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Some of the following information from the U.S. FDA and Centers for Disease Control and Prevention websites.

What is Toxic Shock Syndrome?

Toxic shock syndrome is a rare infection that can happen during a woman's period. The symptoms include a sudden fever of over 101 degrees or more, diarrhea (the runs), vomiting (throwing up), muscle aches and a sunburn-like rash. If you have these symptoms during you period, see a doctor right away.

3. Change your tampon at least every 4-6 hours (read the tampon manufacturers information inside the box).

5. Do not use a birth control sponge or diaphragm during your period. During your period it is preferable to use other methods such as condoms and/or foam.

There are allegations that tampons made from rayon, or cotton with rayon, may cause or be a contributing factor to Toxic Shock Syndrome as well as vaginal dryness or ulcerations of vaginal tissues.

Toxic Shock Syndrome is a rare but potentially fatal disease caused by a bacterial toxin. (Different bacterial toxins may cause Toxic Shock Syndrome, depending on the situation, but most often streptococci and staphylococci are responsible.) The number of reported Toxic Shock Syndrome cases has decreased significantly in recent years.

Approximately half the cases of Toxic Shock Syndrome reported today are associated with tampon use during menstruation, usually in young women.

Toxic Shock Syndrome also occurs in children, men, and non-menstruating women. In 1997, only five confirmed menstrual-related Toxic Shock Syndrome cases were reported, compared with 814 cases in 1980 [according to data from the Centers for Disease Control and Prevention (CDC)].

Although scientists have recognized an association between Toxic Shock Syndrome and tampon use, the exact connection remains unclear. Research conducted by the CDC suggested that use of some high absorbency tampons increased the risk of Toxic Shock Syndrome in menstruating women. A few specific tampon designs and high absorbency tampon materials were also found to have some association with increased risk of Toxic Shock Syndrome. These products and materials are no longer used in tampons sold in the U.S. Tampons made with rayon do not appear to have a higher risk of Toxic Shock Syndromethan cotton tampons of similar absorbency.

Vaginal dryness and ulcerations may occur when women use tampons more absorbent than needed for the amount of their menstrual flow. Ulcerations have also been reported in women using tampons between menstrual periods to try to control excessive vaginal discharge or abnormal bleeding. Women may avoid problems by choosing a tampon with the minimum absorbency needed to control menstrual flow and using tampons only during active menstruation.

To help women compare absorbency from brand to brand, FDA requires that manufacturers measure absorbency using a standard method and describe absorbency on the package using standardized terms. Thus, the terms "junior," "regular," "super," and "super plus," always describe a specific range of tampon absorbency regardless of the brand.

Historical Perspectives Reduced Incidence of Menstruation-related Toxic Shock Syndrome -- United States, 1980-1990

In May 1980, investigators reported to CDC 55 cases of Toxic Shock Syndrome (TSS) (1), a newly recognized illness characterized by high fever, sunburn-like rash, desquamation, hypotension, and abnormalities in multiple organ systems (2). Fifty-two (95%) of the reported cases occurred in women; onset of illness occurred during menstruation in 38 (95%) of the 40 women from whom menstrual history was obtained. National and state-based studies were initiated to determine risk factors for this disease. In addition, CDC established national surveillance to assess the magnitude of illness and follow trends in disease occurrence; 3295 definite cases have been reported since surveillance was established (Figure 1).

In June 1980, a follow-up report described three studies which detected an association between Toxic Shock Syndrome and the use of tampons (3). Case-control studies in Wisconsin and Utah and a national study by CDC indicated that women with Toxic Shock Syndrome were more likely to have used tampons than were controls. The CDC study also found that continuous use of tampons was associated with a higher risk of Toxic Shock Syndrome than was alternating use of tampons and other menstrual products. Subsequent studies established that risk of Toxic Shock Syndrome was substantially greater in women who used Rely brand tampons than in users of other brands and that risk increased with increased tampon absorbency (4-6). In September 1980, Rely tampons were voluntarily withdrawn from the market by the manufacturer.

In 1980, 890 cases of Toxic Shock Syndrome were reported, 812 (91%) of which were associated with menstruation. In 1989, 61 cases of Toxic Shock Syndrome were reported, 45 (74%) of which were menstrual. In 1980, 38 (5%) of 772 women with menstrual Toxic Shock Syndrome died; in 1988 and 1989, there were no deaths among women with menstrual Toxic Shock Syndrome. Reported by: Meningitis and Special Pathogens Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC

For Feminine Hygiene Information, Education, Resources
and Green Menstruation Products, visit:

www.FeminineHygiene.com

Clostridium sordellii Toxic Shock Syndrome After Medical Abortion with Mifepristone and Intravaginal Misoprostol --- United States and Canada, 2001--2005

On July 22, this notice was posted as an MMWR Dispatch on the MMWR website (http://www.cdc.gov/mmwr).

