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.
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). The Pros And Cons Of Tampons 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 Boulder , Colo. Chandler encourages patients to use nonchlorine-bleached, 100 percent-organic cotton tampons and pads. "We're lucky to have healthier choices," she says. Dioxin Dilemma 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 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 TSS is caused when staph or strep bacteria grow in the vagina, usually encouraged by the presence of a higher absorbency tampon or one that has been inserted more than eight hours. The bacteria produce toxins that are absorbed into the bloodstream, which can cause a severe drop in blood pressure (shock) and/or organ failure, especially of the liver and kidneys. In some cases, TSS is fatal. Its symptoms are similar to the flu, including a high fever, vomiting and diarrhea, muscle aches, dizziness or fainting, a red rash, headaches, bloodshot eyes and sore throat. "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 TSS , choose a tampon made of 100 percent cotton, preferably organic. "You're at the lowest risk possible with cotton," says Tierno. "In my research, every synthetic fiber amplified toxin development, whereas cotton did not." Most precautions for guarding against TSS are simple, says holistic nurse practitioner Pam Chandler, a specialist in women's health care. Wear a tampon for a maximum of six to eight hours to avoid bacterial growth. However, she recommends leaving it in for at least two hours. "If you remove a tampon too soon, it won't be saturated," she says. "Then you risk scraping the dry, fragmented cotton across the vaginal mucosa, irritating it and setting the scenario for infection." Also, using a tampon overnight, when planning to sleep longer than eight hours, is risky. At night, consider wearing a pad instead, she advises. Choosing a tampon with proper absorbency is crucial to preventing TSS . "At the beginning of your period, if your flow is heavy, you may need Super Absorbency so you don't have to change tampons too often," says Chandler . When the flow slows, however, don't be tempted to continue with a Super because it's more convenient. Switch to a lower absorbency tampon instead. Also, use tampons only during menstruation. Careful Liberation 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 Chandler , who points out that while this is liberating, it also makes it easy to take their use for granted. 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. Clostridium sordellii Toxic Shock Syndrome After Medical Abortion with Mifepristone and Intravaginal Misoprostol --- United States and Canada, 2001--2005On 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. References
Editorial NoteEditorial 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 and in Memory of Alice Kilvert, who died at the age of 15 due to Alice's Story
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. Posted 30/12/2000 2. JEAN OF SURREY. Posted 30/12/2000 3. JUDY OF OXFORDSHIRE. Posted 30/12/2000 4. ANNETTE OF MIDDLESEX Posted 30/12/2000 5. KAREN OF HAMPSHIRE. 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. 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. 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. 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. 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. 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: Alice Kilvert Tampon Alert16 Blinco Road Urmston Manchester, UK M41 9NF Telephone or Fax: 0161-748-3123 Email: This e-mail address is being protected from spambots, you need JavaScript enabled to view it 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. Clostridium sordellii Toxic Shock Syndrome After Medical Abortion with Mifepristone and Intravaginal Misoprostol --- United States and Canada, 2001--2005On 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. References
Editorial NoteEditorial 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 and in Memory of Alice Kilvert, who died at the age of 15 due to Alice's Story
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. Posted 30/12/2000 2. JEAN OF SURREY. Posted 30/12/2000 3. JUDY OF OXFORDSHIRE. Posted 30/12/2000 4. ANNETTE OF MIDDLESEX Posted 30/12/2000 5. KAREN OF HAMPSHIRE. 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. 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. 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. 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. 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. 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: Alice Kilvert Tampon Alert16 Blinco Road Urmston Manchester, UK M41 9NF Telephone or Fax: 0161-748-3123 Email: This e-mail address is being protected from spambots, you need JavaScript enabled to view it
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? 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:-
Can you catch TSS from other people? What is the link between TSS and tampon use? 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. | |||||||||||
