Over 90 Percent of What Planned Parenthood Does, Part 25: Lost Tampons

Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl never knew about.

tamponPlanned Parenthood Arizona offers a wide variety of services, and someday we hope to cover every last one of them in this series. But today, I’d like to talk about one of the odder services: helping you with a lost tampon.

OK, so “lost” might be a weird word. I mean, you probably know the general area where that tricky tampon is lurking … But it happens even to the best of us: Sometimes, when you go to retrieve a tampon, you just … can’t find it. Maybe it was forgotten about, and then pushed farther up the vaginal canal by a subsequent tampon, or smooshed against the cervix during intercourse, and now you can’t find the string to remove it.

The presence of a certain strain of bacteria in one’s vagina can increase risk for toxic shock syndrome, especially when absorbent tampons are used.

The vagina can be a hiding place for all kinds of things — not just tampons, but sex toys, the remnants of broken condoms, and other foreign objects. And vaginas aren’t the only cavity with magical, or possibly just embarrassing, powers of concealment. When I worked at a medical journal, I came across ample (and very, very detailed!) documentation of all sorts of things getting “lost” in people’s rectums, urethras, ears, and throats. Believe me, a seasoned health care provider has probably seen it all, so if you can’t for the life of you remove something from your vagina on your own, don’t be afraid to ask Planned Parenthood for help. (You might ask about making an emergency, same-day appointment.)

Tampons aren’t designed to be used in a vagina for more than a few hours, and leaving them in for too long might increase risk for certain infections. For example, you might have heard of toxic shock syndrome (TSS), which is probably the No. 1 condition that comes to people’s minds when they think of tampons being left in for way too long. While it’s true that TSS is associated with tampons, tampons aren’t the only cause — they play just one role in the infection process.

TSS is a bacterial infection that can be characterized by a constellation of unpleasant symptoms, including high fever, rash, peeling skin, and low blood pressure. It’s caused by a strain of bacteria called Staphylococcus aureus, which can multiply in tampons and release dangerous toxins into the vagina. It was an outbreak in 1979 to 1980, which started in Wisconsin, that permanently seared an association between TSS and tampons in the public’s mind. The state health department was receiving reports of TSS in numbers much higher than expected for such a rare disease, so they put on their detectives’ hats and started sleuthing.

The first thing that stood out was that all TSS cases were in females of reproductive age. Upon closer investigation, it turned out that the vast majority — close to 100 percent — of people with TSS used tampons, whereas members of the general menstruating population were much less likely to use tampons. The investigators dug deeper, looking at what brands of tampons the patients were using, what materials they were made out of, and how absorbent they were.

Rely brand tampons came onto the market in 1979. Image: CDC

Rely tampons were introduced in the 1970s. Image: CDC

Soon, they zeroed in on a new brand of tampons called Rely, which had been introduced earlier in Wisconsin, where the TSS epidemic originated. This new player in the tampon market was made with a novel material that was so absorbent, users could wear the the teabag-shaped tampons for hours, even days, without changing them. The TSS-toxin-producing strains of S. aureus were able to grow rapidly within the tampons, secreting toxins that flooded the vagina. After the connection between these ridiculously absorbent tampons and TSS came to light, the manufacturer, Procter & Gamble, withdrew it from the market in 1980 — under threat of litigation from the Food and Drug Administration. (While Rely was the most visible offender, other brands of ultra-absorbent tampons were also implicated in toxic shock syndrome.)

Microbiologists studying samples from TSS patients soon isolated a new toxin from the strains of S. aureus that were causing the illness, discovering a new, more dangerous, type of the bacteria. People who developed TSS tended to host thriving colonies of this newly discovered strain of S. aureus in their vaginas — whereas most most vaginas are devoid of these poison-producing bacteria.

All told, at its worst, TSS struck 15 out of every 100,000 menstruating Wisconsinites. Between 1970 and June 15, 1983, there were a total 100 deaths out of 2,204 reported cases of TSS, more than 95 percent of which occurred in females — and, of those, 99 percent were in tampon users.

While this TSS epidemic took place way back during the tail end of the Jimmy Carter administration, its impact is still felt today. The FDA cracked down on tampon manufacturers, and in 1982 required packaging to be labeled with warnings about TSS. By 1990, the FDA eventually standardized absorbency levels, meaning that “regular,” “super,” and “super-plus” actually describe quantitatively measurable ranges of absorbency that can be compared across brands.

Thanks to these new safety standards, and thanks to the lessons we learned regarding tampons that were too absorbent, TSS is very rare these days. Of course, it’s still not recommended that you leave a tampon in your vagina for much longer than four hours — eight hours max — and that you choose a tampon that is just absorbent enough for that day’s menstrual flow. And, of course, if you seriously can’t wrest that tampon from the darkest depths of your vaginal cavity, you should get thee to a medical professional post haste!