On July 19, 2005, the Food and Drug Administration (FDA) issued a public health advisory regarding the deaths of four women in the United States after medical abortions with Mifeprex^® (mifepristone, formerly RU-486; Danco Laboratories, New York, New York) and intravaginal misoprostol (1). Two of these deaths occurred in 2003, one in 2004, and one in 2005. Two of these U.S. cases had clinical illness consistent with toxic shock and had evidence of endometrial infection with Clostridium sordellii, a gram-positive, toxin-forming anaerobic bacteria. In addition, a fatal case of C. sordellii toxic shock syndrome after medical abortion with mifepristone and misoprostol was reported in 2001, in Canada (2). All three cases of C. sordellii infection were notable for lack of fever, and all had refractory hypotension, multiple effusions, hemoconcentration, and a profound leukocytosis. C. sordellii previously has been described as a cause of pregnancy-associated Toxic Shock Syndrome (3).

Investigation by FDA, CDC, and state and local health departments into the two most recently identified U.S. deaths after medical abortion is ongoing. Empiric therapy for patients suspected of having postpartum or postabortion Toxic Shock Syndrome should include antimicrobials with anaerobic activity against Clostridium species. Health-care providers are encouraged to report any cases of postpartum or postabortion Toxic Shock Syndrome to their state or local health department and to CDC at telephone 800-893-0485. Cases potentially associated with of mifepristone or misoprostol should also be reported through the FDA MedWatch system available at http://www.fda.gov/medwatch/index.html or telephone 800-FDA-1088.

References

Important Notes:

The number of Toxic Shock Syndrome cases reported annually to CDC has decreased substantially in the 10-year period since menstrual Toxic Shock Syndrome was first recognized. Changes in public awareness and diminished attention to Toxic Shock Syndrome in the medical literature might have resulted in reduced diagnosis and reporting. However, reporting of non-menstrual Toxic Shock Syndrome has remained constant during this time while menstrual Toxic Shock Syndrome reporting has decreased.

A multistate active surveillance study in 1986-1987 confirmed the trends detected by national passive surveillance (7). Through active case-finding efforts in an aggregate population of 34 million persons, the rate for menstrual Toxic Shock Syndrome was determined to be 1.0 per 100,000 women 15-44 years of age (7). This rate represented a substantial reduction from rates reported in similar studies in 1980 (6.2 per 100,000 women 12-49 years of age in Wisconsin (8), 9.0 per 100,000 women 12-45 years of age in Minnesota (9), and 12.3 per 100,000 women 12-49 years of age in Utah (10)). Active surveillance also confirmed that the proportion of Toxic Shock Syndrome associated with menstruation had decreased considerably: in 1988, menstrual Toxic Shock Syndrome accounted for 55% of cases detected both by active surveillance (7) and by the passive surveillance system.

A principle reason for the decreased incidence of menstrual Toxic Shock Syndrome may be decreases in the absorbency of tampons. In 1980, when tampon absorbency (in vitro) ranged from 10.3-20.5 g (4), very high absorbency products ( greater than 15.4 g) were used by 42% of tampon users (9). After the association between Toxic Shock Syndrome and absorbency was recognized, manufacturers lowered the absorbency of tampons. In 1982, the Food and Drug Administration (FDA) issued a regulation requiring that tampon package labels advise women to use the lowest absorbency tampons compatible with their needs. By 1983, tampon absorbency ranged from 6.3-17.2 g (6), and the proportion of tampon users using very high absorbency tampons had declined to 18%. By 1986, very high absorbency products were used by only 1% of women who used tampons. Effective March 1990, the FDA instituted standardized absorbency labeling of tampons, which currently range from 6-15 g.

Tampon composition has also changed since 1980. Rely tampons consisted of polyester foam and cross-linked carboxymethylcellulose, a combination that is no longer used in tampons. Polyacrylate-containing tampons were withdrawn from the market in 1985. Current tampons are manufactured from cotton and/or rayon. The unique composition of Rely tampons may have been responsible for the increased risk associated with those products (11); however, the role of current tampon composition as an independent risk factor for Toxic Shock Syndrome is unclear since composition may vary even for a particular brand and style of tampon marketed at a given time.

Other factors may have contributed to decreased reports of menstrual-related Toxic Shock Syndrome. For example, public awareness of the syndrome may cause women to seek medical care earlier in their illness; milder disease may not meet the surveillance case definition of severe multisystem illness. Increased variety in menstrual products and concern related to Toxic Shock Syndrome may have resulted in fewer women using tampons or fewer using tampons continuously.

Current public health efforts to prevent menstrual-related Toxic Shock Syndrome include tampon package labels and package inserts which describe early signs and symptoms of Toxic Shock Syndrome and warn the consumer about the risk associated with tampons. Tampon users are encouraged to select lower absorbency products to further decrease risk of Toxic Shock Syndrome. Standardized absorbency labeling permits consumers to compare absorbency between brands.

The precise mechanism by which Rely tampons increased the risk of Toxic Shock Syndrome is unknown. The increased risk associated with high absorbency tampons is also poorly understood; high absorbency may be a surrogate for another effect. However, the withdrawal of Rely tampons and the subsequent decrease in use of high absorbency tampons correlate with a marked decrease in incidence of menstrual-related Toxic Shock Syndrome. The rapid demonstration of the risk of Rely and high absorbency tampons resulted in prompt public health interventions and substantial reduction in menstrual Toxic Shock Syndrome.

and in Memory of Alice Kilvert, who died at the age of 15 due to
Tampon use and Toxic Shock Syndrome

Alice Kilvert, aged 15, died on Tuesday, 26th November 1991 of tampon-related Toxic Shock Syndrome at Trafford General Hospital, Manchester.

