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What is TSS & How Do You Get It?

70 to 85 percent of women in the U.S. use tampons.[1] However, depending on how they’re made, these products can put women in danger. Our mission at Cora is to give you safer and healthier options when it comes to your period, so we wanted to take the time to explain what TSS is, what products can cause it, and how to keep yourself safe.

What is TSS?

I’m sure that you’ve heard frightening stories about toxic shock syndrome (TSS), a serious illness originally linked to the use of tampons. That's because the earliest cases of the illness, back in the late 1970s, were related to super-absorbent tampons made primarily with synthetics like Rayon.[2] Research led to less Rayon in tampons and better habits for using them — like changing tampons more often.[3] The number of TSS cases dropped dramatically, but it still occurs.[4] There was a study in 2004 that determined out of 100,000 tampon users each year, only 3 to 4 would contract TSS. Today, about half of all TSS cases are linked to menstruation.[5]

But, you should know that TSS isn't strictly related to tampons, and men can get it too.[6] You can get TSS if bacteria enters skin broken skin from a cut or other wound, surgery, or a scald or burn; after giving birth; during a chickenpox infection; and from prolonged use of nasal packing for nosebleeds (we’ve all stuck a tissue up there as a makeshift nose tampon before) — however, all of these are rare.[7]

TSS is a systemic illness; that just means that when you contract TSS, it affects the whole body.[8] Two types of bacteria cause it: Staphylococcus aureus (you know it as staph) and Streptococcus pyogenes (have probably had it before, strep).[9] These bacteria can produce toxins and in some people whose bodies can't fight these toxins, the immune system reacts.[10] This reaction causes the symptoms associated with TSS.[11]

Research clearly shows that the toxins of Staphylococcus aureus are amplified by tampons made of any synthetic ingredients like viscose rayon.[12] There has never been a case of TSS caused by the use of all-cotton tampons.

So now that you know a little more about TSS itself, let’s dive into why our vaginas are such a hotbed for it.

The Vagina is the Perfect Place for Exposure

Most of the chemicals used in feminine care products are also found in other cosmetic products.[13] However, feminine care products are specifically intended for use on vaginal and vulvar tissue, which are much different and more sensitive than the skin on the rest of your body.[14]

Quick biology refresher: The vulva is the part of female genitals you can see from the outside of the body, and the vagina is the internal part, which leads to the cervix.[15]

This tissue is different than the skin of the rest of the body.[16] They are more hydrated and more permeable than other skin – A.K.A. more vulnerable to exposure to toxic chemicals and irritants.[17] The walls of the vagina are filled with numerous blood vessels and lymphatic vessels, which allows for everything to go into the rest of your system very fast.[18]

In fact, there’s quite a lot of interest in vaginal drug delivery systems (even marijuana lube products) because the vagina is such an effective site to transfer drugs directly into the blood without being metabolized first.[19] Unfortunately, this feature is a distinct disadvantage when it comes to exposure to toxic chemicals.[20]

Which brings us to the next question, “Why are these dangerous product even allowed to be made?”

Complete Lack of Regulation

It really comes down to the fact that tampons and pads are regulated by the Food & Drug Administration (FDA) as medical devices.[21] That means that unlike cosmetics, medical devices don’t have a government requirement to disclose ingredients to the consumer.[22] This makes it nearly impossible for consumers to avoid chemicals of concern found in these products.[23] Safety and compliance with regulations for other ingredients in over the counter drugs are the sole responsibility of manufacturers, meaning little or no assessment of the safety of the whole product is conducted by the FDA before a product can be sold.[24]

So, unless tampons and pads, along with other products that are in close contact with our vagina are listed as cosmetics, there’s really nothing we can do about it. Luckily, modern brands like Cora believe in transparency, and fully disclose what their tampons are made of (in Cora’s case, 100% certified organic cotton). However, what about the others?

What Are Tampons Even Made Of?

While tampons may appear to be relatively simple devices, the materials and processes for making them often utilize synthetics and chemicals that are known to be highly toxic.[25] Some troubling facts:[26].

