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Inipad™
Safer, Healthier,
Environmentally-Friendly
Feminine Hygiene Products,
Information, Education and Resources
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Femgyn Health's Inipads™ are like a pantyliner - but NOT a pantyliner..... Femgyn Inipads™ are like a tampon, but not a tampon! Our new Femgyn Health's Inipads™ are similar to the previous "inter labial pads" in that they are placed between the labia minora (smaller lips) of a woman's vulva, on the outside of her vagina, and not in the vagina (picture below) like tampons.Best of all, our Femgyn Health's Inipads™ are made from 100% certified organic cotton, the safest and best material that can be used for feminine hygiene.... with no adhesives or harsh chemicals ever used! Our Femgyn Health's Inipads™
stay in place naturally in the "interlabial" space between a
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Tampon Safety
Feminine Hygiene, Gynecology & Menstruation Education, Information and Resources for Dads & Husbands
Tampon Facts and Information About Tampon Usage in the United States
About 70% of the 73 million women are of menstruating age in the U.S. use tampons.
Lifetime tampon usage is about 11,400 tampons per woman! This number based on each woman having 5 days of menstrual bleeding/month x 5 tampons used per day x 38 years
In the U.S., women between 11 and 60 years of age reported 216 cases of menstrual TSS reported in 1993; 244 cases in 1994
The risk of TSS is higher for women under 30 years old; 60% of patients are between 15 and 24 years of age
The fatality rate of TSS is 3% to 5%, but it is estimated that only 10% of cases of TSS are reported, as many women suffer only flu-like symptoms
Absorbency enhancers in tampons can cause peeling of the mucous membrane, vaginal dryness, ulcers, and lesions
Perfumes and fragrances in some tampons are reported to cause vaginal irritation, allergic reactions, and disruptions of a woman's microbial balance
"Tampon users were demonstrated to be 18 times more likely to develop menstrual TSS as non-users", Infectious Diseases in Obstetrics & Gynaecology, 1993, Gilles R.G. Monif
"of [Toxic Shock] cases occurring in menstruating women, up to 99% were using vaginal tampons", Obstetrics and Gynaecologic Infectious Disease, 1994, James McGregor and James Todd, (Chapter 21 - Toxic Shock Syndrome)
"Vaginal inflammation can result from rayon fibres from tampons becoming embedded in vaginal walls", Journal of Obstetrics and Gynaecology, 1980
Tampons made chiefly of rayon have some levels of dioxin.
"Rayon tampons amplify the growth of the Toxic Shock Syndrome bacteria TSST-1" American Society for Microbiology Journal, May 1994, Dr. Philip Tierno of NYU Medical Center
Dioxin levels once thought acceptable are now reported to adversely affect the reproductive and immune systems, "A Health Assessment Document for Dioxin", published by the Environmental Protection Agency, 1996
"Cotton tampons offer no protective advantage over cotton/rayon tampons with regard to protection from TSS" Journal of Infectious Diseases, October 1995 (study by Dept. of Microbiology, University of Minnesota.
The Truth About Tampons
By Catherine-Elliott Lopez
Fall 1998
Swedish studies have shown a link between tampons containing dioxin, and other chlorine by-products, and an increased risk of cancers of the female reproductive tract (especially the uterus, ovaries and bladder).
Rayon itself poses another risk. Unknown to most women, rayon and rayon-cotton blend fibers are widely used in commercial feminine hygiene products. Rayon used to make tampons is usually treated with chemicals to increase the absorption capability.
These super absorbent fibers then absorb not only the menstrual blood, but normal vaginal secretions as well, causing drying, and ulceration of vaginal tissues. The fibers can also become imbedded in the vaginal walls. Rayon fibers have been scientifically proven to amplify the production of Toxic Shock Syndrome Toxin TSST1.
