Are Tampons Safe?
Tampon Safety and Feminine Hygiene Alternatives to Tampons
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What is Toxic Shock Syndrome?
Shock Syndrome is a rare infection that can happen during a woman's
period. The symptoms include a sudden fever of over 101 degrees or more,
diarrhea (the runs), vomiting (throwing up), muscle aches and a sunburn-like
rash. If you have these symptoms during you period, see a doctor right away.
help prevent Toxic
Shock Syndrome you should follow these guidelines:
Wash your hands before unwrapping and placing a new tampon in your vagina.
Never use super-absorbent or deodorant tampons.
3. Change your tampon at least every 4-6 hours (read the tampon manufacturers information inside the box).
Do not use tampons all the time and switch to a pad for part of each day.
Do not use a birth control sponge or diaphragm during your period. During your
period it is preferable to use other methods such as condoms and/or foam.
There are allegations that tampons made from rayon, or cotton with rayon, may cause or be a contributing factor to Toxic Shock Syndrome as well as vaginal dryness or ulcerations of vaginal tissues.
Toxic Shock Syndrome is a rare but potentially fatal disease caused by a bacterial toxin. (Different bacterial toxins may cause Toxic Shock Syndrome, depending on the situation, but most often streptococci and staphylococci are responsible.) The number of reported Toxic Shock Syndrome cases has decreased significantly in recent years.
Approximately half the cases of Toxic Shock Syndrome reported today are associated with tampon use during menstruation, usually in young women.
Toxic Shock Syndrome also occurs in children, men, and non-menstruating women. In 1997, only five confirmed menstrual-related Toxic Shock Syndrome cases were reported, compared with 814 cases in 1980 [according to data from the Centers for Disease Control and Prevention (CDC)].
Although scientists have recognized an association between Toxic Shock Syndrome and tampon use, the exact connection remains unclear. Research conducted by the CDC suggested that use of some high absorbency tampons increased the risk of Toxic Shock Syndrome in menstruating women. A few specific tampon designs and high absorbency tampon materials were also found to have some association with increased risk of Toxic Shock Syndrome. These products and materials are no longer used in tampons sold in the U.S. Tampons made with rayon do not appear to have a higher risk of Toxic Shock Syndrome than cotton tampons of similar absorbency.
Vaginal dryness and ulcerations may occur when women use tampons more absorbent than needed for the amount of their menstrual flow. Ulcerations have also been reported in women using tampons between menstrual periods to try to control excessive vaginal discharge or abnormal bleeding. Women may avoid problems by choosing a tampon with the minimum absorbency needed to control menstrual flow and using tampons only during active menstruation.
To help women compare absorbency from brand to brand, FDA requires that manufacturers measure absorbency using a standard method and describe absorbency on the package using standardized terms. Thus, the terms "junior," "regular," "super," and "super plus," always describe a specific range of tampon absorbency regardless of the brand.
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Toxic Shock Syndrome Continued
Perspectives Reduced Incidence of Menstruation-related Toxic
Shock Syndrome in the
United States, 1980-1990
In May 1980, investigators reported to CDC 55 cases of Toxic Shock Syndrome (TSS) (1), a newly recognized illness characterized by high fever, sunburn-like rash, desquamation, hypotension, and abnormalities in multiple organ systems (2). Fifty-two (95%) of the reported cases occurred in women; onset of illness occurred during menstruation in 38 (95%) of the 40 women from whom menstrual history was obtained. National and state-based studies were initiated to determine risk factors for this disease. In addition, CDC established national surveillance to assess the magnitude of illness and follow trends in disease occurrence; 3295 definite cases have been reported since surveillance was established.
In June 1980, a follow-up report described three studies which detected an association between Toxic Shock Syndrome and the use of tampons (3). Case-control studies in Wisconsin and Utah and a national study by CDC indicated that women with Toxic Shock Syndrome were more likely to have used tampons than were controls. The CDC study also found that continuous use of tampons was associated with a higher risk of Toxic Shock Syndrome than was alternating use of tampons and other menstrual products. Subsequent studies established that risk of Toxic Shock Syndrome was substantially greater in women who used Rely brand tampons than in users of other brands and that risk increased with increased tampon absorbency (4-6). In September 1980, Rely tampons were voluntarily withdrawn from the market by the manufacturer.
In 1980, 890 cases of were reported, 812 (91%) of which were associated with menstruation. In 1989, 61 cases of Toxic Shock Syndrome were reported, 45 (74%) of which were menstrual.
In 1980, 38 (5%) of 772 women with menstrual-related Toxic Shock Syndrome died; in 1988 and 1989, there were no deaths among women with menstrual-related Toxic Shock Syndrome. Reported by: Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.
According to the grapevine in 12-year-old Jerri's North Carolina school, tampons not only cause AIDS, but also can be lost in a woman's body, never to be seen again.
If you're hooked into the Internet, you may notice that tampon tales such as these get more creative as they're passed around. The latest stories claim tampons are tainted with cancer-causing toxins and that rayon tampons are especially dangerous. Another Internet rumor suggests that manufacturers add asbestos to tampons to promote excessive bleeding and boost sales.
