Many times, I’ve read the Toxic Shock Syndrome (TSS) warning on a box of tampons, but I’ve never actually heard of anyone who’s experienced it. That makes it easy to overlook the risks, especially given their convenient aspects.
But I’ve been more and more cautious lately about the products I use and their potential impacts on my health as well as the environment. I’ve noticed many stores now carrying menstrual cups as an environmentally friendly alternative to tampons.
But where I have concerns about what exactly is in the tampons and the health risks they pose, I am also concerned over the hygiene of using a menstrual cup.
I turned to Eericca Bickley, DO, an OB-GYN with Banner Medical Group, to find out the risks of both forms of feminine protection.
TSS is caused by the bacteria staphylococcus aureus and streptococcus pyogenes that are already in the body. Women began being diagnosed with the staphylococcus type of TSS linked with use of highly absorbent tampons in the late 1970s and early 1980s. Manufacturing changes in tampons has reduced the number of TSS cases, but it still occurs and in rare cases can be fatal. The streptococcus TSS is most commonly seen in children and the elderly.
Symptoms of staphylococcal TSS are similar to other infections and can include fever; chills; malaise, headache; fatigue; rash; low blood pressure; vomiting; diarrhea; rash, shedding of the skin in large sheets; muscle pain; increased blood flow to the mouth, eyes and vagina; decreased urine output; decreased liver function; bruising; disorientation and confusion.
In addition to tampon use, TSS can also be caused by surgical wounds, local infections in the skin or deep tissue, use of a diaphragm or contraceptive sponge, or recent childbirth, miscarriage or abortion.
“Women should follow best practices of tampon use and stop using them at the first sign of infection,” Dr. Bickley said.
Best practices include only using tampons while menstruating, never leaving them in longer than the recommended amount of time and using the lowest absorbency needed, she said.
“Sometimes we see patients who insert tampons in anticipation of their period arriving,” she said. “This practice is never advised.”
While the risk for TSS is relatively low given the changes in tampon manufacturing, Dr. Bickley said, there is also potential for vaginal infections with the extended use of tampons.
“These infections include bacterial vaginosis or yeast infections,” she said. “These infections can both be easily treated with a medication prescribed by your gynecologist. “
A menstrual cup is just what it sounds like – a flexible device, usually made of silicone or rubber, placed inside the vagina to collect menstrual fluid, rather than absorb it. The reusable ones can be emptied, washed and reinserted.
There are several pros to using the cups, including more time between changes, but it can also take some time for users to establish a technique and adjust to the cleaning and maintenance required. There have been no documented cases of TSS with the use of a menstrual cup, Bickley said.
“For women who are concerned over waste or seem to always be out of tampons when they need one, the cups can be a good alternative,” Dr. Bickley said. “But it is important to make sure they are sterilized properly or they can cause problems such as bacterial or yeast infections.”
Women who have had TSS or use an IUD (intrauterine device) for birth control are advised to consult their gynecologist prior to using a menstrual cup. Women with latex allergies should also be careful to select a brand that is made entirely of silicone.