One of the most prevalent rumors is that sleeping with a tampon in during your period is practically a guarantee that you’ll wind up with TSS, so you should never do it unless you want to take that risk. But sleeping with a tampon in also happens to be way more convenient and significantly less messy than relying on a pad—so how concerned should you really be? Here, experts discuss the truth about tampons and toxic shock syndrome.
No doubt you’ve heard of TSS before, but you may be hazy on the details.
TSS is primarily caused by Staphylococcus aureus (staph) bacteria, but it can also be caused by a kind of Streptococcus (strep) bacteria, according to the Mayo Clinic. Clostridium sordellii can cause this infection as well, according to the Cleveland Clinic.
Your vagina has its own natural bacterial flora, and it can contain these bacteria without making you sick, G. Thomas Ruiz, M.D., an ob/gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif., tells SELF. But sometimes this bacteria can produce the toxins that lead to toxic shock syndrome, according to the Mayo Clinic.
Unfortunately, no one really knows the exact mechanism that links tampons to TSS, Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School, tells SELF. One theory is that if you leave a tampon in for too long, these bacteria can flourish and become trapped, then enter your uterus through your cervix, according to the Cleveland Clinic.
This may be more likely if you use a really absorbent tampon when your period is too light to need one. Not only does this make it less likely that you’ll change it as often as you should, but the more absorbent a tampon is, the more it can dry out your vaginal mucosa, Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. This can increase the risk of tears in the vagina, which can allow bacteria to enter the body. The cuts don’t need to be big—even microscopic disruptions in your vaginal mucosa can be enough, Dr. Streicher says.
But TSS isn’t just associated with tampons. People can also develop TSS after getting a cut or burn on their skin, having recent surgery, using diaphragms or sponges, or having a viral infection like the flu or chickenpox, according to the Mayo Clinic.
While present-day tampons can cause TSS, the condition was most prevalent when women were using ultra-absorbent tampons that are no longer on the market.
Those tampons contained ingredients like polyester foam and carboxymethylcellulose, a thickening agent that enabled more expansion than other tampons did, according to the Centers for Disease Control and Prevention (CDC). This allowed women to keep ultra-absorbent tampons in for longer periods of time, but the longer wear allowed bacteria to colonize, Suzanne Fenske, M.D., assistant professor of obstetrics, gynecology, and reproductive sciences at Mount Sinai Health System, tells SELF.
Tampons with these ingredients were pulled from shelves after the spate of TSS cases, according to the CDC. Now, the Food and Drug Administration requires that manufacturers use a set system for measuring tampon absorbency so as not to get into dangerous territory. That doesn’t mean that the tampons on sale today can’t cause TSS, but that they’re much less likely to do so than higher-absorbency ones from decades ago.
The vast majority of people who leave a tampon in too long will be fine.
TSS isn’t as common as it once was, but there’s still a small risk of developing it. At its peak in 1980, incidence rates of TSS were 6 to 12 per 100,000 women between the ages of 12 and 49, according to the CDC. By 1986, that went down to 1 in 100,000 women between the ages of 15 and 44, and that’s still the approximate incidence today.
“The most common side effect [of using a tampon for too long] is a smelly vaginal odor,” Sherry A. Ross, M.D., an ob/gyn and women's health expert at Providence Saint John’s Health Center in Santa Monica, Calif., and author of She-ology: The Definitive Guide to Women's Intimate Health. Period., tells SELF.
It’s unclear why a few unlucky people develop TSS after leaving a tampon in for too long while so many others others don’t, Maura Quinlan, M.D., M.P.H., an assistant professor in the Department of Obstetrics and Gynecology at the Northwestern University Feinberg School of Medicine, tells SELF. “For some women, their immune system may not fight off the bacteria as well,” she says. But again, doctors really don’t know.
Still, it’s important to learn the signs of TSS so that, if it ever does happen to you or someone close to you, you can get help as soon as possible.
Common TSS symptoms include a sudden high fever, low blood pressure, vomiting or diarrhea, a rash that looks like a sunburn, confusion, muscle aches, seizures, and headaches, according to the Mayo Clinic.
If you suspect that you have TSS, get to the emergency room immediately—the condition can progress quickly, Dr. Quinlan says. There’s no one test for TSS, but doctors will likely take blood and urine samples to test for a staph or strep infection, according to the Mayo Clinic.
While doctors try to figure out the source of the infection, you’ll be treated with antibiotics, receive medication to stabilize your blood pressure if it’s low, get fluids to treat dehydration, and have other care based on how your illness is presenting. In very serious cases, surgery can be necessary to remove dead tissue that resulted from the infection.
Bottom line: TSS is scary, but you can sleep with a tampon in as long as you don’t push the eight-hour limit.
It’s also important to use the lowest-absorbency tampon possible to lower the odds that you’ll develop TSS, Dr. Minkin says. The less absorbent your tampon, the less likely you’ll leave it in for too long, and the less likely it’ll sap your vaginal mucosa of too much moisture. The guidelines are there for a reason—if you want to be as safe as possible, follow them.
Dr. Ruiz recommends putting in a new tampon right before you go to sleep and changing it as soon as you get up. Even better if you can manage it when you get up to pee in the middle of the night, he says, but it’s not a requirement—if you’d rather tumble back into bed and deal with it in the morning, feel free. And if you’d prefer to avoid the whole question of sleeping with a tampon in altogether, you may want to try something like a menstrual cup instead. These reusable products are typically made of medical-grade silicone, collect blood rather than absorbing it, and can be used safely for up to 12 hours—more than enough time to hit snooze and still be completely in the clear.