"It can be hard to tell what stuff is true," says Jerri.
The truth is that tampons can't get lost forever in a woman's body. Rayon tampons are as safe as cotton ones. And asbestos has never had anything to do with fibers that make up tampons.
"The only way asbestos could be connected to tampons would be through tampering," says Mel Stratmeyer, Ph.D., chief of the Food and Drug Administration's health sciences branch. "And we haven't received any reports of such tampering."
FDA regulates tampons as medical devices, and "we ensure that tampon design and materials are safe through a solid, scientifically valid pre-market review process," says Colin Pollard, chief of FDA's obstetrics and gynecology devices branch. Tampon manufacturers conduct a battery of safety studies, and tampons must pass through FDA review and clearance before they can be marketed.
FDA also regulates the absorbency ratings for tampons. While high levels of absorbency were initially linked to an infection called toxic shock syndrome (TSS), FDA recently proposed a rule to provide an absorbency term for 15- to 18-gram tampons (ultra absorbency) that may help women manage heavier menstrual flows.
"Tampons with this absorbency are available in other countries with very low rates of toxic shock syndrome," explains Kimber Richter, M.D., deputy director of FDA's office of device evaluation. Toxic shock syndrome is the only disease with a proven association to tampon use, according to FDA and the national Centers for Disease Control and Prevention.
Tampon Safety and Toxic Shock Syndrome
Any fear still surrounding tampon use likely dates from a time when toxic shock syndrome was first identified. About half of all cases occur in women using tampons, although the exact link between toxic shock syndrome and tampons remains unclear.
Tampons enjoyed a quiet history from 1933--when the first ones hit the market--until about 1980. That's when CDC noticed a sharp rise in the number of cases of toxic shock syndrome, a serious and sometimes fatal disease caused by toxin-producing strains of the Staphylococcus Aureus bacterium. Experts believe the bacterium releases one or more toxins into the bloodstream.
Between October 1979 and May 1980, 55 cases of toxic shock syndrome and seven deaths were reported. Most were among women who experienced onset of illness within a week following their periods. The TSS epidemic reached its peak in 1980 with a total of 813 cases of menstrual-related toxic shock syndrome, including 38 deaths, according to CDC.
CDC carried out national and state-based studies to pinpoint toxic shock syndrome risk factors and used its national surveillance system to track trends. Research suggested one factor was the use of very highly absorbent tampons made from new materials.
Studies showed that women who used Proctor & Gamble's Rely tampons were at substantially greater risk for TSS than other tampon users. This brand consisted of polyester foam and a special type of highly absorbent cellulose, a combination no longer used in tampons. "Toxic shock syndrome was NOT only limited to Rely tampons, but the Rely tampons did play a major role," says Pollard. Proctor & Gamble voluntarily withdrew that tampon from the market in 1980, and competing manufacturers of tampons made from other superabsorbent materials began removing them as well.
Toxic Shock Syndrome Cases Drop Dramatically
Compared with the 813 menstruation and tampon-caused toxic shock syndrome cases in 1980, there were only three confirmed cases in 1998 and six in 1997. "Although there is some underreporting of cases, this is a real decline," says Rana Hajjeh, M.D., a medical epidemiologist with CDC's division of bacterial and mycotic diseases. She attributes the drop in toxic shock syndrome rates to the removal of Rely from the market and advances in the way FDA regulates tampon materials and absorbency. Women also are much better educated about toxic shock syndrome prevention, she says.
FDA took its first step to protect the public in 1982, when it required that all tampon labels include toxic shock syndrome warning signs. In addition, packages had to include a note that the risk of menstrual TSS can be reduced by not using tampons and by alternating tampons with sanitary napkins. FDA also required that labels advise women to use the lowest absorbency needed to control their flow. CDC studies suggested that, in general, higher tampon absorbency was related to higher toxic shock syndrome risk.
In response to CDC findings and FDA regulatory activities, manufacturers standardized and, in some cases, lowered tampon absorbency. "What's considered superabsorbent today is much less absorbent than superabsorbent tampons used in 1980," Hajjeh says. In 1980, 42 percent of tampon users used very high absorbency tampons, according to CDC. That number dropped to 18 percent by 1983 and to 1 percent by 1986.
In 1990, FDA standardized absorbency labeling, allowing women to compare absorbencies across brands. Before the regulation, super absorbency in one brand could have been the same as regular in another brand. Now, FDA's labeling requirements ensure that a Playtex junior absorbency has an absorbency range of 6 grams of fluid or under, just as an O.B. junior absorbency does.
FDA's Pollard points out that the material of the Rely tampon and its absorbency were very different from that of tampons on the market today. "FDA also has improved its premarket review process and has begun looking at additional tampon characteristics," he says. He adds that all tampon manufacturers, including those introducing new materials, report to FDA on absorbency, as well as on the safety of all components of a tampon, including the cover, string and applicator, and on the chemical composition of any fragrances and color additives.
