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Can Tampons Give You Toxic Shock Syndrome?

Why you shouldn’t panic, according to an OB/GYN.

Photo credit: Getty Images

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I grew up in the ‘90s, which meant most of my sex ed came courtesy of the teen magazines I'd steal from my older cousin. Apparently, nothing sold copies faster than true stories of almost getting toxic shock syndrome (TSS)—a condition which 11-year-old me understood to mean death by tampon.

Why was everyone so afraid of toxic shock syndrome? As Dr. Anita Sadaty, OB/GYN at Northwell Health explains, a lot of the fear surrounding TSS in the ‘90s was left over from the first cases that had surfaced just a decade earlier.

In 1978, a new type of high-absorbency tampon made of rayon fibers (now discontinued) was introduced, which many believe caused a few more cases of TSS than the Centers for Disease Control and Prevention (CDC) was used to seeing (we’re talking six out of every 100,000 menstruating tampon users per year). “There was a time in history where you were completely afraid of using a tampon because of reports in the media," says Dr. Sadaty.

But how exactly does leaving a super absorbent tampon in for too long have the potential to kill you? Here's what you need to know about toxic shock syndrome, including the truth behind the myths you may have grown up believing (like I did), and how often you should actually be changing your tampon.

What is toxic shock syndrome?

Toxic shock syndrome is caused by staphylococcus aureus, bacteria that's commonly found on the skin. "There are certain strains that produce very serious toxins which trigger an inflammatory immune response in the body," Dr. Sadaty explains. "This unusual inflammatory response can cause a high fever, a significant drop in blood pressure, rashes, and can trigger what we call a shock stage." This explains how the syndrome got its name. If it isn't treated fast, you run the risk of your body entering hypotensive shock, where your lungs and heart stop working, which can be fatal.

What do tampons have to do with this?

Unfortunately, using tampons during menstruation can potentially create an optimal breeding ground for TSS. "Blood is a wonderful medium for bacteria to grow in—it’s full of all kinds of great nutrients," Dr. Sadaty explains. Combine a lot of blood with a high absorbency tampon that you forget to change regularly, and you've got a hot box for bacteria.

How common is this, really?

Toxic shock syndrome is extremely rare, but when it happens it’s alarming. For example, you may remember reading about the model who lost both her legs to toxic shock syndrome in 2012. But according to a 2016 report, the average amount of TSS cases in the U.S. hovers around 1 in every 100,000 people per year—that's roughly a .002% chance of getting it annually.

What are the signs of TSS?

Another reason why reported TSS cases are extremely scary: There are no mild, early warning signs of TSS. "With TSS you become very ill very quickly—a high fever, rash, and a drop in blood pressure that could potentially cause you to pass out," Dr. Sadaty explains.  

How is TSS treated?

Once your body enters the shock state, you need immediate medical attention. Get right to the ER. "Patients are treated with an intravenous antibiotic, as well as massive amounts of hydration, and medication to regulate your blood pressure and breathing, if necessary," Dr. Sadaty explains.

How long can you leave your tampon in before you're at risk?

Life inevitably gets in the way of changing your tampon as often as you'd like. But this should bring you some comfort: In the 25 years she's been an OB/GYN, Dr. Sadaty has seen countless cases of forgotten tampons—and zero cases of TSS. "If you leave your tampon in past the eight-to-twelve-hour mark, it could increase your risk, but it is an extremely rare disease—women shouldn't be afraid," she says.

And if you think you're doing your vagina any favors by changing your tampon every hour on the hour in order to decrease your risk of TSS, think again. "One of the issues with changing tampons too frequently is that if the tampon is very dry, it can actually abrade the vaginal wall—you don't want to injure the tissue because you're afraid of toxic shock," Dr. Sadaty says. Just don’t leave it in all day.

My tampon smells funny. Does that mean I have TSS?

It may seem gross to you, but it’s totally normal. Women get nervous about odors and think it's related to toxic shock, especially if they forgot a tampon in there, says Dr. Sadaty. "Blood and bacteria together can cause odor—but odor isn't an indicator of toxic shock syndrome."

Besides letting your tampon marinate for too long, are there other ways you could get toxic shock syndrome?

Not-so-fun fact: Toxic shock syndrome was initially discovered in children—it can grow in any soft tissue injury, Dr. Sadaty says.

Bottom line? Your chances of getting toxic shock syndrome are pretty low—even if you occasionally forget to change your tampon. Try your best to remember to change it at least every eight hours, but don't panic if you find yourself a few minutes past that mark.

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Published January 29th, 2019

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