Menstrual tampons

Toxic Shock Syndrome (TSS)

Toxic Shock Syndrome (TSS) is a rare, but serious infection that occurs when toxins made by certain strains of Staphylococcus aureus bacteria (Staph) get into the bloodstream. The initial symptoms are similar to the flu, and can include high fever, nausea, vomiting, diarrhea, dizziness, fainting, and disorientation. Those affected by TSS might also experience low blood pressure, shock, dehydration, sore throat, muscle pain, peeling skin, and a rash that looks like a sunburn. Toxic Shock Syndrome can be fatal if it is not diagnosed and treated right away.

Minimizing the health risks of tampon use

Tampon use may also cause an increased risk of vaginal dryness and vaginal ulcers, especially if the tampons used are more absorbent than is needed to control menstrual flow. Using tampons may also put you at risk for serious hygiene problems if tampons are forgotten and not taken out on time.

These tips will help you minimize health risks when using tampons:

• Do not use tampons, if you have ever been diagnosed with TSS.
• Use the lowest absorbency that will meet your needs. All tampons licensed for sale in Canada use a standardized, absorbency-labelling system. This means that any tampon of a stated absorbency, no matter which brand, will absorb the same amount of fluid.
• Read the information pamphlet that comes with tampons, and follow all directions.
• Do not use tampons until your period begins. Do not use them as a precaution because you expect your period to start on a given day, or to control other types of discharge.
• Wash your hands before and after inserting a tampon.
• Change your tampon every 4 to 8 hours, and do not use tampons overnight.
• Remember to remove each and every tampon.
• Alternate the use of tampons with external protection, like pads and liners.

If you have any of the symptoms of TSS when using a tampon, remove it and get immediate medical help. If you can't reach your doctor, go to the nearest Emergency Care facility. Make sure the health care professional treating you knows that you were using a tampon when the symptoms started.

Background

Menstrual tampons are made from cotton, rayon, or a blend of both materials. Rayon is a synthetic product made from cellulose, which comes from wood pulp. Women in North America have been using tampons since the 1930s. In the early 1980s, there was an epidemic of Toxic Shock Syndrome in North America that was associated with the use of a high-absorbency tampon and strains of toxin-producing bacteria.

Tampon use and TSS

Tampons do not cause Toxic Shock Syndrome, and the disease is not limited to menstruating women. Men, non-menstruating women, and children can also get TSS. The incidence of TSS has dropped significantly since the epidemic in the early 1980s. Over the last number of years, only a few cases have been reported, and of these, about half were associated with tampon use. Younger women (under the age of 30) are at greater risk than older women because they have not yet developed the antibodies to the toxin that causes TSS.

Scientists have not been able to determine exactly what the link is between tampons and Toxic Shock Syndrome. There may be a number of factors, such as hygiene practices and the length of time a tampon is left in place. Greater tampon absorbency appears to be a factor, because there are more cases reported among women who use high-absorbency tampons. Other risk factors include the use of barrier methods of contraception, like the sponge, cervical cap, or diaphragm. The material of manufacture, whether cotton or rayon, has not been found to be a risk factor.

Health Canada's role

In Canada, menstrual tampons are regulated as medical devices. Health Canada makes sure that the tampons sold in Canada are safe, effective, and of high quality based on requirements for licensing, quality manufacture, and post-market surveillance. Before a device license is given to a manufacturer, tampon-package labelling must contain specific information about absorbency. Labels must also provide details about the risks and symptoms of Toxic Shock Syndrome, and instructions on what to do if you have these symptoms.