I have been struggling to come up with topics to write about, or rather, maybe just unmotivated, hah… however, I decided to go today and write on a topic that I’ve been meaning to write and post for a while. Toxic Shock Syndrome is known for many tampon users, yet, how knowledgeable are we about TSS to help us make an informed decision for the good of our health? I’m not here to necessarily debate whether I think tampons are a “good” form of feminine hygiene product, but today, we will concentrate on TSS alone and while there may be references to tampons, I’m neither “against” them or “for” them.
So what is toxic shock syndrome and like many infections, the name “doesn’t sound good already.” TSS is potentially fatal and caused by a bacterial infection which is usually associated with tampon use. There are multiple viruses which may trigger TSS, however, the most common one for tampon-related TSS infections is called Staphylococcus aureus. Despite what has been said and the belief that TSS only occurs in women who use tampons, this is not true. In fact, men and women are both capable of being infected with this bacterium and tampons are not the only cause of TSS. TSS has surfaced since 1980 and even after 31 years, women are still dying from tampon-related TSS. We may not think much of TSS, because there is very little publicity on it and with enough taboo around menstruation, people are not open to aptly speak about menstrual/feminine hygiene related deaths. It takes a very brave woman (Lisa Elifritz), the owner of You ARE Loved to raise public awareness about TSS and tell a very personal story about the challenges she faced with TSS in the death of her daughter, Amy Rae Elifritz.
TSS infections caused by Staphylococcus aureus can occur in a healthy individual and usually show through flu-like symptoms, particularly with high-fever exceeding 38.9 °C (102.02 °F), along with low blood-pressure, confusion, vomitting, diarrhea, weakness, coma and in more severe/terminal stages, multiple organ failure. Tampon related TSS symptoms also include a typical skin rash which is characterized as being severely painful at the site of the infection. TSS can be managed if discovered soon and with proper treatment, recovery occurs usually in 2 to 3 weeks. However, because of the destructive nature of the bacteria and TSS, death can occur within hours of the onset of the symptoms. Treatment within the ICU (Intensive Care Unit) is necessary for full supportive care, along with antibiotic treatment and toxin-reduction drugs.
Reported TSS cases dropped off rapidly after 1981 when 40 women died of tampon-related TSS and stayed “under the radar” for many years, until the fear of tampons begin to taper off. Tampon-related TSS struck fear in many women at the time, however, as girls begin to get their periods at younger ages in this generation, more of them are opting to use tampons and thus, exposing them to the causative bacteria at a younger age and also increasing the likelihood that they may be candidates for bacterial growth leading to tampon-related TSS. The triggering point for attention towards TSS was in a controversial testing of a tampon usable for an entire menstrual period called Rely by Procter and Gamble (P&G) in 1978. The tampon would, by design, be able to last an entire period without leakage or replacement and is said to be capable of absorbing almost 20 times its own weight. After several reported cases of TSS in menstruating women, the spotlight turned to tampons as the cause and eventually the product was pulled off the shelf.
People under the ages of 30 are less likely to have the antibodies to fight off Staphylococcus aureus bacteria, making individuals more susceptible to contracting TSS. Even the most diligent individuals such as Amy Rae Elifritz can be infected by this bacterium, despite regular changing of the tampon, alternating of menstrual products and using the lowest absorbency necessary for the menstrual flow at the time. While detection of TSS symptoms might be more obvious while menstruating, TSS can also occur any time within the menstrual cycle and menstruation does not need to be present, as bacteria may take time to build up or if chemicals/materials are left behind in the body, such as leftover rayon fibers from a removed tampon. Because symptoms of TSS are too much like the common-flu and become deadly in a very short period of time, it’s so hard to determine whether or not it’s necessary to seek medical attention and of course, most people would not want to be too aggressive in thinking they have TSS every time they get some flu-like symptoms. Nevertheless, some would argue that because of the severity of the infection, it’d be better to be on the “safe side.”
So how can one mitigate or avoid the risk of TSS? With over half the reported TSS cases being attributed to tampons, it is a reality, not just a myth. For those who have never bothered to heed the warning of tampon pamphlets, here’s a rundown with some of my input and additional tips offered by the You ARE Loved team:
- Use the lowest possibly absorbency to handle your menstrual flow
- The higher the absorbency of the tampon, the greater the risk of TSS
- Change tampons frequently and look for signs of any tampon remnants which might be left behind (such as shredding as you withdraw)
- Avoid using tampons overnight
- Tampon-related TSS bacteria require 8 hours to dissipate, therefore, use other products whenever possible throughout the day
- Tampons are NOT meant to absorb discharge, vaginal fluid or ‘just-in-case’ situations; Tampons should only be used when menstruation has begun
- Tampon choice should allow for comfortable insertion and removal, such as being saturated enough to remove easily and comfortable enough to put in. Forcing a tampon in or out may cause minute scratches in the vaginal wall, giving the bacteria an entry for further infection
- Be hygienic and wash your hands before touching your vaginal area, including clean-handling method for your tampon
- Remember to remove the last tampon of your period
- Do remember that as “very rare” that tampon manufacturers may want you to feel about the use of tampons associated with TSS, it is a very serious and real risk
- Consider alternate menstrual products, such as sanitary napkins (pads), sea sponges, menstrual cups or natural tampons (usually made from cotton, non-bleached and not composed with rayon)
- Don’t let TSS-risk slip you over time; Just because TSS hasn’t affected you yet, it doesn’t mean it never will
So what do you do if you believe you or someone else you know has been compromised or showing symptoms of TSS?
- If using a tampon, remove it immediately as this eliminates the source of the bacteria infection
- Seek medical attention and alert the emergency operator and/or emergency crew that the illness may be toxic shock syndrome related
- Avoid using tampons in the future as reinfection is a high possibility
Certainly in the future if I have a little girl, I would certainly give her the choice of using any menstrual product she prefers. Nevertheless, should tampons be her choice of products, I would make sure to educate her on proper tampon handling and hygiene, along with ensuring that cotton tampons are purchased over conventional rayon-based ones. If each and every one of these women fallen can make the world aware of TSS, then at least their deaths will not be for naught.
I would recommend anyone who is interested in learning more about TSS and the story of the Elifritz, please visit: http://www.you-are-loved.org/ and also considering making a DONATION to their cause (due to the site design, I cannot directly link to the donate section).