Can menstrual cups cause TSS?

If you’ve ever used a tampon, you’ve probably heard and feared the words toxic shock syndrome, or TSS. Every tampon box contains a warning that wearing a tampon for too long or using the wrong absorbency can increase the risk of this serious health condition.

One of the questions we often hear is, “Can menstrual cups cause TSS?” It’s important for anyone who menstruates to understand what TSS is, why it’s connected to menstrual products, and how to use your menstrual products safely.

What is toxic shock syndrome?

Most people don’t realize that toxic shock syndrome is not strictly associated with menstruation! TSS is a complication caused by a bacterial infection, which can affect anyone. According to WebMD, TSS “can happen to men and women who have been exposed to staph bacteria while recovering from surgery, a burn, an open wound, or the use of a prosthetic device.”

TSS is a medical emergency that can lead to death. If caught early, TSS can be treated, but symptoms often mimic the flu, and those who have TSS may not seek help right away.

What causes TSS?

The main cause of TSS is an overgrowth of Staphylococcus aureus, or staph bacteria. Staph bacteria is normally present in the vagina, along with other naturally occurring bacteria, but doesn’t usually cause an infection. In order for an infection such as TSS to occur, two things need to happen. First, the bacteria need an environment that allows them to grow rapidly. Second, the bacteria must then enter the bloodstream.

Menstrual fluid is one such environment in which rapid bacterial growth can occur. If tampons are left in for too long, the bacteria can grow to dangerous levels. This is why tampons — or any menstrual product used internally — should never be left in for longer than recommended.

How do the bacteria then enter the bloodstream? This can happen a few different ways. The insertion or removal of a dry tampon can scrape the inside of the vagina, causing small abrasions that could allow the entrance of bad bacteria into the bloodstream. Using a super-absorbent tampon, especially when your flow is light, can cause vaginal dryness, which can also make small tears more likely.

In the 1970s, a particular brand of super-absorbent tampons was linked to several deaths from TSS. That brand was later taken off the market, but cases of TSS do still occur today. While the number of reported cases of TSS from tampon use has declined considerably since the 1980s, the risk still exists, especially for anyone who uses tampons improperly.

More than one third of TSS cases happen in women under the age of 19, and up to 30% of people who get TSS will get it again.

If you are menstruating and you experience a high fever and vomiting, seek medical help right away, especially if you have been using tampons. If you are using a tampon and you become ill, remove it immediately.

Are menstrual cups or menstrual discs dangerous?

Everyone once in a while, a new article pops up claiming that menstrual cups can cause TSS or are otherwise unsafe. However, research overwhelmingly shows that menstrual cups are very safe when used properly. A comprehensive review of 43 different menstrual cup studies found that not only did menstrual cups leak less than pads and tampons, but menstrual cups also posed no increased health risks and had no negative impact on vaginal bacteria.

The study found five reported cases of TSS from menstrual cup use, but it’s unclear whether the cups were used properly.

A 2018 study conducted in France sparked a slew of negative press after claiming that menstrual cups were more likely to increase production of the bacteria that causes TSS. But the study wasn’t actually conducted on humans. The researchers had placed menstrual products inside plastic bags, which is clearly a different environment than inside the vaginal canal.

It’s also important to remember that menstrual cups have been increasing in popularity over the past decade. If menstrual cups were more likely to lead to TSS, we would be hearing of far more reported cases linked to menstrual cup use. That simply hasn’t happened.

Can menstrual cups or discs cause TSS?

The simple answer is yes, menstrual cups can cause TSS if used improperly or left in for too long. The truth is, anything left in the body for too long can encourage the growth of bacteria. If you were to leave your menstrual cup in for an extended period of time (we recommend changing and rinsing your cup every 12 hours), bacteria could begin to grow in the fluid that is trapped inside your cup. If that bacteria is then able to enter your body, that could potentially be very dangerous.

However, in order for that to happen, you would have to leave your cup in for a very long time. Of the known cases of TSS linked to a menstrual cup, at least 2 occurred because the menstrual cup was inserted and not emptied or cleaned for more than 7 days.

TSS with a menstrual cup is unlikely because…

• The silicone will not break down or leave pieces behind. Tampons are especially dangerous because pieces of the tampon can break away and get stuck inside the vaginal canal. These tiny fragments can be imperceptible and become a feeding ground for staph bacteria. Your menstrual cup will not break apart and is always removed in its entirety, leaving no particles to feed bacteria.
• The menstrual cup is gentle and easy to insert and remove, so it’s not likely to cause tears in the sensitive skin of the vaginal canal.

How can I avoid TSS with a menstrual cup or menstrual disc?

First, just your decision to use a menstrual cup or menstrual disc in the first place significantly decreases your risk of toxic shock syndrome! That being said, you still need to be careful to make sure your vaginal canal is kept free of bad bacteria overgrowth.

With any menstrual product used internally, the important thing is to follow the instructions, keep it clean, don’t leave it in for longer than recommended, and use a trusted brand.

Follow these tips to stay healthy while using a menstrual cup:

Keep your Pixie Cup or Pixie Disc clean and sanitized

We can’t stress this enough! Cleaning your menstrual cup properly is probably the most important thing you can learn in your menstrual cup journey.

To keep your cup in the best shape, rinse and wash your cup – preferably with a gentle, natural soap or Pixie Cup Wash – at least once every twelve hours. Make sure you sanitize your cup by boiling or steaming it before and after each cycle.

Empty your Pixie Cup often

We get it… your Pixie Cup is so comfortable that it can be easy to forget you’re wearing it! We are guilty, too! Also if you’re wearing the Pixie Disc! If you know you are prone to forgetting, set a timer on your phone, or leave your Pixie Cup Wash out on the bathroom counter to remind you. It’s important to remove and clean your cup or disc at least twice each day, even on your lighter flow days.

If you can’t get to a bathroom or otherwise can’t remove your cup within 12 hours, don’t freak out! It’s something that’s happened to many menstrual cup users without any harmful effects. Just don’t make a habit out of it!

We hope this blog post helps you feel more comfortable about using menstrual cups safely. If you have any more questions at all, drop them in the comments or send us a message. Our mission is to help every menstruating human live free. We are here to help you achieve success with your menstrual cup… every single time.

Please note: This blog post is not intended as a substitute for the medical advice of your doctor. You should regularly consult a physician in matters relating to your health and particularly with respect to anything related to menstruation and vaginal health. If you have any concerns about using a Pixie Cup, consult your doctor before use. If you have any gynecological conditions, please talk to your physician.

This content was originally written on July 29, 2019, and has been updated for freshness, accuracy, and comprehensiveness.