By now we're all (hopefully) aware of the potential risk of Toxic Shock Syndrome (TSS) associated with tampon use. Many of us remember the scare back in 1980, when a sudden rise in TSS cases was linked to the introduction of highly absorbent, synthetic fiber tampons. At least one brand of tampons—Rely, which used superabsorbent carboxymethylcellulose and compressed beads of polyester for absorption—was immediately pulled from the market. Shortly after the FDA embarked on a massive labeling and educational campaign to make consumers aware of the link between tampon absorbency and risk of TSS—a concept in stark contrast to Rely's tagline, "It Even Absorbs the Worry."
Between 1980 and 1981, tampon-related TSS cases constituted 90% of all TSS cases. However, after 1981 that statistic declined significantly, likely due to an increase in awareness of the link between tampon absorbency and TSS. But recent evidence may suggest that tampon-related TSS in on the rise once again. A Minneapolis-based surveillance group found an increase in the number of cases between 2000 and 2005, consistent with the Centers for Disease Control’s recorded 18% increase from 2002 to 2003.
There are a couple of theories explaining this rise. The first is a change in tampon usage patterns. In 1999, the FDA allowed for the labeling of a new category of high absorbency tampons (with a capacity to absorb 15 to 18 grams of fluid) called “ultra.” Subsequently there was an increase in the availability of ultra tampons in stores. Pre-2000, the most absorbent category of tampons was “super-plus,” which absorbed a maximum of 15 grams of fluid.
Second, the FDA’s relaxed policy of letting tampon manufacturers use the word “overnight” on their packaging could be to blame for some cases of TSS. Although the word “overnight” is supposed to mean eight hours or less in accordance with FDA guidelines, it’s difficult to know whether women are actually regulating their sleep time when wearing a tampon to heed this regulation.
Although the true culprit behind the recent rise in TSS remains unclear, we should consider this a startling reminder about the risks tampons pose if not used with caution. Becoming complacent with our sanitary products, especially after longtime use, may lessen the impact of product warnings. Will it take another health scare like the one in 1980 for us to snap out of it?? Luckily, interest in non-tampon forms of period protection is on the rise as well. Products like Instead Softcup are offering protection as good as, if not better than, tampons, and have not been associated with any incidence of TSS. Softcups don't just provide safe, long-lasting period protection, they offer peace of mind.
Resources: Tierno, Philip M., Jr. 2005. Reemergence of Staphylococcal Toxic Shock Syndrome in the United States since 2000. J. Clin. Microbiol. 43.4.2032–2033.2005.