A menstruator lays in bed, looking at period products and wondering about how they play into toxic shock syndrome.

Toxic Shock Syndrome: Everything to Know

contribRemember that book you read when you first got your period? Inside its pages, you probably found tips on how to handle cramps, good hygiene practices, and a warning about Toxic Shock Syndrome (TSS). But what do you really remember about TSS? We’re here to refresh your memory on TSS, what triggers it, and the pros of switching to a menstrual cup. 

What is TSS? 

Toxic Shock Syndrome (TSS) is an infection caused by two types of bacteria, mainly Staphylococcus Aureus (staph), and Group A Streptococci (strep). TSS occurs when an overgrowth of bacteria releases toxins into the bloodstream, causing severe symptoms and sending your body into shock. While menstrual TSS is serious, it is actually very rare: according to the National Organization for Rare Disorders, TSS affects between 1-3 out of 100,000 menstruators. 

What causes TSS? 

While anyone can get TSS if they are exposed to harmful bacteria through surgery or open wounds, menstrual Toxic Shock Syndrome is most often linked to staphylococcus overgrowth caused by tampon use. Staph exists naturally in 30-50% of the population and 10-20% of people carry staph vaginally. Staph is usually kept in check by other bacteria in the vagina and doesn’t become an issue. However, given the right environment, an overgrowth of staph bacteria can release the toxin that causes TSS. 

What increases risk for TSS? 

When it comes to menstrual TSS, improper tampon use can increase your risk. Wearing a tampon, especially the ultra-absorbent kind, for longer than 4-8 hours can encourage bacterial growth inside the vagina. Tampons can also stick to the vaginal wall, especially on lighter period days, which can create tiny abrasions that make it easier for bacteria to enter the bloodstream. While early research hypothesized that some tampon materials create a better environment for staph growth, more recent studies have shown that there is no meaningful difference between pure cotton and nylon or rayon blend tampons. 

Do menstrual cups cause TSS? 

Switching to a menstrual cup like The June Cup can help reduce your risk for TSS, especially if you have a hard time remembering to change your tampon every 4-8 hours. While it’s highly unlikely to contract TSS with a menstrual cup, it’s not impossible.

One in-vitro lab study showed that it is possible for staph bacteria to grow inside the well of a menstrual cup. While the study was not done with actual human participants, the scientists who conducted the study hypothesized that this staph growth may only become an issue in humans if the cup overflows.

While more research needs to be done to validate that hypothesis, it’s important to remember to empty your cup every 12 hours or when it becomes full. You should also thoroughly wash your cup and your hands with mild soap and water before inserting it.

Sanitizing your cup with boiling water is the only way to ensure that your cup is bacteria-free. We recommend sanitizing your cup after your flow is over, but if you’re worried about TSS, you can sanitize it more often. 

PSA: If you've had TSS, you're at greater risk of developing it again-- talk to your doc before switching to a menstrual cup to make sure it’s the right step for you. Always practice good menstrual hygiene and seek medical help if you start experiencing symptoms or signs of an infection like low blood pressure, a sudden high fever, headaches, seizures, muscle aches, and vomiting. 

Ready to make the switch from tampons to a cup? 

Shop JUNE Kits 



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