and hygiene products. In addition, female participants said they got relevant information from private interactions with their female friends and family, while men listed their girlfriends as key sources. Only a small number of respondents said they had learned about the subject from school-sponsored health education courses.

Without a systematic, formal education in the subject, women naturally have a hard time understanding new and relatively unknown products like tampons. Some women reported that, even though they weren’t against the idea of tampons, they’ve experienced practical difficulties using them. For example, one respondent didn't understand her own anatomy well enough to use them, writing, “I couldn’t find the entrance (on my body).” Another wrote, “My hands were covered in blood, and I couldn’t insert it, no matter what I did.” In the end, they both gave up. A third woman reported going through 10 tampons before getting it right.

Sociocultural taboos toward sex are another barrier for tampon use. A significant number of female survey respondents expressed concern about whether using a tampon would break their hymen. “My boyfriend thinks tampons infringe on his territory, and he finds that unacceptable,” wrote another. These responses suggest that women still don’t have full control over what they insert into their vaginas — they have to consider other people’s reactions.

According to Sharra Vostral, the author of a book on menstrual hygiene technology, these concerns are not unique to China. “A lot of people argued that (tampon use) was not only inappropriate because it might break the hymen, but it might be also pleasurable and might be a way for girls to experience orgasmic pleasure,” she was quoted as saying in The Atlantic.

According to my survey, even the mention of “inserting” a tampon could cause women unease, regardless of whether it was done with their finger or using an applicator. Only in a society in which control over one’s own reproductive tract does not belong to women would this kind of self-touching be taboo.

The promise of “self-liberation” embodied by tampon use first requires women to have control of and autonomy over one’s own body. But in traditional Chinese culture, a woman’s primary function was to reproduce and raise children, and the female body was kept subordinate to men and the family. Menstruation — such a critical part of female fertility — was no exception. Its existence was defined by its relationship to the patriarchy and the need to produce children, not women’s experiences or needs.

As the scholar Harriet Evans has pointed out, after the founding of the People’s Republic of China in 1949, the new state denounced outdated cultural stereotypes and superstitions regarding the female body. But even as it sought to re-educate women, the state continued to emphasize the centrality of fertility: Women needed to take care of their bodies in order to have kids, not for their own comfort or autonomy. Today, the vagina remains a battleground for reproductive and gender rights, a forbidden zone dominated by a persistent patriarchy.

Fortunately, some progress is being made, even if it is slow. In 2016, the swimmer Fu Yuanhui stirred social media when she candidly admitted to having competed in the Rio Summer Olympics while on her period. More and more Chinese women, especially young women, are starting to try internal hygiene products — not just tampons, but menstrual cups, too — that have the potential to help them liberate their bodies, break out of their subordinate social position, and take on a more active role in their lives.

We should encourage this trend by discussing all the options available to women openly and unburdened by traditional taboos and fears. By changing how society views — and women experience — menstruation, we can help build a more equal, more liberated, and less discriminatory world.

Translator: Rachel Critelli; editors: Zhang Bo and Kilian O’Donnell.

(Header image: BSIP/UIG/VCG)