Menstrual Cups & Toxic Shock Syndrome: What You Should Know

At Ruby Cup, we believe in healthy and safe periods. Whether you just started getting your period or you’re besties with Aunt Flo, you’ve probably heard something about toxic shock syndrome (TSS) and are wondering whether it’s a concern if you use menstrual cups.

Fortunately, TSS is extremely rare, regardless of what period product you choose. In this post, we’ll tell you everything you need to know about how to stay healthy and avoid toxic shock syndrome. With the right information, you can have safer, healthier, and easier periods with Ruby Cup and lower the very small risk of toxic shock syndrome even further.

What is Toxic Shock Syndrome (TSS)

TSS is a rare, life-threatening infection caused by bacteria that usually live on your skin, nose, or mouth. If they get deeper into your body from your skin, such as into your vagina or your blood through a cut or wound, they can multiply. These bacteria release toxins, or poison, into your blood, making you very sick, very quickly.

Without treatment, these toxins can cause organs such as your liver, heart, and kidneys to fail. People who are not treated right away for toxic shock syndrome can have seizures, bleeding, and may even die. If you have any symptoms of toxic shock syndrome, you need to see your doctor or go to the hospital as quickly as possible. Researchers tell us that if 100 people were to be diagnosed with toxic shock syndrome, 8 out of those 100 people (8%) would get so sick that they would die. Untreated toxic shock syndrome is a medical emergency. 

Are there different types of toxic shock syndrome?

Yes. There is toxic shock syndrome related to menstruation (mTSS). People can also get sick with toxic shock syndrome if the bacteria that cause TSS infect a cut, wound, burn, or boil. Only about half of all TSS cases are menstrually related.

How common is menstrual toxic shock syndrome (mTSS)?

Fortunately, both types of TSS are extremely rare. Out of 100,000 people, less than one person each year will get TSS. You have a greater chance in your lifetime of dying in a bike accident or from being stung by a swarm of angry bees than of dying from toxic shock syndrome.

Menstrually-associated TSS is more common in menstruating women 15–25 years old. It can affect people of all ages, including non-menstruating women, the elderly, and even children. Cases of TSS are also seen in people after a vaginal birth, cesarean delivery, or gynecological surgery.

What are the symptoms of TSS?

Below are a few of the most common symptoms of toxic shock syndrome to look for:

• A sudden high temperature (above 102° Fahrenheit/38.9° Celsius).
• A rash all over your body that looks and feels like a bad sunburn or red dots.
• Flu-like symptoms such as a sore throat, headache, cough, and general aches.
• Confusion, dizziness, or fainting.
• Watery diarrhea, vomiting, or feeling sick to your stomach.
• Difficulty breathing.
• Redness in your eyes.
• Peeling skin on the soles of your feet or palms of your hands.

The more of these symptoms you have, especially if they start within four days of starting your period, the more important it is to see a healthcare provider. Because some of the symptoms of TSS can be similar to other more minor conditions like the flu, be sure to tell your healthcare provider or emergency room staff that you are using a tampon, menstrual cup or menstrual disc. If you have these symptoms during or immediately after your menses, remove any menstrual products from inside your vagina.

Which period products can cause TSS?

Any period product inserted into the vagina can cause TSS — tampons, menstrual cups, and menstrual discs. Contraceptive caps and diaphragms for birth control can also cause TSS. As you try to decide whether tampons or menstrual cups are better for you, consider that the risk of menstrual cups causing TSS is extremely low when used and cleaned correctly.

How do super-absorbent tampons cause TSS?

Bacteria may grow on tampons, especially if they are not changed often enough, or if you do not wash your hands before inserting them. Staphylococcus and Streptococcus are two types of bacteria found on your hands, skin, and outside your vagina (vulva) that cause TSS. They are relatively harmless as long as they stay on the outside of your body. They both can cause TSS if they enter your bloodstream through your vagina, if you are using atamponmenstrual cup, or 

Super-absorbent tampons do a great job of delivering and trapping these bacteria in your vagina. Using period products such as tampons or menstrual cups can also deliver oxygen into your vagina. Staphylococcus bacteria need oxygen to produce the toxin that causes TSS.

Once this bacteria-friendly home is set up in your vagina, the bacteria may decide to take a trip through the mouth of your uterus (cervix) and venture up into your womb or uterus, causing a more serious infection. Tampons may cause tiny cuts in the vagina through which bacteria can enter the bloodstream, although some research shows that tampons do not damage the vagina in this way.

The kinds of tampons made in the 1970s and 1980s were much more likely to cause TSS. Research identified that polyacrylate, carboxymethyl cellulose, and polyester foam in tampons increased risk. They were banned from use in tampons in the 1980’s.; Public education campaigns also taught people who menstruate to avoid using super tampons on low flow days and to change tampons frequently. The number of TSS cases dropped dramatically, but today, a few people still get sick from TSS when using tampons. The most commonly associated risk factor is usually for wearing higher-absorbency tampons for longer than 12 hours.

