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Sexual Anatomy, Reproduction, and the Menstrual Cycle

Toxic Shock Syndrome

What is TSS?

Toxic Shock Syndrome (TSS) is a disease caused by strains of Staphylococcus aureus bacteria.  Most of us have these bacteria living normally in our bodies, on places such as the skin, nose, and vagina. In cases of TSS, these S. aureus bacteria produce toxins that get into our bloodstream and make us sick.  Younger people (particularly under age 30) are more susceptible to TSS because they have not yet developed antibodies to the toxins. Although most reported cases involve women, anyone can get TSS (for example from an infection from a wound). So why is has it come to be associated with tampons?

The TSS-Tampon Link

In the early 1980s, the TSS-tampon scare began to reach the attention of growing numbers of medical professionals and the national Centers for Disease Control. In 1980, there were 814 menstrually-related TSS cases and 38 deaths, and most of these cases were documented in women who were using super-absorbent synthetic tampons, particularly Proctor & Gamble’s Rely tampon (Rely is no longer on the market).  These super-absorbent synthetic tampons did not create TSS, but they did seem to provide an ideal breeding ground for growth of the S. aureus toxins to grow. They were made of materials that were, as their name suggested, super absorbent (one Rely tampon could hold one woman’s entire menstrual period), and they also had a very large surface area.  The materials used in Rely plus their extensive surface area caused an increase in viscosity (thickness of fluid) inside the vagina.  The more viscous a growth environment S. aureus has, the more toxin will be released. While there are “super-absorbent” tampons on the market today, many of the materials used to manufacture them are different from Rely tampons, and absorbencies are standardized (see below).

Is there cause for worry today?

One very important effect of the attention to TSS in the 1980s was that the FDA implemented regulation of tampons as medical devices and forced manufacturers to standardize tampon absorbencies and include package inserts that warn tampon users of TSS risk.  This means that one manufacturer’s “super” tampon will absorb as much flow as another manufacturer’s “super.”  Similarly, a “light,” is a “light.”  On the market today are tampons made both from synthetic materials, especially rayon, and from cotton only. (Some materials are no longer used, such as polyester and the key ingredient used in Rely). Reported cases of TSS have decreased dramatically since the 1980s --  in 1997, only five confirmed menstrually-related TSS cases were reported.

According to the FDA, the warning signs for TSS are sudden fever (usually 102°F or higher), vomiting, diarrhea, dizziness, fainting or near fainting when standing up, or a rash that looks like a sunburn

What can you do to reduce your risk of TSS from tampon use?

  • If you use tampons, change them regularly, e.g. every 4-6 hours. Be sure to check the box on the products you use for specific length of use recommendations.

  • Use the lowest absorbency tampon that you need. If you are having a light flow day, do not use a super absorbent tampon. If it hurts to remove a tampon, that may be a sign to use a tampon with lower absorbency.

  • Do not use tampons between your periods.

  • Never insert more than one tampon at a time.

  • Use tampons made from 100% cotton instead of from synthetic materials.


Written by: Marianne McPherson. Special thanks for editing help to Chris Bobel.
Last revised: March 2005

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