TSS is a rare but serious illness that may cause death. It can occur in men, women and children, but is significantly more common among young women using tampons during their period. It is caused by toxin (a kind of biological poison) produced by a type of bacteria (Staphylococcus aureus), which may already be present in the body.

If the toxin is produced in the vagina or a wound, and absorbed from there into the bloodstream, a person who is not resistant to the toxin may become ill. Most people develop resistance to the toxin (which is why the illness is so rare) and in these people there is no harmful effect. Tampons do not cause TSS, however tampon use has been associated with an increased risk of TSS. Please note that tampons are not sterile, and neither are your hands or vagina. Tampons, while containing very small amounts of bacteria normally present in the air, have not been shown to carry the bacteria which cause TSS.

The following symptoms of TSS may develop rapidly, and are similar to the "flu". Early recognition and treatment of these symptoms can usually prevent serious illness:

• Feeling very ill, headache, muscular pains
• Sudden onset of high fever and chills (39°C/102°F or higher)
• Vomiting or diarrhea
• Fainting, dizziness, weakness or confusion
• Sunburn-like rash

If you have any of these symptoms during, or soon after your period, REMOVE YOUR TAMPON AND SEE A DOCTOR IMMEDIATELY. Remember, it’s very important to tell the doctor that you have been using tampons. If you have ever had TSS, you should not use tampons until you have discussed it with a doctor. You may not have developed resistance to the toxin and could get TSS again.

• Only use a tampon when menstruating. Only use one tampon at a time.
• Do not insert a tampon if it hurts to do so.
• You may reduce the risk of TSS by using the lowest absorbency tampon necessary to suit your flow. Although TSS can occur with tampons of any absorbency, the risk increases with tampons of higher absorbency.
• Wash your hands before unwrapping and inserting a tampon, and again afterwards. Unwrap a fresh, clean tampon just before insertion – do not handle more than is necessary or place it on any surface. Discard any tampon you may have unwrapped and not used immediately.
• Remove the used tampon before inserting the next one and do not forget to remove the last tampon used at the end of your period.
• Removal of the tampon should be easy. If it is dry and difficult to remove, the absorbency is too high or the tampon has not been in place long enough. Tampons should be changed as often as you need to but should not be left in longer than eight (8) hours.
• Ask a doctor if it is okay to use tampons if you have recently given birth, had a caesarean section, a miscarriage, an abortion or any other operation on your reproductive section.