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What Every Woman Needs to Know About Toxic Shock Syndrome

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    What It Is, Exactly

    Ask your average woman on the street what toxic shock syndrome (TSS) is and she'll probably be able to tell you two things: it's life-threatening, and tampons can cause it...somehow. While both of those are true (and we'll explain the whole tampons thing later), it's good to know what exactly happens to your body when TSS makes an appearance. First, it starts with a bacteria called Staphylococcus aureus that typically lives on your skin. But when it enters the body through a tiny cut or abrasion—which can be caused by removing a tampon before it's fully soaked with blood—it can produce an endotoxin (a toxin that's released when cells are disrupted), which leads to the actual TSS. "This toxin can create increased openings in the blood vessels—we call [it] permeability—that literally causes your blood vessels to leak out fluid into your body," says Nichole Tyson, M.D., an ob-gyn and chief of pediatric and adolescent gynecology at Kaiser Permanente. When that happens, multiple organ systems (like kidney and liver) start to dysfunction. It can lead to a loss of limbs (as was the case for this woman) or even death.

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    It Happens Very Rarely

    Even though it seems like TSS headlines are splashing across the news at an alarming rate—especially when four separate cases are reported in West Michigan within one month, prompting the CDC and FDA to get involved—the truth is that it's still very rare for a woman to get the infection. In fact, the Centers for Disease Control and Prevention (CDC) reported only 26 cases in 2015 (not bad when 70 percent of menstruating women use tampons). And when you consider that about 10 out of every 100,000 women of menstrual age had TSS incidents back in the '80s, before a highly absorbent tampon brand was taken off the market, the numbers are going in the right direction—down.

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    What Tampons Have to Do with It

    So you know that tampons can potentially cause tiny (we're talking microscopic) cuts and abrasions, which give this sneaky toxin the perfect opportunity to worm its way in and wreak havoc on your body. But it doesn't end there. Not using tampons correctly can also increase your risk of TSS, as they absorb blood—rather than collect it like menstrual cups—and create a breeding ground for bacteria if they're left in for too long or have too high an absorption rate for what's appropriate for your flow. "A tampon saturated with blood—especially when it's made from polyester foam versus cotton or rayon fibers—is a place for rapid growth of bacteria," says Maria Sophocles, M.D., a board-certified gynecologist in Princeton, New Jersey. "And a super-absorbent tampon that's used when your menstrual flow is lighter can dry out the vagina, making tearing of the vaginal tissue even more likely." So make sure you're using an absorbency that's appropriate for the current state of your cycle and changing your tampon every four to six hours. Tyson also suggests using a pad rather than a tampon when you're sleeping, as intermittent use of pads is a good preventive practice.

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    Tampons Aren't the Only Culprit

    Only 50 percent of all TSS cases are menstruation related, says Sophocles. Recent surgery, cuts and burns, postpartum wound infections, and even some viral infections like the flu can make you more susceptible. And while the rate of incidence is even lower, it is still possible to get TSS from other devices, like diaphragms, contraceptive sponges, and menstrual cups. That said, Sophocles notes that in the few cases where it occurred with menstrual cups, the product was left in for more than 30 hours. Remember that tampons should never be left in for more than eight hours—though ideally changed every four to six hours—and Sophocles suggests removing and rinsing a menstrual cup after no more than 12 hours of continual use.

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    You Might Think You Have Something Else

    Unfortunately, the symptoms that are most commonly associated with TSS—fever, muscle aches, vomiting, low blood pressure, and diarrhea—can all be connected to other medical issues, like a stomach virus or flu. But the most telling symptom is a sunburn-like rash, says Sophocles. TSS can turn deadly very quickly, so if you notice any of these symptoms—especially in addition to the rash, which Tyson says will present itself in a very severe manner during or after a menstrual cycle—get yourself to the doctor immediately.

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    Guys Can Get It, Too

    Yep, you read that right. Because not all cases are menstruation related, men are also susceptible to toxic shock syndrome (and they're just as prone to infection from recent surgery, cuts and burns, and the flu). "Although most of the time TSS happens in women, about 25 percent of non-menstrual cases occur in men," explains Sophocles. So when you're done reading this, share it with your partner, so he can be just as clued in as you.

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    Your Menstrual History Doesn't Matter

    Scientists have investigated a plethora of potential connections to TSS, and the good news is that you don't have to be super wary of how your periods have been in the past, or what you're wearing during each and every cycle. "Researchers have ruled out feminine deodorant sprays and douches (though you still shouldn't douche—here's why), underwear, and other clothing as causes of toxic shock syndrome," says Sophocles. "The condition is also unrelated to your menstrual history, drug or alcohol use, or sexual activity."

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    If You Get TSS, Say Goodbye to Tampons Forever

    Whether you got TSS from a tampon or not, if you are infected it's time to break up with tampons for life. Why? "Once your vagina has been colonized by the bacteria, your chances of getting TSS again can be as high as 30 percent if you continue to use them," says Tyson, noting that one case report highlights a woman who had five different episodes of it. And using "natural" tampons—which are free of chemicals typically used to make tampons—doesn't matter. Sophocles says there's no evidence showing natural tampons are safer than traditional ones, and the chemicals aren't a problem as far as TSS is concerned because the infection is caused by bacteria, not chemicals. Bottom line: Play it safe and stop using tampons to limit your risk of recurrence.


Samantha Lefave

Samantha is a writer who is living, eating and sweating her way through NYC. You can find her running half-marathons like it's her job, Instagramming her favorite food and fitness finds or, let's be honest, eating peanut butter straight from the jar.

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