If you've heard of tampons, you've probably heard of toxic shock syndrome.

Information about the infection is included with every box on the market, warning users not to leave a tampon in for more than eight hours, to use the correct absorbency, and to alternate with pads where possible - all to curb the risk of TSS. But how exactly does the infection happen, why is it related to menstrual products, and what actually happens if you get it? (It's important to note that TSS isn't just caused by tampons. The infection is commonly linked to the product due to the significantly higher numbers of menstruating women (about half of all patients) who become infected - but men, children, and menopausal women can also experience TSS.) So what is toxic shock syndrome (TSS)?  TSS is a complication caused by bacterial toxins, Streptococcus pyogenes or Staphylococcus aureus. The condition is primarily associated with tampon use, however the removal of certain kinds of high absorbency tampons from the market has lowered the risk of TSS considerably. In the 1980s, 'Rely' tampons were pulled from circulation because they carried a higher risk of TSS than any other tampon. The brand boasted that it could "absorb nearly 20 times its own weight in fluid" and "even absorb the worry!" The tampon was made from compressed pieces of polyester which often led to vaginal dryness due to its high level of absorbency. This made it substantially easier for bacterial toxins to infect the body. Nowadays, TSS affects an extremely small percentage of women, however recent and notable cases have been recorded. What are the symptoms?  A person experiencing toxic shock syndrome may experience any of the following:

• Sunburn-like rash (usually on the palms, feet soles, mouth, and eyes)
• High fever
• Low blood pressure
• Sore muscles
• Vomiting and nausea
• Diarrhoea
• Headaches and migraines
• Confusion

If you have any of the symptoms relating to TSS, the first thing you need to do is remove your tampon right away. If you're concerned that you might have the infection, contact your doctor, and set up an appointment. A lot of the symptoms associated with TSS are also linked to other non-related (and often non-life threatening) conditions so it's extremely important that you don't try to self-diagnose. Is TSS treatable?  TSS is usually treated by antibiotics and other medication in the hospital while doctors determine the source of the infection. The toxins produced by the bacteria maybe lead to organ failure or the presence of non-living tissue. Surgery may be required to remove such tissue. This can include the amputation of limbs or digits. How many people are affected? Over all, about one in 100,000 people are affected by toxic shock syndrome in the US every year. This number is very low making the chance of developing the infection extremely rare, however if TSS is present, it can be detrimental to the patient. A patient with TSS may need surgery to remove the infected area. This can often mean the amputation of the limbs, finger tips, or drainage of the infected area. In 2012, model Lauren Wasser lost part of her right leg to toxic shock syndrome associated with tampon use. A few years later, she lost her left one. Wasser filed a lawsuit against the company that manufactures Kotex tampons in 2015. She said that she'll never use a tampon again.  Have people died from toxic shock syndrome?  TSS can be fatal but a lot of the noted cases resulting in death have been unrelated to tampon use. However, one recent case that garnered widespread media attention was attributed to the product. In 2017, a teenage girl named Sara Manitoski died of toxic shock syndrome while she was on a school trip in British Colombia. The coroner's report later detailed that a strain of staphylococcus aureus was found on the tampon that Manitoski had been using at the time of her death. She had also exhibited other signs of TSS, as well as intense stomach cramps. The 16-year-old's family later issued a warning about the use of tampons over extended periods of time and the signs and symptoms associated with the illness. What can I do to prevent TSS? TTS is rare, but not there are still certain things you can (and should) do to lower the risk of infection. If you're a tampon user, always ensure that you use the lowest absorbency possible. Information about this is clearly available on the side of the tampon box. If you find that your tampon is still white in places when you remove it after five or so hours, you may want to consider opting for a lower absorbency. The lower the absorbency of the tampon, the lower your chances of infection. Irrespective of how heavy your flow is, you should never leave a tampon in for more than eight hours. Make it six or seven to be safe. Ideally, a tampon should be changed every four or five hours. You should avoid sleeping with a tampon in, unless you're absolutely sure that you won't sleep for more than eight hours. Switching to a pad or panty liner on days when your flow is lighter is also highly recommended. https://www.youtube.com/watch?v=5PedBkPNvIk&feature=youtu.be

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For the month of February, Her will be #OnTheRag.  We'll be chatting all things periods, products, and pain as we delve deep inside the uterus to figure out why we bleed and - more importantly - how we cope. We'll also be talking to the experts about some of the period related conditions you have heard of - and all of the ones that you haven't.  You can follow the rest of the #OnTheRag series here or follow our Instagram account for more period related content.  Want to get in touch? Email us at jade@her.ie.