Companies conduct clinical tests in tampon users to look for bacterial growth and adverse effects, such as allergies and ulceration, with tampon use. Through toxicological testing, manufacturers must show that the tampon will not enhance the growth of Staphylococcus Aureus or increase the production of toxic shock syndrome toxin.
"This testing is ongoing for new tampon products," Richter says. "We continue to monitor tampons for safety issues."
FDA also tracks medical device problems through its MedWatch system, which allows consumers and health professionals to report adverse effects from FDA-regulated products.
Although toxic shock syndrome is rare, tampon users should still be aware of it, says Richter. "All tampons are associated with the risk of toxic shock syndrome, and it's important for women to know the signs," she says. "If a woman becomes ill or has any concerns at all about toxic shock syndrome, she should remove her tampon immediately and contact her doctor."
Today, tampon manufacturers in this country produce tampons made of rayon, cotton, or a blend of the two. Cotton is commonly referred to as "natural," while rayon is considered "synthetic." But consumers shouldn't assume that "synthetic" means bad and "natural" means safer, says Jay Gooch, Ph.D., a toxicologist and senior scientist at Proctor and Gamble. Rayon is made from cellulose fibers derived from wood pulp. "Technically speaking, rayon is synthetic, but it's more like natural cellulose than it is different," Gooch says. "There is a lot of confusion out there about what rayon is and a lot of unsupported allegations about the safety of the two fibers." Previous CDC studies have found no increased risk with rayon versus cotton for the same absorbency and brand of tampon.
Other Tampon Ingredients
John McKeegan, spokesman for Johnson and Johnson, makers of O.B. tampons, says his company tells women who call with questions about the presence of cancer-causing dioxin in tampons that the company uses elemental chlorine-free bleaching, which does not produce dioxin.
Chlorine gas, which can produce a small amount of dioxin, used to be the bleaching agent for rayon used in tampons, says Gooch. "But elemental chlorine-free bleaching uses a chlorine dioxide agent. Chlorine dioxide may sound like chlorine gas, but they are two very different things," he says. Bleaching is necessary because all fibers have impurities associated with them that will inhibit absorbency. "Bleaching cleans and purifies raw material, but it does not leave toxins," he explains. And unlike what some people think, he adds, the white color of tampons is a consequence of the purification process, not an appearance goal.
Using a method approved by the Environmental Protection Agency, major tampon manufacturers have tested their products for dioxin. Data show that dioxin levels in tampons range from undetectable to 1 part in 3 trillion, far below the level that occurs through daily environmental exposure and considerably below the level FDA believes would put consumers at risk, Stratmeyer says.
"That doesn't mean that dioxin couldn't get there from another source," he adds. "You could end up with dioxin in rayon or cotton simply because of decades of pollution." It can be found in air, water or the ground before the wood pulp or the cotton is produced. "But what we know today is that you will find more dioxin already in your body than in any tampon," he says.
Many experts say the proof of tampon safety lies in its long history. But others want more research into diseases other than toxic shock syndrome. Rep. Carolyn Maloney (D-N.Y.) introduced the Tampon Safety and Research Act in 1997 and again in March 1999. The bill, which was referred to the Subcommittee on Health and Environment, proposes to provide NIH with research support to determine the extent to which dioxin, synthetic fibers, and other additives in tampons pose health risks such as cancer, endometriosis, infertility, and pelvic inflammatory disease.
But from FDA's perspective, there is no indication right now that such research is necessary, Stratmeyer says. "We are not aware of evidence that would call for a large-scale study on tampons' relation to these diseases."
Symptoms of toxic shock syndrome can be hard to recognize because they mimic the flu. If you experience sudden high fever, vomiting, diarrhea, dizziness, fainting, or a rash that looks like a sunburn during your period or a few days after, contact your doctor right away. Also, if you're wearing a tampon, remove it immediately. One or two weeks after initial symptoms begin, flaking and peeling of the skin occurs, mainly on the palms and soles. If your doctor determines that your symptoms are toxic shock syndrome, you will probably be sent to a hospital for treatment. With proper treatment, patients usually get well in two to three weeks.
Women under 30, especially teenagers, are at a higher risk for toxic shock syndrome, because some females that age may not yet have antibodies to the toxin. Using any kind of tampon--cotton or rayon of any absorbency--puts a woman at greater risk for toxic shock syndrome than using menstrual pads.
Absorbency--the rate at which a tampon absorbs or soaks up menstrual blood--is measured in grams of fluid. Research suggests that the risk of toxic shock syndrome may increase with tampon absorbency. But that doesn't mean you have to steer clear of higher absorbency tampons completely, according to Colin Pollard, chief of FDA's obstetrics and gynecology branch. "You should match absorbency to your flow," he says. For a lighter flow, use regular or junior absorbency. If your tampon absorbs as much as it can and has to be changed before four hours, you may want to try a higher absorbency. There's usually less need for higher absorbency when your period is ending.
