To determine the incidence of vaginal mucosal alterations associated with the use of digitally inserted tampons, 100 women were prospectively evaluated colposcopically for three consecutive menstrual cycles. Three groups of 20 women each used the regular, super, and super-plus sizes of a digitally inserted rayon and cotton tampon; two additional groups of 20 each used external sanitary protection or an applicator-inserted rayon polyacrylate tampon. Vaginal mucosal drying and layering were significantly more common in all tampon users than in pad users; vaginal mucosal ulceration was a more rare event, seen only in tampon users, and statistically more commonly in the rayon polyacrylate group. The incidence of these alterations was not related to the presence of Staphi/lococcus aureus. All ulcerations healed without treatment. The common occurrence and relatively benign nature of these changes are discussed in view of the concern that these changes might predispose a woman to developing toxic shock syndrome.