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Understanding Toxic Shock Syndrome -- the Basics

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What Causes Toxic Shock Syndrome? continued...

Staph is normally -- and harmlessly -- present in the vagina. How staph causes toxic shock syndrome is not understood. But two conditions are necessary: First, the bacteria need an environment in which they can grow rapidly and release poisons. Then the poisons must get into the bloodstream.

A tampon saturated with blood is a supportive place for rapid growth of bacteria. It also seems to matter what the tampon is made of; polyester foam provides a better environment than either cotton or rayon fibers.

In cases from menstrual sponges, diaphragms, and cervical caps, either the device had been in the vagina for a long time -- more than 30 hours -- or, in the case of the sponge, pieces of the sponge remained in the vagina. 

The way in which bacterial poisons enter the bloodstream may also be related to tampon use. Sliding a tampon into place in the vagina may make microscopic tears in its walls, rupturing tiny blood vessels. A super-absorbent tampon -- especially if it's left in place too long, or if it is used when the menstrual flow is light -- can dry out the vagina, making such tearing even more likely.

Researchers investigating the causes of toxic shock syndrome have ruled out feminine deodorant sprays and douches, underwear, and other clothing. The condition is also unrelated to the woman's menstrual history, drug or alcohol use, cigarette smoking, swimming or bathing, or sexual activity.

WebMD Medical Reference

Reviewed by Nivin Todd, MD on March 17, 2014
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