What is TSS - toxic shock syndrome - and how can we avoid it?

By Nikki Michelsen

Oct 7, 2022

What is TSS - toxic shock syndrome - and how can we avoid it?
Hi ohne babes. I’m Bella and I write about periods for a living. But until less than a year ago, I thought that Toxic Shock Syndrome, or TSS, was caused by periods. Like, not by tampons, not by external toxins entering the body (despite the name), but by period blood. By our own gross period blood, congealing around a tampon, staying in our weird bodies too long, and doing something nasty and toxic. Now let’s be clear: our period blood is not gross. Our bodies are not weird. And I’m still learning everyday of the myriad ways in which period taboos are not just stupid, they’re actually really bloody harmful.
Would I have ever got to my early 20s thinking that my risk of contracting TSS was the fault of my own body if it weren’t for period taboos? No. The stigma around periods meant I grew up in a world which treated periods as something inherently disgusting and seriously limited the conversations about menstruation that I was exposed to (including in school, but that’s a rant for another time).
So let’s get a-myth busting, shall we? You can play the Ghostbusters theme in your head to really get in the spirit of the thing (I ain’t afraid of no sexist societal conditioning… hey, I tried).
TSS is caused by toxins
TSS, or toxic shock syndrome, is a condition caused by bacteria getting into the body and releasing harmful toxins. It is most commonly known as a problem related to tampon usage, but it’s really important to be clear here: TSS is caused by toxins.
Anyone can get it, including men and children and people who have never even touched a tampon. Any wound, such as a cut, insect bite, burn, or boil, that could have become infected with bacteria (though it is important to note that, if a case of TSS were to be caused by an infected wound, the wound itself may not actually look infected).
That’s… not comforting
Actually, it is. If you think about the number of cuts, bites, scrapes, wounds, and so on and so on, that happen every day and compare it with the diagnosis rates for TSS, it should help put the more anxious/hypochondriacal minds among you at rest. Roughly 40 people are diagnosed with TSS each year in the UK – and only an average of two of these cases are fatal.
Now, I know you’re probably ignoring how tiny a percentage of the UK’s population two people really is and instead focusing on the great big flashing-neon sign that is the word ‘fatal’. But think about how many knee scrapes and first periods and mosquito bites and cigarette burns happen every second. In short: TSS is very serious, yes, but it’s also incredibly rare.
So how do you contract TSS?
TSS is caused by two types of bacteria: Staphylococcus aureus (AKA ‘staph’) or Streptococcus. According to the NHS, “these bacteria normally live harmlessly on the skin, nose, or mouth, but if they get deeper into the body they can release toxins that damage tissue and stop organs working.” TSS is a systemic illness, meaning that, once contracted, it affects the whole body. And, as mentioned, it can result from cuts, etc, anywhere on the skin. However, the reason discussions of TSS seem so unfairly weighted towards things relating to vaginas and our personal choices (what period products we use, what contraception works for us, and even the decision to have a baby…) is because the vagina has the thinnest and most absorbent skin of anywhere in the body. The vaginal tissue is more permeable than in other areas, making it much more vulnerable to absorbing some of the nasties that wouldn’t necessarily be harmful coming into contact with skin elsewhere around the body.
So let’s talk about tampons.
Because yes, a lot of recorded cases of TSS are linked to tampon usage and this is where I got my aforementioned misguided ideas about period blood going stale on a tampon inside my body being the one and only cause of TSS. But tampons were kicking about long before TSS became linked to them. Time for a history lesson…
From around the 1960s, companies began working to make their tampons more and more absorbent, using a variety of decidedly non-organic materials (wood pulp, polyester, rayon… the list goes on). The prevalence of cotton-only tampons (let alone organic cotton) decreased and the prevalence of those made with synthetic fibres increased… as did the recorded cases of TSS. As this report states, the link between bacterium and innovative technology (the evolution of the tampon) was never even considered by the people developing the product. This actually all makes for pretty fascinating reading; if your interest has been piqued, start by looking up Proctor and Gamble’s ‘Rely’ tampon – AKA the tampon marketed with the tagline ‘it even absorbs the worry’ – the super absorbent tampon linked to a disproportionate number of cases of TSS.
