Period & Health

Written by: Katrine Svensmark

New research sheds light on the impact of tampons and menstrual cups on the growth of Staphylococcus aureus and the production of toxic shock syndrome toxin 1 (TSST-1).

Toxic Shock Syndrome (TSS) is a rare but severe disease characterized by the growth of Staphylococcus aureus bacteria and the production of TSST-1 toxin. It presents with symptoms such as sudden high fever, rash, muscle aches, dizziness, and abdominal pain. Recent studies have examined the effects of currently marketed tampons and menstrual cups on S. aureus growth and toxin production, providing valuable insights into this condition’s characteristics and treatment.


What is Toxic Shock Syndrome?

Toxic Shock Syndrome (TSS) is a potentially life-threatening condition caused by certain strains of Staphylococcus aureus bacteria. It is important to distinguish between two types of TSS: menstrual Toxic Shock Syndrome (mTSS) and non-menstrual TSS. While both types are caused by the same bacteria, mTSS is specifically associated with menstruation and tampon use.

Proper diagnosis of TSS can be challenging as the symptoms can mimic other common illnesses, leading to underdiagnosis or misdiagnosis. Studies have shown that only a small percentage of TSS cases are correctly diagnosed. This highlights the need for increased awareness and education among healthcare professionals to ensure timely and accurate identification of TSS.

One factor that contributes to the development of TSS in menstruating women is the use of high-absorbency tampons. When tampons are left in place for an extended period, they create an environment conducive to bacterial growth and toxin production. However, it’s important to note that not all tampon use leads to TSS, and the risk can be mitigated by following proper tampon usage guidelines, such as using the lowest absorbency tampon necessary and changing it regularly.

Improving physician training and awareness regarding the symptoms and risk factors of TSS is crucial for early detection and appropriate management of the condition. By recognizing the unique challenges in diagnosing TSS and understanding the role of tampon usage and bacterial absorption, healthcare providers can contribute to better outcomes and patient safety.

Tampons vs. Cups: Safety Considerations for Menstrual Hygiene

When comparing the safety of tampons and menstrual cups, cups have been found to pose lower risks. Reported cases of complications associated with menstrual cups have been relatively low. However, it is important to consider factors that may contribute to bacterial growth and toxin production.

The bacterium S. aureus is linked to toxic shock syndrome (TSS) and it has different ways of controlling the production of a toxin called TSST-1, through several systems. Additionally, factors such as carbon dioxide, certain chemicals, pH level, temperature, and stems in the bacterium can also influence the production of TSST-1.

Understanding these complex factors can help ensure the safe use of menstrual cups and promote women’s health. It is crucial to implement proper hygiene practices, such as thorough cleaning and sterilization between uses, to minimize the risk of bacterial proliferation. Following the manufacturer’s guidelines for insertion and removal is also essential to reduce potential irritation and minimize the risk of TSS.

In conclusion, menstrual cups have demonstrated lower risks compared to tampons. By considering the various factors influencing bacterial growth and toxin production, we can take appropriate measures to ensure the safe and effective use of menstrual cups, prioritizing women’s well-being during menstruation.

New Research on Tampons and Menstrual Cups:

In a study investigating the growth of bacteria on menstrual cups, researchers examined the factors that contribute to bacterial colonization and the potential risk of infection. One of the key factors identified was oxygen exposure. Furthermore, the study highlights the importance of considering oxygen and carbon dioxide concentrations in the vaginal environment. During menstruation, the introduction of tampons can convert the vaginal environment from anaerobic to aerobic due to sustained oxygen tension. This change in the vaginal environment occurs due to the shedding of the endometrial lining, leading to the presence of oxygen. Consequently, menstrual cups, although made of silicone or rubber, can accumulate blood, providing a suitable medium for bacterial growth.

In this particular case, a 37-year-old woman developed symptoms of TSS after using a menstrual cup for the first time. The patient experienced fever, abdominal cramps, myalgias, and a generalized rash. Laboratory tests confirmed the diagnosis of TSS. The exact mechanism for the development of TSS, in this case, remains unclear, but it is speculated that factors such as mucosal irritation, high placement of the cup, and the presence of menstrual blood may have contributed.

