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Toxic shock syndrome (TSS) is a potentially fatal illness that results from a bacterial infection. In most cases, the affecting bacterium is the staphylococci strain, but occasionally it is streptococci. The United States Food and Drug Administration (FDA) acknowledge that there is a link between TSS and tampon use, however, the exact link remains unknown as of 2011. It is generally believed that TSS may result from the prolonged use of super absorbent tampons, which may lead to bacteria buildup trapped in the vaginal canal. There are other theories though that may explain why a woman could get TSS from tampon use.
Many health care professionals believe that the main connection between tampons and TSS in menstruating women is due to the frequent use of high absorbency tampons, which are typically labeled as "super" or "super plus." This is because the high absorbency tampons tend to be left inside the vagina for longer periods of time. As a result, the warm and moist vaginal canal becomes a suitable area for rapid bacteria growth and reproduction with little opportunities for the body to release and self-cleanse the area. This is the most agreed upon connection between tampons and TSS as of 2011.
Higher absorbent tampons also tend to expand more inside the vagina and occasionally stick to the vaginal walls, which may be another link between tampons and TSS. This may mean that layers of the vaginal walls may be scraped out when the tampon is removed. Dryness in the vagina may allow for ulcerations or even scratches in the lining, which may in turn leave a more direct route to the bloodstream for bacteria to enter.
Previously, it was suspected that the material in the tampons were a main link between tampons and TSS. Rumors spread that dioxins from bleached rayon in tampons may result in TSS. Though with regulations put forth by the Environmental Protection Agency (EPA), the bleaching process performed on the rayon create such minimal amounts of dioxin that as of 2011 it has shown little to no affects on the human body.
Although not all events involving TSS are from tampon usage, according to reports from the FDA, approximately half of all TSS cases were menstruating women who used tampons. The overall number of tampon related TSS cases has gone down after FDA regulations on absorbency measurements and labeling was put forth. Generally, it is believed that the raised awareness in the connection between tampons and TSS has helped to lower the number of cases.