Tampon Tell-All: The Real Truth About TSS

By Erika Stalder, Refinery29

.We all see the toxic shock syndrome (TSS) warnings that come on those tiny pamphlets inside every box of tampons. And, most of us largely ignore the message until a TSS horror story hits the Internet every once in awhile. As if the accounts of sudden and extreme illness weren't enough, these cyclical "it happened to me" stories have recently been joined by another tampon-safety freak-out: an internet-spurred rumor about manufacturers spiking tampons with asbestos as a sort of make-em-bleed-to-move-more-tampons warfare.

The tale has become so rampant that the FDA recently issued a statement to deflect the unfounded rumors, saying, "Asbestos is not an ingredient in any U.S. brand of tampons, nor is it associated with the fibers used in making tampons...If any tampon product was contaminated with asbestos, it would be as a result of tampering, which is a crime. Thus far, FDA has received no reports of tampering."

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With so much hype circulating about what goes into our hoo-has come period time, we sought the counsel of a few OB/GYNs to get clean intel on tampon use.

While the asbestos thing is, thankfully, totally bogus, TSS and dioxin poisoning are real. TSS can be caused by toxins from certain strains of bacteria in the vagina. Those who contract TSS can be hit with a sudden high fever, chills, vomiting, diarrhea, and muscle aches, followed by low blood pressure, and sometimes, shock. And, yes, the affliction can be fatal.

. TSS from Staphylococcus infections began cropping up in the late '70s and early '80s and was linked to high-absorbency tampon use in research by the Centers for Disease Control. But, here's the deal: We've come a long way since 1980, in which 814 cases were reported. Today, tampon-related TSS cases are extremely rare. Like, Scarlet Fever rare. (For example, there have only been five confirmed menstrually related TSS cases reported since 1997, according to the CDC.) And, researchers think it's largely due to a few changes in the iffy materials and designs - including gelled carboxymethylcellulose, which helped provide a medium where Staphyloccus Aureus bacteria could grow, according to research from The Yale Journal of Biology and Medicine - once used for a few specific products. The FDA states: "These products and materials are no longer used in tampons sold in the US."

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"[TSS] is a rare event. I've been in practice for 25 years and I've seen one case," says OB/GYN Lauren Streicher, an Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University's medical school and author of The Essential Guide to Hysterectomy, noting that the case was a teen who had been bleeding and using tampons for two months straight. "If you interviewed 100 gynecologists, 99 would probably tell you, 'I've never seen a case,'" she says.

Streicher also deflects the idea that using tampons that are bigger and more absorbent than what one might need is a gateway to TSS.

"You're not going to get Toxic Shock Syndrome if you use a tampon that's a little too absorbent," she continues. "The reason you don't use a tampon that's too absorbent is for comfort, period. If you use a tampon that's on the dry side, it's going to [cause] this tugging, dry sort of feeling."

"There's also this myth that if you sleep with a tampon in or leave a tampon in all day, that's going to contribute to toxic shock. There's absolutely no issue with that," Streicher says. "One of the problems that gynecologists see is when women put a tampon in and forget about it for four months, then that's bad because of the odor, discharge, and bacterial vaginitis. But, it's not bad in that these women are keeling over from toxic shock syndrome." Gynecologists deal with forgotten tampons on a regular basis, but even these big, oopsie moments won't necessarily lead to toxic shock.

.But, while TSS is rare, it's still fatal. And, Streicher notes, seriously catastrophic when it does occur. So, researchers are working to better understand the bacterial strains that can produce TSS. One recent study by scientists from the University of Western Ontario found that the presence of certain types of bacteria in the vagina might influence why certain women get TSS and others don't. It also found that various species of lactobacillus bacteria diminished the toxin production of toxic shock-causing bacteria by up to 72%. The study's researchers suggested that probiotics could potentially manipulate the microbiota in our bodies and neutralize toxins in the vagina.

Now what about dioxins, a family of chemical compounds that could once be found in tampons in trace amounts? Their presence is next to nil and not much to worry about, according to Dr. Oluwatosin Jaiyeoba, a gynecologist with Cleveland Clinic's Women's Health Institute, who says, "Dioxin poisonings from tampons are rare."

While the bleaching process for the wood pulp found in rayon tampons was once considered a potential source of the trace amounts of dioxins in tampons, that method is no longer used in the U.S. The rayon now used in tampons sold in the States is bleached with dioxin-free methods created by the EPA and wood pulp producers. Of course, the materials used to make tampons have trace amounts of dioxins in them before being processed for tampon manufacturing, so the product isn't entirely dioxin-free. But, the FDA reasons that since we already have dioxins in our bodies due to environmental exposure, the one part per trillion dioxin measure that the FDA has found in tampons (that's about a teaspoon in a lake fifteen feet deep and a mile square), is negligible.

.Bottom Line: There's a very small chance that one will contract TSS or dioxin poisoning. But, if a sudden onset of symptoms occur (like high fever, chills, and vomiting, followed by a drop in blood pressure), it's best to seek immediate treatment to help prevent going into shock and potentially dying.

That said, according to Streicher, when it comes to purchasing a type of tampon, there's no "healthiest" choice to protect us against these freak incidents.

"People who think organic, all-cotton tampons are doing something beneficial for their body? That is not the case," Streicher says. "If that's what they prefer for environmental and political reasons, that's fine, but it's not a health thing."

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