Alice's symptoms were initially very mild and did not cause any undue concern. On the Sunday prior to her death she complained of a headache which persisted, but eased with aspirin. During Sunday evening she was able to watch television, but she was sick during the night. Although very pale on Monday morning, she went to school in order to start her mock GCSE exams, but was taken home as she appeared to be developing influenza.. Alice went straight to bed and by tea time she had a slight temperature. At 7pm she was alert enough to talk about the early evening TV she had missed, but by 10pm she seemed vague and confused and a little faint.

The next morning Alice's breathing was shallow and she had a higher temperature, so the emergency doctor was called. The doctor phoned for an ambulance for Alice to be taken to hospital, but when the ambulance staff tested for blood pressure, it was so low it hardly registered. She arrived at hospital at 9am and her condition was diagnosed as either TOXIC SHOCK SYNDROME or meningitis, and treatment began. She was taken into Intensive Care and put onto a ventilator as her breathing was giving cause for concern. However, the strain on her heart brought on two cardiac arrests. She did not recover from the second one and died at 1pm.

More Stories on Women and Girls who
Died or Were Injured due to Tampon use and
Tampon-induced Toxic Shock Syndrome

1. KATIE OF NOTTINGHAMSHIRE.

In the summer of 1990, Katie, then aged 15, went on holiday to Devon with her family. It was a holiday that she'll never forget.

One morning she woke up with a headache and feeling shivery. Her mother thought that it could be flu and suggested that she should stay in bed. During the day her symptoms worsened as her temperature rose; she had aching muscles, a stiff neck and a sore mouth.

By tea time she became breathless and she was so weak that she needed assistance to go to the toilet. Her parents sent for the doctor, who diagnosed a virus and prescribed antibiotics. That night Katie's temperature soared to 102 degrees. The next morning she felt awful and had a severe headache. Her mother noticed a red rash on her leg. Katie's eyes were pink and sticky and her skin was turning yellow. The doctor was called again. He took one look at her and called for an ambulance. She was rushed to hospital.

At the hospital, the doctors performed a lumber puncture to test for meningitis and took a blood sample to test for glandular fever. Then the doctor discovered that Katie was menstruating and took a vaginal swab for testing. By now, her joints were swollen, her mouth was blistered, her liver and kidneys were failing and her veins and arteries had gone into spasm. She was transferred to Intensive Care.

The next morning a microbiologist had identified that Katie was suffering from Toxic Shock Syndrome, brought on by the tampons she had been using. She was being treated by the right antibiotics, and the doctors said that they would just have to wait and hope. Katie remained conscious for the three days that she was in Intensive Care. The pain was excruciating. She was transferred to a ward and after a week she was strong enough to go home with the aid of a wheelchair.

Katie felt weak for months. Thick layers of skin peeled off her hands and feet. This was as a result of the blood supply being cut off from her extremities during her illness. Then her hair started to fall out in clumps. This lasted for six months, and it has never grown back to its previous thickness. She realized that her memory wasn't as good and her ability to concentrate had diminished.

Katie remembers being told at school that Toxic Shock Syndrome is caused by leaving a tampon in too long. Now she knows differently. Any woman or girl who uses tampons can get TSS. That's why she'll never use tampons again. It might be rare, but you never know who it might strike next.

2. JEAN OF SURREY.

Jean was 46 when she suffered from Toxic Shock Syndrome. It was the second day of her period and she was using tampons. She'd had a headache all day that wouldn't go away, so she decided to go to bed early that evening. Jean couldn't sleep and her headache intensified. Suddenly she was vomiting and suffering from diarrhea. Jean thought that it must be food poisoning. The next day, Jean felt no better, although the sickness and diarrhea had stopped. When she began to lapse into unconsciousness her daughter telephoned the doctor, who immediately summoned an ambulance. By this time Jean's lips had a bluish tinge and she was having breathing difficulties. She went into a coma on the way to hospital as her blood pressure plummeted.

In Intensive Care, Jean needed a ventilator and dialysis as her kidneys had ceased to function. Doctors noticed that the tips of her fingers and toes were turning black with gangrene. Over the next three weeks Jean was so weak that she only had a 20% chance of survival. Because of the drugs her weight ballooned from 10 stone to 13 stone. Her blonde hair turned grey and her green eyes turned blue. The gangrene spread to her knee, nose and the back of her head. Jean went into stress and was given a tracheotomy to help her to breathe. Her veins were collapsing and it was almost impossible to insert the necessary drips.

At this point the doctor asked Jean's husband if he could try an experimental drug which he hoped would increase her extremely low blood pressure. Within minutes Jean started to respond and her blood pressure began to increase. She was going to make it, although she was still critically ill. Two days later she opened her eyes and asked where she was. She noticed her black toes. Jean spent six months in hospital and eventually had her toes amputated. Her feet were very painful and she had to get used to walking again. Now she wears special shoes and occasionally uses a walking stick. Jean finds it difficult to concentrate and has problems with her short-term memory.

