Safe tampon use to prevent toxic shock syndrome

In 2012, fashion model Lauren Wasser lost her leg and nearly her life to toxic shock syndrome (TSS), a condition she contracted from using a tampon during her period. The case raised fears among women about tampon use, leading many to swear off the product entirely. Experts, however, deem tampons ‘safe’ despite the risks of TSS, provided appropriate preventive measures are taken and any early symptoms are addressed immediately.

TSS is a rare but potentially fatal condition, typically caused by toxins from the bacteria Staphylococcus aureus (staph). Normally living on the skin surface and in the female reproductive tract, this species of bacteria can cause an infection by releasing toxins when it breaches the skin and enters the blood system, usually from skin wounds, including surgery or even breastfeeding. From there, the infection multiplies and can lead to serious illness, from multisystem organ failure to decreased circulation, causing limb death, amputation, and even fatality.

The condition is often associated with tampons because the blood that accumulates in a tampon can be a source of infection and bacterial growth.

Some of the earliest warning signs of the condition are flu-like symptoms, including vomiting, high fever, diarrhea, and muscle pain or weakness, as well as a red, sunburn-like rash that can appear on the palms of the hands or soles of the feet.

“If you have one or two flu-like symptoms and happen to have your period, there’s no reason to panic. It’s the rash that’s key,” said Dr Gillian Dean, senior director of medical services at Planned Parenthood Federation of America to the BBC.

"Most of the time, when people are sick during their period, it’s either because of their period, or it’s the cold they caught from their neighbor,” she said. “But if you’re using a tampon and feeling very ill and you notice that rash, you need to be seen in an ER or by a clinician immediately.”

Despite its dangers, TSS is eminently treatable. “In diagnosing and treating TSS, full recovery is not only possible, but probable,” Dean explained.

Since many people, both men and women, are ‘intermittent carriers’ of this specific staph strain, contracting TSS after using a tampon is merely a consequence of the bacteria found in the body, while tampon use in itself is not dangerous.

Nevertheless, there are a number of simple ways to avoid contracting TSS when using tampons.

“It’s about practising good hygiene and changing the tampons every four to eight hours. Women who have heavy flow will change them anyway as they might otherwise start leaking, but those who have lighter flow tend to leave them in longer or forget to change them, which is when there’s a risk of TSS,” said Dr Shilpa Nambiar Balakrishnan, Consultant Obstetrics and Gynaecologist at the Prince Court Medical Centre in Malaysia, to Global Health and Travel.

She also recommends using lower absorbency tampons as the super absorbency type can hold more blood, allowing them to be left in longer. Women should also avoid using tampons entirely when they have a vaginal infection during their period.

"I don't think women should be afraid to use tampons, especially if it’s their preferred method of dealing with their period," advised Dean.

This story was originally published in the Global Health and Travel issue of March-April 2018.