Crucially, it’s not the tampons themselves that cause TSS, it’s the way the materials that the tampons are made of *may* interact with the body… Which of course means that every single person alive will have a different likelihood and different risk factors for contracting it, purely because, say it with me now, every body is different. As described in the report linked above, TSS is thought to occur when the live bacteria naturally present in the vagina and the synthetics in the (non-organic) tampons ‘energetically interact’ to produce the illness.
The key piece of advice for lowering your risk of contracting TSS comes down to using the lowest possible absorbency type for your flow. This is because we really want to avoid allowing any of the synthetic fibres to be left inside us. If you pull out a mainstream tampon that is still dry – as in, you can still see a lot of the white fibres – aside from not feeling too nice, some of the fibres can stick to the inside of your vagina. So don’t be using super-absorbent tampons if you have a medium to light flow just because you think you’ll have to change it less often. It’s much more advisable to use a lower-absorbency tampon and have to change it more frequently. By the same reasoning, you should be changing your tampons every 4-6 hours in order to reduce your exposure to whatever is on those tampons…
Which brings me to this mic-drop of a sidenote: an organic cotton tampon has never once been linked to a case of TSS. That’s not to say using organic tampons means you can’t get TSS – like we said, anyone can get TSS, so it is possible that you could be an organic tampon user who contracts TSS. But I refer you back to the fact that your vaginal bacteria is quite happily minding its own business until synthetic fibres from certain tampons muscle their way in there looking to ‘energetically interact’ like some pushy, intoxicated (pun intended) dude hitting on you at a bar. So it’s safe to say your chances of contracting it significantly decrease if you’re not putting toxin-soaked tampons into your body at all. (If this were Twitter I’d insert a gif of someone sipping tea but it’s not so you’re just gonna have to picture us smugly shaking our ohne tampons around like maracas).
Snog, Marry, Avoid, Avoid, Avoid
Now, the whole point is to try to avoid getting unwanted bacteria inside your very sensitive vagina. That’s why we’re often told to wash our hands before inserting or removing a tampon – unless you want whatever your hands have come into contact with since the last time you washed them getting all up in there too. The same rules broadly apply to female barrier contraceptives. When using a diaphragm or contraceptive cap, you need to be careful and hygiene-conscious when inserting and removing them and follow the product guidelines about how long you can leave them in for.
Other things which can increase your risk of TSS include nasal packing, childbirth, wounds, bites, cuts, boils and staph infections. Again, none of these things, including having a staph infection (which is caused by the same bacteria that can cause TSS), cause TSS directly. They just increase your risk of certain bacteria making their way into your body and, in turn, releasing harmful toxins.
Let’s talk symptoms
The symptoms of TSS can be incredibly similar to flu symptoms, with a headache, chills, coughing, and muscle aches being common indicators. Most of these are, obviously, also merely symptoms of a cold or flu, so let’s not go freaking out every time we feel a bit under the weather. Other symptoms include:

  •  A fever of 39 degrees celsius or above
  • Vomiting and/or diarrhoea
  • A rash resembling a sunburn
  • Whites of the eyes, lips, and tongue turning red
  • Difficulty breathing
  • Confusion and/or drowsiness
     If you think you or someone close to you may have TSS, you need to get to a doctor as soon as possible. If you know you or the person in question has recently used a tampon (especially a mainstream-brand one that’s probs chock-full of toxins), female barrier contraceptive, or had a minor skin infection, it’s better to just play it safe, babe. This girl’s experience is undeniably traumatic, but also a hopeful lesson that early diagnosis and treatment can help a person make a full recovery.
    In summary…
    Keep it basic, babe. Wash your hands regularly when using tampons, clean your cuts n scrapes, and pay attention to the product guidelines on your tampons and contraceptives and you’ll be significantly reducing your risk of contracting TSS. The takeaway from this should be to be mindful, but don’t live your life in fear. TSS is rare and it shouldn’t prevent you from using the period products or contraceptives of your choice… But let’s be real, the moral of this story is that organic tampons are literal heroes come to save us all from the monster under the bed that it is the mainstream period product industry (plug: shameless).
    Be safe out there, babe!
    Words by Bella
    Photo by Daria Liudnaya from Pexels