Can menstrual cups cause Toxic Shock Syndrome?

Yes, but very rarely. To date, there have not been many large-scale studies of rates of TSS in menstrual cup users for several reasons, including:

• More people use tampons than menstrual cups.

• Some people use both menstrual cups and tampons.

• TSS happens so rarely, and even less frequently in menstrual cup users. Larger studies of more period cup users collecting data over many years are needed to know with certainty if menstrual cups cause TSS.that menstrual cups do or do not cause toxic shock syndrome.

Nevertheless, medical experts agree that, although tampons and menstrual cups can cause TSS, they are safe period products. Researchers suggest that, in the few cases of TSS among menstrual cup users, the infection was coincidental, meaning the bacteria may have come from a menstrual pad or tampon used in combination with the menstrual cup and were not caused by the cup itself.

Because menstrual cups and discs are made from non-absorbent medical-grade silicone, they are much less friendly environment for TSS-causing bacteria to grow. There has not yet been any published research showing whether the presence of suction holes in the rim of silicone period cups, such as Ruby Cup, Moon Cup, or Diva Cup, increases or decreases the risk of TSS.

Does the size of your menstrual cup increase or decrease your risk of TSS?

You may be sensing a theme here: There is still much we don’t know about a possible connection between menstrual cups and toxic shock syndrome. The research has not yet been done or is not yet complete enough to answer this question.

In general, the more often you change your menstrual cup (with clean hands, of course), the lower your risk of TSS. When it comes to tampons, research shows that risk increases when they are worn for longer than 12 hours. For Ruby Cups (and most other menstrual cups), it is safest and healthiest to empty your cup at least every 8-12 hours.

Some people choose larger cups for heavier flow so that they don’t have to change their cup as often. There is no research showing that using a larger cup causes any cuts or abrasions or increases your risk of TSS in that way. Ruby Cup offers a cup sizing guide to help you find that perfect balance between comfort, fit, and no leaks. We also have a very detailed guide on how to safely and comfortably insert your Ruby Cup so that you are less likely to cause any injury to the inside or outside of your vagina.

When should I seek urgent care if I think I have TSS?

If you think you might have TSS, call your healthcare provider immediately. Toxic shock syndrome can become life-threatening very quickly, so you must be screened for TSS right away. If your regular healthcare provider can’t see you ASAP and you have early warning signs of TSS (high fever, aches and chills, nausea, vomiting, diarrhea, or a suspicious rash), it’s time to find an urgent care center.

Healthcare providers diagnose TSS with blood tests, a vaginal examination, and testing your vagina and cervix for the bacteria that can cause TSS.

How is toxic shock syndrome treated?

People diagnosed with TSS need to be hospitalized to receive medicines to kill the toxic bacteria (antibiotics) through an IV directly into their bloodstream. The hospital is the safest place for people with TSS because it can be so dangerous. Hospitals also treat TSS patients with intravenous (IV) fluids and other medications to raise their blood pressure if it is low.

How can I prevent toxic shock syndrome?

The same common-sense tips for good period cup care work to keep you safe from toxic shock syndrome. To lower your risk for toxic shock syndrome:

• Wash your hands thoroughly before and after handling your menstrual cup 
• Empty your menstrual cup at least every 8-12 hours.
• Keep your nails clean and short to avoid scratching yourself when inserting your cup.
• Rinse your cup well inside and out every time you empty it (take a small bottle of water with you into the stall if you are in a public bathroom without individual sinks). 
• Disinfect your menstrual cup after every period. 
• Use menstrual cups for period flow only. Do not use menstrual cups for vaginal discharge.
• Wash your period cup storage bag regularly. 

Don’t use tampons, period cups, or menstrual discs if you have had TSS. People who have had TSS once are more likely to get it again. If you have any type of skin infection near your vulva or skin in your genital area, wait for it to heal before using your menstrual cup.

Will sanitizing my period cup lower my risk of toxic shock syndrome?

With the correct information on safely using and cleaning your Ruby Cup, you can enjoy the full benefits of using a period cup without worrying about toxic shock syndrome. While the medical information and numbers we described above may be alarming, it is important to put them all in perspective. Yes, toxic shock syndrome is a dangerous medical condition. But it is also extremely unlikely that you will get TSS using your period cup. Medical case reports show that TSS is fully curable when diagnosed and treated early.

At Ruby Cup, our innovative, body- and planet-friendly period cup impacts lives. We are here to help you have better and safer periods. If you have more questions concerning TSS and menstrual cups, please contact us at hello@rubycup.com.