What is my daughter’s risk of getting TSS and how can she avoid it?

Younger females, such as those under 30, may be at a higher risk for TSS because they have not yet formed antibodies to the staph toxin. Therefore, it’s important for you and your daughter to be vigilant for TSS. However, it’s also important to know that there now are actually very few TSS cases reported each year.

Toxic Shock Syndrome became a hot topic in 1980 when 813 cases of menstrual-related cases of TSS—and 38 deaths—were reported. Research ended up showing that use of a specific type of tampon that is no longer on the market put women at a higher risk of TSS than use of other tampons. This tampon was made with a new combination of materials including polyester foam  and a highly absorbent cellulose that enhanced absorption. Although not all TSS cases occurred in women who used this specific type of tampon, it clearly played an important role. Therefore, it was removed from the market, along with other new, highly absorbent tampons of similar substances.

Because of the discontinued use of these types of tampons, as well as the Food and Drug Administration’s regulation of tampon materials and absorbency, there has been a dramatic drop in the number of TSS cases. In 1997, only six cases were confirmed, and in 1998, only three cases. Nevertheless, the FDA recommends that women take the following steps to avoid tampon problems:

• Follow the package directions for insertion;
• Choose the lowest absorbency that will handle your menstrual flow;
• Change your tampon at least every 4 to 8 hours;
• Consider alternating pads with tampons;
• Don’t use tampons between periods; and
• Know the warning signs of Toxic Shock Syndrome.

What are the symptoms of TSS?

The symptoms of TSS include fever, vomiting, dizziness, diarrhea, fainting, a sunburn-like rash, muscle aches, sore throat, headache, joint pain, red eyes, and sensitivity to light. As the illness progresses, TSS can also lead to mental confusion, kidney failure, a drop in blood pressure, and collapse. One to two weeks after the initial symptoms, peeling patches of skin on the palms and soles can occur.

These symptoms typically appear during a woman’s period or a few days after. If a woman suspects she has TSS, she should remove her tampon immediately and call her doctor or go to the emergency room for immediate evaluation. Treatment requires hospital admission for intravenous antibiotics to kill the bacteria, intravenous fluids to treat the low blood pressure and dehydration, and observation and treatment for signs of kidney failure. With appropriate treatment, most patients will recover in 2 to 3 weeks.

What is Toxic Shock Syndrome?

Toxic Shock Syndrome (or TSS) is a rare but potentially life-threatening illness. Researchers believe it is caused by an infection resulting from certain staph and strep bacteria that often exist even in a healthy woman’s vagina. The exact process is unknown, but it’s thought that these bacteria multiply in the presence of a bloodsoaked tampon. It’s actually not the bacteria that cause the TSS directly. Rather, it’s the toxins that the bacteria produce that do the harm.

It’s important to note that staph bacteria are very common.We all have them on our skin and inside our noses. Usually they are harmless, but if they gain access to the bloodstream or deeper tissue, they can cause a serious infection.

For TSS to occur, certain strains of the bacteria have to overpopulate and produce large amounts of toxin. This toxin then has to gain access to the bloodstream. One generally accepted theory is that super-absorbent tampons that are left in the vagina for extended periods of time can encourage growth of the bacteria. And importantly, these super-absorbent tampons can also adhere to the vaginal wall if they are dry and the menstrual flow is light, thereby causing tiny abrasions when removed. These abrasions then provide access to deeper tissue or to the bloodstream for the bacteria and toxins.

How can my daughter choose the right tampon?

The type of tampon that is right for your daughter depends on her menstrual flow. Simply stated, she should match the absorbency of the tampon to her flow. If she has a light flow, then she should try the junior or regular tampon. If her tampon is completely soaked before 4 hours, she should try one with higher absorbency.

However, you should caution your daughter that if a tampon is too absorbent for her flow, vaginal dryness and even vaginal ulcerations can occur. If a tampon is dry and hard to remove, shreds, or doesn’t need to be changed for many hours, she should switch to a less absorbent tampon. Why is this important? Because research suggests that the risk of Toxic Shock Syndrome may increase with tampon absorbency. However, please note this doesn’t mean your daughter should shy away from using higher absorbency tampons if she really needs them.

What are the different types of tampons?

The Food and Drug Administration now regulates tampon absorbency, which is defined as the rate at which a tampon soaks up menstrual blood. Absorbency is measured in grams of fluid, and you will find absorbency ratings on all tampon boxes. Specifically, the following tampons are readily available:

• Light or Junior Absorbency: 6 grams of blood or less. This tampon is good for the end of a woman’s period when she has the lightest flow.
• Regular Absorbency: 6 to 9 grams of blood. As the name suggests, this tampon is good for many women on most days of their periods.
• Super Absorbency: 9 to 12 grams of blood. This tampon will provide the extra absorption that some women need on their first 1 to 2 days of heavier bleeding.
• Super-Plus Absorbency: 12 to 15 grams of blood. Some women experience especially heavy bleeding on their period and may require this tampon.
• Ultra-Absorbency: 15 to 18 grams of blood. Most women will never need to use this tampon. If this tampon is necessary, a visit to the gynecologist may be wise in order to evaluate the cause of this extremely heavy menstruation.

When should my daughter use tampons?

After using sanitary pads for a while, it’s likely that your daughter will tell you one day that she’d like to try tampons. That means it’s time for you to go to the store and stare at the many options on the shelf. (And when I say “you,” I mean that in the singular rather than the plural form. Unless you’re willing to travel to a different state and perform your task in disguise, don’t count on your adolescent daughter being willing to stand in a store aisle next to you as you both publicly survey the menstrual products they have available.)

What are reusable menstrual pads?

One product that seems to be gaining increased attention is reusable menstrual pads. These are washable, highly-absorbent cloths that are usually secured by wings around the underwear. In many ways they are a modern version of what was used by women in “the old days” during their menstrual cycles. (In fact, it’s from this practice that the demeaning and archaic phrase “on the rag” comes from.)

Although relatively few women use reusable menstrual pads, they do have certain advantages:

• They are allergen-free, chemical-free, and perfume free and are thus less likely to cause irritation and contact dermatitis on the vulva and the vagina, and they are generally more comfortable for women with sensitive skin.
• They are less expensive than disposable pads over the long term.
• They carry less menstrual odor and are more breathable.
• They are environmentally friendly because they are made of natural materials rather than plastic and do not contribute to growing landfill problems.

Reusable pads do have disadvantages, however. For instance:

• They are more time consuming due to the need to wash and dry them.
• Washing them is not particularly easy because the
water with the menstrual blood needs to be disposed of properly.
• If the user has a yeast infection the pad must be sanitized in order to prevent re-infection.
• Their initial cost is higher, although over time they become more economical.

Reusable menstrual pads are certainly not for everyone, but they are worth considering if they fit your lifestyle.