Toxic Shock Syndrome is a rare bacterial illness that caused over 50 deaths between 1979 and 1980. Unlike medical grade cotton, upon which the TSS toxin will not grow, the rayon acts like a petri dish encouraging bacterial growth. What makes these toxic residues even more disturbing, is that they come in direct contact with some of the most absorbent tissue in a woman's body.
According to a doctor at New York University Medical Center, almost anything placed on this tissue, including Dioxin, gets absorbed into the body.
Why is it acceptable to have toxic substances in our feminine hygiene products? The tampon industry is convinced that women need bleached white products. They seem to think that we view this as "pure" and "clean." The fact is, if Dioxin puts women at risk for cancer and Dioxin is stored in fatty tissue (just like that found in the vagina), and a woman uses as many as 11,000 tampons in her lifetime, could the long term use of tampons increase cancer risk?
An FDA report said that "the most effective risk-management strategy would be to assure that tampons, and menstrual pads, contain no Dioxin." Although the FDA currently requires tampon manufacturers to monitor Dioxin levels, the results are not available to the public. The dioxin tests, are done by the manufacturers themselves, who insist their products are safe. Tampon manufacturers are not required to disclose ingredients to consumers, although many will do so voluntarily.
How much Dioxin exposure is considered safe for humans? Why has there been more research done on the possible health effects of chlorine-bleached coffee filters than on chlorine bleached tampons and related products? Women need to demand that more research be done on these issues. We have a right to know about any potential hazards associated with tampons and related products. It is only when women fully understand the consequences that we can make informed decisions regarding our health and well being.
Writer's note: Currently there are only a few non-chlorine bleached all cotton tampons available in the US. Ask about them at your local store, if they are not available, ask them to special order!
The
Pros And Cons Of Tampons
The type of tampon you choose may affect your health
By Laurel Kallenbach
Today's average woman uses an estimated 12,000 tampons in her lifetime, a convenience that allows an unprecedented freedom to be active and confident in avoiding embarrassing leaks. We've come a long way since rags pinned into undergarments or belted-on bulky pads were the norm, but with our freedom comes risk. There are potential problems attached to tampon use that every consumer should know about: Chlorine-bleached products, as some tampons are, contain traces of carcinogenic dioxins. Highly absorbent tampons may still cause toxic shock syndrome, a potentially fatal bacterial infection that occurs when tampons are worn for too long. There are even environmental ramifications, including pesticides sprayed on cotton crops and pollution created when tampon ingredients are bleached.
But,
there are safe and ecological alternatives that enable women to still benefit
from tampons. Here, natural is the rule of thumb. "Plainer is just better
when it comes to tampons," says Pam Chandler, a family nurse practitioner
and certified nurse midwife who practices at the holistic clinic Wellspring for
Women in
Dioxin
Dilemma
The most urgent tampon health concern is that chlorine-bleached and
rayon-containing products carry trace amounts of dioxin, an extremely toxic
chemical that is associated with cancer of the stomach, sinus lining, liver and
lymph system. Many people are familiar with the danger of dioxins from publicity
about Agent Orange and the
Check your tampon box for a list of ingredients. Whereas natural brands state that they're nonchlorine bleached, some conventional brands mention little on the subject, because along with the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA), they believe chlorine-dioxide bleaching is safe.
Tierno disagrees: While trace quantities of dioxin aren't in and of themselves a problem, tampons aren't your only exposure. "The problem is that measurable amounts of dioxins are everywhere, including food and water. Some portion of the dioxin that enters your bloodstream lodges in the body's fat cells and stays there a long time," he says. "This residual effect becomes progressively larger as you're exposed to even more dioxins."
The only way to avoid vaginally absorbed dioxin, Tierno says, is to eliminate chlorine-bleached and rayon-containing tampons and switch to peroxide-bleached products instead. Tierno also says if the label on your tampon box doesn't say "nonchlorine-bleached," it's possible that it contains chlorine. Most manufacturers proudly promote the fact that their product doesn't contain chlorine.
