How can my daughter choose the right tampon?

The type of tampon that is right for your daughter depends on her menstrual flow. Simply stated, she should match the absorbency of the tampon to her flow. If she has a light flow, then she should try the junior or regular tampon. If her tampon is completely soaked before 4 hours, she should try one with higher absorbency.

However, you should caution your daughter that if a tampon is too absorbent for her flow, vaginal dryness and even vaginal ulcerations can occur. If a tampon is dry and hard to remove, shreds, or doesn't need to be changed for many hours, she should switch to a less absorbent tampon. Why is this important? Because research suggests that the risk of Toxic Shock Syndrome may increase with tampon absorbency. However, please note this doesn't mean your daughter should shy away from using higher absorbency tampons if she really needs them.

What is Toxic Shock Syndrome?

Toxic Shock Syndrome^[1] (or TSS) is a rare but potentially life-threatening illness. Researchers believe it is caused by an infection resulting from certain staph and strep bacteria that often exist even in a healthy woman's vagina. The exact process is unknown, but it's thought that these bacteria multiply in the presence of a blood-soaked tampon. It's actually not the bacteria that cause the TSS directly. Rather, it's the toxins that the bacteria produce that do the harm.

It's important to note that staph bacteria^[2] are very common. We all have them on our skin and inside our noses. Usually they are harmless, but if they gain access to the bloodstream or deeper tissue, they can cause a serious infection.

For TSS to occur, certain strains of the bacteria have to overpopulate and produce large amounts of toxin^[3]. This toxin then has to gain access to the bloodstream. One generally accepted theory is that super-absorbent tampons that are left in the vagina for extended periods of time can encourage growth of the bacteria. And importantly, these super-absorbent tampons can also adhere to the vaginal wall if they are dry and the menstrual flow is light, thereby causing tiny abrasions when removed.

These abrasions then provide access to deeper tissue or to the bloodstream for the bacteria and toxins.

What are the symptoms of TSS?

The symptoms of TSS include fever, vomiting, dizziness, diarrhea, fainting, a sunburn-like rash, muscle aches, sore throat, headache, joint pain, red eyes, and sensitivity to light. As the illness progresses, TSS can also lead to mental confusion, kidney failure, a drop in blood pressure, and collapse. One to two weeks after the initial symptoms, peeling patches of skin on the palms and soles can occur.

These symptoms typically appear during a woman's period or a few days after. If a woman suspects she has TSS, she should remove her tampon immediately and call her doctor or go to the emergency room for immediate evaluation. Treatment requires hospital admission for intravenous antibiotics to kill the bacteria, intravenous fluids to treat the low blood pressure and dehydration, and observation and treatment for signs of kidney failure. With appropriate treatment, most patients will recover in 2 to 3 weeks.

• [1] A rare and potentially lethal illness caused by toxins excreted from bacteria. Historically linked to tampon use, Toxic Shock Syndrome can occur anytime these toxins have an opportunity to gain access into the human body. Symptoms include fever, a drop in blood pressure, rash, peeling of skin from palms and soles, nausea and vomiting, liver inflammation, renal failure, low blood platelets, and confusion.
• [2] A common type of bacteria normally found on skin surfaces that can cause infections. The staphylococcus aureus bacteria can produce a toxin that is the cause of Toxic Shock Syndrome.
• [3] A poisonous product of animal and plant cells or bacteria that causes tissue damage and antibody formation.