DEAR DR. GOTT: I’ve been a chemist and forensic scientist for more than 50 years, and in your column you address a woman’s questions regarding chronic vaginal inflammation and repeated yeast infections. Years ago, I had a legal case involving a woman who used Premarin cream packaged in metal-walled “toothpaste”-type tubes. Her complaints and symptoms were much the same as your reader’s. In working as her expert witness on that case, I opened up and examined the offending Premarin tubes she had used. What I found was a badly designed delivery system that could not fail to cause horrific injury to anyone that used the product down to its completely collapsed, scrolled-up endpoint.
Such tubes are made of soft metal-like zinc but with an internal layer of polymer plastic coating the interior surface to prevent metal contamination or any reactive ingredients from chemically reacting with the metal walls. The defect comes when the user squeezes and deforms the tube walls to such an extent that the internal plastic layer fractures into small chips and delaminates from its attachment to the wall. What results are a myriad of small and almost microscopic flakes of the lining plastic, with sharp points and razor-sharp edges like broken glass mixing into the cream product as it is delivered. Such a production of tissue-cutting particles will cause visible to microscopic lacerations in the delicate barrier tissues it comes into contact with and thus allow infections to occur or reoccur.
This should be the first thing a woman needing such a product should look at and demand an alternative to. Plastic-walled cream-delivery tubes or pre-filled syringe packaging would eliminate this kind of injury. Inform and warn your readers, please. Perhaps others have experienced the same, and an informed buying public has a great deal of economic clout when it comes to forcing improvements in product designs.
As an aside, the case was ultimately settled quietly after I demonstrated to both sides that this was the defect in the product leading to her injuries. I am not sure whether the makers of such products have changed from that design of packaging and delivery or not. But in my considerable experience with product-defect cases, including medical device-based cases, it is a rarity that the manufacturer has voluntarily eliminated such a defect. It’s usually an economic decision for them, and the cost of a few legal cases a year is just cranked into a slightly higher product price in the following years. The actual costs of their errors is in reality much greater when you factor in those who have sustained injury or worse but have not filed for or prevailed in legal actions.
DEAR READER: I have chosen to print your letter almost in its entirety because it is a well-written, informative piece. I thank you for bringing an alternate cause to the table, one I had never even thought to consider.
I, like you, am unaware of what type of packaging Premarin and similar estrogen creams come in; therefore, I am hoping that this letter is either late (in the case of newer, safer packaging) or will bring greater attention to this issue.
If packaging has not been improved, there may be many women suffering the effects who either don’t know the cause or are too embarrassed to bring up the issue with their general physicians or gynecologists.
Vaginal infections are often minor and disappear with treatment, but if left untreated can result in considerable symptoms and problems. I urge any woman who has symptoms of a vaginal infection to speak with her gynecologist so that she may receive appropriate treatment early before the infection can take hold and cause even greater discomfort, embarrassment and, perhaps, even damage.
As I have said many times in the past, there is no reason to be embarrassed by symptoms for any condition. Doctors have been there and done that. Any physician worth his salt will do his best to get to the bottom of the problem and offer help, support and treatment.
Readers who would like related information can order my Health Report “Vaginal Infections and Disorders” by sending a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.
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