The cumulative risks of dioxin are unknown. While a single tampon may contain only 0.1 parts per trillion of dioxin, the fact that most women use between 10,000 and 15,000 tampons in a lifetime increases the exposure. "A trace quantity of dioxin is not acceptable in a tampon, because a woman does not expose herself to a single tampon," Tierno says. "It's trace quantity upon trace quantity upon trace quantity, multiplied by the number of tampons per month, multiplied by the number of months in a year, multiplied by 40 years of menstruation. Then add in all the dioxins you get from your diet, plus all the ones occurring in the environment."
Earth-friendly
Options
The environmental impact of the manufacturing of feminine products is another
reason to use organic tampons. While cotton tampons may seem better than
synthetic, most cotton undergoes industrial bleaching in a polluting process
that dumps dioxins, along with other hazardous organochlorines, into the water
supply. Organic cotton tampons and pads are treated with hydrogen peroxide
instead of bleach, making them a safer alternative. If the label states that the
product is third-party certified organic, that means the cotton has been grown
without pesticides on land where no pesticides have been applied for at least
three years.
In response to concerns over dioxin in tampons and their impact on the environment, the EPA and some manufacturers have worked to find a better way of purifying wood pulp and cotton without creating dioxins. The result is chlorine-dioxide bleaching, a process that has replaced the elemental chlorine-gas method of the past but still generates low trace levels of dioxins.
The packaging of tampons is another troublesome environmental issue. Most are encased in a paper or cellophane wrapper, contain a cardboard or plastic applicator, and are packed in boxes. Though you can't recycle cotton tampons, there are waste-saving alternatives to dealing with menstruation, such as washable natural sponge tampons and cloth pads, and reusable, but awkward, vaginally inserted menstrual cups that collect flow.
Toxic
Shock: Still A Risk
In the '70s and '80s, toxic shock syndrome (
"Highly absorbent tampons, especially those containing synthetic fibers, increase the amounts of toxin present in the vagina," says Tierno.
In the mid-'70s, synthetic fibers were used in tampons because manufacturers wanted to produce more absorbent, leak-resistant products. Since then, three of the four problematic synthetics have been eliminated from tampons. "The only one left is viscose rayon," Tierno says.
To
minimize your risk of contracting
Most
precautions for guarding against
Choosing
a tampon with proper absorbency is crucial to preventing
Careful
Liberation
Within the last couple of years, a rash of e-mails warned women that tampon
manufacturers put asbestos in their tampons to make women bleed more in hopes of
selling more product. Tierno says the rumor was false. "I have been privy
to every manufacturer's records over the last 21 years, and I have never seen
anything related to asbestos in tampons," he says.
Though the asbestos scare amounted to nothing but an urban myth, true additives to be concerned about are fragrances and deodorants. Perfumes may mask odors, but some women suffer allergic reactions to them. "Without question, a deodorized tampon is dangerous," asserts Tierno, adding that deodorants encourage overgrowth of certain bacteria, upset the vagina's normal flora and irritate the mucous membrane.
The
main point, when it comes to tampon use, is to stay informed and weigh the
options. "Over the years, tampons have allowed women to be more active and
fuss less during their periods," says
What
is Toxic Shock Syndrome?
Toxic
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.
To
help prevent toxic shock syndrome, you should follow these guidelines:
1.
Wash your hands before unwrapping and placing a new tampon in your vagina.
2.
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).
4.
Do not use tampons all the time and switch to a pad for part of each day.
5.
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.
Historical Perspectives Reduced Incidence of Menstrual Toxic-Shock Syndrome -- 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 (Figure 1).
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 Toxic Shock Syndrome 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 Toxic Shock Syndrome died; in 1988 and 1989, there were no deaths among women with menstrual Toxic Shock Syndrome. Reported by: Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.
On July 22, this notice was posted as an MMWR Dispatch on the MMWR website (http://www.cdc.gov/mmwr).
