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Jacqueline Komada
Hi friends,

I just saw a medical article recently published in 2015 about a woman who had toxic shock syndrome while wearing a menstrual cup. Scrolling through the comments below the article, there were some people mentioning they have had TSS symptoms while wearing a menstrual cup. One user specifically mentioned it was because despite boiling the cup and cleaning it out, the little suction holes still had dried blood in them which harbored the bacteria. Now I am freaking out a little bit..does anyone know anything about this? Are big brands like DivaCup, MeLuna, and Lunette advertising that cups have no association with TSS when really they're not entirely sure or may?


Also...here is the link to the paper and article
Kai: 2Cupskuradi8 on July 16th, 2016 01:56 pm (UTC)
On the other hand:
A cup is as hygienic as the person using it. Also, we all have different levels of sensitivity to microbes. Some people are more susceptible to infection while others are more resistant. Just because it can happen doesn't mean that it will.
Sarcasticia Nitpickersontisiphone on July 16th, 2016 04:01 pm (UTC)
It is not surprising that TSS is a possibility with menstrual cups, though the fact that this is a single case report and not a general study suggests its rare. The same possible conditions as with tampons are possible with menstrual cups. Overall, TSS is a very rare occurrence, and not something that most women will ever experience. I don't think this is something you need to worry about, really.
citrinesunset: Fountain pencitrinesunset on July 16th, 2016 08:44 pm (UTC)
It doesn't really surprise or concern me.

I've read that study, and it sounds like the main problem was that the woman had a small abrasion in her vagina, which may have made it easier for bacteria to get into her blood stream.

Anything put into the vagina like this can potentially cause an infection. I didn't decide to use cups because I thought they were 100% safe, because nothing is 100% safe.

In the case of marketing, saying that cups aren't associated with TSS isn't the same as saying that they don't pose any risk. It just means that no cases have been reported (which may change now since this study has come out).
..::bella vita::..por_que_no on July 17th, 2016 01:13 am (UTC)
Yes, it was her nails that caused the abrasion. Common sense: file your nails. Or don't have enormous fake nails around that time of the month if you're a cupper.

(I'm in a field where you CAN'T have any nails, so frankly, the idea of having nails that long at all kind of disgusts me. But models and other types who need to have done-up nails for work purposes should just make allowances for that time of the month)
rebecca2525rebecca2525 on July 17th, 2016 10:06 am (UTC)
nothing is 100% safe

This. Ever read through the list of averse reactions to pain killers? Looking at the worst possible outcomes of things can be scary, but you really have to put it into perspective.
..::bella vita::..por_que_no on July 17th, 2016 01:11 am (UTC)
Nope. The girl in the original article had scratched herself around her opening because she didn't file down her talons before fiddling with the cup. Common sense would say you can't have both huge nails and hygienic practices with cup use...

I know it sounds harsh but I have exactly zero tolerance for misinformation being spread, and people blaming this girl's TSS on the cup itself is 110% misinformation. Victim blaming? Maybe. But who else is there to blame? Her manicurist?

Edited at 2016-07-17 06:49 pm (UTC)
Kartos Dal'Avier: Avatar - Katara D:kartos on July 18th, 2016 06:10 am (UTC)
I'm laughing, (I know, poor taste), because I always wondered how people did anything with long nails, especially with cups, and here's the reason to never, ever try.
..::bella vita::..por_que_no on July 18th, 2016 06:46 pm (UTC)
Oh I know! A large part of the field I'm in requires short/no nails, so actually having extremely long nails now makes me feel really sensory-defensive (grossed out/crawly feeling).
Kartos Dal'Avier: Avatar - Zuko unnervedkartos on July 18th, 2016 08:13 pm (UTC)
I'm an artist so I know that all too well. I also don't understand how anyone can type when they have anything going past their fingertips.
elisamba on July 18th, 2016 09:04 am (UTC)
There was already a thread on that study, if you look for it in the search side bar.

Something like 50% of TSS cases occur in menstruating women, but other victims include post-menopausal women, children and even men. So you can get TSS if you are using cups, pads, tampons, sponges, those little gel packets from shoeboxes... or even if you have no period.

I did not switch to cups for any supposed health benefits, and used tampons for over 20 years with no problem. I switched partly because my organic cotton tampons got a bit too expensive for my budget.
Kartos Dal'Avierkartos on July 18th, 2016 08:14 pm (UTC)
Don't the bleached, cheaper ones have a higher risk, too?
elisamba on July 18th, 2016 09:21 pm (UTC)
I don't know, but I used OB's for about fifteen years before going with the organic ones until they got too expensive for me.
..::bella vita::..por_que_no on July 20th, 2016 06:30 pm (UTC)
I'd certainly think that those bleached ones could cause allergic reactions in some people, leading to swelling, itching, irritation--and with that swelling and probably scratching the itch--abrasions that would be perfect for letting bacteria in and contributing to TSS.
Sarah Hudson Hofhine: pic#126303989Sarah Hudson Hofhine on July 31st, 2016 09:18 pm (UTC)
I read about this too just as I started using cups. I am frustrated that cup companies advertise the toxic shock risk in what seems to me a misleading way. I am also frustrated at the seemingly arbitrary 12 hour limit. And blaming the cup user's TSS on a cut she gave herself is possible, but developing TSS during menstration without cuts and without the use of inserted hygiene products is possible.

I do love my cup despite a rocky start and try to use common sense and body awareness in using it. I don't feel comfortable going 12 hours so I don't. If I were to develop a high fever I would get checked out by a doctor.
elisamba on August 1st, 2016 03:12 pm (UTC)
Good points. I, too, am increasingly skeptical about the TSS marketing angle, which is what I now believe it to be.

TSS is already extremely rare, even amongst tampon users. This study from 2000-2006 in a city of 2.6 million people found only 61 TSS cases diagnosed in that time frame. That's 0.52 per 100,000. 33 were menstrual, and 28 were non-menstrual. The menstrual incidence alone was 0.69 per 100,000. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157910/

I quote elsewhere in the abstract:

"The estimated incidence of TSS in 1980 among young menstruating women was 13.7 per 100,000 persons [7]. Following multiple public health interventions including removal of highly absorbent tampons and messages regarding proper use of tampons, the number of cases declined sharply. By 1986 the rates of menstrual and non-menstrual TSS cases were 1 and 0.3 per 100,000, respectively."

I think something a bit more analagous to cups would be diaphragms and guess what? They too have been associated with - already extremely rare - toxic shock syndrome. Back in 1989 when they were more widespread the occurrence was 2.4 cases per 100,000 diaphragm users. (Footnote 14 here http://www.aafp.org/afp/2004/0101/p97.html#afp20040101p97-b14)

Now if I am not mistaken, diaphragms at that time were still latex, so I don't know if a similar study has been done since then with the newer generation of silicone diaphragms, which would be even more analogous to most cups except the latex Keeper.
Since silicone is non-porous, it is theorized that it is not a good growing medium for bacteria.

Anyways, all this to say: TSS exists, is very rare, strikes randomly, and is IMO just another one of those unpredictable, unlucky occurrences we have to come to terms with as mortals right up there with any other rare disease we could catch or develop.