By Dr. Mercola
Many women have heard of toxic shock syndrome (TSS), a rare bacterial infection that can lead to a potentially fatal drop in blood pressure (shock) and organ damage, and most associate it with the use of tampons -- particularly super absorbent varieties that are left in too long.
In fact, most tampon boxes contain a warning about TSS, leading many people to believe, mistakenly, that tampons themselves are the cause of this disease.
Instead, and more importantly, the health risks associated with tampons depends on how they interact with your body as a whole; your bodily state of health, or lack thereof, can create a perfect storm of conditions for TSS to develop.
As described in the Yale Journal of Biology and Medicine, tampons are an example of biologically incompatible technology, which can react with constituent bacteria and women's menstrual cycles "to create the ideal environment for the Staphylococcus aureus bacteria to live and flourish in some women."
The real cause of TSS is typically toxins produced by Staphylococcus aureus (staph) bacteria -- and this cause is often exacerbated by the use of certain tampons.
Why Staph Bacteria and Synthetic Tampons Can be a Deadly Mix
Staphylococcus aureus (S. aureus) bacteria are commonly found on your skin and mucous membranes, such as in the vagina.
Normally they are harmless but under certain conditions they can enter your bloodstream, releasing toxins that can even turn deadly. For instance, TSS can occur from an infected wound or insect bite, and cases occur every year in children and men -- along with menstruating women.
It's been known for decades that a significant number of TSS cases occur in women using tampons, but conventional medicine notes the reason for this is still not understood.
It appears, however, that tampons alter the course of this disease in a complex way, one that began when synthetic materials were introduced into the feminine hygiene product market. In an essay in the Yale Journal of Biology and Medicine, Sharra L. Vostral, PhD, Department of Gender and Women's Studies and Department of History, University of Illinois Urbana-Champaign, writes:
"The link between TSS and tampons was not intuitive. Tampons had become a trusted and normalized technology in upwards of 70 percent of women's hygiene routines. What had changed were the materials, whose composition shifted from cotton to synthetic materials. Companies often sought cheaper ingredients, and rayon — derived from wood pulp and combined with cotton — served to be a cost-effective and efficient absorptive material in some tampons.
As new polymer technology emerged during the 1960s, companies began to add more synthetic materials, such as polyachrylates, to tampons. Most major brands utilized synthetics to varying degree … "
The Three Major Factors That May Trigger S. Aureus to Turn Into TSS
S. aureus bacteria are a normal part of a woman's vagina, and ordinarily they are harmless. Under certain conditions, however, these bacteria can grow out of control, releasing toxins that send your body into hypotensive shock (a dangerous drop in blood pressure), which causes your organs to stop working.
As it turns out, synthetic tampon components, coupled with higher absorbency, appear to be particularly "amenable" to S. aureus bacteria, as are certain other conditions in a woman's body during menstruation. Vostral explains using the example of Proctor & Gamble's Rely superabsorbent tampon, which was recalled in 1980 due to its link to TSS (while Rely is no longer on the market, many superabsorbent tampons made from synthetic materials are):
"The unique components, instead of being inert as Proctor & Gamble scientists assumed, possessed what I call reactive traits that set into motion a complex chain of events that few understand well to this day. Philip Tierno, a politically active microbiologist, contends in his 2004 book The Secret Life of Germs that there were three major factors promoting S. aureus to present as TSS.
First were the synthetic components of Rely, consisting of foam cubes and the gelling agent carboxymethylcellulose encased in a polyester pouch. The gelled carboxymethylcellulose in essence acted like agar in a petri dish, providing a viscous medium on which the bacteria could grow. Along with this, the foam cubes offered increased surface area for proliferation.
Second was the changing pH of the vagina during menstruation, to about 7.4. The optimal pH for S. aureus to trigger TSS is 7, or neutral. The relatively acidic, non-menstrual vagina measures a pH of about 4.2, which keeps S. aureus well in check. Tierno also hypothesized that a tampon introduces both carbon dioxide and oxygen into the usually anaerobic vagina, thus the gases offered an abundant food source to S. aureus.
Finally, the pyrogenic toxins produced by S. aureus induced fever in humans.
This fever of about 102 degrees proved to be the perfect temperature for S. aureus to reproduce and thus create further deadly toxins. An additional factor was a woman's age; many adult and older women had built up immunity to some forms of S. aureus, while young women and teenagers were more susceptible without a developed immune response to the pathogen. In some cases, TSS presented as mild, flu-like symptoms, while in others the toxins released literally sent the person into shock."