On July 19, 2005, the Food and Drug Administration (FDA) issued a public health advisory regarding the deaths of four women in the United States after medical abortions with Mifeprex® (mifepristone, formerly RU-486; Danco Laboratories, New York, New York) and intravaginal misoprostol (1). Two of these deaths occurred in 2003, one in 2004, and one in 2005. Two of these U.S. cases had clinical illness consistent with toxic shock and had evidence of endometrial infection with Clostridium sordellii, a gram-positive, toxin-forming anaerobic bacteria. In addition, a fatal case of C. sordellii toxic shock syndrome after medical abortion with mifepristone and misoprostol was reported in 2001, in Canada (2). All three cases of C. sordellii infection were notable for lack of fever, and all had refractory hypotension, multiple effusions, hemoconcentration, and a profound leukocytosis. C. sordellii previously has been described as a cause of pregnancy-associated toxic shock syndrome (3).
Investigation by FDA, CDC, and state and local health departments into the two most recently identified U.S. deaths after medical abortion is ongoing. Empiric therapy for patients suspected of having postpartum or postabortion toxic shock syndrome should include antimicrobials with anaerobic activity against Clostridium species. Health-care providers are encouraged to report any cases of postpartum or postabortion toxic shock syndrome to their state or local health department and to CDC at telephone 800-893-0485. Cases potentially associated with use of mifepristone or misoprostol should also be reported through the FDA MedWatch system available at http://www.fda.gov/medwatch/index.html or telephone 800-FDA-1088.
Food and Drug Administration. FDA Public Health Advisory: sepsis and medical abortion. Rockville, Maryland: Food and Drug Administration, Center for Drug Evaluation and Research; 2005. Available at http://www.fda.gov/cder/drug/advisory/mifeprex.htm.
Sinave C, Le Templier G, Blouin D, Leveille F, Deland E. Toxic shock syndrome due to Clostridium sordellii: a dramatic postpartum and postabortion disease. Clin Infect Dis 2002;35:1441--3.
McGregor JA, Soper DE, Lovell G, Todd JK. Maternal deaths associated with Clostridium sordellii infection. Am J Obstet Gynecol 1989;161:987--95.
Editorial Note: The number of Toxic Shock Syndrome cases reported annually to CDC has decreased substantially in the 10-year period since menstrual Toxic Shock Syndrome was first recognized. Changes in public awareness and diminished attention to Toxic Shock Syndrome in the medical literature might have resulted in reduced diagnosis and reporting. However, reporting of non-menstrual Toxic Shock Syndrome has remained constant during this time while menstrual Toxic Shock Syndrome reporting has decreased.
A multistate active surveillance study in 1986-1987 confirmed the trends detected by national passive surveillance (7). Through active case-finding efforts in an aggregate population of 34 million persons, the rate for menstrual Toxic Shock Syndrome was determined to be 1.0 per 100,000 women 15-44 years of age (7). This rate represented a substantial reduction from rates reported in similar studies in 1980 (6.2 per 100,000 women 12-49 years of age in Wisconsin (8), 9.0 per 100,000 women 12-45 years of age in Minnesota (9), and 12.3 per 100,000 women 12-49 years of age in Utah (10)). Active surveillance also confirmed that the proportion of Toxic Shock Syndrome associated with menstruation had decreased considerably: in 1988, menstrual Toxic Shock Syndrome accounted for 55% of cases detected both by active surveillance (7) and by the passive surveillance system.
A principle reason for the decreased incidence of menstrual Toxic Shock Syndrome may be decreases in the absorbency of tampons. In 1980, when tampon absorbency (in vitro) ranged from 10.3-20.5 g (4), very high absorbency products ( greater than 15.4 g) were used by 42% of tampon users (9). After the association between Toxic Shock Syndrome and absorbency was recognized, manufacturers lowered the absorbency of tampons. In 1982, the Food and Drug Administration (FDA) issued a regulation requiring that tampon package labels advise women to use the lowest absorbency tampons compatible with their needs. By 1983, tampon absorbency ranged from 6.3-17.2 g (6), and the proportion of tampon users using very high absorbency tampons had declined to 18%. By 1986, very high absorbency products were used by only 1% of women who used tampons. Effective March 1990, the FDA instituted standardized absorbency labeling of tampons, which currently range from 6-15 g.