Jean says that it's a miracle that she's alive today. She has enormous admiration for the doctors, nurses and of course her family who were with her all the time. Jean says that she will never use a tampon again. She has told all her friends and neighbors not to believe those trendy tampon adverts on the TV. "Tampons nearly killed me and they will kill others," she says.

3. JUDY OF OXFORDSHIRE.

Judy, a 27 year old mother, had been using tampons since she was 12. Her episode of Toxic Shock Syndrome began 10 weeks after the birth of her second daughter. She woke up on the third day of her period feeling tired and her head was spinning, but she had to look after her new baby and her 2 year old daughter. By evening she was exhausted and went to bed really early and just slept. The next morning, Judy got up and felt fine. But an hour after her husband had gone to work she had no strength to do anything. She vomited twice and had severe diarrhea. She phoned her mother to look after the girls and went back to bed. She felt worse and worse before eventually getting off to sleep.

The next morning was the same. Judy was fine until after her husband had left for work. A sudden attack of diarrhea hit her before she could reach the toilet. Once again she asked her mother to look after the children, and her mother also called the doctor. Judy was taken to the hospital by her sister-in-law and nearly fainted. Her legs were so painful and weak that she needed a wheelchair. Her skin was yellow. Judy was admitted to the infectious diseases ward for tests and the diarrhea was still running out of her. Within the hour they had put two drips into her. The doctors had found her tampon by now and had taken it away for testing. She had a rash on her lower legs and feet.

By the next morning, and numerous doctors later, they had diagnosed Toxic Shock Syndrome. Judy was put on even more drips and had heart and kidney checks. Her fingers and toes tingled all the time, like a burning sensation. The skin on her fingers and toes later peeled off and it was terrifying and very painful. A week in hospital and she was fit enough to go home.

Judy had to take tablets and return to hospital for heart and kidney checks and blood tests. She seemed to recover quite well, but lost her sense of taste for about 5 weeks. She was under health surveillance for 6 months and received the all clear. Then Judy's hair started falling out. It didn't leave her bald, but it was very thin in places. This lasted about two months before getting back to normal.

Judy says that not enough people know about the dangers of tampons and Toxic Shock Syndrome. She will never use tampons again, and there's no way she'd let her daughters use them either.

4. ANNETTE OF MIDDLESEX

Annette was a healthy 17 year old at boarding school in Surrey. One Friday, in June 1989, just seven weeks before her 18th birthday, she felt a bit under the weather. She had just started her period and was using high absorbency tampons. By Sunday, she was in the school sick bay, and her worried parents were driving to visit her. Annette had a high temperature, severe headache and "appeared distant". However, it wasn't until the Wednesday that she was rushed to hospital, with what doctors thought was a burst appendix.

In the early hours of the Thursday, she was put onto a ventilator, and her parents had what was to be their last conversation with Annette. The doctors advised her parents that she was suffering from toxic shock syndrome, a disease that they had never heard of.

During the night Annette's condition suddenly deteriorated and she suffered two massive heart attacks and died.

5. KAREN OF HAMPSHIRE.

One Thursday in January 1991, 20 year old Karen became ill with sickness and diarrhea. Although she was not aware of the connection, she was having her period and using tampons. She called the doctor who initially diagnosed gastro-enteritis and gave her some medicine. Karen continued vomiting, suffered severe diarrhea and was in agony, and on Sunday the doctor suspected appendicitis and she was rushed to hospital. As she was severely dehydrated, Karen was immediately put on a drip, whilst the diagnosis was being made.

The next morning (Monday), Karen felt fine and was laughing and joking with her parents. However, her mother noticed that her breathing was labored and that she had a red rash on her leg. But by 3 pm, Karen's condition worsened and she was given oxygen. By 9 pm she had lapsed into unconsciousness and transferred to Intensive Care. The medical staff did not know what was causing the problem, although toxic shock was considered. She had 15 tubes going into and out of her. At 10 pm Karen suffered a cardiac arrest, and the IC staff resuscitated her, but her condition was critical.

At 1 am on the Tuesday morning, Karen had a last injection to stimulate her blood flow, and her parents were told that this was her last hope.

6. DELYSE OF BUCKINGHAMSHIRE.

Delyse was a 32 year old secretary. Early in August 1993, Delyse' menstrual period started and she began using tampons as usual. However, this time it was to have tragic consequences.

On Saturday morning, Delyse suddenly started vomiting, had severe diarrhea and a high temperature. She thought that she was suffering from food poisoning. Later that day her partner called the doctor, who diagnosed flu.

On the Monday, Delyse went back to her GP who diagnosed gastritis - inflammation of the lining of the stomach. Her condition worsened and on Tuesday she was admitted to the local hospital with a suspected burst appendix.

Delyse seemed to be in a stable condition whilst the diagnosis began, but within 24 hours, she was rushed into Intensive Care, then onto a ventilator as her lungs had collapsed. She was then transferred to a specialist hospital nearby, where her condition improved slightly. When her vital organs, including liver and kidneys, failed, Delyse was put onto a dialysis machine.

After 5 weeks of fighting for her life, Delyse suffered a massive brain haemorrhage and died on 9th September.

7. SHARON OF COUNTY DURHAM.

Sharon, a keen sportswoman, died of Toxic Shock Syndrome two months after giving birth to her second child.

