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tampon toxic shock syndrome

Story at-a-glance -

  • Toxic shock syndrome (TSS) is a risk associated with tampon use. Using super absorbent tampons, and/or leaving them in too long, are two primary risk factors
  • Michigan recently detected a clustered spike in tampon-associated TSS. In the first quarter of 2016, there were five cases. In the past decade, TSS reports have averaged fewer than four per year
  • A French investigation revealed traces of dioxins, pesticides, insecticides, and halogenated byproducts in 11 brands of tampons and pads. Glyphosate was found in an organic cotton tampon brand

This Life-Threatening "Tampon Syndrome" Has Increased 5 Times Over Recent Months

May 18, 2016 | 76,771 views
| Available in EspañolDisponible en Español

By Dr. Mercola

The average woman uses anywhere from 11,000 to more than 16,000 tampons in her lifetime. In addition to that, many regularly use sanitary pads. But did you know that these products can be a major source of toxic exposure?

For example, phthalates — which give paper tampon applicators that smooth feel and finish — are known to dysregulate gene and hormone expression.

Manufacturers of tampons and sanitary pads are not required to disclose the ingredients used because feminine hygiene products are considered "medical devices," and the contents are proprietary.

That said, most tampons contain a blend of cotton, rayon, and synthetic fibers. Today, most cotton is genetically engineered (GE), and while the risks are unknown, inserting GE cotton into your vagina several times every month is likely no different than ingesting GMO food.

For all we know it may be worse, considering the fact that the vaginal wall is highly permeable, allowing GMO proteins direct access into the bloodstream. Pesticide contamination is another concern, as is the addition of any number of undisclosed chemicals and byproducts from the manufacturing process.

Toxic Shock Syndrome

Toxic shock syndrome is not new. It has always been a risk associated with tampon use. The link between tampons and toxic shock syndrome (TSS) was initially discovered in the 1980s by microbiologist Philip Tierno, PhD and his team.

At the time, it was determined that TSS was linked to the synthetic materials used in superabsorbent tampons. Those synthetic materials are no longer permitted, yet TSS continues to be a problem. Various allergic reactions are now also being reported. According to CNN:1

"Those fibers amplified the bacteria staph, if a toxigenic strain was present,' Tierno said. About 20 percent of people naturally have the bacteria staph. At the height of the TSS scare in 1980, there were 890 cases reported to the CDC.

... [T]he number of TSS cases since 1998 has varied between 138 to as low as 65 in 2012. But Tierno said there are still products using viscose rayon, which he called 'the best of the four bad ingredients.'

Rayon is a synthetic made from sawdust and a byproduct of it is dioxin, which the EPA says is likely carcinogenic ... 'Sure, one tampon is trace,' said Tierno, 'but consider the menstrual lifetime of a woman... That's a lot of dioxin absorbed directly through the vagina.'

It goes directly into the blood ... Every single product contained in a tampon has to be researched. We already know the fibers contain dozens (of chemicals), polyester contains hundreds of chemicals. It's not just a fiber you put in the vaginal vault." 

TSS Cases Spike in Michigan

For reasons that are still unknown, the Michigan Department of Health and Human Services recently detected a clustered spike in tampon-associated TSS. In the first quarter of 2016, five TSS cases were reported. Over the past 10 years, TSS reports have averaged fewer than four per year. As reported by CBS Detroit:2

"[T]oxic shock is a rare but serious syndrome caused by bacterial infection. Symptoms include sudden fever, vomiting, diarrhea, dizziness and shock with multi-organ dysfunction.

According to the agency, tampon-associated toxic shock has historically been attributed to improper use, such as leaving a tampon in too long. The agency says tampons shouldn't be left in longer than six to eight hours, and to always use the lowest absorbency needed."

As has historically been the case, superabsorbency is a primary risk factor. In four of the five Michigan cases, the women were using Playtex Sport brand super absorbency tampons. According to the Michigan Department of Health, product selection was the only common factor between the five cases.