When you shop, you'll find these absorbency terms and ranges on all tampon packages:
Junior absorbency: 6 grams and under
Regular absorbency: 6 to 9 grams
Super absorbency: 9 to 12 grams
Super plus absorbency: 12 to 15 grams
According to the American College of Obstetricians and Gynecologists, your tampon is probably too absorbent if the tampon is hard to remove, you experience vaginal dryness, if a tampon shreds, or if it doesn't need to be changed after several hours. Vaginal dryness and ulcerations may occur when a tampon is too absorbent for your flow.
The strategy had worked for years, says Tracy, 28. She always inserted a small tampon on the morning she expected her period. But a few years ago, her period started one day late. "By the time it came, I had forgotten about the first tampon," she says. "The bleeding was so heavy that I figured I must not have had one in. So I put another one in."
All day she changed her tampon every few hours like she normally does. Then on one trip to the bathroom that night, she noticed a second string. When she finally removed the first tampon, the mild cramps she had experienced all day worsened. The pain became so intense she couldn't walk. Severe cramps and heavy bleeding ultimately landed her in the emergency room.
Putting in a tampon and forgetting about it is rare, but it does happen, says Gerald Joseph, M.D., former chairman of the department of obstetrics and gynecology at the Ochsner Medical Foundation. Joseph says he sees such cases--mostly among women under 30--a few times each year. Joanne, 44, says she forgot once and didn't realize the tampon was still there until six days later when she went to her doctor complaining of foul odor and vaginal discharge.
FDA recommends the following tips to help avoid tampon problems:
Follow package directions for insertion.
Choose the lowest absorbency for your flow.
Change your tampon at least every 4 to 8 hours.
Consider alternating pads with tampons.
Know the warning signs of toxic shock syndrome.
Don't use tampons between periods.
Truth's and Tragedies
The Following Information Courtesy of: http://www.tamponalert.org.uk
in Memory of Alice Kilvert, who died at the age of 15 due to
Tampon use and Toxic Shock Syndrome
Alice Kilvert, aged 15, died on Tuesday, 26th November 1991 of tampon-related Toxic Shock Syndrome at Trafford General Hospital, Manchester.
Alice's symptoms were initially very mild and did not cause any undue concern. On the Sunday prior to her death she complained of a headache which persisted, but eased with aspirin. During Sunday evening she was able to watch television, but she was sick during the night. Although very pale on Monday morning, she went to school in order to start her mock GCSE exams, but was taken home as she appeared to be developing influenza.. Alice went straight to bed and by tea time she had a slight temperature. At 7pm she was alert enough to talk about the early evening TV she had missed, but by 10pm she seemed vague and confused and a little faint.
The next morning Alice's breathing was shallow and she had a higher temperature, so the emergency doctor was called. The doctor phoned for an ambulance for Alice to be taken to hospital, but when the ambulance staff tested for blood pressure, it was so low it hardly registered. She arrived at hospital at 9am and her condition was diagnosed as either TOXIC SHOCK SYNDROME or meningitis, and treatment began. She was taken into Intensive Care and put onto a ventilator as her breathing was giving cause for concern. However, the strain on her heart brought on two cardiac arrests. She did not recover from the second one and died at 1pm.
Stories on Women and Girls who
Died or Were Injured due to Tampon use and
Tampon-induced Toxic Shock Syndrome
KATIE OF NOTTINGHAMSHIRE.
In the summer of 1990, Katie, then aged 15, went on holiday to Devon with her family. It was a holiday that she'll never forget.
One morning she woke up with a headache and feeling shivery. Her mother thought that it could be flu and suggested that she should stay in bed. During the day her symptoms worsened as her temperature rose; she had aching muscles, a stiff neck and a sore mouth.
By tea time she became breathless and she was so weak that she needed assistance to go to the toilet. Her parents sent for the doctor, who diagnosed a virus and prescribed antibiotics. That night Katie's temperature soared to 102 degrees. The next morning she felt awful and had a severe headache. Her mother noticed a red rash on her leg. Katie's eyes were pink and sticky and her skin was turning yellow. The doctor was called again. He took one look at her and called for an ambulance. She was rushed to hospital.
At the hospital, the doctors performed a lumber puncture to test for meningitis and took a blood sample to test for glandular fever. Then the doctor discovered that Katie was menstruating and took a vaginal swab for testing. By now, her joints were swollen, her mouth was blistered, her liver and kidneys were failing and her veins and arteries had gone into spasm. She was transferred to Intensive Care.
The next morning a microbiologist had identified that Katie was suffering from Toxic Shock Syndrome, brought on by the tampons she had been using. She was being treated by the right antibiotics, and the doctors said that they would just have to wait and hope. Katie remained conscious for the three days that she was in Intensive Care. The pain was excruciating. She was transferred to a ward and after a week she was strong enough to go home with the aid of a wheelchair.
Katie felt weak for months. Thick layers of skin peeled off her hands and feet. This was as a result of the blood supply being cut off from her extremities during her illness. Then her hair started to fall out in clumps. This lasted for six months, and it has never grown back to its previous thickness. She realized that her memory wasn't as good and her ability to concentrate had diminished.
