Widely considered more convenient and less messy than their sterile pad competitors, tampons have been around for hundreds of year,s with surprisingly little mass incident. However, the 1970’s and 80’s turned the tampon industry on its head with the discovery and epidemic of TSS.

Toxic Shock Syndrome, or TSS, is an acute disease caused by bacteria, and characterized by high fever, a sunburn-like rash, skin-peeling, abnormally low blood pressure, and abnormalities in multiple organ systems. With prompt and proper treatment, TSS can usually be cured in a couple of weeks. However, TSS can also be fatal, and has been known to kill its victims within hours.

TSS is most commonly found in young menstruating women, and has been linked to the use of high-absorbency tampons, the prolonged use of tampons, and the misuse of tampons.

History

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The term “Toxic Shock Syndrome” was first used by pediatrician James K. Todd, to describe the staphylococcal illness he found in three boys and four girls aged 8–17 years. At the time, the fact that three of the girls were menstruating and using tampons was overlooked; the connection between TSS and tampons wasn’t steadily established until the TSS epidemic that started in 1980.

In May of 1980, investigators reported to the CDC 55 cases of Toxic Shock Syndrome. Fifty-two (95%) of the reported cases occurred in women, with the onset of illness occurring during menstruation in 38 (95%) of the 40 women from whom menstrual history was obtained.

National and state-based studies were initiated to determine risk factors for this newly-discovered and alarming disease. In addition, the CDC established national surveillance to assess the magnitude of illness, and to follow trends in disease occurrence.

In June of 1980, a follow-up report described three studies, all of which detected an association between Toxic Shock Syndrome and the use of tampons. Case-control studies in Wisconsin and Utah, and a national study by the CDC, all indicated that women with TSS were more likely to have used tampons than were their control-group counterparts. The CDC study also found that continuous use of tampons was associated with a higher risk of TSS than was the alternating use of tampons and other menstrual products.

No one knew at the time why most of the sufferers were women, and the ‘mystery disease’ caused widespread panic.

The Tampon Manufacturers

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As tension and attention rose around the scary ‘mystery disease,’ the CDC and epidemiologists worked fast to figure out what was causing the TSS epidemic.

As the discovery of the connection between menstruation and TSS was established, doctors started looking at the feminine products the women were using. The Toxic Shock Syndrome Task Force was created, and it began investigating the epidemic, as the number of reported cases rose throughout the summer of 1980.

It wasn’t until September of 1980 that the CDC  reported that the users of the Rely brand tampons were at increased risk for developing TSS. The Rely brand was owned by Proctor and Gamble, which recalled the Rely brand and all of its products on September 22 of 1980, following the report by the CDC.

As part of the voluntary brand recall, Procter and Gamble also entered into a consent agreement with the FDA, “providing for a program for notification to consumers and retrieval of the product from the market.” However, it was clear to some investigators that Rely was not the only culprit, after it was established that many regions of the United States saw increases in menstrual TSS before Rely was ever introduced.

It was later established that higher-absorbency tampons were associated with an increased risk for TSS, regardless of the materials used or the brand of the tampon. However, the sole exception was Rely brand, for which the risk for menstrual TSS was still higher even when corrected for its absorption rate.

According to the National Center for Biotechnology Information, as of October 2017, The incidence of TSS is estimated to be around 0.8 to 3.4 per 100,000 in the United States.

While TSS does still exist, the epidemic ended with the withdrawal of extreme-absorbency tampons, and TSS is now considered a very rare disease with a fairly-positive prognosis, with many of the reported cases seemingly unrelated to tampons.

The next time you buy a box of tampons for yourself or your teenage daughter, remember to choose the lowest-absorbency tampons you can find.