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Toxic Shock Syndrome (TSS)   

June 28, 2024 . jessie

Although not common, for many who menstruate, Toxic Shock Syndrome (TSS) is a lingering worry often pushed to the back. Since the 1980s it has been legally required for all tampons to have warnings about TSS, but what do we really know about this rare but deadly illness? Back in 2015, model Lauren Wasser opened up about her scary run-in with TSS in an interview with Vice. She became extremely ill while on her period and had to be rushed into hospital. Luckily, the doctors realised she had a tampon in, but by then Lauren had contracted sepsis and had to have an amputation. In 2012, Lauren had been rushed into hospital after becoming severely ill. She was in a near critical state, but the doctors could not find what was wrong with her. Her organs started to fail, and she became sceptic. A specialist questioned if she was using tampons and that this could be TSS. By this point Lauren’s organs were failing. The infection turned into gangrene, causing her right leg to be amputated. Lauren survived but her life was permanently changed. After years of discomfort, caused by the aftermath of TSS, she decided to have her other leg amputated. Lauren Wasser’s story is an extreme example of TSS and what can happen if the infection is not caught quickly.For the last decade Lauren has been an activist and spokesperson to warn about the dangers of TSS.  

TSS can be easily treated, when caught in time. Just this year, a teenager named Sadie Kirdar almost lost her life to TSS after an emergency plane landing. As Sadie began to have a fever and was losing consciousness, the plane had technical problems and needed to land. On the ground, Sadie was already in bad condition. Doctors recognised her symptoms in time, and she was able to make a full recovery. She says that it was pure luck which caused the plane to land and doctors onsite to recognise that she had contracted TSS. If the plan had continued its long journey, she believes that she would have died.  

These stories remind us that even though TSS is rare, it’s still important to know about it and take steps to stay safe 

What is Toxic Shock Syndrome (TSS)  

Toxic Shock Syndrome (TSS) is an uncommon but serious condition caused by bacterial invaders, specifically staphylococcus aureus and streptococcus pyogenes 1. These bacteria are common tenants of our body, typically causing no harm and living on our skin, in our noses, armpits and vaginas. Yet, according to a study conducted in America for every 1 in 100,000 menstruators these bacteria can quickly spiral out of control, unleashing dangerous toxins 2. These dangerous toxins swiftly enter the bloodstream, to which it can rapidly cause serious illness, organ failure and death. It is possible for anyone to contract TSS, whether they menstruate or not. Though TSS still affects worldwide 2-3 people a year, catching it early can mean a full recovery. Early diagnosis and treatment can make all the difference3

What causes Toxic Shock Syndrome? 

Bacteria flourish in dark, warm and moist areas – sounds familiar? Unfortunately, the vagina offers the perfect condition for bacteria to grow. By leaving a period product in for longer than advised, or by using tampons with a too high absorbency level, the bacteria have a chance to over grow and produce large amounts of the TSS toxins. The bacteria may also already exist on your body, and using unclean hands to insert products can cause contamination. While using pads and menstrual cups the risk is lower but it is still possible to contract TSS from them. Tampons are linked to TSS because they are inserted into the vagina. A saturated tampon can host the growth of bacteria. Using a tampon which has a higher absorbency than what your flow needs can cause dryness and tearing in the vagina. These tears allow bacteria to enter your bloodstream and TSS to spread. However, TSS is not only caused by using menstrual products. TSS caused by staphylococcus aureus can occur also from another infection such as pneumonia, sinusitis or other infections, or from a skin wound from cuts, burns and surgery 4. The other bacteria which causes TSS, streptococcus pyogenes, can occur in in people who have recently had chickenpox, bacterial cellulitis or have recently given birth. 

Warnings about TSS 

Maybe you’re wondering why there is such an alarm about TSS, given its rarity and preventability. In the late ’70s and early ’80s, super-absorbent tampons were in the spotlight after some tragic deaths in the US 5. They were great at preventing leaks but also created a cozy spot for bacteria to thrive. They were made from materials like polyester and rayon, linked to higher TSS risk 6. When tampons and TSS made headlines, it sparked action from the CDC, FDA and tampon brands. Sadly, little was known about how tampons interacted with our bodies. Understanding the nitty-gritty of how tampons absorb menstrual flow was a big mystery. Reproductive and menstrual health research was, and still is, sadly underfunded. 

