Not very, most experts agree. But some also say that TP is worth examining more closely.
Some research cautions against toilet paper made from recycled paper because it could be made with discarded newspapers or recycled cash-register receipts, which can contaminate the product with BPA, a substance linked to reproductive issues, cardiovascular disease, and more.
The ingredients in toilet paper, which manufacturers aren’t required to disclose, are potentially concerning because the skin on the genitalia and anus is thinner and more absorbent than other skin on the body, says Dr. Julia Saylors, an oncologist and integrative medicine physician based in Charleston, South Carolina.
“It is well known that applying a medication to the vaginal mucosa results in a substantially higher absorption if the same medication is applied to the skin,” Saylors says. “Therefore, any potentially harmful chemical is best to avoid in that area.”
Toilet paper does not pose a major risk
How toilet paper interacts with people’s skin in these areas and their overall health is not well studied. But the research that has been done suggests that toilet paper does not pose significant health risks, experts agree.
“Many of these chemicals, including PFAS, phthalates, BPA, and trace dioxins, can be found in small amounts throughout modern life,” he adds. “The highest exposures usually come from what we eat, drink, or breathe over time, not from brief skin contact with toilet paper.”
Bleaching, likewise, is not a huge concern, and modern processes don’t pose a significant cancer risk, he says.
Dr. Alok A. Khorana, professor of medicine in the department of hematology and medical oncology at Case Western Reserve University, agrees that toilet paper probably isn’t a major cause of exposure to toxins. “Exposure to environmental toxins through toilet paper is likely much smaller than those we’re exposed to in food and water, which has a more direct route into our system,” he says. Still, he says exposure to toxins through toilet paper is "worth investigating further.”
He adds that we don’t have many studies yet, likely because concerns over toilet paper are relatively new—plus, Khorana notes it may be difficult for researchers to find people in the U.S. who don’t use toilet paper to compare to those who do. “Studies become challenging to conduct when the candidate risk factor is as prevalent as toilet paper use,” he says.
Still, he advises patients to choose products with fewer unnecessary additives when possible. “Fragrances, lotions, and dyes don’t improve hygiene, and they may increase the risk of irritation in susceptible individuals. For most people, a simple, unscented, dye-free toilet paper is a reasonable choice.”
An unexpected issue with toilet tissue
“I’ve had patients come in with itching and irritation, which they thought was a yeast infection or eczema flare, only to discover that the culprit was their toilet paper,” Kopelman says. “Most people assume all toilet paper is the same, but the reality is that some formulations can cause problems.”
Dr. Meagan W. Shepherd, an allergist and immunologist based in Barboursville, West Virginia, says people are often surprised to learn how commonly allergens are found in toilet paper, noting that both traditional paper and flushable wipes can cause irritation.
“I frequently see patients with severe vulvar rashes caused by hidden chemicals,” she adds.
Shepherd also cautions against recycled toilet paper—as well as anything marketed as “ultra soft.” “While meant to soothe, these products may contain softening agents such as lanolin, as well as fragrances, dyes, preservatives, and adhesives,” she says. “These can be irritating for some people and can cause unpleasant symptoms like itching, redness, and contact dermatitis.”
“On its own, toilet paper is unlikely to be a major source of chemical exposure,” says Kopelman. “But for those with sensitive skin, choosing products without unnecessary chemicals in toilet paper is a simple way to avoid skin irritation.”
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