Her husband Anthony recalls the joy and the tragedy of eight weeks in late 1991.

Twenty six year old Sharon used tampons for her first period after the birth of Rebecca. It started one Sunday when she began to feel very tired.

By Monday, Sharon was suffering with diarrhea, vomiting and a prickly red rash. The doctor was called and diagnosed a virus.

On Thursday, her condition had deteriorated. Now, Sharon's fingernails and lips were turning blue, the rash was like sunburn and she was having breathing difficulties.
Sharon was rushed to hospital. Her condition improved slightly, but then her kidneys collapsed and she was transferred to Intensive Care. Doctors diagnosed toxic shock syndrome, caused by the tampon that she had been using.

The deadly toxins were causing all sorts of problems as they poisoned every part of her body. Her lungs were beginning to fail and she was transferred to the Regional specialist hospital where a lung transplant was considered. However, Sharon was too ill to undertake this operation. Doctors fought so hard to save her life, but after eight weeks of intensive care, Sharon suffered a cardiac arrest and died

8. SHANE OF BRISTOL.

Thirty three year old mother of two, Shane, died of tampon-related Toxic Shock Syndrome in March 1994.

On Friday 4th March, Shane said she didn't feel well. During the early hours of Saturday morning she began vomiting and felt awful. She asked her mother to look after the children.

By Sunday she was suffering severe diarrhea, she had a red rash and was now semi conscious. She had a high temperature, her breathing was labored, and she had pus coming from her eyes. At 9 am her husband phoned the doctor who suggested that it was a stomach bug. Shane's husband insisted that the doctor must visit, but on arrival, the doctor confirmed a stomach bug, and suggested paracetamol to lower her temperature.

By Monday, Shane's condition had not improved and her mother called the doctor again. The doctor took one look at Shane and called an ambulance. She arrived at hospital at 3 pm and went straight into Intensive Care. But after six cardiac arrests, Shane died at 5.30 pm.

One Sunday in March 1993, Pamela aged 34, took to her bed with a severe sore throat. At the time she knew that a lot of people round about had flu, so she thought that she must be getting it too.

On Monday morning she felt really faint. Her husband went off to work, but asked Pamela's mother to phone the doctor. The doctor diagnosed a sore throat and prescribed penicillin. Although Pamela was able to talk coherently to the doctor, she can't remember the rest of the day, not even talking strangely to her husband when he arrived home from work. She felt so tired. The doctor was telephoned again and he suggested looking to see if Pamela had spots on her feet! She did have. The doctor called 'round again and got her admitted to hospital with suspected meningitis.

Luck was with Pamela that evening because the Specialist on duty had seen Toxic Shock Syndrome before. The tampon that had been removed when Pamela was admitted to the hospital was tested positively for Staphylococcus aureus and TSS was diagnosed.

Ten days of hospital treatment saved Pamela's life, but she was so weak that she had to leave the hospital in a wheelchair and learn how to walk again.

It took months to recover physically and even longer to recover mentally. She lost a lot of her hair, her skin started peeling off and she ached all over. She had been using tampons since she was 17, but will never again use tampons.

On New years Eve 1990, 22 year old Fiona, woke up with crippling period pain. Her mother phoned work to let them know that Fiona would not be in today. As the day wore on Fiona became worse and started vomiting. At tea time the doctor was called and flu was diagnosed. But over the next few hours, Fiona's condition deteriorated. She started with diarrhea, her temperature soared and she developed a rash all over her neck. A worried mother called the doctor again at 2 am, and again flu was diagnosed.

The next morning, Fiona was unconscious and the ambulance was called. On arrival at the hospital, meningitis was first suspected, (but it wasn't until 3 months later that tampon-related toxic shock syndrome was confirmed). Fiona's temperature had rocketed and she was surrounded by bags of ice. The intensive care staff worked through the day, but at 3 am the next morning, Fiona suffered a cardiac arrest. The team managed to save Fiona, but the shattering news was that Fiona may be brain damaged, blind and paralyzed in all four limbs.

In the next two weeks Fiona fought for her life. Her kidneys failed and she needed dialysis, and her toes turned black with gangrene and would have to be amputated.

Three months later, Fiona started to come out of her coma. She couldn't speak, but she could hear and smile. Fiona stayed in hospital over the next year and was on drips and dialysis, and having physiotherapy and speech therapy. She was transferred to a Nursing home to be close to her parents. As a result of using a tampon, Fiona is totally blind, confined to a wheelchair, unable to use her arms and only has limited speech.

I thought that you only got Toxic Shock Syndrome if you forgot to change your tampon. Is this true?

Any woman may develop Toxic Shock Syndrome when using tampons as directed by the manufacturer's instructions if she is carrying the particular strain of bacteria that produces toxins and if she has not developed immunity to these toxins.

The exact combination of circumstances in which toxin production occurs in the vagina of individual women is not known. It is therefore not possible to state any completely safe time limits on the use of a tampon, although it could be assumed that the longer a tampon is left in place or the more tampons are used continuously, the greater the chance of toxin production starting. This is why we recommend keeping tampon use to a minimum and breaking the use regularly by using a sanitary towel/pad.