  1. Most tampons are made from non-organic cotton, rayon or other synthetic  fiber.
  2. Non-organic cotton is considered one of the dirtiest crops in the world, making up 2% of cultivated land while using 24% of the world’s pesticides.
  3. Historically, tampons have been bleached with chlorine compounds, a process that contaminates them with highly toxic dioxins

FDA guidance for the marketing of tampons recommends that tampons be “…free of 2,3,7,8- tetrachlorodibenzo-p-dioxin and any pesticide and herbicide residues.”[27] Unfortunately, this recommendation is not mandatory and testing results reveal that both dioxins and pesticide residue have been found in non-organic tampons.[28]

Clearly, that recommendation from the FDA does little to protect us. It looks like we need to take this into our own hands, ladies.

How Can You Prevent TSS?

  • Choose Organic Tampons -- As we discussed, TSS has been linked in many cases to tampons that are made with synthetics like Rayon and Polyester, so always avoid those by using a tampon that is 100% organic cotton.
  • Use The Lowest Absorbency for Your Flow -- Select the tampons with the lowest absorbency that can handle your menstrual flow and change them often.[29] And how do you know what that is on a given day? Look at your tampon before flushing and make a judgement call. If it’s fully soaked, take care to change it often that day. If there are just a few spots of red, you’ve got some leeway. As a rule, however, it’s better to change a low absorbency tampon more often than to leave a high-absorbency in for a longer period of time.
  • Keep Track of Time -- In the craziness of our lives, who among us doesn’t occasionally lose track of how long they’ve been rocking their current tampon? If you have a hectic schedule, make a habit to check the string every time you go to the bathroom to pee. If needed, set a timer on your phone to check your tampon and change it every few hours.

Store tampons away from heat and moisture because that’s where bacteria can grow.[30] For example, keep them in your bedroom rather than in a bathroom closet.[31] However, Cora’s Little Black Box keeps your organic tampons nice and safe too! Also, since bacteria are often carried on hands, wash your hands thoroughly before and after inserting a tampon.[32]

What are the Signs & Symptoms?

The most proactive thing you can do is be aware of your body and to never ignore or minimize the way your body feels. Get familiar with the following symptoms of TSS. As they usually occur suddenly, the more familiar you are the more quickly you can know if you might be experiencing them. The signs and symptoms of TSS include:[33]

  • High fever (greater than 102°F [38.8°C])
  • Rapid drop in blood pressure (causing lightheadedness or fainting)
  • Sunburn-like rash that can be anywhere on the body, including the palms of the hands and soles of the feet
  • Vomiting or diarrhea
  • Severe muscle aches or weakness
  • Bright red coloring of the eyes, mouth, throat, and vagina
  • Headache, confusion, disorientation, or seizures
  • Kidney and other organ failure

The average time before symptoms appear for TSS is 2 to 3 days after an infection, although this can vary depending on the infection.[34] At the first sign of a fever or rash, remove your tampon immediately - this may help prevent your symptoms from worsening.[35] Then, seek medical care immediately.[36]

P.S. Since you are reading this, definitely spread the word to your friends so that if you see each other or even a stranger with symptoms, you know what to do.

But, What Happens if You Have TSS?

TSS is a medical emergency. Depending on the symptoms, a doctor may see you in the office or refer you to a hospital emergency department for immediate evaluation and testing.[37]

If doctors suspect TSS, they will probably start intravenous (IV) fluids and antibiotics as soon as possible.[38] They may take a sample from the suspected site of the infection, such as the skin, nose, or vagina, to check it for TSS; they also may take a blood sample.[39] These blood tests can help show how various organs (like the kidneys) are working and check for other diseases that might be causing the symptoms.[40]

People with TSS usually need to stay in the hospital for several days so doctors can monitor their blood pressure and breathing and watch for signs of other problems, such as organ damage.[41]

TSS is a very rare illness and if recognized and treated promptly it is curable.[42] This woman even continued her modeling career with her prosthetic leg.

The Bottom Line

There is nothing wrong with using tampons as long as you change them out frequently and use brands that are transparent about their ingredients and promote women’s health by offering chemical and synthetic-free products. Cora offers only 100% organic cotton tampons. They contain zero synthetics, chemicals, or fragrances and are biodegradable and hypoallergenic.

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