Q:Please tell us what you can about toxic shock syndrome and the general dangers of tampons. Are there any health risks with sanitary towels? M F, Washington, DC…….

A:Toxic shock syndrome, which was identified in the US in 1980, is a potentially fatal severe infection of the blood, caused by a toxin called TSST-1. This toxin is produced by the otherwise benign staphylococcus aureus bacteria, which is present in the warm moist parts of the human body, including the vagina. In nearly a third of the population it tends to sit there without doing much harm. Although we don’t understand how the staph germ gets converted into this toxin, the majority of cases occur in young women, and are mainly caused by using tampons.

The current statistics are that one in 30,000 to one in a million women will contract TSS each year. In the US, the estimates are even higher: 17 cases a year of tampon related TSS for every 100,000 women.

The symptoms we think of as TSS are the body’s wholesale effort to fight extreme poisoning. These usually include flu-like symptoms, sudden high temperature, dizziness, headache, sore throat and aching muscles, vomiting and diarrhea, low blood pressure and a rash which appears to be sunburn. The danger phase begins with a sudden drop in blood pressure and respiratory failure. If caught early enough, TSS can be treated quickly with antibiotics in hospital; the main problem is identifying the problem.

Left untreated, TSS can lead to kidney or respiratory failure or even heart attack. If you do survive, nearly every major organ can be affected. Victims typically lose their hair, fingernails and toenails, and often their concentration and memory, for as long as a year. Some women are left with liver and kidney problems or deafness and arthritis.

Two-thirds of all cases occur the under 25s, with the 15-19 year olds most at risk, largely because their immune systems may not be fully developed.

In the UK, the Women’s Environmental Network, and an organization called the Alice Kilvert Tampon Alert (AKTA), run by the parents of Alice, a 15 year old who died of TSS, have been at the forefront of campaigns to identify tampons as a significant health risk. Although medicine doesn’t really know what it is in tampons that triggers the production of toxins, the AKTA says that the surface of the tampon may provide a place for the bacteria to colonize. Although the longer the tampon is in place, the more bacteria can multiply, TSS has also occurred in women who change tampons regularly.

WEN notes that tampons absorb a goodly number of vaginal secretions, along with menstrual blood. This can lead to vaginal dryness, which in turn can actually damage vaginal walls, leading to peeling of the mucous membrane. WEN has gathered statistics showing that a fifth of all tampon users suffer from “micro ulceration”, which heals between periods, but whose long term significance isn’t known. It’s thought that this micro ulceration can lead to larger ulceration and increase bleeding. Up to three-quarters of all tampon users have some alteration to the mucous membrane of the vagina.

The greatest risk factor appears to be super absorbent tampons, which appear to increase the risk of damage and ulceration. They also contain more rayon, which appears to change the chemical environment of the vagina; fibres from tampons have been found in vaginal walls. By drying out and damaging the vaginal walls, the tampons may also make it easier for the bacterial toxins to make their way into the bloodstream.

Rayon, a synthetic fibre, is also potentially dangerous because the process of processing the eucalyptus woodpulp involves the use of chlorinated compounds, which causes dioxin as a byproduct, minute remnants of which remain in the fibre. The US Environmental Protection Agency has gone on record to say that dioxin causes cancer in humans and that there may be no safe level. Increasing evidence points to dioxin in santitary products as a major cause of endometriosis (see

WDDTY vol 5 no 10).

Although the US mandates that absorbancy rates be standardized and the individual rates of every brand be published on the outside packaging, they are not regulated in the UK.

The best form of protection is to avoid tampons altogether, particularly if you are under 25. But if you must use them, AKTA recommends that you use the lowest absorbency possible and a low-fibre loss brand, and change all tampons every four to six hours.

In case you’re feeling complacent about using sanitary towels, you might wish to see what the WEN has uncovered about these. Up until 1989, all sanitary towels were made from paper pulp entirely bleached with chlorine. This process not only produces dioxin but many hundreds of other organo-chlorine compounds, which reek havoc with human health, making their way into our food and water supplies (see WDDTY issue on pesticides, vol 6 no 3). However, now that the dangers of chlorine bleaching have been well publicized, some manufacturers have attempted to produce pulp bleached by alternative means. The best so far is a process called Chemo Thermo Mechnical Pulp (CTMP), which uses hydrogen peroxide and appears to be safer; beware of methods called “oxygen bleaching” which use a smaller percentage of chlorine gas and still release OC compounds. British cotton only tampons are bleached with hydrogen peroxide and sodium hypochlorite.

The new style super-thin towels being pounced on by most manufacturers these days contain super-absorbent materials as polyacrylate gels the same substances which are used in disposable nappies. The initial studies which passed the US and UK governments demonstrate that the toxicity is low. However, we do know that workers in plants which manufacture these gels suffer eye and lung damage. And the bottom line is we don’t know the long term dangers of these gels on women (or, for that matter, babies), or whether the plastic coverings used will be breeding grounds for illnesses like toxic shock syndrome.

Your safest bet is to stick with the older style cotton towels, to avoid bleached varieties and perhaps to investigate the idea of reuseable toweling, which are both good for you and the environment.

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Written by What Doctors Don't Tell You

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