Katie remembers being told at school that Toxic Shock Syndrome is caused by leaving a tampon in too long. Now she knows differently. Any woman or girl who uses tampons can get TSS. That's why she'll never use tampons again. It might be rare, but you never know who it might strike next.
JEAN OF SURREY.
Jean was 46 when she suffered from Toxic Shock Syndrome. It was the second day of her period and she was using tampons. She'd had a headache all day that wouldn't go away, so she decided to go to bed early that evening. Jean couldn't sleep and her headache intensified. Suddenly she was vomiting and suffering from diarrhea. Jean thought that it must be food poisoning. The next day, Jean felt no better, although the sickness and diarrhea had stopped. When she began to lapse into unconsciousness her daughter telephoned the doctor, who immediately summoned an ambulance. By this time Jean's lips had a bluish tinge and she was having breathing difficulties. She went into a coma on the way to hospital as her blood pressure plummeted.
In Intensive Care, Jean needed a ventilator and dialysis as her kidneys had ceased to function. Doctors noticed that the tips of her fingers and toes were turning black with gangrene. Over the next three weeks Jean was so weak that she only had a 20% chance of survival. Because of the drugs her weight ballooned from 10 stone to 13 stone. Her blonde hair turned grey and her green eyes turned blue. The gangrene spread to her knee, nose and the back of her head. Jean went into stress and was given a tracheotomy to help her to breathe. Her veins were collapsing and it was almost impossible to insert the necessary drips.
At this point the doctor asked Jean's husband if he could try an experimental drug which he hoped would increase her extremely low blood pressure. Within minutes Jean started to respond and her blood pressure began to increase. She was going to make it, although she was still critically ill. Two days later she opened her eyes and asked where she was. She noticed her black toes. Jean spent six months in hospital and eventually had her toes amputated. Her feet were very painful and she had to get used to walking again. Now she wears special shoes and occasionally uses a walking stick. Jean finds it difficult to concentrate and has problems with her short-term memory.
Jean says that it's a miracle that she's alive today. She has enormous admiration for the doctors, nurses and of course her family who were with her all the time. Jean says that she will never use a tampon again. She has told all her friends and neighbors not to believe those trendy tampon adverts on the TV. "Tampons nearly killed me and they will kill others," she says.
JUDY OF OXFORDSHIRE.
Judy, a 27 year old mother, had been using tampons since she was 12. Her episode of Toxic Shock Syndrome began 10 weeks after the birth of her second daughter. She woke up on the third day of her period feeling tired and her head was spinning, but she had to look after her new baby and her 2 year old daughter. By evening she was exhausted and went to bed really early and just slept. The next morning, Judy got up and felt fine. But an hour after her husband had gone to work she had no strength to do anything. She vomited twice and had severe diarrhea. She phoned her mother to look after the girls and went back to bed. She felt worse and worse before eventually getting off to sleep.
The next morning was the same. Judy was fine until after her husband had left for work. A sudden attack of diarrhea hit her before she could reach the toilet. Once again she asked her mother to look after the children, and her mother also called the doctor. Judy was taken to the hospital by her sister-in-law and nearly fainted. Her legs were so painful and weak that she needed a wheelchair. Her skin was yellow. Judy was admitted to the infectious diseases ward for tests and the diarrhea was still running out of her. Within the hour they had put two drips into her. The doctors had found her tampon by now and had taken it away for testing. She had a rash on her lower legs and feet.
By the next morning, and numerous doctors later, they had diagnosed Toxic Shock Syndrome. Judy was put on even more drips and had heart and kidney checks. Her fingers and toes tingled all the time, like a burning sensation. The skin on her fingers and toes later peeled off and it was terrifying and very painful. A week in hospital and she was fit enough to go home.
Judy had to take tablets and return to hospital for heart and kidney checks and blood tests. She seemed to recover quite well, but lost her sense of taste for about 5 weeks. She was under health surveillance for 6 months and received the all clear. Then Judy's hair started falling out. It didn't leave her bald, but it was very thin in places. This lasted about two months before getting back to normal.
Judy says that not enough people know about the dangers of tampons and Toxic Shock Syndrome. She will never use tampons again, and there's no way she'd let her daughters use them either.
ANNETTE OF MIDDLESEX
Annette was a healthy 17 year old at boarding school in Surrey. One Friday, in June 1989, just seven weeks before her 18th birthday, she felt a bit under the weather. She had just started her period and was using high absorbency tampons. By Sunday, she was in the school sick bay, and her worried parents were driving to visit her. Annette had a high temperature, severe headache and "appeared distant". However, it wasn't until the Wednesday that she was rushed to hospital, with what doctors thought was a burst appendix.
In the early hours of the Thursday, she was put onto a ventilator, and her parents had what was to be their last conversation with Annette. The doctors advised her parents that she was suffering from toxic shock syndrome, a disease that they had never heard of.
