My brain has discarded most of the information I once obtained from teen magazines, save for something that creeps back to the forefront of my mind on a monthly basis: toxic shock syndrome. Every single time I use a tampon, cautionary tales I read in issues of Seventeen and CosmoGirl during my youth flash before my eyes. Alongside embarrassing moment roundups and dubious advice about crushes came frighteningly detailed articles about young women being hospitalized, losing limbs, and even dying after leaving a tampon in for too long. I remember the articles as being so intense that, in retrospect, I have to wonder if they were placed by Big Pad.
I’m hardly alone. “I first encountered TSS when my mother warned me about it, but my paranoia was truly cemented after reading articles in teen magazines. One of my best friends in middle school was a teen magazine connoisseur and I can remember sitting in her bedroom flipping lightheartedly through Cosmo and Seventeen, but really searching for the TSS horror stories that I knew they contained,” my friend Eliza told me. “I was afraid to use tampons at first and, once I started, I went through tampons like I had a much heavier flow than I did. TSS was such an ingrained part of my understanding of menstruation so it never altered my habits, but instead helped to form them.”
In fact, TSS seems to be all that some can remember from how teen magazines covered menstruation. “I lived and died by my magazines — and they all made me convinced I was going to get TSS!” my friend Mary Jane shared. “None of them were helpful in teaching me how to, say, use a tampon, which baffled me when I was 15.” Funnily enough, for all of my worrying about it, I could only vaguely define what TSS actually is. For those wondering the same, it’s a rare and sometimes fatal complication of a bacterial infection linked to Staphylococcus aureus bacteria; per the Mayo Clinic, symptoms include a sudden fever, a sunburn-like rash on your palms and soles, vomiting, and confusion.
Ultimately, the TSS stories created the perfect storm of fear. First, you have a captivated audience of inexperienced young people who are just learning to navigate their changing bodies. There’s the literal name of the condition, which manages to include both the words “toxic” and “shock.” Perhaps the scariest part, though, is the sheer banality of it all: your mind slips, you leave a tampon — a product you were using in the first place because it’s far more convenient than the alternative — in longer than the recommended time, and something catastrophic happens. And while some stories have since emerged and assuaged my anxiety (say, Moe Tkacik’s iconic 2008 Jezebel story about leaving a tampon in for ten full days), there have been others that have newly stoked it — namely, model Lauren Wasser’s harrowing tale of losing both of her legs to TSS or 16-year-old Canadian teenager Sara Manitoski’s TSS-related death just last month.
Dr. Jen Gunter, the internet’s resident OB/GYN, told me that her first experience encountering TSS was during the Rely scandal of the early ’80s. Rely, which hit the market in the late ’70s, was produced by Procter & Gamble and marketed as a super-absorbent option. (This was due to an ingredient called carboxymethylcellulose, which has since been banned for use in tampons.) According to The Atlantic, nearly a quarter of tampon users were estimated to be Rely users by 1980, some of them wearing a single tampon for the entire duration of their periods. This ended up being disastrous: that same year, the CDC linked tampons to TSS and found that Rely tampons “were the only variables that significantly increased the relative risk of TSS.” Rely was swiftly pulled off the market, and Procter & Gamble faced a number of lawsuits on behalf of women who had fallen ill from or died of TSS after using their product.
“Seeing young girls dying, we’re not used to that,” Gunter said of the reaction to the crisis. “We’re used to car accidents, and of course there were still young girls dying in car accidents, but this was kind of new and catastrophic. And nobody really understood it.” Research has indicated that by 1990, there was a significant decrease in tampon use because of the Rely fallout; another CDC study of 739 women in the early aughts indicated that 62 percent used pads while only 42 percent preferred tampons.
But is the amount of worrying justified? The short answer is: no. For starters, tampon use isn’t the only way to get the condition and menstruating women aren’t the only people at risk. While the rate of occurrence of menstrual-related TSS is higher than non-menstrual TSS, it’s still very rare — the condition has a frequency of about 1 to 3 cases per 100,000 people every year. And in order to contract it in the first place, you need to be part of the 20 percent of the population with the bacterial strain Staphylococcus aureus present in your body. “I don’t think that we teach people how to look at their own personal risk benefit ratio, and I think that it’s very easy for a scare story to run away,” Gunter added, when asked about her own perception of TSS coverage. “I also think too, fear sells.”
Susan Schulz, who worked at CosmoGirl starting in 2000 and became editor-in-chief in 2003, told me that she remembered reading about TSS in Seventeen back in the mid-’80s. In particular, we discussed an article published during her tenure titled “I Almost Died of Toxic Shock Syndrome.” From Schulz’s perspective, the magazine wasn’t trying to stoke fear in girls as much as it was trying to raise awareness for those who hadn’t been around during the Rely days. “The thinking at the time when we were at CosmoGirl was that the new generation of kids, they didn’t remember that,” she explained. “We were always trying to think of ‘what do girls need to know?’ Who knows what kind of a health class they have in school, who knows what kind of a relationship they might have with their mom?”
“We didn’t want anyone to think ‘oh my God, I’m never going to use tampons again, I don’t want this to happen to me,’” Schulz added. (She also told me that she hadn’t encountered anyone else who said they’d developed a fear of TSS because of teen magazines.) The article did indeed mention how rare the condition is and emphasize to readers that “you don’t have to stop wearing tampons,” but it’s not difficult to see how those details could get lost to time in favor of focusing on the main, terrifying narrative. Looking back, I also wonder if the articles didn’t appear nearly as frequently me and my peers remembered — that it was the fear that made them still loom so large in our minds.
Still, by now I have a logical understanding of what the actual risks of TSS are — enough so that I shouldn’t be thinking about it as frequently as I do. Will I ever stop, though? Well, there’s always menopause.