Toxic Shock Syndrome

The Happy Trail

By Nayla Lee

(TSS) as some sort of tampon boogeyman. Since I was too scared to actually try to understand it, my imagination took the reins. I thought it had something to do with letting a tampon get rotten, or getting it stuck so far that it wouldn’t be able to come out and would eventually disintegrate inside of me.

While TSS should definitely be a concern, it should not be a mystery. It’s pretty rare (according to, most doctors will never see it in their careers), but also very serious. Here’s what goes down: a bacteria (usually Staphylococcus aureus, more commonly known as “staph”) develops or is introduced, and then gets re-absorbed into the bloodstream through an opening in the skin or through mucus membranes. 20 percent of people carry the bacteria in their bodies already, according to the Yale Journal of Biology and Medicine.

We most often hear about this occurring when an internal menstrual product (tampon, cup, sponge) gets left in for too long. Surprisingly, as menstrual cases of TSS (infections occurring within three days of menses) decline, the proportion of non-menstrual cases has increased. These cases can actually occur from complications after a surgical procedure, from postpartum wounds, and even in relation to bone infections. However, since the bacteria grows best in warm and wet places, the vagina is prime real estate, and the majority of cases in the U.S. occur from tampon use, according to the Center for Disease Control (CDC). In the U.K., only half of cases are menstrual, according to

A 1999 study by the CDC divides national trends in TSS as such: the epidemic years (1979- 1980), the years of increased awareness (1981- 1986), and the declining years (1987-1996). After super absorbent tampons hit the market and caused several noteworthy cases, leading to new regulations that required tampon boxes to have information about TSS and to advise users about changing them regularly and using the lightest tampon that is appropriate for the flow. Those instructions are there for a reason. Listen to them.

There is good reason for concern; according to the CDC, “At least 40% of menstrual TSS cases continue to affect women 13 to 19 years old, an age group not as likely to be aware of the risk for TSS and for whom further education may be needed.”

If you’re worried about it, here’s what to look out for: A fever above 102 degrees, low blood pressure, watery diarrhea, disorientation, vomiting, dizziness and a flat rash on the palms and soles that looks like a sunburn and turns white when pressed. Desquamation is the fancy name for what happens when the rash peels off. I would recommend not Googling it unless you’ve got a particularly strong stomach. If these symptoms apply, go to a doctor immediately.

And as for what it does to your innards? Muscle myalgia, kidney failure, liver inflammation and a low platelet count. It’s no fun. Just ask Lauren Wasser, the model whose severe case of TSS required a leg amputation and multiple surgeries in 2012. Wasser and congressmember Carolyn Maloney are working to pass the Robin Danielson Act, which would establish a program to independently research the products such as fibers and chemicals that are used in menstrual hygiene products and to encourage the FDA to require transparency by tampon manufacturers. The act has been blocked nine times already.

Until then, stay vigilant. Don’t leave your tampon in for longer than the package recommends. The CDC recommends using a mix of pads and tampons, especially for long periods of sleep. Do not use tampons or pads that have been in unsanitary conditions or pre-opened.

The first case of TSS from the use of a menstrual cup was confirmed in 2015. As an article in the Canadian Journal of Infectious Diseases & Medical Microbiology notes, the silicone and rubber used in cups does not promote the microbiological growth in the same way that carboxymethylcellulose, an ingredient in tampons, does. (Carboxlmethylcellulose, by the way, isn’t an inherently dangerous ingredient; it’s hypoallergenic and used in foods, eyedrops, toothpaste, and more, but in the vagina it helps harbor bacteria.) However, it isn’t impossible, so make sure to dump them at least every 12 hours and clean them thoroughly when possible.

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