During the night Annette's condition suddenly deteriorated and she suffered two massive heart attacks and died.
KAREN OF HAMPSHIRE.
One Thursday in January 1991, 20 year old Karen became ill with sickness and diarrhea. Although she was not aware of the connection, she was having her period and using tampons. She called the doctor who initially diagnosed gastro-enteritis and gave her some medicine. Karen continued vomiting, suffered severe diarrhea and was in agony, and on Sunday the doctor suspected appendicitis and she was rushed to hospital. As she was severely dehydrated, Karen was immediately put on a drip, whilst the diagnosis was being made.
The next morning (Monday), Karen felt fine and was laughing and joking with her parents. However, her mother noticed that her breathing was labored and that she had a red rash on her leg. But by 3 pm, Karen's condition worsened and she was given oxygen. By 9 pm she had lapsed into unconsciousness and transferred to Intensive Care. The medical staff did not know what was causing the problem, although toxic shock was considered. She had 15 tubes going into and out of her. At 10 pm Karen suffered a cardiac arrest, and the IC staff resuscitated her, but her condition was critical.
At 1 am on the Tuesday morning, Karen had a last injection to stimulate her blood flow, and her parents were told that this was her last hope.
Tragically, Karen died at 2.15 am from Toxic Shock Syndrome due to tampons.
DELYSE OF BUCKINGHAMSHIRE.
Delyse was a 32 year old secretary. Early in August 1993, Delyse' menstrual period started and she began using tampons as usual. However, this time it was to have tragic consequences.
On Saturday morning, Delyse suddenly started vomiting, had severe diarrhea and a high temperature. She thought that she was suffering from food poisoning. Later that day her partner called the doctor, who diagnosed flu.
On the Monday, Delyse went back to her GP who diagnosed gastritis - inflammation of the lining of the stomach. Her condition worsened and on Tuesday she was admitted to the local hospital with a suspected burst appendix.
Delyse seemed to be in a stable condition whilst the diagnosis began, but within 24 hours, she was rushed into Intensive Care, then onto a ventilator as her lungs had collapsed. She was then transferred to a specialist hospital nearby, where her condition improved slightly. When her vital organs, including liver and kidneys, failed, Delyse was put onto a dialysis machine.
After 5 weeks of fighting for her life, Delyse suffered a massive brain haemorrhage and died on 9th September.
SHARON OF COUNTY DURHAM.
Sharon, a keen sportswoman, died of Toxic Shock Syndrome two months after giving birth to her second child.
Her husband Anthony recalls the joy and the tragedy of eight weeks in late 1991.
Twenty six year old Sharon used tampons for her first period after the birth of Rebecca. It started one Sunday when she began to feel very tired.
By Monday, Sharon was suffering with diarrhea, vomiting and a prickly red rash. The doctor was called and diagnosed a virus.
Thursday, her condition had deteriorated. Now, Sharon's fingernails and lips
were turning blue, the rash was like sunburn and she was having breathing
Sharon was rushed to hospital. Her condition improved slightly, but then her kidneys collapsed and she was transferred to Intensive Care. Doctors diagnosed toxic shock syndrome, caused by the tampon that she had been using.
The deadly toxins were causing all sorts of problems as they poisoned every part of her body. Her lungs were beginning to fail and she was transferred to the Regional specialist hospital where a lung transplant was considered. However, Sharon was too ill to undertake this operation. Doctors fought so hard to save her life, but after eight weeks of intensive care, Sharon suffered a cardiac arrest and died
SHANE OF BRISTOL.
Thirty three year old mother of two, Shane, died of tampon-related Toxic Shock Syndrome in March 1994.
On Friday 4th March, Shane said she didn't feel well. During the early hours of Saturday morning she began vomiting and felt awful. She asked her mother to look after the children.
Sunday she was suffering severe diarrhea, she had a red rash and was now semi
conscious. She had a high temperature, her breathing was labored, and she had
pus coming from her eyes. At 9 am her husband phoned the doctor who suggested
that it was a stomach bug. Shane's husband insisted that the doctor must visit,
but on arrival, the doctor confirmed a stomach bug, and suggested paracetamol to
lower her temperature.
By Monday, Shane's condition had not improved and her mother called the doctor again. The doctor took one look at Shane and called an ambulance. She arrived at hospital at 3 pm and went straight into Intensive Care. But after six cardiac arrests, Shane died at 5.30 pm.
9. PAMELA OF EDINBURGH.
One Sunday in March 1993, Pamela aged 34, took to her bed with a severe sore throat. At the time she knew that a lot of people round about had flu, so she thought that she must be getting it too.
On Monday morning she felt really faint. Her husband went off to work, but asked Pamela's mother to phone the doctor. The doctor diagnosed a sore throat and prescribed penicillin. Although Pamela was able to talk coherently to the doctor, she can't remember the rest of the day, not even talking strangely to her husband when he arrived home from work. She felt so tired. The doctor was telephoned again and he suggested looking to see if Pamela had spots on her feet! She did have. The doctor called 'round again and got her admitted to hospital with suspected meningitis.