The study conducted experiments to assess bacterial growth on menstrual cups by simulating menstrual conditions. They observed that menstrual blood, when retained in the cup, created an environment conducive to the growth of Staphylococcus aureus, a bacterium commonly associated with toxic shock syndrome (TSS). It was found that the combination of the high placement of a previously handled cup, a substantial volume of menstrual blood, and mucosal irritation within the vagina contributed to the growth of bacteria.

Moreover, the study compared the composition and structure of menstrual cups to tampons, which have been historically associated with TSS. It was noted that tampons made with hyper-absorbable materials could lead to the accumulation of blood and an increase in vaginal pH, providing a favorable condition for bacterial growth. In contrast, menstrual cups, made of silicone or rubber, do not support microbiological growth by themselves. However, due to the accumulation of menstrual blood, they can serve as a medium for bacterial colonization.

The study emphasized the importance of proper hygiene practices when using menstrual cups, such as thorough cleaning and sterilization between uses. It is also essential to follow the recommended guidelines for insertion and removal to minimize the risk of mucosal irritation, which refers to the inflammation or irritation of the mucous membranes lining the vaginal walls, and potential abrasions.

Prevention of Toxic Shock Syndrome:

To prevent Toxic Shock Syndrome, it is essential to follow proper hygiene practices during menstruation. Here are some guidelines to minimize the risk:

  1. Use the lowest absorbency tampon suitable for your flow and change it regularly, at least every 4 to 8 hours.

  2. Consider using sanitary pads or menstrual cups as an alternative to tampons. Menstrual cups, in particular, have been shown to have lower levels of S. aureus growth compared to tampons.

  3. Wash your hands before and after inserting or removing tampons or menstrual cups.

  4. Avoid using tampons overnight if possible. Opt for pads or menstrual cups instead.

  5. Familiarize yourself with the symptoms of TSS, such as sudden high fever, rash, muscle aches, dizziness, and abdominal pain. If you experience these symptoms while using tampons, remove the tampon immediately and seek medical attention.

Treatment of Toxic Shock Syndrome:

Toxic Shock Syndrome is a medical emergency, and prompt treatment is crucial. If you suspect you may have TSS, take the following steps:

  1. Remove any tampons or menstrual cups immediately.

  2. Seek medical attention without delay. Inform the healthcare provider about your symptoms and mention the possibility of TSS.

  3. Treatment typically involves hospitalization, where intravenous antibiotics are administered to fight the bacterial infection, and supportive care is provided to manage the symptoms.


Raising awareness about Toxic Shock Syndrome (TSS) and promoting vigilant menstrual hygiene practices is of utmost importance in ensuring the well-being and health of individuals during menstruation. While TSS is a rare condition, it can have serious consequences, particularly for menstruating women. Recent research focusing on the effects of tampons and menstrual cups on S. aureus growth and toxin production provides valuable insights that can inform prevention strategies.

In light of these findings, it is crucial for individuals to understand the significance of selecting tampons with the lowest absorbency and changing them regularly. Adhering to proper hygiene practices is also essential in reducing the risk of TSS. When used correctly, menstrual cups have been identified as a potentially safer alternative.

Furthermore, recognizing the early symptoms of TSS and seeking prompt medical attention is crucial for effective treatment. By promoting awareness of these symptoms and encouraging individuals to seek timely medical assistance, the impact of TSS can be mitigated.

In conclusion, the importance of raising awareness about TSS and emphasizing the need for individuals to be vigilant about their menstrual hygiene practices cannot be overstated. With the proper dissemination of knowledge, the adoption of preventive measures, and the availability of timely medical intervention, the risk of TSS can be minimized, ultimately ensuring the well-being and health of individuals during menstruation.


  • Mitchell, M. A., Bisch, S., Arntfield, S., & Hosseini-Moghaddam, S. M. (2015). A confirmed case of toxic shock syndrome associated with the use of a menstrual cup. The Canadian Journal of Infectious Diseases & Medical Microbiology, 26(4), 218–220. Retrieved 8. June 2023 from Link

  • Nonfoux, L., Chiaruzzi, M., Badiou, C., Baude, J., Tristan, A., Thioulouse, J., Muller, D., Prigent-Combaret, C., & Lina, G. (2018). Impact of Currently Marketed Tampons and Menstrual Cups on Staphylococcus aureus Growth and Toxic Shock Syndrome Toxin 1 Production In Vitro. Applied and Environmental Microbiology, 84(12), e00351-18. Retrieved 8. June 2023 from Link

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