In late 2018, the Kimberly-Clark company issued a voluntary recall on Kotex “U” brand tampons, after reports from customers that parts of the product were getting stuck inside their bodies (yikes). In addition to causing irritation, injury and straight up panic, these trapped tampons also had the potential to result in Toxic Shock Syndrome (TSS).
I first heard about TSS in high school, when a friend told me that a friend of her family had suddenly died from it. She’d left a tampon in for too long, felt sick, gone to the hospital and was dead the next day. The story fully terrified the tampon-users among us, making me secretly grateful that my mother had already instilled a deep and abiding fear of tampons in me (which was, in retrospect, problematic in itself).
So do you need to ditch your tampons to avoid getting TSS? Is it really as common as we think? Read on. We’re about to break it all down for you.
WTF is TSS?
TSS, first identified in 1978, is caused by certain strains of bacteria (staphylococcus aureus, clostridium sordelli and streptococcus pyogenes), which, under particular circumstances, get into the bloodstream and produce toxins. If unchecked, these toxins can lead to organ failure. You probably associate TSS with tampons, but in actuality, fifty percent of cases have nothing to do with menstruation, they’re the result of skin wounds, surgical incisions, and burns.
Menstrual TSS, associated with the use of tampons, was initially reported in the early 1980s. After investigating the 55 cases of TSS and realizing that the patients in 95 percent of those cases were women who were menstruating or whose periods had recently ended, the connection was made between women who regularly used super absorbent tampons and TSS. The super absorbent tampons were being left in for too long (more than 8-12 hours), even when a period was light, leaving the bacteria that causes TSS — staphylococcus aureus — to flourish. Those same tampons, which were recalled in September of 1980, also contained polyester foam infused with a chemical carboxymethylcellulose. If that sounds sketchy, it’s because it is. The chemicals not only changed the pH balance in the vagina, but promoted bacterial growth, further adding to the likelihood of developing TSS.
“TSS is defined as menstrual if it occurs during or within 2-3 days of the end of a period,” says Dr. Jen Gunter, an obstetrician and gynecologist with nearly three decades of experience as a vulvar and vaginal diseases expert, and author of the upcoming The Vagina Bible (where you can find this information about menstrual TSS).
The symptoms of menstrual TSS include fever, a peeling rash (this is an important telltale symptom), muscle aches, dizziness, vomiting and diarrhea. Organs can shut down, and amputation, the result of lack of blood flow to the limbs, can be necessary in rare situations. If one is hospitalized, it’s usually an average of six days, and some people do end up in intensive care. There is the possibility of reocurrence, as well as memory loss and lasting health problems.
Good News: menstrual TSS is now extremely rare
Before you freak all the way out, Gunter emphasizes that only 1% of people who menstruate, those who carry the staphylococcus aureus bacteria, are at risk for developing menstrual TSS in the first place, so it’s pretty rare. (The current rate of menstrual TSS is about 1 case per 100,000 women.) The risk of dying from menstrual TSS if you have good medical care is less than 4%.
Many menstrual products have thankfully changed for the better since the 1980s, when menstrual TSS was at its peak. According to Dr. Angela Jones, Astroglide’s resident sexual health advisor, this is because of the change in tampon materials (no more foam), absorbency, stricter label guidelines (making it clear exactly how long to leave it in for), and increased awareness of menstrual TSS. It is important to note, however, that tampon manufacturers to date still do NOT need to disclose all the ingredients in their products. Tampon users should continue to seek out brands that are transparent and openly list all ingredients… hopefully it’s only organic cotton.
How do you avoid getting TSS?
Avoiding menstrual TSS isn’t tricky, says Jones. “Common sense: doing things such as making sure you are using products as directed; like not leaving tampons in for more than 8 hours at a time.” You might also consider switching to pads at night, or when your flow is at its heaviest.
It’s not just tampons that can cause TSS. Anything that gets inserted into the vagina can cause an infection if it isn’t used correctly, and that includes menstrual cups, which, Jones stresses, should be cleaned according to the instructions they come with (for example, cups should be disinfected in boiling water for 3 minutes before each cycle). You should also be sure to wash your hands before and after you insert a tampon or menstrual cup to avoid spreading bacteria.
You are the CEO of your body. Let your instincts be your guide— if something doesn’t feel right, seek medical attention.