Tampon composition has also changed since 1980. Rely tampons consisted of polyester foam and cross-linked carboxymethylcellulose, a combination that is no longer used in tampons. Polyacrylate-containing tampons were withdrawn from the market in 1985. Current tampons are manufactured from cotton and/or rayon. The unique composition of Rely tampons may have been responsible for the increased risk associated with those products (11); however, the role of current tampon composition as an independent risk factor for Toxic Shock Syndrome is unclear since composition may vary even for a particular brand and style of tampon marketed at a given time.
Other factors may have contributed to decreased reports of menstrual-related Toxic Shock Syndrome. For example, public awareness of the syndrome may cause women to seek medical care earlier in their illness; milder disease may not meet the surveillance case definition of severe multisystem illness. Increased variety in menstrual products and concern related to Toxic Shock Syndrome may have resulted in fewer women using tampons or fewer using tampons continuously.
Current public health efforts to prevent menstrual-related Toxic Shock Syndrome include tampon package labels and package inserts which describe early signs and symptoms of Toxic Shock Syndrome and warn the consumer about the risk associated with tampons. Tampon users are encouraged to select lower absorbency products to further decrease risk of Toxic Shock Syndrome. Standardized absorbency labeling permits consumers to compare absorbency between brands.
The precise mechanism by which Rely tampons increased the risk of Toxic Shock Syndrome is unknown. The increased risk associated with high absorbency tampons is also poorly understood; high absorbency may be a surrogate for another effect. However, the withdrawal of Rely tampons and the subsequent decrease in use of high absorbency tampons correlate with a marked decrease in incidence of menstrual-related Toxic Shock Syndrome. The rapid demonstration of the risk of Rely and high absorbency tampons resulted in prompt public health interventions and substantial reduction in menstrual Toxic Shock Syndrome.
Tampon
Truth's and Tragedies
The Following Information Courtesy of: http://www.tamponalert.org.uk
and
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.
More Stories on Women and Girls who Died or were Injured due to Tampon-induced Toxic Shock
1.
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.
Posted 30/12/2000
2.
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.
Posted 30/12/2000
3.
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.
Posted 30/12/2000
4.
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.
Posted 30/12/2000
5.
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.
Posted 30/12/2000
6.
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.
Posted 30/12/2000
7.
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.
On
Thursday, her condition had deteriorated. Now, Sharon's fingernails and lips
were turning blue, the rash was like sunburn and she was having breathing
difficulties.
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
Posted 30/12/2000
8.
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.
By
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.
Posted 30/12/2000
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.
Posted 30/12/2000
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:
Toxic Shock Syndrome (TSS)
What is " Toxic Shock" and Toxic Shock Syndrome?
Toxic
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.
To
help prevent toxic shock syndrome, you should follow these guidelines:
1.
Wash your hands before unwrapping and placing a new tampon in your vagina.
2.
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).
4.
Do not use tampons all the time and switch to a pad for part of each day.
5.
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.
Historical Perspectives Reduced Incidence of Menstrual Toxic-Shock Syndrome -- 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 (Figure 1).
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 Toxic Shock Syndrome 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 Toxic Shock Syndrome died; in 1988 and 1989, there were no deaths among women with menstrual Toxic Shock Syndrome. Reported by: Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.
On July 22, this notice was posted as an MMWR Dispatch on the MMWR website (http://www.cdc.gov/mmwr).
