Menstrual Tampons

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The Issue

Using menstrual tampons or external protection is a personal decision. However, you should be aware that using tampons may expose you to certain health risks, including an increased risk of Toxic Shock Syndrome.

Background

Menstrual tampons are made from cotton, rayon, or a blend of both materials. Rayon is a synthetic product made from cellulose, which is derived from wood pulp. Women in North America have been using tampons since the 1930s. In the early 1980s, there was an epidemic of Toxic Shock Syndrome in North America that was associated with the use of a high absorbency tampon and strains of toxin-producing bacteria.

Toxic Shock Syndrome (TSS)

Toxic Shock Syndrome (TSS) is a rare but serious disease that occurs when toxins produced by certain strains of Staphylococcus aureus bacteria (Staph) get into the bloodstream. The initial symptoms are similar to the flu, and can include high fever, nausea, vomiting, diarrhea, dizziness, fainting, and disorientation. There may also be low blood pressure, shock, dehydration, sore throat, muscle pain, peeling skin, and a rash that resembles a sunburn. Toxic Shock Syndrome can be fatal if it is not diagnosed and treated immediately.

Tampon Use and TSS

Tampons do not cause Toxic Shock Syndrome, and the disease is not limited to menstruating women. Men, non-menstruating women, and children can also get TSS. The incidence of TSS has dropped significantly since the epidemic in the early 1980s. Over the last number of years, only a few cases have been reported, and of these, approximately half were associated with tampon use. Younger women (under the age of 30) are at greater risk than older women because they have not yet developed the antibodies to the toxin that causes TSS.

Scientists have not been able to identify the exact nature of the link between the use of tampons and Toxic Shock Syndrome. There may be a number of factors involved, including hygiene practices and the length of time a tampon is left in place. Greater tampon absorbency appears to be a factor, as there are more cases reported among women who use high absorbency tampons. Other risk factors include the use of barrier methods of contraception, such as the sponge, cervical cap, or diaphragm. The material of manufacture, whether cotton or rayon, has not been identified as a risk factor.

Other Health Effects associated with Tampon Use

Tampon use is associated with an increased risk of vaginal dryness and vaginal ulcers, especially if the tampons that are used are more absorbent than is needed to control menstrual flow. There is also a risk of serious hygiene problems if tampons are forgotten and not removed on time.

False Rumours about Tampons

In recent years, a number of false rumours about tampons have been circulating over the Internet. These e-mails may say that tampon manufacturers add asbestos to tampons to promote heavy bleeding, or that tampons contain toxic chemicals, such as dioxins. Another rumour claims that tampons made of rayon pose a greater risk of TSS than tampons made of cotton. These rumours should be treated as false for the following reasons:

• It is illegal to contaminate a tampon, or any other product, with asbestos or other toxins. Health Canada has received no reports of any such contamination.
• The manufacturing processes used in the production of tampons sold in Canada are dioxin-free. Dioxins are a known environmental pollutant, so it's possible that tiny amounts may be found in tampons as a result of environmental pollution. However, these trace amounts do not pose a health risk to tampon users.
• There is no scientific evidence that tampons made of rayon pose a greater risk of TSS than tampons of the same absorbency that are made from cotton.

Minimizing Your Risks

The following advice will help to minimize health risks related to the use of tampons:

• If you have ever been diagnosed with TSS, do not use tampons.
• Use the lowest absorbency that will meet your needs. All tampons licensed for sale in Canada conform to a standardized absorbency labelling system. This means that any tampon of a stated absorbency, no matter which brand, will absorb the same amount of fluid.
• Read the information pamphlet that comes with tampons, and follow all directions.
• Do not use tampons until your period begins. Do not use them as a precaution because you expect your period to start on a given day, or to control other types of discharge.
• Wash your hands before and after inserting a tampon.
• Change your tampon every 4 to 8 hours, and do not use tampons overnight.
• Remember to remove each and every tampon.
• Alternate the use of tampons with external protection.

If you experience any of the symptoms of TSS while using a tampon, remove it and seek immediate medical attention. If you cannot reach your doctor, go to the nearest Emergency Care facility. Make sure the health care professional treating you knows you were using a tampon when the symptoms started.

Health Canada's Role

In Canada, menstrual tampons are regulated as medical devices. Health Canada ensures that the tampons sold in Canada are safe, effective and of high quality through requirements for licencing, quality manufacture, and post-market surveillance. Before a device licence is issued to a manufacturer, tampon package labelling must contain specific information about absorbency. They must also provide details about the risks and symptoms of Toxic Shock Syndrome, and instructions about what to do if you have these symptoms.

Need More Info?

To report problems with menstrual tampons, including cases of suspected Toxic Shock Syndrome to the Health Products and Food Branch Inspectorate of Health Canada at 1-800-267-9675 (toll-free in Canada), or by using the problem report form

For reliable sources of health information on the Internet, visit The Canadian Health Network