All known victims of Toxic Shock Syndrome followed the manufacturers instructions on usage implicitly, but they still became seriously ill or even died.

We think that there are several reasons why people think that a "forgotten tampon" causes Toxic Shock Syndrome:-

What is the link between Toxic Shock Syndrome and tampon use?

The link between TSS and tampons is not completely understood.

However, tampon research highlights three high RISK FACTORS: high absorbency tampons, continuous tampon use and low body immunity.

Tampon Absorbency: the higher the absorbency the higher the risk; the lower the absorbency the lower the risk. That is why a woman should always use the lowest absorbency tampon for her menstrual flow. It also accounts for the high number of deaths due to super-absorbent tampons in 1980.

Continuous tampon use: women should not use tampons continuously during a period. It is recommended that the most convenient time to break the continuous use is at night, by using a sanitary towel/pad.

Low immunity: this is the factor that you cannot control as it may vary from time to time. It is generally understood that immunity improves with age therefore girls are at a higher risk that older women.

Menstrual-related Toxic Shock Syndrome recurs in around 30% of cases. Dr Mary Andrews of the Dartmouth-Hitchcock Medical Centre in New Hampshire, advises that symptoms were most likely to return in women who were not treated during their first attack, and continued to use tampons. Two thirds of Dr Andrews' study group experienced a recurrence within 5 months, although only 16% of women who were treated had recurring symptoms of Toxic Shock Syndrome.

What are the symptoms of Toxic Shock Syndrome?

Symptoms can be similar to flu or food poisoning, but they can become serious very quickly.

What should I do if I get these symptoms?

If you have any of these symptoms and are using a tampon you should, remove and save your tampon and seek immediate medical attention (preferably at an emergency HOSPITAL). Tell the doctor that you have been using tampons and suspect Toxic Shock Syndrome

With early diagnosis, Toxic Shock Syndrome can generally be effectively treated with antibiotics and other medication to counteract the symptoms.

Professor Joan Chesney, Head of Paediatrics at the University of Tennassee said in September 1997 that concerns that Staphylococcus Aureus could become resistant to antibiotics have so far proved unfounded. Tests on Toxic Shock Syndrome-associated strains of Staphylococcus Aureus at the Dartmouth-Hitchcock Medical Center in New Hampshire failed to find any methicillin-resistant Staphylococcus Aureus (MRSA), the strain which has caused so many problems for hospitals in Europe and America. All 62 samples from menstrual and non-menstrual cases referred to the D-H Medical Center between 1984 and 1995, were susceptible to two key antibiotics - oxacillin and clindamycin - although only a handful would have responded to treatment with penicillan.

Standard therapy for Toxic Shock Syndrome continues to be on high-dose antibiotics, usually with a beta lactam agent, with or without clindamycin or a related drug. You also need to stop toxin production which can be best done with a protein synthesis inhibitor such as clindamycin, gentamycin, erythromycin or clarithromycin. Introvenous fluids are another essential aspect of management, but doubts remain over the value of introvenous immunoglobulin (IVIG) injections as they carry the risk of side-effects.

When using tampons, it's important to choose the lowest absorbency necessary for your menstrual flow. Because the amount of flow varies from day to day, it is likely that you will need to use different absorbencies on different days of your period. Selecting the right absorbency comes with experience, but as a guide, if a tampon absorbs as much as it can and has to be changed before 4 hours, then you may want to try a higher absorbency. On the other hand, if you remove a tampon and after 4-6 hours white fibre is still showing, you should choose a lower absorbency.

Research indicates that tampons should not be used continuously during a period as continuous use is a high risk factor. The most obvious time to break this continuous use is at night. AKTA recommends the use of a sanitary towel at night. However, if you choose to use a tampon at night, choose the lowest absorbency needed, insert a fresh one just before going to bed and remove it as soon as you wake up in the morning. Slim line tampons are quite absorbent for their size, so it is highly recommended that young girls do not use tampons at night.

References

2. Todd J, Fishaut M, Kapral F, Welch T. Toxic-shock syndrome associated with phage-group-1 staphylococci. Lancet 1978;2:1116-8.

4. Osterholm MT, Davis JP, Gibson RW, et al. Tri-state toxic-shock syndrome study: I. Epidemiologic findings. J Infect Dis 1982;145:431-40.

5. Schlech WF, Shands KN, Reingold AL, et al. Risk factors for development of toxic shock syndrome: association with a tampon brand. JAMA 1982;248:835-9.

6. Berkley SF, Hightower AW, Broome CV, Reingold AL. The relationship of tampon characteristics to menstrual toxic shock syndrome. JAMA 1987;258:917-20.

7. Gaventa S, Reingold AL, Hightower AW, et al. Active surveillance for toxic shock syndrome in the United States, 1986. Rev Infect Dis 1989;2(suppl S1):S35-42.

8. Davis JP, Chesney PJ, Wand PJ, LaVenture M, the Investigation and Laboratory Team. Toxic-shock syndrome: epidemiologic features, recurrence, risk factors, and prevention. N Engl J Med 1980;303:1429-35.

