What is Toxic Shock Syndrome?

If you’ve ever read the tiny warning label on the side of a tampon box and thought, “Toxic Shock Syndrome? That sounds scary, but it probably doesn’t happen anymore,” you’re definitely not alone. A lot of girls read about TSS once, brush it off, and never think about it again, especially because it’s so rare. But here’s the truth: even though TSS doesn’t happen often, it can be extremely dangerous when it does. And because it usually affects healthy, active girls and young women who are just trying to manage their periods, it’s important to understand what it is, how it works, and how to protect yourself.

Toxic Shock Syndrome (or TSS) is a serious illness caused by bacteria, usually one called Staphylococcus aureus, that sometimes lives on our skin or in our bodies without causing any problems. The problem happens when these bacteria grow really fast and start producing toxins, which then get into your bloodstream. Once those toxins are in your blood, they can spread throughout your body and confuse your immune system into overreacting. This leads to something called a “cytokine storm,” where your body basically attacks itself, causing your organs to shut down. That’s what makes TSS so scary. It can go from feeling like a regular fever or flu to something life-threatening in just hours. And even though it can happen to anyone — including people who’ve never had a period — about half of all TSS cases happen to people who are menstruating, usually from using tampons or menstrual cups the wrong way.

This connection between tampons and TSS was first discovered in the 1980s, when a wave of teenage girls and young women started getting seriously ill after using a certain brand of high-absorbency tampons. The tampons were made of synthetic materials that were really good at absorbing blood — maybe too good. They dried out the vagina, caused tiny cuts inside, and created the perfect place for bacteria to grow and release toxins. After hundreds of cases and some deaths, that brand was pulled off the shelves, and tampon companies were forced to add warning labels and safer materials. Since then, cases of TSS have dropped, but they haven’t disappeared. People still get TSS every year, often because they didn’t know how long they could safely wear a tampon, or they didn’t realize that menstrual cups and other internal products can carry risks too. It’s not about fear — it’s about knowing your body and how to take care of it safely.

One of the reasons TSS is still dangerous is because it doesn’t always look serious at first. It can start with symptoms that seem kind of normal — like a fever, nausea, vomiting, or diarrhea. Your muscles might ache, your throat might be sore, and you might just feel really tired and off. But as the hours go by, the symptoms can get worse really fast. Some girls get dizzy, confused, or start fainting. Others develop a rash that looks like a bad sunburn, especially on their hands and feet. Their blood pressure can drop, their organs can start to fail, and if they don’t get to a hospital quickly, it can be deadly. Even though most people recover with fast medical help, some survivors of TSS have had to go through amputations because the lack of blood flow caused their limbs to die. Others deal with long-term health issues and emotional trauma.

So how can you stay safe? The best way to prevent TSS is to use tampons and menstrual cups correctly. If you use tampons, always go for the lowest absorbency that still works for your flow. Don’t leave one in for more than 4 to 6 hours during the day, and definitely don’t sleep with one in overnight. Instead, switch to a pad or period underwear when you go to bed. If you’re using a menstrual cup, make sure you wash your hands before putting it in or taking it out, and clean the cup properly between uses. Most cups need to be boiled between periods to kill bacteria. And if you’ve ever had TSS before, you should avoid tampons and cups completely, because your risk of getting it again is higher. It’s also smart to take a break from internal products now and then during your period — mixing it up with pads or breathable underwear can give your body a rest.

Another huge part of staying safe is speaking up when something doesn’t feel right. Don’t ignore a fever during your period. Don’t brush off dizziness or nausea if you’ve had a tampon in for a while. If you notice a rash that looks like a sunburn, or if you just feel really weird and weak for no reason, it’s okay to tell someone and ask for help. In fact, it’s not just okay — it’s strong and smart. TSS isn’t something to be embarrassed about. If you need to go to the ER or see a doctor, you deserve to be taken seriously. It’s your body, your health, and your life — and you’re allowed to protect it.

A lot of girls never get taught about this stuff. Health class might spend five minutes on periods and then move on to something else. Maybe your family doesn’t talk much about menstrual health. Maybe you’ve only ever seen period product commercials that talk about “feeling fresh” instead of telling you what can actually go wrong. But here’s the thing: you deserve real answers and honest facts. Knowing about TSS doesn’t mean you have to be afraid of your period — it means you’re more informed, more prepared, and more in control. Just like we learn how to wear sunscreen to prevent skin cancer or how to recognize signs of dehydration, we should be learning how to protect ourselves from TSS.