Luck was with Pamela that evening because the Specialist on duty had seen Toxic Shock Syndrome before. The tampon that had been removed when Pamela was admitted to the hospital was tested positively for Staphylococcus aureus and TSS was diagnosed.
Ten days of hospital treatment saved Pamela's life, but she was so weak that she had to leave the hospital in a wheelchair and learn how to walk again.
It took months to recover physically and even longer to recover mentally. She lost a lot of her hair, her skin started peeling off and she ached all over. She had been using tampons since she was 17, but will never again use tampons.
10. FIONA OF ROSS-SHIRE.
On New years Eve 1990, 22 year old Fiona, woke up with crippling period pain. Her mother phoned work to let them know that Fiona would not be in today. As the day wore on Fiona became worse and started vomiting. At tea time the doctor was called and flu was diagnosed. But over the next few hours, Fiona's condition deteriorated. She started with diarrhea, her temperature soared and she developed a rash all over her neck. A worried mother called the doctor again at 2 am, and again flu was diagnosed.
The next morning, Fiona was unconscious and the ambulance was called. On arrival at the hospital, meningitis was first suspected, (but it wasn't until 3 months later that tampon-related toxic shock syndrome was confirmed). Fiona's temperature had rocketed and she was surrounded by bags of ice. The intensive care staff worked through the day, but at 3 am the next morning, Fiona suffered a cardiac arrest. The team managed to save Fiona, but the shattering news was that Fiona may be brain damaged, blind and paralyzed in all four limbs.
In the next two weeks Fiona fought for her life. Her kidneys failed and she needed dialysis, and her toes turned black with gangrene and would have to be amputated.
Three months later, Fiona started to come out of her coma. She couldn't speak, but she could hear and smile. Fiona stayed in hospital over the next year and was on drips and dialysis, and having physiotherapy and speech therapy. She was transferred to a Nursing home to be close to her parents. As a result of using a tampon, Fiona is totally blind, confined to a wheelchair, unable to use her arms and only has limited speech.
For more information on the above stories, please contact:
FAQ's About Tampons, Tampon Safety
and Toxic Shock Syndrome
thought that you only got Toxic
Shock Syndrome if you forgot to change your tampon. Is this
Any woman may develop Toxic Shock Syndrome when using tampons as directed by the manufacturer's instructions if she is carrying the particular strain of bacteria that produces toxins and if she has not developed immunity to these toxins.
The exact combination of circumstances in which toxin production occurs in the vagina of individual women is not known. It is therefore not possible to state any completely safe time limits on the use of a tampon, although it could be assumed that the longer a tampon is left in place or the more tampons are used continuously, the greater the chance of toxin production starting. This is why we recommend keeping tampon use to a minimum and breaking the use regularly by using a sanitary towel/pad.
All known victims of Toxic Shock Syndrome followed the manufacturers instructions on usage implicitly, but they still became seriously ill or even died.
We think that there are several reasons why people think that a "forgotten tampon" causes Toxic Shock Syndrome:-
Many women have been admitted to hospital with Toxic Shock Syndrome while still using a tampon. They had become seriously ill extremely quickly and had not been physically capable of removing or changing their tampon.
The term "retained tampon" in medical reports, refers to a tampon being in place on admission to hospital. It is not an indication of length of use.
It blames the tampon user, who was too ill to defend herself; it exonerated the tampon manufacturers and it reassured dedicated tampon users.
It made it easier for newspaper editors (usually men) to explain why someone was ill.
Can you catch Toxic Shock Syndrome from other people?
No. Toxic Shock Syndrome is not a contagious disease that can spread to others.
What is the link between Toxic Shock Syndrome and tampon use?
The link between TSS and tampons is not completely understood.
However, tampon research highlights three high RISK FACTORS: high absorbency tampons, continuous tampon use and low body immunity.
Absorbency: the higher the absorbency the higher the
risk; the lower the absorbency the lower the risk. That is why a woman should
always use the lowest absorbency tampon for her menstrual flow. It also accounts
for the high number of deaths due to super-absorbent tampons in 1980.
Continuous tampon use: women should not use tampons continuously during a period. It is recommended that the most convenient time to break the continuous use is at night, by using a sanitary towel/pad.
Low immunity: this is the factor that you cannot control as it may vary from time to time. It is generally understood that immunity improves with age therefore girls are at a higher risk that older women.
it possible to get Toxic
Shock Syndrome more than once?
Yes. A person who has had Toxic Shock Syndrome can develop it again. If a woman or girl has had Toxic Shock Syndrome in the past, it is advisable not to use tampons again.
Shock Syndrome recurs in around 30% of cases. Dr Mary
Andrews of the Dartmouth-Hitchcock Medical Centre in New Hampshire, advises that
symptoms were most likely to return in women who were not treated during their
first attack, and continued to use tampons. Two thirds of Dr Andrews' study
group experienced a recurrence within 5 months, although only 16% of women who
were treated had recurring symptoms of Toxic
Toxic Shock Syndrome Symptoms
are the symptoms of Toxic
Symptoms can be similar to flu or food poisoning, but they can become serious very quickly.
