Can menstrual cups cause Toxic Shock Syndrome?

Have you heard of Toxic Shock Syndrome but not really sure what it is? 

You may have seen a warning for TSS on tampon boxes before - which can be quite scary. In fact, there are many women around the world that avoid insertable products because of TSS, but no one fully understands what exactly TSS is and how it happens. 

So in this blog we will cover everything you need to know about TSS, the definition for toxic shock syndrome, the causes, symptoms, treatment and the prevention of toxic shock syndrome. 

what is toxic shock syndrome (tss)? what causes it?

TSS is a rare bacterial infection which can impact both women and men. To make this as simple as possible, we are going to break down for you what TSS is and how it happens.

For you to suffer from TSS, there have to be 3 factors that happen all at the same time:

  1. You must be a carrier of strep or staph bacteria 

For the development of toxic shock syndrome, you need to be a carrier of one of two types of bacteria -  either staphylococcus or streptococcus. About 30% of the population are carriers of this bacteria, which usually sits on your skin or inside your nose or vagina in a dormant state. 

While this bacteria must be present for TSS to develop, having this bacteria does not alone mean you will get TSS or another infection related to these bacterium. 

Millions of people across the world carry this bacteria and it does not cause TSS or harm them in any way.

2. There needs to be a catalyst for the bacteria to grow 

In order for TSS to develop, the bacteria present needs to grow to a stage where it can become toxic and harmful. The way in which this can happen is if your tampon or menstrual cup is left in for too long – in most cases, far too long, such as several days.

3. The bacteria needs to enter your bloodstream 

TSS is a condition that spreads across your body via your bloodstream - so in order for it to develop the bacteria needs to enter your bloodstream. This means that you need to have a cut or an abrasion which will expose your bloodstream to the bacteria.

Sometimes tampons can cause tiny little abrasions in the inside of your vagina. If you’re a carrier of this particular bacteria, you have abrasions inside your vagina, AND you’ve worn your tampon for too long, leading bacteria to multiply, then you are at greater risk of developing TSS.

how are period products associated with tss? 

Most cases of TSS do tend to be related to menstruation - and more specifically tampon use. 

The prevalence of toxic shock syndrome caused by tampon use was more common in the late 1970’s and early 1980's when tampons started to gain more popularity. 

There was a much higher use of super-absorbent tampons then - people with light flow were using super-absorbent tampons when they didn’t need to. This would make the tampon stick to the vaginal wall, causing tiny abrasions when it was removed.  Also, a super-absorbent tampon was more likely to grow bacteria due to prolonged use.

During this outbreak, the risk of menstrual toxic shock syndrome was 6 to 12 times higher than it is today. 

Once tampon manufacturers realised this, they changed the shape and size of tampons and ensured that you choose the correct size for your flow. There have also been stricter requirements from tampon manufacturers to test the product. Tampon packaging also has more informative labelling to ensure that users are well informed and make safe decisions for their bodies.

how common is toxic shock syndrome? 

The likelihood of developing TSS today is extremely low - fewer than 0.5 cases per 100,000 - and those who are treated promptly are highly likely to make a full recovery.

can i get toxic shock syndrome when using a menstrual cup? 

Have you ever wondered, can a menstrual cup cause toxic shock syndrome? 

The possibility of a menstrual cup causing TSS is extremely low. In fact, there are only a handful of recorded cases in history.

As menstrual cups collect rather than absorb your period blood, they are less likely to trigger bacteria to grow – which means it is extremely rare for menstrual cups to cause TSS. 

Also, since a menstrual cup is made from smooth silicone rather than cotton, it is less likely than a tampon to create abrasions when you insert or remove it – even on the lighter days of your period.

The Asan cup is designed with Class VI medical grade silicone, which is the same material used in heart stents and breast implants. It is the highest quality silicone available and is super smooth and safe to sit inside your body. 

The cup's bell shape has been designed to perfectly sit inside your vaginal canal so it does not cause any abrasions or discomfort. 

Although it is highly unlikely for a menstrual cup to give you TSS, please remember to remove the cup every 12 hours. Globally, only two people have had cases of TSS caused by a menstrual cup - who both left their cups inserted inside them for 7 days! 

what are the symptoms of tss? 

Toxic Shock Syndrome (TSS) symptoms will usually develop between 3-5 days of using a tampon or after a skin injury or surgery. 

The possible signs and symptoms of TSS include:

  • Low blood pressure 
  • A sudden high fever  
  • Vomiting or diarrhoea 
  • Redness of eyes, throat or mouth 
  • A rash on your palms or soles of the feet that resembles sunburn  
  • Headache 
  • A seizure 
  • Difficulty in breathing 
  • Muscle aches 

If you are wearing a tampon or menstrual cup and experience TSS symptoms, it’s best to be on the safe side – remove your tampon or cup immediately and head to the nearest hospital. When detected early, TSS is highly treatable.

how do i know if i have it? how will i get diagnosed?

A few early signs of toxic shock syndrome from a menstrual cup or tampon can include any of the symptoms listed above. But there is no specific diagnostic test for TSS. 

You may undergo blood and urine sample tests to check for the presence of a bacterial infection. Your doctor might also take a swab test of your vagina, cervix or throat for bacteria samples. 

Depending on the results of initial tests, you may be required to undergo further testing such as an X-ray, CT scan or lumbar puncture. This is because TSS can affect multiple organs so it is important to assess the extent of your illness. 

If you have recently used an insertable period product or have a skin or wound infection, then it might be a sign of TSS. As the bacteria gets deeper inside your body it can start to damage tissue and cause your organs to stop working. 

If left untreated, TSS can sometimes become fatal so it is important to immediately remove your tampon/menstrual cup and seek medical attention early. 

can tss be treated? what does the treatment involve? 

Yes, please don’t worry! TSS can be properly treated if you seek medical attention in time. 

You might be hospitalised if you develop TSS so that you can be treated with antibiotics and receive medication to stabilise your blood pressure. 

As everyone’s body reacts differently to TSS, each case will receive the required support and care to treat the symptoms of TSS. 

how can I reduce the risk of toxic shock syndrome?

Yes absolutely! There are a few things to do to avoid TSS

If you are a tampon user, always use the right one for your period flow and don’t keep the tampon in longer than the instructions given on the packaging. 

The same thing applies for a menstrual cup - always remember to remove it after 12 hours, wash it and then reinsert. You can read this blog that explains exactly how to use a menstrual cup.  

When using a menstrual cup, please ensure that you sterilise your cup by boiling it in water for 10 minutes at the start of each period cycle. 

To be extra cautious, you can also use a few drops of the Asan One-Drop menstrual cup cleanser whenever you remove, rinse and reinsert the cup during your period.

If you’d like to learn about a gynaecologist's opinion on menstrual cups, watch this video with OBGYN Dr. Premalata, which includes many topics including TSS. You can skip forward to 6.38 to learn more about TSS. 

Please do not use a menstrual cup if you have a history of TSS. 

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