9. Osterholm MT, Forfang JC. Toxic-shock syndrome in Minnesota: results of an active-passive surveillance system. J Infect Dis 1982;145:458-64. 10. Latham RH, Kehrberg MW, Jacobson JA, Smith CB. Toxic shock syndrome in Utah: a case-control and surveillance study. Ann Intern Med 1982;96:906-8. 11. Broome CV. Epidemiology of TSS in the United States: overview. Rev Infect Dis 1989;2 (suppl S1):S14-21.

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Gynecologic Urology, also referred to as Uro-gynecology, is a subspecialty within the field of Obstetrics and Gynecology. Uro-gynecology's specialty is female pelvic disorders such as pelvic organ prolapse (bulges that extend from the uterus into the vagina or extend out of the vagina), urinary incontinence, fecal incontinence and constipation.

Doctors that complete their residency in Obstetrics and Gynecology, then go onto complete fellowship training in Uro-gynecology, where they spend several years focusing only on Uro-gynecology and female pelvic disorders.

What is Adhesiolysis?

Treatment for the removal of Pelvic Adhesions is through a surgical procedure called "adhesiolysis." The adhesiolysis procedure may involve cutting and releasing the adhesions during a laparoscopy procedure or treating the adhesions during a laparotomy.

Pelvic adhesions are bands of scarlike tissue that form between two surfaces inside the body. Inflammation from infection, surgery, or trauma can cause tissues to bond to other tissues or organs.

Pelvic adhesions are the cause of many gynecological problems including significant pain, infertility and conception. Pelvic adhesions are irritations of a woman's pelvic organs as a result of a "pelvic inflammatory event" or from trauma to the area such as in the case of pelvic or gynecological surgery.

Pelvic Organ Prolapse or Pelvic Prolapse, is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapsee in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Organ Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse, vaginal relaxation or vaginal vault prolapse.

Pelvic Prolapse is another term used for "Pelvic Organ Prolapse." Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by Pelvic Organ Prolapse is unknown.

Pelvic Prolapse may also be called; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor dysfunction, urogenital prolapse or vaginal vault prolapse.

What are the symptoms that indicate a woman is suffering from Pelvic Organ Prolapse?

What is Pelvic Reconstruction?

Pelvic Reconstruction is a surgical procedure performed by gynecologists or uro-gynecologies to repair pelvic organ prolapse and vaginal vault prolapse, among types of prolapse, and to correct the problem(s) and relieve the symptoms.

Typically, Pelvic Reconstruction is performed vaginally and uses an implant to reinforce the strength of the weakened pelvic tissues.

A Prolapsed Uterus refers to a collapsed uterus, or descended uterus, or other change in the position of the uterus in relation to the surrounding structures within the pelvis. The pelvis contains many soft tissue structures vital to normal body functions, supported primarily by the diaphragms, layers of muscles, fibrous coverings called fasciae, and various ligaments and tendons. These soft tissues of the pelvis derive their ultimate support from the bony pelvis.

A Prolapsed Uterus may be one of three types, depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside of the
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs when the entire uterus extends outside the vagina.

Perineoplasty, also known as "Perineorrhaphy,"is one of the fastest growing elective medical procedures and is the reparative or plastic surgery of the perineum which helps women with problems with vaginal opening laxity or looseness - medically referred to as "Vaginal Relaxation." Many also incorrectly call this procedure "vaginoplasty" or "vaginaplasty."

Perineorrhaphy is the reconstruction of the muscles and tissues at the opening of the vagina and has successfully decreased the vaginal "introitus" or size of the vaginal opening. Perineorrhaphy does NOT reduce sexual sensation, in fact, properly performed, Perineorrhaphy INCREASES sensation for the woman as well as her husband.

What is Colporrhaphy?

Colporrhaphy is the surgical repair of the vaginal wall. This includes repairing many types of vaginal surgery, including the repairs of the vagina in a "Pelvic Organ Prolapse," "vaginal prolapse," "Vaginal Vault Prolapse," or the repair of a "cystocele" in the vaginal wall(s) or vaginal vault or a rectocele. A cystocele occurs when the bladder protrudes into the vagina, and a rectocele when the rectum protrudes into the vagina.

In the Colporrhaphy procudeure, a uro-gynecologist, or gynecological surgeon, places a vaginal speculum inside the vagina, which spreads/keeps the vagina open, for the doctor to inspect and repair the vagina. The vaginal wall is cut opened to reveal an opening in the supporting structures, or fascia and the defect is closed and then the vagina is repaired by suture and closed, and the speculum removed.

Who performs the Colporrhaphy and where is it performed?

Colporrhaphy is usually performed in a nearby hospital operating room by a uro-gynecologist, urologist or gynecological surgeon.

What is Colpopexy?

Colpopexy is the surgical suturing of the prolapsed vagina to a surrounding structure - such as the abdominal wall or the sacrum, which is then called Sacral Colpopexy or Sacrocolpopexy

Sacral Colpopexy, also referred to as also referred to as also referred to as also referred to as also referred to as also referred to as Sacrocolpopexy, is the preferred surgical procedure for treating and correcting Vaginal Vault Prolapse with excellent results. Sacral Colpopexy (Sacrocolpopexy) has a very high rate of success and the surgical procedure involves suturing a synthetic mesh that connects and supports the vagina to the sacrum, or tailbone. The Sacrocolpopexy operation is performed from the abdomen to support the vagina to the ligament on the spine (after previous or present surgery to remove the uterus) by using a synthetic mesh.