The symptoms of Toxic Shock Syndrome include one or more of the following:
Always begin AFTER a menstrual period starts.
Early symptoms may include headache, and/or sore throat,
aching muscles and high temperature (fever).
Followed by vomiting, watery diarrhea,
Confusion and dizziness
A red, sunburn-like, rash on chest, abdomen or thighs
Very low blood pressure.
Please note: Only one or two of the above symptoms may occur. They do not necessarily occur all at once and may not persist.
should I do if I get these symptoms?
If you have any of these symptoms and are using a tampon you should, remove and save your tampon and seek immediate medical attention (preferably at an emergency HOSPITAL). Tell the doctor that you have been using tampons and suspect Toxic Shock Syndrome
Don't worry about wasting the doctor's time, you could be saving your life.
What Is The Treatment For Toxic Shock Syndrome?
With early diagnosis, Toxic Shock Syndrome can generally be effectively treated with antibiotics and other medication to counteract the symptoms.
Professor Joan Chesney, Head of Paediatrics at the University of Tennassee said in September 1997 that concerns that Staphylococcus Aureus could become resistant to antibiotics have so far proved unfounded. Tests on Toxic Shock Syndrome-associated strains of Staphylococcus Aureus at the Dartmouth-Hitchcock Medical Center in New Hampshire failed to find any methicillin-resistant Staphylococcus Aureus (MRSA), the strain which has caused so many problems for hospitals in Europe and America. All 62 samples from menstrual and non-menstrual cases referred to the D-H Medical Center between 1984 and 1995, were susceptible to two key antibiotics - oxacillin and clindamycin - although only a handful would have responded to treatment with penicillan.
Standard therapy for Toxic Shock Syndrome continues to be on high-dose antibiotics, usually with a beta lactam agent, with or without clindamycin or a related drug. You also need to stop toxin production which can be best done with a protein synthesis inhibitor such as clindamycin, gentamycin, erythromycin or clarithromycin. Introvenous fluids are another essential aspect of management, but doubts remain over the value of introvenous immunoglobulin (IVIG) injections as they carry the risk of side-effects.
Choosing the Right Tampon Absorbency or "Size"
When using tampons, it's important to choose the lowest absorbency necessary for your menstrual flow. Because the amount of flow varies from day to day, it is likely that you will need to use different absorbencies on different days of your period. Selecting the right absorbency comes with experience, but as a guide, if a tampon absorbs as much as it can and has to be changed before 4 hours, then you may want to try a higher absorbency. On the other hand, if you remove a tampon and after 4-6 hours white fibre is still showing, you should choose a lower absorbency.
Research indicates that tampons should not be used continuously during a period as continuous use is a high risk factor. The most obvious time to break this continuous use is at night. AKTA recommends the use of a sanitary towel at night. However, if you choose to use a tampon at night, choose the lowest absorbency needed, insert a fresh one just before going to bed and remove it as soon as you wake up in the morning. Slim line tampons are quite absorbent for their size, so it is highly recommended that young girls do not use tampons at night.
1. CDC. Toxic-shock syndrome--United States. MMWR
2. Todd J, Fishaut M, Kapral F, Welch T. Toxic-shock syndrome associated with phage-group-1 staphylococci. Lancet 1978;2:1116-8.
3. CDC. Follow-up on toxic-shock syndrome--United States. MMWR 1980;29:297-9.
4. Osterholm MT, Davis JP, Gibson RW, et al. Tri-state toxic-shock syndrome study: I. Epidemiologic findings. J Infect Dis 1982;145:431-40.
5. Schlech WF, Shands KN, Reingold AL, et al. Risk factors for development of toxic shock syndrome: association with a tampon brand. JAMA 1982;248:835-9.
6. Berkley SF, Hightower AW, Broome CV, Reingold AL. The relationship of tampon characteristics to menstrual toxic shock syndrome. JAMA 1987;258:917-20.
7. Gaventa S, Reingold AL, Hightower AW, et al. Active surveillance for toxic shock syndrome in the United States, 1986. Rev Infect Dis 1989;2(suppl S1):S35-42.
8. Davis JP, Chesney PJ, Wand PJ, LaVenture M, the Investigation and Laboratory Team. Toxic-shock syndrome: epidemiologic features, recurrence, risk factors, and prevention. N Engl J Med 1980;303:1429-35.
9. Osterholm MT, Forfang JC. Toxic-shock syndrome in Minnesota: results of an active-passive surveillance system. J Infect Dis 1982;145:458-64. 10. Latham RH, Kehrberg MW, Jacobson JA, Smith CB. Toxic shock syndrome in Utah: a case-control and surveillance study. Ann Intern Med 1982;96:906-8. 11. Broome CV. Epidemiology of TSS in the United States: overview. Rev Infect Dis 1989;2 (suppl S1):S14-21.
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