Tampon Training Workshops

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By Helen Milligan, MPT, PT

Why is using a tampon so mysterious? Tampon Training Workshops take the fear and mystery out of starting to use tampons!

Puberty is a complicated time for most adolescent females and their families. Young women may have concerns about their body image, sexuality, and how having a period will impact their lives. Their parents – often mothers or female guardians – may worry about the impact of pubertal development on the lives and health of their daughters. These concerns are often compounded for young women with special healthcare needs, including those with Down syndrome and other developmental disabilities.1

Monthly Tampon Training Workshop Available

Tampon Training Workshops are held at 5 p.m. on the third Tuesday of each month in the Trisomy 21 Clinic. Additional sessions can be arranged in the community, by appointment. To request a workshop, email TamponToolkit@chop.edu.

Kirkham, et al. showed that central concerns of parents for their adolescent daughters with intellectual disabilities included menstrual suppression, hygiene, parental burden, and menstrual symptoms.2 Naturally, clinical providers and the medical home play a key role in providing anticipatory guidance on these topics prior to the onset of menstruation and even the emotional and behavioral changes associated with puberty.

The onset of the first menstruation (menarche) can be a significant milestone in a young woman's life for a wide array of reasons. In a time marked by gradual physical and psychosocial changes, the first period is a sharply defined, sudden and distinct event – often without a predictable arrival time. The first period is also laden with its own socio-cultural stigma that is often informed by many factors including individual and societal cultures, media and religion.

Although menarche is discrete event, the time that follows necessitates that girls draw on the knowledge they have gathered from others to manage and make sense of their physical and emotional experiences.3 Family relationships can have an important influence on girls’ experience at this time. Most girls regard their mothers or female guardians as their primary source of information.4-5 Regardless of the source, however, it has been shown that girls who learned more from their families perceived menstruation in a more positive light, while those who learned less, viewed it more negatively.6 With that in mind, females who had a negative emotional response to their first period were more likely to report feeling unprepared4,6. In one study, females who were unprepared for their first period were also more likely to report a negative self-image.6

Navigating these physical and emotional changes can be particularly challenging for girls and young women with special needs. This is often due to developmental challenges, as well as physiologic ones. For example, young women with cerebral palsy tend to begin puberty earlier and end later than typically developing young women.7 In general, children with developmental disabilities (DD) are 20 times more likely to experience early puberty changes than their typically developing counterparts.8 In addition to the challenges inherent to their special healthcare needs, precocious puberty can often provide a second hurdle as these girls approach the physical and psychosocial challenges that their first menstruation poses.

As a result, the experience of menarche was well studied in the 1970 and 1980s3-6. However, societal change over the past 30 years has dramatically changed how today’s young women – with and without intellectual disabilities – experience menstruation. The void in recent literature about the first period has led to very few evidence-based products in the market that could educate and support young women.


Zacharin M, Savasi I, Grover S. The impact of menstruation in adolescents with disabilities related to cerebral palsy. Arch Dis Child. 2010;95(7):526-530. doi: 10.1136/adc.2009.174680.

Kirkham YA, Allen L, Kives S, Caccia N, Spitzer RF, Ornstein MP. Trends in menstrual concerns and suppression in adolescents with developmental disabilities. J Adolesc Health. 2013;53(3):407–412. doi: 10.1016/j.jadohealth.2013.04.014.

Brooks-Gunn J, & Ruble D. (1983). The experience of menarche from a developmental perspective. In J. Brooks-Gunn & A. C. Petersen (Eds.), Girls at puberty: Biological and psychological perspectives (pp. 155-177). New York: Plenum.

Greif EB. & Ulman KJ. (1982). The psychological impact of menarche on early adolescent females: A review of the literature. Child Development, 53, 1413-1430. PMID: 6756807.

Koff E, Rierdan J, & Sheingold K. (1982). Memories of menarche: Age, preparation, and prior knowledge as determinants of initial menstrual experience. Journal of Youth and Adolescence, 11(1), 1-9. doi: 10.1007/BF01537812. PMID: 12264253.

Brooks-Gunn J, & Ruble D. (1982a). The development of menstrual-related beliefs and behaviors during adolescence. Child Development, 53, 1567-1577. PMID: 7172782.

Worley G, Gordon CM, et al. Secondary sexual characteristics in children with cerebral palsy and moderate to severe motor impairment: a cross-sectional survey. Pediatrics 110.5 (2002): 897-902. doi: 10.1542/peds.110.5.897. PMID: 12415027.

Siddiqi SU, Van Dyke DC, Donohoue P, McBrien DM. Premature sexual development in individuals with neurodevelopmental disabilities. Developmental Medicine & Child Neurology 41.6 (1999): 392-395. doi: 10.1017/s0012162299000857. PMID: 10400173.

Helen Milligan, MPT, PT, is a physical therapist in the Trisomy 21 Program at Children’s Hospital of Philadelphia.