Let’s break down how the body actually reacts to the toxins that cause TSS. When the bacteria Staphylococcus aureus or Streptococcus pyogenes produce toxins, they don’t just trigger a basic infection. These are known as “superantigens,” which means they overstimulate your immune system by activating tons of T-cells all at once. Normally, your immune system targets infections carefully, like a laser. But superantigens cause it to behave more like a floodlight on full blast — your body starts attacking its own cells, tissues, and organs. This is why people with TSS can go into shock so fast. The immune response sends your blood pressure crashing, cuts off circulation to your brain and organs, and fills your body with inflammation. You might even hear doctors refer to it as “toxic shock septicemia” when it becomes extreme. When this happens, your kidneys might shut down, your liver might stop functioning, or your lungs may struggle to deliver oxygen. It’s not that the bacteria themselves are directly destroying your body — it’s that your body’s reaction to them is so strong, it becomes deadly.

One thing that’s often ignored in conversations about TSS is how much it can affect your mental health — not just during the illness, but after it too. Imagine being 14 or 15, and suddenly landing in the ICU with a mysterious illness no one warned you about. Many girls who survive TSS report feeling scared, ashamed, or confused because they had no idea this was even possible. Some go through serious trauma, especially if they needed emergency surgery or faced long-term complications like nerve damage or partial amputations. Others struggle with guilt, thinking they “should have known better,” even though nobody ever taught them how to use period products safely. When girls are hospitalized and have no one to talk to about what happened, they often feel isolated — like their experience is too weird, too rare, or too embarrassing to bring up. But it’s not. It’s real. And talking about it openly is one of the best ways to protect future generations of menstruators.

TSS also opens up a much bigger conversation about how little girls are actually taught about their own periods, and how badly we need better education. Think about it: how many health classes actually explain what TSS is? Most rush through the reproductive system in one or two weeks. Maybe someone mentions changing your tampon every few hours, but it’s usually without context. Almost no one talks about vaginal pH balance, internal vs. external menstrual products, or how to identify signs of infection. And even fewer teachers talk openly about what periods are like for girls with disabilities, hormone disorders, or different body types. The result? Girls end up relying on product instructions or word-of-mouth to learn what’s “safe,” but without understanding the why. That’s not fair — and it’s not okay. TSS might be rare, but it’s not impossible. And pretending like girls can’t handle medical information just leaves us more vulnerable.

Let’s also talk about the variety of period products on the market, because not all of them carry the same risk — and not all of them work for everyone. Tampons are the most common internal product, and they’re effective, discreet, and easy to carry around, which is why many teens start using them. But not every tampon is the same. Some are made with rayon, some with cotton, and some with blends. The more synthetic the material, the more likely it is to absorb not just blood, but your body’s natural moisture — which can leave the vaginal walls dry and irritated, making them more likely to tear and let bacteria in. Organic tampons made with 100% cotton might reduce that risk slightly, but no tampon is 100% risk-free if left in too long. Menstrual cups, on the other hand, are made from medical-grade silicone and collect blood instead of absorbing it. While this can reduce some risks, cups come with their own warnings — they must be inserted with clean hands, removed on time, and thoroughly sterilized between cycles. Studies show that cups can still cause TSS if not used correctly.

Other products like period underwear and pads are completely external and carry no TSS risk, but some girls don’t like how they feel or worry about leaks. The best choice is always the one that makes you feel safe, comfortable, and informed — and you should never feel pressured to use something just because it’s popular or advertised as “cleaner.”

You also might be wondering if your hormones or birth control can affect your risk of TSS — and the answer is, yes, in some ways. Estrogen levels can impact how thick your vaginal lining is, which affects how easily it can tear or become irritated. If you’re on birth control pills that contain estrogen, your vaginal environment might be slightly different than someone who isn’t, but more research is still needed to know exactly how this connects to TSS. However, some contraceptives like diaphragms, cervical caps, and vaginal sponges have been linked to TSS in non-menstrual cases. These products also sit inside the vaginal canal and can trap bacteria the same way a tampon might. Just because something is sold over the counter doesn’t mean it’s automatically safe for everyone.

One of the most powerful yet heartbreaking ways to understand TSS is by listening to the girls who have lived through it. Take the case of Lauren Wasser, a model and athlete who developed TSS at age 24 after using a tampon during a heavy period. She started feeling sick, like she had the flu, but didn’t realize it was anything serious until her organs began shutting down. She went into toxic shock and ended up losing both her legs due to tissue death from poor circulation. Lauren has since become an advocate, using her voice to raise awareness about TSS and call for transparency in period product labeling. Her story proves that TSS can happen to anyone, even someone young, healthy, and strong. Other girls have reported similar experiences, sometimes after just one missed warning sign. What they all have in common is that they didn’t know enough to connect the dots. And that’s why we need to talk about this more; in school, online, in families, and in friend groups.