Colposcopically visible alterations of the vaginal mucosa associated with the use of tampons have been identified. These include mucosal drying, epithelial layering, and microulcerations. The pathophysiology of these transient changes appears to involve fluid transfer with subsequent impairment of intercellular bridges and loss of cell coherence. Tampon products containing superabsorbents are significantly more likely to produce microulceratons than are conventional tampons when worn at times other than during active menstruation. Chronic production of these alterations could lead to clinically obvious lesions of the vagina, and should now be considered in the differential diagnosis of vaginal ulcers.