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A Guide To Toxic Shock Syndrome For All Menstruators: Symptoms, Causes And Precautions

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This post is a part of Periodपाठ, a campaign by Youth Ki Awaaz in collaboration with WSSCC to highlight the need for better menstrual hygiene management in India. Click here to find out more.

Written by: Nirajana Sinha

Toxic Shock Syndrome (TSS) is an extremely rare and serious medical condition that is caused by the bacterium Staphylococcus aureus. It occurs when this bacterium gets introduced to the bloodstream and produces toxins. The toxins then produced can cause organ damage, including kidney and heart failure, and even death. Many scientists believe that other factors that can act as a catalyst are oxygen (brought into the vaginal canal by the tampon) that creates an aerobic rather than an anaerobic environment, a less acidic environment during menstruation to name a few. Although it has been linked to super absorbent tampon use in menstruators, it can affect anyone irrespective of their age.

Some of the symptoms of toxic shock syndrome include sudden fever, low blood pressure, vomiting or diarrhoea, muscle pain, redness of eyes, mouth and throat, seizures and headaches. Tampons used by menstruators are one of the causes of menstrual TSS (mTSS). They are commonly made of cotton, rayon or a blend of the two. The absorbent fibres used in most tampons sold commercially today are made with a bleaching process, which is free from elemental chlorine. This prevents products from having dangerous levels of dioxin.

Tampons should always be used once. Tampons marketed as reusable may carry the risk of infections such as yeast, fungal and bacterial infection. In the 1980s, the Center for Disease Control and Prevention (CDC) in the United States implicated Rely tampons produced by Procter & Gamble as the single tampon contributing to the mTSS.

period care

After being threatened by the US Food and Drugs Administration (FDA), the company decided to withdraw all the unpurchased products from the market shelves. Between 1970 and 1980, there were 941 confirmed cases of toxic shock syndrome, 928 in women and 905 at the onset of menstruation in which 73 women died.

Ways To Prevent Menstrual Toxic Shock Syndrome

Here are some ways to prevent mTSS:

  1. Change tampons every 3-8 hours. Do not use a tampon longer than that.
  2. Use a low absorbency tampon or sanitary napkin during menstruation (if a tampon can be used for more than eight hours a day, it is possibly high absorbent).
  3. Shift to reusable silicone menstrual cups (they are also environment and pocket friendly).
  4. Wash hands thoroughly before and after changing.
  5. Do not reuse an already used tampon.
  6. Since menstrual toxic shock syndrome can occur again, it is advisable to not use tampons if one has once survived mTSS.

One important point that needs to be taken into consideration is the ingredients used by the producers and manufacturers of these menstrual hygiene products. Often times, producers shift the ingredient composition in their tampons. A non-disclosure of these menstrual product ingredients creates a gap in the standards set for these products.

However, because of more advanced and rigid safety procedures that menstrual hygiene products now have to go through, cases of menstrual Toxic Shock Syndrome or mTSS have decreased drastically. But the cases are not nil. The threat of mTSS continues to loom large over menstruators if they do not adhere to certain safety and hygiene guidelines.

In India, incidents of mTSS are unknown and occurrences are reported only in isolated case reports. This is because very few menstruators in India use tampons or are even aware of them. For a very long time, tampons were considered something that “break one’s hymen” and lead to a loss of virginity. This “loss” of virginity is in turn linked to the honour of a woman, her family, and in some cases, her entire village or clan. India’s obsession with controlling women’s sexuality and virginity restricts menstruators from accessing menstrual hygiene products.

We face issues finding tampons at local medical stores; even mainstream media chooses to not talk about tampons or popularise or normalise them, feeding more to the situation. Families like mine raise eyebrows at the very thought of inserting something inside the vagina, even if it is for managing menstruation, because any form of vaginal insertion before marriage makes a menstruator impure.

This lack of awareness around menstruation is probably one of the biggest contributors to why India has few isolated incidents of mTSS which, though is a positive thing, puts the health of menstruators in jeopardy and indicates an urgent need to address and fight menstruation-related social stigma.

For in a country where only 36% of women use sanitary pads, only 48% of adolescent girls know what menstruation is prior to their menarche, and where thousands of women die every year due to lack of menstrual hygiene management, proper tools and menstrual knowledge, the urgency is yet to be felt.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

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Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

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MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

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A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

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A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

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A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
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