When it gets unbearably hot and sticky outside, Nehal, 27, grabs her talc and douses herself down there.

“It keeps me dry and fresh,” she says.

A friend first vouched for the ‘clean feeling’ talc gives, and similar advice from Nehal’s beautician led her to add it to her hygienic arsenal, swelling the ranks of Indian talc users, already one of the largest groups of talc users in the world, according to Dr. Abha Majumdar. Some powder their face for fairness; others, their nether regions for freshness and comfort.

But most, like Nehal, are completely unaware that two recent lawsuits are casting doubt on the safety of this old practice.

Since the beginning of the year, Johnson & Johnson, a leading global manufacturer of talcum products, has lost two separate lawsuits that awarded millions in damages to an ovarian cancer survivor and the family of a woman who died of ovarian cancer, after doctors found the brand’s talc particles in both women’s ovaries. It’s the latest development in a long series of links between talcum powder and ovarian cancer.

Talc, a soft mineral composed of magnesium and silicon, is, in its natural state, found in close proximity with asbestos, a natural carcinogen. It’s difficult to separate the two minerals in the mining process, but in the 1970s, the US put standards in place that have all but eliminated the sale of adulterated talc for years. In India, a 2012 report on domestic brands affirmed all are free of asbestine, a term used for asbestos in powdered form.

Talcum Powder and Cancer

The question is not whether talc itself is carcinogenic, but rather whether the powder gets trapped in the body, creating the conditions for ovarian cancer to develop.

“It was common knowledge when I was a student of medicine [in the 70s] that talc particles could travel up the fallopian tubes and cause inflammation of the ovaries, which is a possible precursor of cancer,” Dr. Majumdar, who is the director of Sir Ganga Ram Hospital’s IVF center in New Delhi. “But it is surprising that many gynaecologists in India don’t consider or know about this.”

Several gynaecologists interviewed for this article dismissed out of hand a link between talcum powder and cancer. To be fair, it is contentious territory. Bodies of research have almost alternately linked and delinked talc use and ovarian cancer over the years. A collective review of most of this research found talc use on the genitals increased the risk for ovarian cancer by 24%. But this meta analysis had its critics, too, who called it a spurious correlation and said talc was an easy scapegoat for the very human need to pin down a cause.

“Though the trials are not clear, it’s better to be safe than sorry, especially when talc use is not a necessity, but a created need in a society where awareness levels are low,” says Dr. Kiran Lohia, Medical Director of Lumiere Dermatology in New Delhi.

Even doctors who disagree on the link between talcum powder and cancer agree on one thing: Talc is just not necessary.

Dr Ahmed Ismail, a London-based gynaecologist who finds the body of research on talc inconclusive, told a Telegraph reporter earlier this year: “We don’t advise women to use any powders in the genital area. It’s moist and if it mixes with the powder it becomes muddy and easily prone to infections. It can go into the cervix or uterus and spread further.”

Talcum Powder and Feminine Hygiene

For Nehal and millions of other Indian women, it’s advice that challenges a fundamental idea of what it means to be clean.

While it’s unknown at what point talc became part of the Indian hygiene regimen, douching with powders and liquids has been a practice for women in all parts of the world since ancient times for contraception, infection and STD treatment, cleansing and purification. Here, where many see vaginal discharge as cause for concern and consider menstruation impure, the popularity of a drying agent is, perhaps, unsurprising even if it’s escalation is impossible to track.

The practice has been handed down from grandmother to mother to daughter over decades of conditioning, Dr. Lohia says, ingraining a belief that dryness equals cleanliness. And even as the body of knowledge around talcum powder and cancer grows, the practice will likely be difficult to curb. Dr. Majumdar says patients rarely bring up the subject before her.

“It is only during examination that I realize how popular talc is for genital use,” she says.

She tries to leave them with one message: All women need is “good old soap and water.”