Rely Tampons

Toxic Shock Syndrome

TSS, what is and why it's important to look out for.

7 minute read


If you grew up in the 70s, 80s or early 90s chances are you’ve heard of TSS, or Toxic Shock Syndrome. You may have been warned in a magazine, by an older sister or parent that if you left a tampon in too long, you’d be at risk of getting the very scary and sometimes deadly disease. But do you know what TSS actually is and what it can do?

Toxic shock is a serious staph infection (staphylococcus aureus) that happens when the bacteria is able to get into the bloodstream. While it can occur due to surgery, a bad tattoo, or any open wound, it is most related to the use of tampons.

According to the National Center for Biotechnology Information only 0.8 to 3.4 per 100,000 will be diagnosed with TSS per year. According to the TSS information page on Playtex’s website it’s between 1 and 17 per 100,000. So, the jury’s still out on how rare or common this disease truly is, partially because it often goes misdiagnosed and the CDC only tracks the strep version rather than staph, which directly affects menstruating people.


How is It Contracted?

We can all agree that absorbency is exactly what you want in a tampon, but it’s also what makes them dangerous. An absorbent tampon (that’s all tampons, not just super) if left in too long can encourage bacteria to grow. Again, while you want a tampon to absorb menses, the risky problem is that it also absorbs everything else and can leave the vagina dryer than it should.

Now, let’s talk about pH levels. Vaginal pH is on a scale of 0-14, acidic to alkaline. On a regular day the pH level of the vagina is about 4.2, which is relatively acidic and can keep most bacteria in check. However, during menstruation the pH level rises to about 7.4. The optimal pH level for the presence of S. aureus bacteria to trigger TSS is 7.


pH Scale


During menstruation, the vagina also becomes softer and more sensitive, and therefore more susceptible to abrasion. If the s. aureus bacteria have had an opportunity to brew and the tampon has stuck to the vaginal walls due to them being dry, then lesions can occur upon removal and allow the bacteria to get into the bloodstream through the vaginal wall.

It should be noted as well that these lesions can also occur upon insertion of the tampon, with or without applicator, and symptoms of TSS can occur within two hours of usage. The bacteria can also get into the vagina right away via the fingers or a tampon that did not go right out of the wrapper and into you (it happens).


What are the Symptoms?

As referenced above, the symptoms can happen anytime, whether you’ve been wearing a tampon for two or twelve hours (twelve hours is too long, please don’t ever do that!). Be on the lookout for:

  • sudden fever
  • low blood pressure
  • headache
  • muscle aches
  • confusion
  • diarrhea
  • nausea
  • vomiting
  • sun burn like rash, typically first appearing on hands and soles of feet
  • redness of eyes, mouth, and throat
  • seizures

Because some of these are general symptoms of having your period anyway, pay special attention to the bolded points. The two most common and noticeable symptoms are excessive vomiting and diarrhea. It would be hard not to notice excessive expelling out both ends.


TSS works very fast, so it is of the utmost importance that if you experience these (does not need to be all of them) you get to a hospital immediately and ideally by ambulance as time is of the essence. And please tell them you have your period so toxic shock is taken seriously as the cause. Without swift treatment, after the initial symptoms comes renal failure and then death.

There have been high profile cases of TSS in the media, including the Rely tampon scandal of 1980, where Proctor & Gamble designed a tampon so absorbent that it turned into a staph petri dish inside the vagina. Or supermodel Lauren Wasser’s story of surviving TSS in 2012, but losing first one leg and then the other after gangrene left her heel and toes damaged and subjected her to chronic pain. Unfortunately, though, Toxic Shock Syndrome still has the moniker of being elusive and rare. This is not true, and casual Googling can confirm that.

So take care, pay attention and maybe consider switching to an external period product.


If you’d like to hear a podcast cover all of this, including the full story of how Rely tampons were discontinued, you can listen to episode 6 of our podcase, Why So Mysterious? on Toxic Shock Syndrome.

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