What Are Some of the Mystery Ingredients in Your Tampons?

A 2014 analysis by Women's Voices for the Earth, which acquired public patent documents held by Proctor & Gamble (the maker of Tampax and Always), showed the following chemicals may be in your tampons:3

Creped cellulose wadding

Meltblown polymers

Chemically-stiffened fibers, polyester fibers, peat moss, and foam

Tissue wraps and laminates

Super absorbent gels and open-celled foams

Myreth-3-myristate (as lubricant) (U.S. Patent # 5,591,123)

Natural and synthetic zeolites (as odor-absorbing particles) (U.S. Patent # 5,161,686)

Alcohol ethoxylates

Glycerol esters, polysorbate-20 (as surfactants to disperse fragrance)

Unnamed anti-bacterial agents (U.S. Patent # 8,585,668)

Cancer-causing chemicals such as: styrene, pyridine, methyleugenol, and butylated hydroxyanisole (scented products)

Phthalates of concern (DEP and DINP) (scented products)

Synthetic musks (potential hormone disruptors) (scented products)

Numerous allergens (scented products)

Women's Health Advocates Call for Greater Transparency

Continuing reports of TSS and allergic reactions, and testing that has revealed questionable chemicals in both pads and tampons has led to a growing movement for transparency and disclosure of ingredients in feminine hygiene products, both in the U.S. and abroad. As reported by CNN:4

"... Women's Voices for the Earth ... has been leading a two-year campaign5 it calls 'Detox the Box.' When the group tested6 P&G's Always pads, it found the sanitary napkins emitted chemicals, like styrene, chloroethane and chloroform.

The World Health Organization classifies styrene as a carcinogen. And the EPA says short-term exposure to high concentrations of chloromethane can have neurological effects.

The Centers for Disease Control and Prevention says high levels of exposure to chloroethane can result in lack of muscle coordination and unconsciousness."

French Investigation Leads to Product Withdrawals

A recent investigation7 by the French magazine 60 Millions de Consommateurs also revealed traces of harmful chemicals in 11 different tampons and sanitary pads, including dioxins, organochlorine pesticides, pyrethroid insecticides, and halogenated byproducts.

Brands tested included Tampax, Always, O.B., Nett, and even an organic brand. The discovery of glyphosate in Organyc panty liners caused the manufacturer, Corman, to withdraw 3,100 boxes of the pads sold in France and Canada.

The investigation also led the French National Institution for Consumers to demand stricter government control on feminine hygiene products, and increased transparency in labeling. According to The Independent:8

"There has been extensive debate over whether the widely used chemical is carcinogenic and the firm said the move was merely a 'precaution' while it investigates its supply chain of raw materials.

A spokesperson for Corman said residual traces of glyphosate were found in one sample that 'should not have been present in organic cotton.'"

The Price You Pay for White Tampons and Pads

Part of the problem has to do with the processing of the ingredients used in the tampons. To give tampons that pristine, "clean" white look, the fibers used must be bleached. Chlorine is commonly used for this, which can create toxic dioxin and other disinfection-by-products (DBPs) such as trihalomethane. The FDA recommends that tampons be free of dioxin, pesticide, and herbicide residues. But this is simply a recommendation, not a requirement.

According to the FDA, trace amounts of dioxins in tampons pose no expected health risks, yet studies have shown that dioxin accumulates in your fatty tissues, and according to a draft report by the U.S. Environmental Protection Agency (EPA), dioxin a serious public health threat that has no "safe" level of exposure. Why does the FDA not take this into account? Published reports show that even low or trace levels of dioxins may be linked to:

  • Abnormal tissue growth in the abdomen and reproductive organs
  • Abnormal cell growth throughout the body
  • Immune system suppression
  • Hormonal and endocrine system disruption

Research has shown that not only are chemicals rapidly absorbed and circulated through the rest of your body via your vagina, but some chemicals, like hormone-mimicking substances, may lead to "higher than expected exposures" in the rest of your body. For instance, a vaginally applied dose of estradiol resulted in systemic estradiol levels 10 to 80 times higher than resulted from the same dose taken orally.9

How to Avoid Toxic Shock Syndrome

It's important to remember that tampons, regardless of what they're made of, can create a favorable environment for bacteria growth. Micro tears in your vaginal wall from tampons allow bacteria to enter and accumulate. 

