Toxic Shock Syndrome

Apart from - maybe - a module in your sex ed’ class, anything you know about TSS (AKA Toxic Shock Syndrome) you probably had to find out for yourself. Sound about right? Yup, us women and our bits don’t generally get priority when it comes to sexual education!

TSS is something that as women with periods, we definitely don’t talk about enough. In fact, although still rare, cases are rising in some places. You might have spied TSS warnings in the small print of your tampon packets, but what exactly is it?

There are articles online about TSS, but some of the information can be contradictory. At Yoppie, we wanted to clear up any confusion to help make sure you always feel comfortable and confident wearing tampons.

Now, let’s don our science specs to cover the risks, potential symptoms and how you can protect yourself against Toxic Shock Syndrome.

What is toxic shock syndrome?

Toxic Shock Syndrome (TSS) is caused by the bacteria Staphylococcus Aureus (S. aureus) entering into our bloodstream and producing harmful toxins.

Although it’s very rare, this toxin can be extremely dangerous for our immune system, attacking the major organs which can lead to kidney failure, lung collapse, cardiac arrest and death.

What is Staphylococcus Aureus?

Staphylococcus isn’t harmful in itself, and it’s estimated that 20% to 30% of us humans carry it as part of our normal skin flora. It can often be found in the nose, on our skin, under our armpits, in our vaginas and generally just harmlessly hanging out, minding its own business. Problems occur only if staphylococcus gets into our bloodstream and produces toxins.

Most strains of the bacteria Staphylococcus aureus don’t actually produce TSS causing toxins. Only certain strains of the bacteria produce them. Even if a toxin-producing strain is present, it is often not enough for TSS to develop on its own. Although, it’s thought that our bodies can ramp up the production of the toxin when exposed to the air trapped in tampons. Research suggests that TSS mainly only goes on to develop if the person doesn’t have enough antibodies to fight against these toxins.

Although half of TSS cases occur in menstruating women, they can also occur in both men and women as a result of things like:

• Recent surgery.
• An injury (even a minor injury) that breaks the skin such as a burn, insect bite, boil or deep scratch.
• Leaving tampons in for longer than the recommended time, or using a higher absorbency than you need.
• Using barrier contraceptives, such as the diaphragm or cap.
• Using nasal packing to treat an excessive nosebleed.
• Having a staphylococcal infection or streptococcal infection - sometimes referred to as “staph infection” or “strep throat.

What causes TSS?

TSS isn’t caused by tampons directly. Toxic Shock Syndrome from tampon use is thought to be caused when a tampon creates tiny, microtears inside the vagina, allowing staphylococcus aureus bacteria to enter the bloodstream.

This shouldn’t happen if you’re using the right size tampon for your flow, but if you’re using a tampon with a higher absorbency than necessary, this can cause undue stress on the tissue inside the vagina as it enters and/or exits the vaginal passage.

TSS and tampon use are associated with two key things:

• absorbancy
• length of tampon use

So, the higher the absorbency and the longer a tampon is left in your vagina, the higher the risk of TSS.

The importance of the right tampon absorbency

This part is really important. Although our vaginas might be hardy enough to push out babies and welcome lots of great sex, the layers of tissue that make up the vaginal walls can be delicate and sensitive to friction. You may have noticed how uncomfortable it feels trying to put in a new tampon near the end of your flow. Or that dragging feeling when pulling out a tampon that hasn’t absorbed as much blood as you anticipated. This probably means you’re not using the right absorbency for your flow.

To ensure minimal irritation, we’re told to choose the right absorbency for our flow. But what if we don’t always get the same flow every month? This can make it kind of hard to predict what absorbency we’ll need. What if on day 1 it can either be super heavy or super light… maybe it sometimes lasts 3 days and sometimes 6 or longer? What should we do?

Get prepped to avoid TSS

We think the best advice is to keep a selection of absorbencies handy. This way, no matter what’s going on with your flow that month, you’re prepped and ready.

If your period tends to be a regular absorbency flow, for example, keep more regular tampons around but also a stash of light absorbency tampons. Likewise, if you’re usually expecting the Niagara Falls of periods, keep some regular absorbencies handy.

And, even if you’re a through-and-through tampon advocate, a little stash of pads won’t go amiss, especially for overnight use.

To ensure minimal irritation, we’re told to choose the right absorbency for our flow. But what if we don’t always get the same flow every month? This can make it kind of hard to predict what absorbency we’ll need. What if on day 1 it can either be super heavy or super light… maybe it sometimes lasts 3 days and sometimes 6 or longer? What should we do? That's where having the variety on hand is invaluable. Everyone's cycle is different!

Key takeaways

The most important things to always remember are:

Toxic Shock Syndrome (TSS) is rare but it can be fatal. To reduce your risk you can:

• Wash your hands well before and after inserting or/and removing a tampon
• Use the correct absorbency (or lower, if in doubt) for your flow
• Change your tampon every 4 hours or less
• Switch up to a pad every now and again during your period
• Try to use a pad at night instead of a tampon if you can
• Never use more than one tampon at once

If you notice these symptoms, remove your tampon and seek medical advice immediately:

• A sudden high fever (usually over 39°C but not always)
• Dizziness
• Fainting
• Feeling sick, nausea or vomiting
• Diarrhoea
• Sore throat
• Sunburn-like rashes
• Aching muscles
• Convulsions

Remember, you don’t need to stress about TSS. Just being aware of your menstrual health and potential TSS symptoms is all you need to get through your bleed!

References & useful links

Rising TSS incidence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1081400/

Tampons and Toxins: https://www.newscientist.com/article/dn4199-dispute-over-test-for-toxic-shock-syndrome/

TSS & Antibodies: https://www.ncbi.nlm.nih.gov/pubmed/6491377