Why Is Sacrocolpopexy Performed?

Sacrocolpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of the uterus.

A woman's vagina that has one or more of these vaginal protrusion(s) may experience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causes pain.
• Difficulty with urination (e.g. unable to completely empty the bladder)
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
• Pain
• Infection
• Bleeding

The objective of the Sacrocolpopexy operation is to relieve the woman's symptoms and to restore her vagina and her vaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacrocolpopexy surgery?

Sacrocolpopexy surgery is a very common and relatively safe operation with excellent prognosis and outcomes. However, like any surgical procedure, there are complications which may occur. Possible complications from Sacrocolpopexy surgery may include:

• Bleeding
• Infection
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines)
• Formation of blood clot(s) in the legs or lungs
• Recurrence of problem
• Slow return of bowel or bladder function
• Erosion of synthetic material through vaginal mucosa

What Happens Before Sacrocolpopexy Surgery?

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health for Sacrocolpopexy surgery.

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing.

3. You will be admitted to the hospital one day before Sacrocolpopexy surgery.

4. You will be given preparations to clear your bowels.

5. Your pubic hair surrounding your vulva will be shaved.

6. You will not be allowed to eat or drink after midnight on the day before the surgery.

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled.

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at least one week before Sacrocolpopexy surgery.

What happens during the Sacrocolpopexy surgery?

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after the Sacrocolpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacrocolpopexy surgery?

1. Immediately after the operation, you may experience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities.

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort.

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. You will need to wear a menstrual pad during the recovery period, but you will not be permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You will be encouraged to move around. Blood chemistries and normal follow-up visits will be performed.

3. The catheter that was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery if the doctor is pleased with your progress and the outcome of the Sacrocolpopexy procedure.

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor.

• Using tampons, douching, sexual intercourse and driving for 4 weeks.

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacrocolpopexy surgery.

6. You should (immediately) return to the hospital or notify your doctor if you notic any of the following:

• Heavy vaginal bleeding
• Foul smelling vaginal discharge
• Severe abdominal distension and / or pain not relieved by painkillers
• High fever
• Pain associated with passing urine
• Difficulty in passing urine
• Constipation

Follow-up doctor visits after Sacrocolpopexy surgery

You will be examined by your doctor (at your doctor's office) at approximately; 2 weeks, 4 weeks, six months and and one year after Sacrocolpopexy surgery.

It is important to keep your follow-up appointments to ensure the best possible results.

One of the most annoying feminine or gynecological problem a girl or woman will face in her life is feminine itching. Every young girl and woman will experience the discomfort, embarrassment and possible pain of feminine itching at some point in their life. For most women, feminine itching may be a recurring nuisance, and potential indication of a minor or possibly serious medical symptom and condition which should also be a signal to her that she needs to see her gynecologist as soon as possible.

There are many reasons and causes for vaginal and/or vulva itching. A few of these are;

Even a woman's monthly hormonal changes and variations may play a role in contributing to vaginal dryness which, in turn, may cause feminine itching. Sexual intercourse - with prolonged intercourse or too much friction inside a woman's vagina can lead to internal soreness and irritation.... and feminine itching.

Vaginal and vulva perspiration can lead to irritation, and damp panties from excessive vaginal moisture, not changing panties after they become wet from whatever reason(s) (exercise, sexual activity, excessive vaginal moisture or perspiration), poor hygiene and/or failure to properly wipe from front to back after urination may provide an ideal environment for yeast and bacteria to grow. Changing your panties when they become wet, removing/changing from your swimsuit bottoms after you're finished swimming, and sleeping without panties at night to allow your vagina and vulva adequate airflow will help prevent a number of problems.

Vaginal yeast infections are a common side effect from using antibiotics, the primary treatment for many medical conditions including urinary tract infections ("UTIs"). One of the most common reasons why young girls from 5-8 years-old suffer from urinary tract infections comes from their improper wiping habits - not wiping from front to back - after urinating. Other causes include everything from allergies to soap, bubble baths, laundry detergents to anatomical variations of their vulvas.

Vaginal yeast infections and bacterial vaginosis are very common problems from women in their postmenopausal years. Menopause itself, with the associate vaginal dryness is another contributing factor to feminine itching as the lack of estrogen, which occurs after menopause, leads to thinning, sensitive vaginal tissues that are also much dryer than before menopause.

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Information provided on this website is for educational purposes only. Always seek the advice and care of a competent physician with regards to any and all questions you have regarding regarding a medical condition, and before undertaking any diet, exercise or other health program and before relying upon this or any other website's information. NEVER rely on the information on any website without first confirming with a competent physician. While we have made every effort to check, update and verify the accuracy of our information and resources, we cannot be held responsible for any inaccuracies. The information contained on this website has not been evaluated by the FDA and not intended to treat, diagnose, cure or prevent any disease, medical or health condition.

Clostridium sordellii Toxic Shock Syndrome After Medical Abortion with Mifepristone and Intravaginal Misoprostol --- United States and Canada, 2001--2005

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Alice's Story

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