On July 19, 2005, the Food and Drug Administration (FDA) issued a public health advisory regarding the deaths of four women in the United States after medical abortions with Mifeprex® (mifepristone, formerly RU-486; Danco Laboratories, New York, New York) and intravaginal misoprostol (1). Two of these deaths occurred in 2003, one in 2004, and one in 2005. Two of these U.S. cases had clinical illness consistent with toxic shock and had evidence of endometrial infection with Clostridium sordellii, a gram-positive, toxin-forming anaerobic bacteria. In addition, a fatal case of C. sordellii toxic shock syndrome after medical abortion with mifepristone and misoprostol was reported in 2001, in Canada (2). All three cases of C. sordellii infection were notable for lack of fever, and all had refractory hypotension, multiple effusions, hemoconcentration, and a profound leukocytosis. C. sordellii previously has been described as a cause of pregnancy-associated toxic shock syndrome (3).
Investigation by FDA, CDC, and state and local health departments into the two most recently identified U.S. deaths after medical abortion is ongoing. Empiric therapy for patients suspected of having postpartum or postabortion toxic shock syndrome should include antimicrobials with anaerobic activity against Clostridium species. Health-care providers are encouraged to report any cases of postpartum or postabortion toxic shock syndrome to their state or local health department and to CDC at telephone 800-893-0485. Cases potentially associated with of mifepristone or misoprostol should also be reported through the FDA MedWatch system available at http://www.fda.gov/medwatch/index.html or telephone 800-FDA-1088.
Food and Drug Administration. FDA Public Health Advisory: sepsis and medical abortion. Rockville, Marylan: Food and Drug Administration, Center for Drug Evaluation and Research; 205. Available at http://www.fda.gov/cder/drug/advisory/mifeprex.htm.
Sinave C, Le Templier G, Bluin D, Leveille F, Deland E. Toxic shock syndrome due to Clostridium sordellii: a dramatic postpartum and postabortion disease. Clin Infect Dis 2002;35:1441--3.
McGregor JA, Soper DE, Lovell G, Todd JK. Maternal deaths associated with Clostridium sordellii infection. Am J Obstet Gynecol 1989;161:987--95.
Editorial Note: The number of Toxic Shock Syndrome cases reported annually to CDC has decreased substantially in the 10-year period since menstrual Toxic Shock Syndrome was first recognized. Changes in public awareness and diminished attention to Toxic Shock Syndrome in the medical literature might have resulted in reduced diagnosis and reporting. However, reporting of non-menstrual Toxic Shock Syndrome has remained constant during this time while menstrual Toxic Shock Syndrome reporting has decreased.
A multistate active surveillance study in 1986-1987 confirmed the trends detected by national passive surveillance (7). Through active case-finding efforts in an aggregate population of 34 million persons, the rate for menstrual Toxic Shock Syndrome was determined to be 1.0 per 100,000 women 15-44 years of age (7). This rate represented a substantial reduction from rates reported in similar studies in 1980 (6.2 per 100,000 women 12-49 years of age in Wisconsin (8), 9.0 per 100,000 women 12-45 years of age in Minnesota (9), and 12.3 per 100,000 women 12-49 years of age in Utah (10)). Active surveillance also confirmed that the proportion of Toxic Shock Syndrome associated with menstruation had decreased considerably: in 1988, menstrual Toxic Shock Syndrome accounted for 55% of cases detected both by active surveillance (7) and by the passive surveillance system.
A principle reason for the decreased incidence of menstrual Toxic Shock Syndrome may be decreases in the absorbency of tampons. In 1980, when tampon absorbency (in vitro) ranged from 10.3-20.5 g (4), very high absorbency products ( greater than 15.4 g) were used by 42% of tampon users (9). After the association between Toxic Shock Syndrome and absorbency was recognized, manufacturers lowered the absorbency of tampons. In 1982, the Food and Drug Administration (FDA) issued a regulation requiring that tampon package labels advise women to use the lowest absorbency tampons compatible with their needs. By 1983, tampon absorbency ranged from 6.3-17.2 g (6), and the proportion of tampon users using very high absorbency tampons had declined to 18%. By 1986, very high absorbency products were used by only 1% of women who used tampons. Effective March 1990, the FDA instituted standardized absorbency labeling of tampons, which currently range from 6-15 g.