Toxic Shock Syndrome (TSS) is typically associated with poisonous toxins from either Staphylococcus aureus (staph) or group A streptococcus (strep) bacteria.  TSS can be a life-threatening condition, so it's important to recognize the signs and symptoms. Should any of the following symptoms arise while using tampons during your period, make sure you seek medical help:

Sudden high fever



Low blood pressure


Rash on palms or soles of feet

Muscle aches

Redness of your eyes, mouth and/or throat

To minimize your risk of this potentially life-threatening condition:

Avoid super absorbent tampons — choose the lowest absorbency rate to handle your flow, and change the tampon more frequently instead

Never leave a tampon inserted overnight; use overnight pads instead

When inserting a tampon, be extremely careful not to scratch your vaginal lining (avoid plastic applicators)

Alternate the use of tampons with sanitary napkins or mini-pads during your period

Change tampons at least every 4 to 6 hours

Do not use a tampon between periods

Safer Alternatives

Many of today's feminine hygiene products are made primarily from rayon, viscose, and cellulose wood fluff pulp … not cotton — let alone organic cotton. Rayon and viscose present a potential danger in part because of their highly absorbent fibers. When used in tampons, these fibers can stick to your vaginal wall, and when you remove the tampon, the loosened fibers stay behind inside your body, thereby raising your risk of TSS.

Fortunately, there are safer alternatives, and since the FDA regulates tampon absorbency, all tampons on the market must meet the same absorption guidelines. According to Tierno at NYU Medical Centre, 100 percent cotton tampons "consistently test under detectable levels for TSS toxins."

However, considering the high probability of cotton being contaminated with pesticides and insecticides, I would urge you to opt for USDA certified 100 percent organic cotton tampons.

The 2002 introduction of Bt cotton, which is genetically modified to produce its own internal pesticide, was supposed to lead to a reduction in the use of insecticides on cotton crops. In reality, Bt cotton requires more pesticide sprayings than indigenous cotton. Bt cotton has created new resistant pests, and to control them farmers now use 13 times more pesticides than they were using prior to its introduction.10

So not only is the cotton itself a pesticide (as the Bt toxin is produced in every cell of the plant), but the crop is also contaminated with topical pesticides! On the whole, this makes Bt cotton a questionable choice for tampons. Another alternative is the Diva Cup, which works in a similar way as a diaphragm, allowing you to avoid tampons altogether. Also look for tampons that are:

  • Processed without chlorine to avoid toxic byproducts like dioxin
  • Free of synthetic fibers and plastics
  • Wood fluff pulp-free — Breathable, absorbent and saves trees, too
  • Hypoallergenic, especially if you have sensitive skin

Take Action: Ask for Full Disclosure

Representative Carolyn Maloney (NY-D) has introduced legislation nine times since 1997 that would require manufacturers to disclose the contents of their feminine hygiene products.

The law would also require research into the potential health risks of any ingredient used, including endometriosis, cervical, ovary and breast cancers. So far, her bills have always failed to gain traction. To push for full disclosure labelling, a number of consumer's petitions have been created instead, including the following. To make your voice heard, I encourage you to sign them.

Naturally Savvy has created a petition asking Proctor & Gamble to disclose the ingredients in their feminine hygiene products.

Sign the Naturally Savvy Petition
Click here

Women's Voices of the Earth has created a 'Detox the Box' campaign, pushing for full disclosure of ingredients in pads and tampons.

Sign Detox the Box Petition
Click here

If you live in France, you may sign the French Tampax disclosure petition.

Sign the French Tampax Disclosure Petition
Click here

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