By Andrew Caster

Toxic Shock Syndrome is a life-threatening infection of bacteria which release toxins into the bloodstream. These toxins circulate quickly throughout the body, causing shock and organ failure, and can cause death within a few days. Symptoms can include high fever, low blood pressure, and skin peeling. While TSS can be contracted by anyone, it is often associated with premenopausal women. The strain of bacteria that causes TSS in young women, Staphylococcus aureus, is normally found on the skin and mucosa of the human body. However, when presented with the right conditions and an opportunity to infect the bloodstream, it will produce the toxins dangerous to the person. Both S. aureus, and the other strain, Streptococcus pyogenes (also found on skin and mucosa) can affect people of all ages and genders.

Prolonged usage of the same tampon allows unwanted bacterial growth while still in the vagina. It is generally believed that tampon induced TSS is caused by leaving a tampon or part of a tampon in the vagina for more than 30 hours. Tampon removal is believed to cause microscopic cuts in the vaginal mucosa, which allow the bacteria an avenue into the bloodstream. In the 1980s, a study was published reporting a correlation between TSS and women who chose to use super absorbent tampons marketed under the Rely name by Procter & Gamble. When this brand was taken off the market, cases of TSS in menstruating women decreased.

Procter & Gamble had chosen to use a polyester compound, instead of cotton or rayon in its Rely brand. This material was cheaper and more absorbent, but also friendlier to bacterial colonies. Currently, feminine hygiene companies are not required to disclose the exact makeup of materials of their products. Avoid polyester based tampons if it is listed as a material. Super absorbent tampons, which can be changed less often, dry out the vaginal mucosa and make it more susceptible for tearing during removal. If possible, change tampons as often as is needed and use normal absorbency tampons or pads for lighter periods.

While TSS during menstruation is extremely rare, cases do still occur, some of which happen to relatively high-profile women. Italian Vogue model Lauren Wasser lost a leg in 2012 to tampon induced TSS. She used a Kotex brand tampon. Her other leg was severely damaged during this episode, and she made the tough decision to amputate it as well earlier this year. Her case attracted media attention due to its sudden onset and unfortunate consequences. Wasser has seen more exposure due to her experience and is working on increasing awareness of TSS in young women. However, TSS can occur from a variety of other scenarios, including vaginal birth and intra-vaginal contraceptives in women, and from surgical wounds, burns, and other open wounds in anyone. Since the symptoms are general but sudden and severe, it is difficult to diagnose yourself with TSS. While we should not live in fear of TSS, it is important to be aware of the risk factors to minimize any chance of an infection.