What are the symptoms of toxic shock syndrome? 

TSS symptoms can vary and seem like other infections. Symptoms cancome on suddenly, such as; 7 :  

  • A sudden high temperature (Fever >38.9°C/ >102°F)  
  • Vomiting  
  • Diarrhea 
  • Dizziness from low blood pressure (may result in fainting) 
  • Aching muscles  
  • Confusion  
  • A red rash like sunburn on the hands and feet that later peels 
  • Increased heart rate (Tachycardia) 
  • Rapid breathing (Tachypnea) 

If you begin to feel any of these symptoms, seek medical advice. If you are concerned about TSS (or if you have TSS) be sure to mention to your doctor that you have been using menstrual products. 

How to reduce your risk of TSS? 

TSS is as rare as finding a four-leaf clover, but getting informed on the risks is the best way to protect yourself in the future. Here are a few simple ways to reduce your risk suggested by esteemed doctors and researchers 8:  

  • Avoid leaving a tampon in for longer than 4-8 hours. 
  • Use the lowest absorbency possible that still fits your flow. 
  • Avoid leaving a menstrual cup for longer than 12 hours. 
  • Rinse your cup well inside and out every time you empty it. Keep it clean by boiling it for 5 minutes. 
  • Wash your period cup storage bag regularly. 
  • Always wash your hands before and after using a period product. 
  • Keeping cuts and surgical incisions clean and changing dressings often. 
  • If you have ever had TSS before avoid using tampons, as reinfection is common. 

Keep calm and TSS-proof your life. With your TSS knowledge and prevention hacks you can breathe deeply, bleed easy. At Yoni, we stand beside you, offering our GOTS-certified 100% organic cotton tampons that are also biodegradable. If tampons are not your thing, look at our 100% organic cotton pads, cups or menstrual underwear! Studies exploring organic cotton vs non-organic cotton have shown various results, it is therefore not currently certain if organic cotton reduces the risk of TSS.  

Here is to looking after yourself! Be kind to your vagina.

Love, Yoni x 

  1. Ross, Adam. “Toxic Shock Syndrome.” StatPearls [Internet]., U.S. National Library of Medicine, 7 Aug. 2023, www.ncbi.nlm.nih.gov/books/NBK459345/ ↩︎
  2. DeVries, Aaron S et al. “Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical features, and molecular characteristics.” PloS one vol. 6,8 (2011): e22997. doi:10.1371/journal.pone.0022997  ↩︎
  3. https://www.edana.org/how-we-take-action/product-stewardship/toxic-shock-syndrome ↩︎
  4. “Toxic Shock Syndrome.” Toxic Shock Syndrome | Boston Children’s Hospital, www.childrenshospital.org/conditions/toxic-shock-syndrome. ↩︎
  5. Lakey, emma, and Isabella Martingano. “Understanding Toxic Shock Syndrome (TSS): Are Tampons the Cause?” Period Education Project, Tilman J. Fertitta Family College of Medicine University of Houston, 22 Mar. 2024, periodeducationproject.org/2024/03/22/understanding-toxic-shock-syndrome-tss-are-tampons-the-cause/.  ↩︎
  6. Langmaid, Stephanie. “Toxic Shock Syndrome (TSS) – Basics & Causes.” Edited by Jabeen Begum, WebMD, WebMD, 11 Oct. 2023, www.webmd.com/women/understanding-toxic-shock-syndrome-basics↩︎
  7. “Menstrual Toxic Shock: Respect the Conditions for Wearing Feminine Hygiene Products.” Anses, 10 May 2024, www.anses.fr/en/content/menstrual-toxic-shock-respect-conditions-wearing-feminine-hygiene-products#:~:text=Which%20sanitary%20protection%20products%20are,cannot%20cause%20TSS↩︎
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556184/  ↩︎

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