When you have period cramps, inserting a tampon into your vagina may be the last thing you want to do since you’re already feeling sensitive. But do tampons actually make period cramps worse? 

Molly Green, a 38-year-old in Los Angeles, says tampons definitely cause her pain: “I hated using pads because they felt messy, so I accepted the extra pain tampons caused me for years. It was always a relief when I’d remove one. I found a brand that was more comfortable for me than others, but it still wasn’t perfect. Eventually, a friend who is also a sex educator convinced me to try a menstrual cup and it changed my life. I’ve used tampons a few times since, and the regret is almost always instant.”

It’s been years since Vanessa Michele, a 50-year-old in Michigan, could use a tampon. She describes not cramping, but a “much worse” scratching: “I used to use the smallest size and would still be very uncomfortable. It would feel like scratches all over inside. I would also get vulva inflammation that itched so much. I can’t handle most commercial disposable products or any internal items. I use reusable cloth items now for the most part.” 

At the time of publication of this article, there are no existing studies that specifically looked for a connection between menstrual pain and tampon use. However, there has been some research on tampons and other types of gynecological pain. One study concluded that tampon use was not associated with endometriosis, a condition associated with menstrual pain. Another study found that early tampon use was associated with vulvodynia, a poorly understood condition characterized by chronic pain in the vulva. These studies aren’t very conclusive about the topic as a whole, and more research is needed. 

Since there isn’t much data on tampon use and period cramps, we asked medical experts what they thought. Their answers reveal something very important about bodies with vaginas and uteruses.‍

Would tampons be able to cause (worse) period cramps?‍

According to OB/GYN Kristin Yates, cramping is caused when the uterus contracts, so having a tampon in the vagina will have little effect on cramping. “Menstrual cramping is most often caused by the release of prostaglandins in the genital tract,” Dr. Yates tells O.school “Prostaglandins cause the sensation of pain and also cause the uterus to contract, which is what causes the sensation of cramping.” So basically, hormones making the uterus squeeze is the cause of cramps.

A little anatomy refresher: your period happens when the lining of the uterus  sheds and is released through the cervix and then out the vagina. The vagina is the part of your body in which a tampon is inserted. The cervix separates the vagina from the uterus. The tampon doesn’t come into contact with the cervix. ‍

Other reasons why using tampons may be painful‍

While the medical data may say that tampons don’t cause period cramps, other conditions might cause tampon insertion to be painful.

Pelvic floor physical therapist Sallie Sarrel explains: “Typically, what hurts with tampon insertion is the pelvic floor muscles and not the organs. If your pelvic floor is in spasm and already painful, when you have cramps you may feel more pain. But, the tampon technically is aggravating the muscles and not the organs so it may hurt more, but it's not making them worse.” She continues: “If someone tried to wear a tampon and did not know they had nodules of endometriosis in the area behind the vagina called the cul-de-sac, a tampon might make that pain a lot worse as it agitates the painful nodules.”

Heather Jeffcoat, also a pelvic floor physical therapist, says, “I routinely see patients that have painful tampon insertion, or report their cramps are worse with tampon use. Universally, these vulva owners all present with an overactive pelvic floor and are typically given a primary diagnosis of vaginismus, or pain with penetration. The pelvic floor muscles can be responsible for referred pain that mimics period cramping.” 

Dr. Sarrel wants to make it clear that “cramping that interferes one's life is not normal. No one should miss out on school, social participation, career, or [parenthood] because of pain and painful periods.” Dr. Jeffcoat adds, “Release to key muscles by a trained and licensed pelvic floor physical therapist can reduce tampon-use associated pain. Often, there are other pains that are driving this pelvic floor overactivity, such as endometriosis, or hip or lower back issues.”

The bottom line is that it’s most likely tampons can cause pain that feel like period cramps, but aren’t technically period cramps. If you have pain when using a tampon, talk to your gynecologist or medical provider to rule out an underlying cause like endometriosis. Going to a pelvic floor physical therapist can also help you get to a point where using a tampon will not cause pain.

If you do want to use tampons over alternatives like pads or cups, make sure you read up on risks like toxic shock syndrome and fever so you can use them safely. You also might want to consider new tampon brands like VIPON specifically designed not to cause pain.