In the late 1970s, close to 1300 Americans were hospitalized for a condition called Toxic Shock Syndrome or TSS. Later research confirmed that most of these cases were possibly because of the use of a specific tampon called Rely, which was subsequently withdrawn from the market. This episode led to plenty of research on tampons and their association with TSS. Years later, even though the safety of tampons and other menstrual products has been established, a lot of women ask if they should be concerned about TSS. Here is a list of 10 things you must know about TSS. 

  1. Early symptoms of TSS resemble those of any viral fever: High body temperature, nausea, vomiting and/or diarrhoea, lethargy and low blood pressure. But unlike a viral flu, symptoms of TSS deteriorate rapidly and a patient may even develop rashes over the body.
  2. TSS is a type of shock or vascular collapse, where due to release of a toxin in the blood, the blood vessels dilate or increase in diameter. Obeying the laws of physics, as diameter of vessel increases, the pressure inside it falls. This leads to the typical symptoms of low blood pressure experienced by the patient. 
  3. Bacteria known as Staphylococcus or rarely streptococcus produce this toxin. These bacteria are often part of our body’s normal flora but are harmful only if they enter the bloodstream
  4. For these bacteria to enter the blood, they need an entry point. This entry point is often an abrasion or wound on the skin surface or mucosa anywhere in the body and not specifically in the vagina.
  5. So TSS is not specific to females wearing tampons, it can occur in men, women and children of all ages. The only common factor is bacteria entering the blood through a skin wound.
  6. In the case of tampons, if worn incorrectly or if they are inserted with friction, they might cause an abrasion inside the vagina.  As Staphylococcus sp. is part of normal skin flora, it may be carried inside the vagina while being inserted (ascending infection). Finding an abrasion there, these organisms gain access to the bloodstream and cause TSS
  7. Soft tampons inserted properly with the help of applicators reduce the risk of both abrasion and ascending infection. 
  8. Changing tampons after appropriate time, depending on your flow will also reduce the risk of TSS and other infections. If you keep tampons (or pads or cups) in place for long durations, the collected blood along with warm humid condition in vagina and perineum, act as a culture medium for bacteria. Therefore it’s important to change these at the appropriate time as per your flow
  9. Research proves that certain women might be more susceptible to develop TSS as compared to others. However, science is yet to find a way to see who is more susceptible than others
  10. If you are a tampon or a cup user, you should keep in mind to use these properly as per instructions accompanying these. If despite following instructions, you suspect yourself to be having symptoms of TSS, please remove tampon immediately, temporarily shift to pads and visit your nearby emergency.

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