The Scenario: It's a summer evening, you're rocking out with your most cherished companions at an outdoor music fest. It's remote, the scenery is divine, and the music is killer. Smells of nature fill the air accompanied by an occasional whiff of the overwhelmed port-a-potties. You could stay here forever.
Until you realize your buddy is bleeding. Not because they've been shot or stabbed, but because every 28 days or so, blood, mucus, and dead endometrial tissues come tumbling out of their genitals. Fortunately, god (or someone shortly after her) invented tampons. Since pre-sunrise, your friend has had a wad of cotton shoved up there, and that insertion is well beyond the box-recommended eight-hour mark.
"How long can I realistically leave a tampon in?" your friend asks. You get it—no one wants to visit a bathroom stall (especially one without sinks) at a music festival more often than they need to.
The Concern: The box says eight hours, the directions say eight hours, my middle school hygiene teacher said, "eight hours!" Do tampons self-destruct after eight hours?
I still haven't determined where that eight-hour timeline originated, but manufacturers warn that wearing a tampon for longer than eight hours, increases the risk of toxic shock syndrome [TSS]. I clearly remember learning about toxic shock syndrome in my early tampon education. Perhaps it was my mom or maybe the school nurse, but "It can kill you," I was told. For a long time, I was afraid to anywhere near a tampon.
Even now decades later, with every monthly cycle, those three little letters still boggle my mind: TSS–just how dangerous is it?
Worst Case Scenario: TSS can be fatal, so the worst case scenario is death. Breathe, though: TSS is extremely rare. Each year, less than 1 out of every 100,000 people contracts toxic shock syndrome, and not all of those cases are related to menstruation. Many of the recorded TSS cases are complications of burns or wound care.
So, death by forgotten tampon is theoretically possible but highly unlikely. Still, let's say your friend is one of the few unlucky folks who develop menstrual-related TSS. You might be relieved to hear that the infection usually progresses fairly slowly. This means they'll probably have time to pursue life-saving antibiotic treatment after the festival.
But seriously, anyone showing symptoms of TSS should immediately go to the emergency room. TSS usually begins with a sudden fever, sore throat, muscle pains, and a rash that looks like sunburn. Symptoms like diarrhea, nausea, vomiting, and peeling of the skin can also pop up. If untreated, the patient will experience a drop in blood pressure, multiple organ failure, and will eventually kick the can.
A forgotten tampon, "can be a breeding ground for bacteria just like any other foreign object that's left in the body too long," says Zoe Rodriguez, assistant professor of obstetrics, gynecology, and reproductive science at Icahn School of Medicine at Mount Sinai in New York. Rodriguez explains that not all bacteria causes TSS but, "if the bacteria that does flourish is of the staph aureus variety of the strain that has that particular toxin then that's what could put the patient at risk."
And while Rodriguez acknowledges that leaving a tampon in for too long does increase the risk of TSS, she also emphasizes, "it's super rare."
What'll Probably Happen: Most of the time nothing happens if you leave a tampon in for too long. Some people do experience complications, but those complications aren't as dangerous as TSS. For example, if a person uses a tampon too absorbent for their menstrual flow, they might experience excessive drying of the internal mucus membranes. Rodriguez says that this could cause discomfort and even internal abrasions when it's time to yank that sucker out. But if the individual has adequate internal lubrication, removal shouldn't be an issue.
Rodriguez encourages patients to "try to use products that are less absorbent on lighter days…because it's the super absorbent products that can put one at risk for TSS." For those who've left a tampon in for longer than the recommended time, Rodriguez advises to "just remove it and go on about their business and typically nothing will happen."
Of course, the longer a tampon stays in, the higher the risk of complications. And forgetting tampons or "losing" them is not uncommon. Individuals frequently need medical assistance to retrieve internally misplaced tampons. Don't be embarrassed if it happens to you. Reach out and ask for a helping hand (ha). Just make sure that hand is attached to a licensed medical professional.
As for the health effects of retained tampons, Rodriguez explains, "The most common consequence of leaving a tampon in for too long or forgetting a tampon inside, is a very foul-smelling discharge and irregular spotting." She describes the experience as a "mild or minor condition" and elaborated that it often only develops after leaving a tampon inside the body for days or even weeks.
Advice for Your Friend: As long as your friend is healthy and symptom-free, it's probably okay to wait for adequate bathroom facilities before diving-in to retrieve that bloody wad of cotton. Most likely they won't suffer any serious health effects.
But if at any point, during or after, your friend begins to notice a discharge or discomfort, they should head to the doctor, because Rodriguez adds, "In my patients who do present with a foul smelling discharge because they've left a tampon in too long, I will treat them empirically with antibiotics."
Knowledge is important—know the symptoms of TSS, but if you can't avoid leaving a tampon in for more than eight hours, don't freak out. Just don't forget about the damn thing altogether and you should be fine.
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