Millions of women use tampons while on their periods with pads, menstrual cups, and period panties being the other products used during menstruation. Women may especially prefer using tampons and menstrual cups due to the lesser chance of leakage and staining of clothes if used correctly. But these products come with the risk of a potentially fatal disease called Toxic shock syndrome though it is rarely caused by sanitary pads and menstrual cups.
Toxic shock syndrome was first recognized in the year 1978 and it was later associated with tampons in menstruating women in most of those cases. These cases were associated with high absorbency tampons and later caused the removal of such tampons from the shelves.
What is Toxic shock syndrome?
Toxic shock syndrome(TSS) is a life-threatening bacterial infection caused by Staphylococcus aureus or Streptococcus pyogenes. These bacterias produce superantigens which cause the uncontrolled release of substances and leads to inflammation. This inflammation leads to toxic shock syndrome among other syndromes and can be fatal. It became a common topic in the 1980s among mothers and daughters when research paved the way to understanding the progression and investigation of the disease. Toxic shock syndrome was associated with menstruation and the studies lead to warning labels on tampons.
Menstrual toxic shock syndrome (mTSS) can be caused by both group A streptococci and S. aureus however tampon associated menstrual toxic shock syndrome has been associated with staphylococci TSS. Tampons introduce oxygen into the vagina due to their absorbency and this oxygen is needed by S. aureus to produce the toxin TSST-1 which causes TSS. It was initially seen in women who used tampons made of polyester and carboxymethylcellulose both of which favored the growth of S. aureus and the growth of TSST-1 toxin, however, it has also been seen in the currently marketed tampons made of cotton, viscose, and rayon.
What are the symptoms of menstrual toxic shock syndrome
Signs and symptoms help physicians narrow down a disease but they are extremely important in order to know when you should pay a visit to your ER immediately. Women suffering from Menstrual Toxic Shock Syndrome may experience symptoms including:
- Fever
- Diarrhea
- Vomiting
- Headaches
- Rash that looks like sunburn
- Low blood pressure
- Confusion
- Peeling of skin on hands and feet
As of 2022, the CDC’s clinical criteria for TSS included fever, hypotension, rash, and multisystem organ involvement. Streptococcal TSS was defined by CDC as an illness with:
- Low blood pressure with systolic blood pressure less than or equal to 90mm for adults
- Multiorgan failure is characterized by two of the following:
- Liver involvement
- Renal failure
- Coagulopathy
- Acute respiratory distress syndrome
- Death of soft tissue
- Rash
If you think you are suffering from TSS it is important to immediately stop using tampons/menstrual cups and visit your ER. TSS can be fatal and early medical intervention is important.
Do only tampons cause menstrual toxic shock syndrome?
If you are freaked out and want to stop using tampons, hear me out. Toxic shock syndrome is rare and is caused by all three commonly used products during menstruation — tampons, menstrual cups, and pads, though it is much rarer due to pads.
The use of tampons increases the risk of TSS in 2 different ways:
- Long-term use of a single tampon — long term use of a single tampon especially the super absorbent ones may encourage the growth of bacteria
- Abrasions due to removal of tampon — On the days your blood flow is light, tampons can stick to your vaginal walls. Removal of these walls can cause small cuts in the walls.
A study conducted found higher levels of S. aureus and toxin in menstrual cups than in tampons. It was also seen that the air introduced in the vagina according to the shape and volume of the cup influenced toxin production more than the material of the cup.
How is toxic shock syndrome treated?
Toxic shock syndrome requires immediate medical attention and you need to go to the nearest ER if you think you are suffering from toxic shock syndrome. As TSS is caused by bacteria, its treatment involves antibiotics. You will also be required to stay in the hospital. Low blood pressure and dehydration are treated with fluids given intravenously.
Most importantly any tampon or menstrual cup will be removed, if it hasn’t already been removed. Appropriate treatment is given if there is organ failure.
How can you safely use tampons/ menstrual cups for your periods?
Tampons and menstrual cups have been around for a really long time and a lot of women may not want to change to wearing pads or period panties though pads may also lead to TSS. It is important to know how to safely use these hygiene products when you are on your period.
Safe use of tampons
Tampons have been around for decades now and though the material of tampons has changed, they are still a risk factor for menstrual toxic shock syndrome. It is extremely important to change tampons regularly as keeping a single tampon in your body may lead to mTSS. Try to switch out the super absorbable tampons for the less absorbent ones. Practice hygiene including washing your hands before and after handling tampons. Try to use pads while sleeping so that you don’t keep a tampon inside your body for hours on end. Using pads during the last few days when your flow is light is also a good idea.
Safe use of menstrual cups
Menstrual cups though not usually associated with mTSS may lead to it in rare cases. Companies have marketed menstrual cups as safe to reuse after emptying and rinsing them but this study found that the cup had a significant amount of S. aureus biofilm even after 8 hours and 3 washes with water. This means that by following the instructions of the package women may be putting a contaminated cup back into their bodies.
Menstrual cups bring in air inside the vagina which is generally devoid of oxygen, which is why this study recommends a smaller to be used. Cups should also be emptied according to your flow as when the amount of fluid in the blood exceeds the cup, this brings it in contact with the wall of the vagina and allows the toxins to be transferred into the blood.
KEY TAKEAWAYS
- Toxic shock syndrome is an acute condition caused due to toxins produced by bacteria.
- Symptoms of TSS include fever, low blood pressure, and rash.
- Menstrual Toxic Shock Syndrome is mostly associated with tampons though menstrual cups and pads can also lead to it.
Education regarding various female hygiene products is available to a large part of the female population but more efforts need to be done to educate them on how to use these products safely. Keeping an alarm or reminders on your phone to remove your tampon or menstrual cups is a good way especially if you tend to forget. With TSS being an acute and potentially fatal disease, more efforts are needed to educate women on how to safely use these products.