Archive for February, 2016

TSS (Toxic Shock Syndrome) Myths and Truths.

Hey all, I was interviewed for an article which appeared on the website Hello Giggles. I copied it below but all credit goes to the author, Sammy Nickalls, my interviewer Sandee Roston, and to the folks at Hello Giggles. I’m just the expert opinionator, natch 😉

Check out for other great articles!

9 myths about toxic shock syndrome we’ve all believed

Toxic shock syndrome (TSS) is something we’ve all heard horror stories about ever since we were young and first learned about periods. It’s become a sort of monster looming whenever we realize we’ve left our tampons in just a *little* too long, or that maybe we should have used a different size tampon to deal with the current ~flow~.

Ultimately, it’s super important to prevent TSS because it can most certainly be fatal, but there are some myths floating around that many of us believe. And they’re simply untrue. HelloGiggles spoke to some experts about tampons, periods, and feminine hygiene to get to the bottom of what really causes TSS —and what doesn’t.

Myth #1: TSS is entirely caused by tampons


What’s the first word that comes to mind when you think of TSS? For many, it’s “tampon.” However, TSS is not only caused by tampons, and it’s important to understand its real origins: bacteria.

It’s technically caused by a strain of the bacteria Staphylococcus aureus, otherwise known as Toxic Shock Syndrome Toxin-1 (TSST-1), Sara Gottfried, MD, Harvard-educated gynecologist and NYT-bestselling author of The Hormone Reset Diet, told HelloGiggles. “It is thought that the hyper-absorbent tampons aid the TSST-1 infection because their prolonged use enhances bacterial growth,” she told us. “However, tampons are not the only cause of TSS.”

Because it’s caused by bacteria, it can actually be contracted if that bacteria enters the skin through an open cut, an infected burn, or even while recovering from a surgery. In fact, according to Dr. Linda Nicoll, assistant professor of the department of obstetrics and gynecology at NYU Langone Medical Center, that very bacteria resides symptom-free in 30 to 50 percent of healthy adults and children, “most commonly on the skin or in the nostrils, vagina, and/or rectum.”

“These bacteria can produce and excrete toxins which are the cause of TSS,” Dr. Nicoll told HG. “Small numbers of the bacteria produce smaller amounts of toxin than larger numbers of bacteria do. So the problem of TSS often occurs when staph are allowed to grow.”

Myth #2: If you leave a tampon in too long, you’ll *definitely* get sick

“Even in cases where TSS is associated with menses, it is not clear that tampons are causative factors in the development of this syndrome,” Dr. Tosin Goje, Cleveland Clinic OB/GYN, told us.

Dr. Goje explains that their clinic much more often sees women who inserted a tampon weeks ago and are only coming in because of resulting bad smells — not because of TSS. “I have never seen a patient with a retained tampon present with symptoms of TSS and, upon removal of the tampon, none of the patients subsequently developed TSS,” Dr. Goje told HG.

Myth #3: TSS is a “period” infection

Sure, you can get TSS from scrapes and cuts, but it’s still pretty much a “period” infection, right? Nope, Dr. Nicoll explained. In fact, about half of the reported cases aren’t even related to menstruation. “Other causes include infections related to childbirth or surgical procedures, breast infections during nursing, burns, and other serious infections,” she said.

Myth #4: You can’t get TSS from a period cup

Menstrual cup

Because people so often associate TSS with tampons, many use period cups thinking that it’s impossible to contract TSS from them no matter how long you leave them in. While there are many benefits to period cups, that’s certainly not one of them, and it’s an incredibly dangerous myth to spread around.

Really, there’s a certain amount of risk accompanying pretty much anything you leave in the vagina, Dr. Gottfried told HG. “TSS has been linked to the use of menstrual sponges and cups, diaphragms, and cervical caps,” she said.

Myth #5: Tampons are dangerous

There can be a lot of pressure out there to convert to a method of feminine hygiene you’re not comfortable with, but if tampons are your favorite way, keep on using them. “In general, tampon use is safe,” Dr. Goje told us.

In fact, tampon manufacturers have been very careful since the media attention surrounding TSS and tampon use. “Tampon manufacturers have removed chemical constituents previously used to enhance absorbency,” she explained. “They have also markedly reduced the maximum absorbency of tampons available for purchase. This industry-wide response has drastically improved the safety of tampons.”

That said, it’s still essential to use tampons correctly, such as changing them every four to six hours, never wearing them longer than eight hours at a time, and wearing pads at night and at the end of your cycle, Dr. Goje told us.

“It’s also important that women choose tampons appropriate for their menstrual flow,” she said. “Women with light bleeding should be discouraged from using regular or maximum absorbency tampons. . . It is especially important for young women to be educated with regard to proper tampon use and feminine hygiene.”

Myth #6: You feel TSS in your vagina

Woman having menstrual pain

I’ve certainly left my tampon in for too long at times, and while trying to get to a bathroom, I got it in my head that my vagina felt “different.” Maybe it was achey, or dry, or just felt off.  It’s toxic shock syndrome! I thought to myself, panicking. Turns out that’s just my imagination running rampant, because while TSS causes a ton of truly unpleasant symptoms, you don’t feel them in your vagina.

“Symptoms can include fever, low blood pressure, rash, chills, malaise, headache, sore throat, muscle pain, fatigue, vomiting, diarrhea, abdominal pain, and dizziness or loss of consciousness,” Dr. Nicoll told us. (It’d probably be pretty hard to “feel” vomiting and fatigue in your vagina.)

Myth #7: Only women can contract TSS

Because TSS is so commonly associated with periods, it’s thought that women are the only ones who can get it — but men and non-menstruating women are in danger as well.

“Toxic shock syndrome is caused by a bacteria, so anyone can be affected by it — men, women, and children,” Dr. Gottfried told HG. “One may think only women can get toxic shock syndrome because of its association with tampon wearing, but this is not true. . . Burn units with men and women see TSS — and your risk is related to your immunity.”

Myth #8: TSS is a sexually transmitted disease

Though this is a myth Dr. Nicoll comes across, it’s most certainly false, she told us. So don’t feel like that’s another STD you’ve got to watch out for (though please, please, stay protected!).

Myth #9: TSS is common

We hear so much about TSS in the media and in women’s magazines that you’d think it’s happening to everyone and their mother, but it’s actually rare — more rare than it’s ever been in its history. “[T]oxic shock syndrome is very rare and there has been a significant decline in cases since the 1980s, probably because of the public health message about changing tampons more often,” Dr. Gottfried told HG.

In fact, Dr. Nicoll believes this is the “most damaging” myth of all. “In reality, menstrual-related TSS affects approximately 1 in 100,000 women,” she told us. “So even though it is serious, it is rare.”

(Image via iStock)

February 3, 2016 at 7:16 pm 1 comment

Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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February 2016

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