Toxic shock syndrome: are tampons and menstrual cups safe?

tampons and menstrual cups
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Following a number of recently reported serious cases of toxic shock syndrome (TSS) associated with the use of tampons and menstrual cups, we wanted to investigate the risks of using these types of products. Are these incidences of TSS isolated rarities, or should users of tampons and menstrual cups reconsider their choices? 

We asked Dr. Africa Rebollo Cuadro, a specialist in gynaecology and obstetrics, who has over 40 years experience in this area and is also a member of Top Doctors. 

This is what she told us.

"I honestly don't think you have to worry about using tampons or menstrual cups. The tampon is something that has been used by my women for many years and I have never come across a case of toxic shock syndrome as a result of a tampon during my long professional career."

The gynaecologist explained that cases of “forgotten” tampons found in the vagina are quite common, but usually do not cause anything sinister. Aside from discomfort, irritation and quite a bad smell once removed, patients recover very quickly with no lasting damage.

What actually is toxic shock syndrome? 

Toxic Shock Syndrome (TSS) is caused by bacteria entering the body and releasing harmful chemicals. Even though it is particularly rare, and is usually associated with young women and the use of menstrual products such as tampons and the menstrual cup. It can however, happen to anyone - including both men and children. Often the TSS results from toxins produced by Staphylococcus aureus (staph) bacteria, but group A streptococcus (strep) bacteria can also be a cause.

Cases of TSS are uncommon, but its consequences can be extremely serious.

One recent case of TSS was reported, involving a 36 year-old French woman, Sandrine Graneau, who had to have her feet and almost all the bones in her fingers removed as a result of TSS. This case was the result of using the menstrual cup. Another recently reported incident  of TSS was a 17-year-old Belgian girl, who died as a result of using tampons. 

From these cases you could perhaps automatically assume that the use of tampons or menstrual cups are responsible for TSS. 

Dr Rebollo Cuadro explains: "Both the use of tampons and the use of a menstrual cup do not in themselves produce toxic shock. It could be that when the menstrual cup is inserted, despite being made of silicone, the vaginal mucous membrane is abraded and, if there is bacteria present or the menstrual cup or tampon is contaminated, it is this that could contribute to the development of TSS”, explained Dr Rebollo Cuadro.

Symptoms of TSS include: high temperature, flu-like symptoms, such as a headache, feeling cold, feeling tired or exhausted, an aching body, a sore throat and a cough, feeling and being sick, diarrhoea, a widespread sunburn-like rash, lips, tongue and the whites of the eyes turning a bright red, dizziness or fainting, difficulty breathing, confusion, and low blood pressure.  Diagnosing TSS can be difficult because symptoms can be confused with other issues.

With regards to treatment, the gynaecologist explained that when toxic shock is identified, it is normally treated with antibiotics in hospital. Amputation is extremely rare - but it is important that symptoms are treated as soon as possible to prevent this.

How can women who use a menstrual cup or tampons prevent toxic shock syndrome?

Dr. Africa Rebollo Cuadro says: "I would suggest that if you use tampons, make sure you change them regularly. It is important to not leave them in for more than eight hours. Store tampons in a cool dry place, avoiding damp areas - as this can increase the chances of infection and bacteria growing. Ensure you wash your hands before inserting a tampon or menstrual cup. Where possible it is better to use pads or panty liners, but it is not dangerous to use either tampons or menstrual cups so long as the correct hygiene and storage guidance is followed”.

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