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Dr. Jane: Are Women to Blame for New Wave of TSS?

Dr. Jane: Are Women to Blame for New Wave of TSS?

This week, international media has been abuzz with news of TSS outbreaks and near-death experiences for young women. As a board certified OBGYN, I’ve been shocked to see how this news has incited critical and judgmental reactions from both men and women:

“How could a woman forget that she put a tampon in?”
“That’s stupid!”
“There’s no excuse.”

Leaving a tampon in, forgetting you put a tampon in, accidentally putting two tampons in…. or all of the above, can happen to ANY woman. Whether that woman has a high school education or a college education or a graduate degree or a medical degree herself. It happens. Maybe due to stress or busy lives.

But maybe it’s not due to anything at all. Maybe it’s simply an honest, common mistake.

Lots of women have come to my office through the years with vague complaints of smell or discomfort — not knowing that they’ve accidentally left a tampon in for a few days or even a few weeks. As other OB/GYN colleagues can attest, my experience with patients is all too common.

The Centers for Disease Control stopped tracking TSS back in 1986, so it’s not surprising that it’s felt like like toxic shock syndrome has disappeared.

There’s been a lot of misinformation out there, so I want to help clarify what toxic shock syndrome is, and help people better understand how to prevent it.

Emily Pankhurst
Photo credit: The Independent, Emily Pankhurst, 20, was rushed to the hospital late February and fought for her life after getting TSS from an old tampon. 

What is TSS and what are the symptoms?

Toxic shock syndrome (TSS) is an acute, multi-system, toxin-mediated infection that can lead to septic shock and multi-organ failure, and even death (mortality rates for TSS are 30–70%). It was originally associated with super absorbent tampons, but can be associated with any size tampon made of any material. It is typically caused by transmission of normal skin bacteria (staphlococcus aureus or group A steptococcus) into the vaginal canal through insertion of tampons.

TSS was first described in the 1980s but continues to be a danger for menstruating women. Many of us don’t recognize the early symptoms of TSS as they are eerily similar to countless other diseases and conditions, both viral and bacterial.

Symptoms also mirror the side effects that prostaglandin release causes in one’s menstrual cycle every month and are considered “normal” side effects of menstruation. These include lower abdominal pain, cramping, back pain, restlessness, muscle aches or myalgia, diarrhea, nausea, emesis and low-grade fever.

It may surprise you to learn that toxic shock can occur after usage for less than 24 hours.

It’s unknown as to why some women are affected by TSS in a short period of time, while others have tampons left in the vagina for weeks with no incidence.

The toxins released by the staph or strep bacteria act as “superantigens” in the immune system and trigger activation of cytokines which can causes severe tissue damage.

De-Bunking the “Organic Tampons=No Risk of TSS” Myth

Headlines about TSS and the rise in the popularity in organic personal care products have led to an increased demand for “all natural,” 100% cotton, and organic tampons. This is evidenced by the number of all-natural and organic brands and startups that were introduced in the U.S. last year.

But there’s no medical data that would support the use of organic tampons or pads.

Making claims in the media that imply natural tampons are safer — or that they can’t cause TSS — is irresponsible and dangerous since this is not supported by any scientific evidence or endorsed by the FDA.

So, Let’s Recap:

  1. TSS is caused by naturally occurring staph or strep bacteria (that’s on your skin)
  2. 20% of humans carry this bacteria on our skin, and an even higher percentage of us carry it in our nose.
  3. At low levels, this bacteria doesn’t cause significant harm to us, but tampons create an environment where it can thrive: warm, dark and moist (like a vagina).
  4. All tampons (including “all natural”) can exacerbate the risk for TSS because bacteria grow in organic materials, like the cotton found in the tampon that’s in your vagina right now.

Let’s stop judging women, get the facts out there, and help prevent TSS from afflicting more women, together.

About the author: Dr. Jane van Dis is a board certified OB/GYN and has been practicing medicine for 13 years. She is also an advisor to The Flex Company.

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