To sum up, it's suspected that the following, in combination, may provide a prime breeding ground for S. aureus bacteria, greatly increasing the risk of TSS:
- Synthetic components in tampons, which encourage bacterial growth, along with the outgassing of carbon dioxide and oxygen from the tampon, which provide a food source for bacteria
- A change in vaginal pH during menstruation, transitioning from an acidic environment that keeps bacteria in check to a more neutral pH that allows bacteria to grow. Once the S. aureus bacteria released toxins, it induces fever of about 102 degrees F, which further promotes bacterial growth and the production of more toxins
- Younger women and teenagers, who are the most frequent tampon users, are also less likely to have built up immunity to S. aureus; many adult and older women already have immunity to certain forms of the bacteria
You Can't Predict What Will Happen When You Introduce a Foreign Material Into Your Body
What is becoming more and more frequently understood is that your body does not exist in isolation from its environment; it is, rather, an active participant. Any time you introduce a new technology, be it a cell phone, a drug, a medical device or even something as seemingly innocuous as a tampon, it alters the very complex, intricate workings of your body and the microbial communities it coexists with.
As Vostral explains:
"This naturalized understanding of the body as empire falls far short in conceptualizing how multiple life forms interact with technologies in and out of the body. It may be that there are technologies that are fundamentally compatible with muscle tissue, but not the indigenous bacteria living quite well on the skin. I suggest the category biologically incompatible technology to help interrogate those innovations that are not primarily deadly or harmful to humans but have potential to produce other biological harm through their use.
With this analytical move, I suggest that it is not enough for scientists and designers to consider just the human body, but a core question in the design of medical and bodily technologies must also be "how will this object interact with bacterial constituents?"
In the case of TSS, this powerful relationship between technology and bacterium was not just overlooked (since this would imply willful disregard) but worse, unimagined as a possibility."
The truth of the matter is, some woman harbor S. aureus communities as a permanent fixture in their vaginas, and as such may be at increased risk of TSS every time they use a tampon. The only way to know for sure would be to run a bacterial culture, which is not commonly done. Further, because the bacteria can be transient, repeat cultures would be needed.
What's the Bottom Line Regarding Feminine Hygiene Choices?
Toxic Shock Syndrome is rare, impacting only about 1 to 2 women per 100,000 each year. Still, for those who are impacted, the disease can be devastating, even deadly in about 5 percent of cases. If you're a woman looking for the safest feminine hygiene options, this risk may seem like too much to take, in which case avoiding tampons altogether is one strategy you can take. If you prefer the convenience and fit of tampons to pads, you should use only those that are natural, with NO synthetic ingredients and made with 100% organic cotton, such as the ones in my Premium Feminine Care line.
These tampons are not only made from 100% hypoallergenic organic cotton, but they also have a special cotton safety layer to help prevent fibers from remaining inside your body (the fibers left behind from rayon, viscose, and fluff pulp in tampons may contribute to TSS, especially since micro-tears in the vaginal wall from tampons allow bacteria to enter and accumulate).
While any tampon can create a friendly environment in your vagina to the growth of either Staphylococcus aureus or group A streptococcus (strep) bacteria, which is also sometimes linked to TSS, there are several other steps you can take to minimize your risk of this potentially life-threatening condition:
- Avoid super absorbent tampons -- choose the lowest absorbency rate to handle your flow
- Alternate the use of tampons with sanitary napkins or mini-pads during your period
- Never leave a tampon inserted overnight; use overnight pads instead
- Change tampons at least every 4-6 hours
- When inserting a tampon, be extremely careful not to scratch your vaginal lining (avoid plastic applicators)
- Do not use a tampon between periods
Finally, no matter what type of feminine hygiene products you choose, it's important to seek out natural organic varieties to avoid being exposed to unnecessary chemicals and toxins. For instance, popular feminine hygiene products may contain:
- The toxic carcinogen dioxin and disinfection-by-products (DBP's) such as trihalomethane, which are present whenever a product is bleached
- Phthalates – chemical plasticizers used in plastic tampon applicators and to make the glossy coatings on cardboard applicators
- Pesticides, herbicides and synthetic fertilizers found in non-organic cotton
Remember, vaginal tissue is an exceptionally absorbent area, which is why you need to give careful consideration to choosing only pure feminine hygiene products.