The One Thing You Should Know About Tampons & Toxic Shock Syndrome

If you're a tampon user and have spent any time around other women or read about them in the media, you'll know about toxic shock syndrome. Every so often, a news story erupts about TSS and the carnage it causes, and the panic is always roughly the same: tampons are dangerous death machines, and they're the only cause of TSS. The reality, however, is very different. TSS remains a risk for tampon users, but it's not just associated with tampon use, it doesn't just "happen" to women, and it is far less likely nowadays than it was in the 1980s, due to shifts in tampon composition and new education about their usage. Ignore the media hysteria; let's get into facts.

Let's make no mistake: TSS is very dangerous and can lead to death. But it's not the inevitable boogie man that it's been made out to be, and it isn't wedded completely to tampon use. It's a far more wide-ranging bacterial infection, and we're still trying to figure out what it is about certain types of tampon usage that create the conditions for TSS to occur in a very small percentage of women. The reality is more complicated, and more hopeful, than common knowledge has made it out to be.

Let's get into the one thing you should really know about tampons: if you use them correctly, it's pretty unlikely you're going to get TSS.

Toxic Shock Syndrome Is Not Just Caused By Tampons

If you believed the media frenzy about TSS cases, you'd have the impression that the condition is uniquely tied to tampon usage. As it happens, however, it's not, and particularly not these days. Toxic shock syndrome occurs when Staphylococcus aureus (and, more rarely, Streptococcus progenies) bacteria, which often live harmlessly as part of your skin's normal bacterial flora, multiply within a wound, cut, sore, or opening in the skin (like the vagina). The staph or strep bacteria release superantigens (which are toxic) at the site of the wound, which then release into the bloodstream.

The toxins cause raging infection, with offshoots like multiple organ failure and extremely high fever. TSS is characterized by Medscape as a "toxin-mediated life-threatening illness," but you may have understood by now that this isn't just about tampons. It's also been associated with diaphragm or sponge use, but, notably, only 50 percent of all TSS cases have anything to do with menstruation. It's a pretty broad bacterial infection; it's also occurred in open wounds, nasal packing for nosebleeds, surgery, arthritis complications, and burns. It's not "the tampon disease".

We should also note that we're not entirely sure about the connection between modern tampons and TSS; research suggests that too much absorbency might have been a factor in earlier tampons, but Healthline names a few schools of thought, including the possibility that the material of the tampon creates abrasions in the vaginal tissue, or the idea that a tampon left too long attracts more bacteria.

... And It's Not Restricted To Women, Either

The 50 percent of TSS cases that don't involve menstruating women often involve men and children. Young kids and the elderly are more likely to get the toxic shock syndrome associated with strep bacteria, according to Johns Hopkins, though other risk factors include recently giving birth or having had surgery, infections, and miscarriages. Around 25 percent of staph-based TSS occurs in men, and it's also associated with immuno-suppressive drugs or diseases like diabetes.

And it wasn't all about tampons when TSS was first discovered, either. The first diagnosis of toxic shock syndrome happened in 1978, when Dr. James Todd described its symptoms in seven different children. It wasn't until a year or so later that medical professionals started to associate it with tampon usage, but those cases were so terrifying that the connection has stuck. TSS can, after all, cause death.

TSS Was A Bigger Threat In The '80s Than It Is Today

Here's the big thing to realize about TSS: we're still dealing with the shockwaves of the first cases in the '70s and '80s, even though tampons have changed substantively since then and seem far safer for TSS now. In a revealing article for the Yale Journal of Biology And Medicine, Dr. Sharra Vostral points out that early tampons (specifically a brand called Rely) were much more likely to produce toxic shock syndrome because of certain things about their composition.

Vostral explains that Rely tampons were synthetic, and some of those synthetic materials "provided a viscous medium on which the bacteria could grow," along with increasing "surface area for proliferation". Tampon use might also have introduced air and carbon dioxide into the vagina to "feed" the bacteria, though this is still just a theory. What's important here is that the structure of tampons at the time, plus lack of education about keeping them in for long periods, seems to have been the cause of the rise in TSS cases throughout the 1980s.

But how they're made has since changed, making them safer for use; the synthetics in the 1980s tampons like Rely, carboxymethylcellulose and polyester, are now illegal in tampons, and today they only contain cotton and rayon by order of the FDA. That, plus lower absorbency in today's tampons and more information about choosing the absorbency that fits your flow, has contributed to lowering the TSS rate a lot.

These days, it's estimated that the occurrence of toxic shock syndrome is about 0.52 per 100,000 people, though it's increased in women between 13 and 25, where it's more 1.4 per 100,000. In other words, it's incredibly rare.

The Bottom Line

While getting TSS is much more unlikely than you might have thought, if you're a tampon user, have had a miscarriage or abortion, or have any of the other risk factors, it's worth keeping an eye out for the particular symptoms of TSS to avoid becoming a statistic. Alongside fever, disorientation, chills, nausea, and vomiting, you should look out for a raised red rash all over your body, red eyes and mouth, and skin shedding on your palms and the bottom of your feet. If you're experiencing any of those symptoms, get to the hospital immediately.

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Image: Museum Of Menstruation And Women's Health