How to Reduce Your Risk of Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a rare, potentially life-threatening condition that can develop in menstruating women when certain types of bacteria in the vagina enter the body and bloodstream. Although scientists have recognized a connection between tampons and cases of TSS, the exact connection remains unclear. Learn more about what causes toxic shock syndrome and what you can do to prevent it.

Pile of unwrapped tampons close up
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Causes of Toxic Shock Syndrome

Toxic shock syndrome is caused by three different types of bacteria, including:

  • Staphylococcus aureus: This type is part of the body's "normal bacteria." It can live on the body without causing infection and many people can develop antibodies against it.
  • Clostridium sordellii: This type of bacteria is commonly found in the vagina and may not cause infection.
  • Streptococcus pyogenes: This type of bacteria is found in patients with weakened immune systems or other infections (like cellulitis).

Keep in mind that using tampons isn't the only way you can get toxic shock syndrome. In fact, only about half of all cases are found in menstruating women. Although the condition is most commonly linked to tampon use in menstruating women, it can affect people of all ages, including men and children.

Infection usually occurs when bacteria enters your body through an opening in your skin. For instance, bacteria can enter through a cut, sore, or other open wounds. Tampons—or in rare cases a menstrual cup—can trap bacteria in the vagina, where they grow and multiply. From there, bacteria can pass through the cervix into the uterus, or enter the bloodstream through small microabrasions in the vagina.

Toxic Shock Syndrome and Tampons

First, the good news: You don't have to quit using tampons in order to avoid TSS. Most cases of tampon-related TSS are a result of using tampon products the offer the highest absorbency and/or leaving them in for too long. When it comes to TSS, most medical professionals agree that it’s not the tampons that are the problem; rather, it's improper tampon use.

Manufacturers of tampons sold in the United States no longer use the materials or designs that were associated with early cases of TSS in the 1970s. The Food and Drug Administration (FDA) now also requires manufacturers to use standard measurements and labeling for absorbency and to print guidelines for proper use on the boxes.

Still, when it comes to the risk of a serious condition, it doesn't hurt to play it safe.

How to Prevent Toxic Shock Syndrome

If you use tampons, follow these seven safety tips to avoid toxic shock syndrome:

  1. Always use the lowest possible absorbency tampon for your flow. This might mean using different absorbency levels at different points during your period. All tampon products in the United States use the standard Light, Regular, Super, and Super Plus labeling, according to FDA guidelines for tampon absorbency.
  2. Change tampons at least every four to eight hours, and avoid wearing one to bed unless you plan on waking during the night to change it. When your flow is light, use sanitary napkins or mini pads.
  3. Be sure to wash your hands thoroughly before and after inserting tampons. Staphylococci bacteria are often found on the hands.
  4. If vaginal dryness is an issue, use a lubricant when inserting a tampon to avoid irritating the vaginal lining.
  5. Do not use tampons—for vaginal discharge or any other reason—between menstrual cycles.
  6. Do not use tampons if you have a skin infection near your genitals.
  7. If you've had a case of TSS in the past, talk with your doctor before resuming tampon use.

When to Call Your Doctor

If you experience any signs of TSS—a sudden, high fever; vomiting or diarrhea; a sunburn-like rash on the palms of your hands and soles of your feet; redness of your eyes, mouth, and throat; or a drop in blood pressure—call your physician immediately. If toxic shock syndrome is left untreated, it can be fatal.


If you develop toxic shock syndrome, you'll likely be hospitalized and treated with antibiotics and fluids to treat dehydration. Depending on your symptoms, your doctor may ask for blood and urine samples to test for the presence of a staph or strep infection. Since TSS can affect multiple organs, your doctor may also order other tests like a CT scan, lumbar puncture, or chest X-ray.

A Word from Verywell

Selecting a menstrual product to use during your monthly cycle is an individual decision. If you use tampons, it's important to understand how to use them properly, and how misuse can contribute to the risk of developing toxic shock syndrome. Talk to your doctor if you have questions about how to use tampons safety to avoid TSS.

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Article Sources
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  1. Johns Hopkins Medicine. Toxic shock syndrome (TSS).

  2. Cleveland Clinic. Toxic shock syndrome. Updated July 11, 2018.

  3. U.S. Food & Drug Administration. The Facts on Tampons—and How to Use Them Safely. Updated September 30, 2020.