More than a third of women who contract toxic shock syndrome (TSS) are under the age of 19. Experts explain symptoms, causes, and tips on safe tampon use to teach teens in order to prevent this rare but potentially fatal bacterial infection.


I will never forget the first time that I encountered a tampon. I was 13 years old and had just gotten my period while at the beach with my family. My mom, realizing that I was flustered since I'd only used pads up to that point, took me to the ladies' room, pulled a tampon out of her purse and said, "I think it's time we had a little chat." Admittedly,  at 13 I was most worried about sharks smelling blood and eating me alive. But my mom had a more realistic and scarier fear when it came to tampon use: toxic shock syndrome.

While there are many myths out there about what toxic shock syndrome is, like its a "period infection" that only girls get (not true), or that it's really common and no big deal (also not true), toxic shock syndrome, or TSS for short, is actually deadly so understanding it as a parent is essential when it comes to protecting your teenager.

teen reaching in back pocket for tampon
Credit: Illustration by Parents Staff; Shutterstock (1)

"Toxic shock syndrome is a sudden, potentially fatal condition caused by the overgrowth of a normally present bacteria called Staphylococcus aureus, says Jack Forbush, D.O., a Maine-based physician and founder of the Osteopathic Center for Family Medicine. "This bacteria is part and parcel with our normal bacterial flora, but when allowed to overgrow, it will release toxins which cause a constellation of symptoms ranging from generalized muscle aches and pains, to fever and vomiting." He goes on to explain that if allowed to continue growing, the bacteria can lead to low blood pressure "shock" and even death.

The causes of TSS are generally thought to be limited to tampon use, but it turns out that this is yet another myth. Men and women are equally susceptible to developing TSS most especially when there is an open wound.

"Anyone with a wound infection or after a surgery is at risk for developing TSS," says Huma Farid, M.D., who practices in the OB-GYN department at Beth Israel Deaconess Medical Center. "About 50 percent of cases of TSS are not related to menstruation. Those are due to surgery, wound infections, burns, etc. The incidence of tampon associated TSS has decreased dramatically to 1 in 100,000 cases, and the mortality rate for menstruation-related TSS has also decreased to 1.8 percent from 5.5 percent [since 1986]."

How to Prevent Menstrual Toxic Shock Syndrome

Though TSS is not common, menstrual TSS is not impossible to contract, and research indicates that menstruation-associated TSS most commonly occurs in young women aged 15 to 25 years who are using tampons. To lessen your child's risk of TSS, here's what to teach your teen when it comes to safely using of menstruation products:

Use the right tampon size and change it every 3 to 4 hours.

Make sure your daughter uses tampons with low absorbency and changes them often, says Why? The longer a tampon is in, the longer the Staphylococcus aureus has to grow. It's crucially important to understand that tampons, menstrual cups, etc. should never be left in overnight, says Dr. Forbush.

Research has also shown that hyperabsorbent tampons create conditions conducive to the production of staphylococcal TSS. Experts advise women choose the least absorbent option possible to lessen risk of infection. Another benefit of always using a smaller tampon size is there will be less chance of leaving it in longer than the recommended 3-4 hours.

Abide by the same timing rules for menstrual cups.

TSS may be commonly associated with tampons but recent research suggests that menstrual cups, which are made of silicone, can also cause toxic shock. Menstrual cups, which have become popular in recent years for their relative ease of use and low carbon footprint are approved for use by the FDA and the common conception is that they are safe to leave in for longer periods of time. However, with so few studies existing on the TSS connection to silicone-based menstruation devices, experts advise to change them every 3-4 hours and avoid leaving them in overnight just like with a tampon.

Know the symptoms of toxic shock syndrome and act fast.

According to, signs of TSS develop rapidly, often beginning with a high fever (at least 102 degrees), then they can progress into the following:

  • Vomiting
  • Watery diarrhea
  • Headache
  • Sore throat
  • Aching muscles
  • Sunburn-like rash
  • Bloodshot eyes
  • Redness under the eyes, inside the mouth, in the vagina
  • Confusion

Dr. Forbush emphasizes that it's critical for any woman using a menstruation product who suddenly experiences a fever and flu-like symptoms immediately remove the device and seek medical attention right away.