Tampon composition has also changed since 1980. Rely tampons consisted of polyester foam and cross-linked carboxymethylcellulose, a combination that is no longer used in tampons. Polyacrylate-containing tampons were withdrawn from the market in 1985. Current tampons are manufactured from cotton and/or rayon. The unique composition of Rely tampons may have been responsible for the increased risk associated with those products (11); however, the role of current tampon composition as an independent risk factor for Toxic Shock Syndrome is unclear since composition may vary even for a particular brand and style of tampon marketed at a given time.
Other factors may have contributed to decreased reports of menstrual-related Toxic Shock Syndrome. For example, public awareness of the syndrome may cause women to seek medical care earlier in their illness; milder disease may not meet the surveillance case definition of severe multisystem illness. Increased variety in menstrual products and concern related to Toxic Shock Syndrome may have resulted in fewer women using tampons or fewer using tampons continuously.
Current public health efforts to prevent menstrual-related Toxic Shock Syndrome include tampon package labels and package inserts which describe early signs and symptoms of Toxic Shock Syndrome and warn the consumer about the risk associated with tampons. Tampon users are encouraged to select lower absorbency products to further decrease risk of Toxic Shock Syndrome. Standardized absorbency labeling permits consumers to compare absorbency between brands.
The precise mechanism by which Rely tampons increased the risk of Toxic Shock Syndrome is unknown. The increased risk associated with high absorbency tampons is also poorly understood; high absorbency may be a surrogate for another effect. However, the withdrawal of Rely tampons and the subsequent decrease in use of high absorbency tampons correlate with a marked decrease in incidence of menstrual-related Toxic Shock Syndrome. The rapid demonstration of the risk of Rely and high absorbency tampons resulted in prompt public health interventions and substantial reduction in menstrual Toxic Shock Syndrome.
Tampon
Truth's and Tragedies
The Following Information Courtesy of: http://www.tamponalert.org.uk
and
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.
More
Stories on Women and Girls who
Died or Were Injured due to Tampon use and
Tampon-induced Toxic Shock Syndrome
1.
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.
Posted 30/12/2000
2.
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.
Posted 30/12/2000
3.
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.
Posted 30/12/2000
4.
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.
Posted 30/12/2000
5.
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.
Posted 30/12/2000
6.
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.
Posted 30/12/2000
7.
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.
On
Thursday, her condition had deteriorated. Now, Sharon's fingernails and lips
were turning blue, the rash was like sunburn and she was having breathing
difficulties.
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
Posted 30/12/2000
8.
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.
By
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.
Posted 30/12/2000
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.
Posted 30/12/2000
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 and
Toxic Shock Syndrome
I
thought that you only got TSS if you forgot to change your tampon. Is this true?
Any woman may develop TSS 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 TSS 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 TSS whilst 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 TSS from other people?
No. TSS is not a contagious disease.
What is the link between TSS and tampon use?
The link is not clearly understood.
However, tampon research highlights three high RISK FACTORS: high absorbency tampons, continuous tampon use and low body immunity.
Tampon
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.
Is it possible to get TSS more than once?
Yes. A person who has had TSS can develop it again. If a women or girl has had TSS in the past, it is advisable not to use tampons again.
Menstrual TSS 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 TSS.
Toxic Shock Syndrome Symptoms
What
are the symptoms of TSS?
Symptoms can be similar to flu or food poisoning, but they can become serious
very quickly.
The symptoms of TSS 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.
What
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 TSS (Take a TSS information leaflet with you).
Don't worry about wasting the doctor's time, you could be saving your life.
What Is The Treatment For TSS?
With early diagnosis, TSS 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 TSS-associated strains of S-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 TSS 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
1980;29:229-30.
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.
1. CDC. Toxic-shock syndrome--United States. MMWR
1980;29:229-30.
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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