Are Tampons Safe?

The adverse effects of improper tampon use.


For fear of sounding too sensationalistic, when used properly, tampons are safe.  However, like many things in life, including lawn mowers, nail guns and chainsaws, when used improperly, tampons are deadly.

Although now rare once upon a time, tampons commonly caused menstruation-related toxic shock syndrome, a deadly infection which affects the skin, blood and multiple organs.

Toxic shock syndrome first rose to prominence in the early 1980s among young, healthy women who used tampons.

  Tampons make toxic shock syndrome 33 times more likely in those using tampons.

After realizing that tampons were causing a deadly infection, manufacturers of these insertable devices that soak up menstrual blood changed this plug's composition.  Now tampons are mostly made of cotton and rayon.  These new materials limit the risk of infection.

Additionally, the FDA stepped in and limited absorbancy of tampons to 4 categories: junior, regular, super and super-plus.  By limiting absorbancy, users of tampons are obliged to change a full tampon more regularly thus limiting exposure to a retained tampon.  The longer a tampon stays in, the more likely the tampon will pick up bacteria from your vagina and elsewhere that can cause toxic shock syndrome.

Staphylococcus aureus (S. aureus) is a type of bacteria that commonly colonizes the skin and can cause skin infections.   The vagina is a ripe breeding ground for S. aureus, and S. aureus releases toxin shock syndrome toxin-1, which causes toxic shock syndrome.

  Certain conditions increase your susceptibility to toxic shock syndrome including a neutral pH and body temperature as well as carbon dioxide and oxygen levels   An inserted and retained tampon further changes the vaginal milieu increasing the release of toxins by S. aureus.

The toxin that causes toxic shock syndrome has direct effects on the normal regulatory and homeostatic mechanisms of the body.

  Specifically, this toxin causes fever and messes with the immune system, kidneys and blood pressure.

Here are some specific symptoms of toxic shock syndrome:

  • fever;
  • low blood pressure;
  • confusion;
  • nausea;
  • shock;
  • vomiting;
  • muscle aches;
  • redness and inflammation of they eyes, throat and mouth;
  • fever;
  • widespread rash that resembles sunburn;
  • organ failure (liver and kidneys).

Infection with toxic shock syndrome can be mild, resulting in more constitutional symptoms like fever and chills, or severe, resulting in organ system failure.  A diagnosis of toxic shock syndrome is based on clinical history and the diffuse and characteristic nature of the symptoms.

Severe toxic shock syndrome is treated in an intensive care setting using the following measures:

  • removal of the tampon
  • antibiotics
  • intravenous fluids and pressors to stabilize blood pressure
  • dialysis (if needed)
  • gamma globulin (if needed)

Severe toxic shock syndrome is deadly about 50 percent of the time.  Interestingly, antibiotics aren't used to treat toxic shock syndrome per se but rather to decrease its recurrence.

The best way to prevent toxic shock syndrome is to maintain good hygiene and change tampons regularly--every 4 to 8 hours.  If you think that you "lost" a tampon--retained it in your body--and can't find it, contact a physician immediately.

  Signs of a retained tampon can include discomfort, pain, pressure, malodorous vaginal discharge and fever.  Please remember that the longer a tampon stays in your body, the greater the risk of infection.  

Selected Sources

Perry SJ, Reid RD. Chapter 145. Toxic Shock Syndrome and Streptococcal Toxic Shock Syndrome. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e. New York, NY: McGraw-Hill; 2011. Accessed November 25, 2015.


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