Put A Cup In It

Do Menstrual Cups Cause TSS?

A new string of articles by sensationalist publications stating that menstrual cups are more likely to cause TSS have been making the rounds and giving menstrual cup users quite a scare. We wanted to ease the minds of cup users who have read the articles or simply saw the headline that “menstrual cups cause TSS” by giving some perspective on the study and proper cup usage.


What is TSS?

TSS (Toxic Shock Syndrome) is a condition caused by bacterial toxins (pathogen Staphylococcus aureus) that is often associated with the use of tampons but can be contracted in both men and women through various methods. In some cases TSS can cause death or lead to limb amputations. When caught early enough it is not fatal but since the symptoms closely mimic common flu many afflicted refuse to seek help in time.

Tampons have been a major cause of TSS for decades but the height of TSS cases occured during the 1970’s when a super absorbent tampon called “Rely” made by Proctor and Gamble lead to numerous deaths. This tampon was taken off the market but cases continue even today that are connected with both proper and improper usage of tampons. The leading advice for tampon users is to follow wear instructions, avoid tampons made from synthetic fibers or those bleached by a method not producing dioxin. Organic tampons have been rising in popularity in part due to the belief that they are less likely to cause TSS. The number of reported TSS cases from tampon use are down considerably but the risk is still there, especially for anyone not following the proper guidelines of tampon use.

FDA tampon TSS

Do Menstrual Cups Cause TSS?

The general consensus has been that menstrual cups do not directly cause or contribute to the development of TSS, and PACII continues to support this statement. A recent study has found that cups are as likely or more to lead to TSS. Before you panic we want to address this study  and remind everyone that only two menstrual cup users have reported cases of TSS. We know TSS is possible to contract while using a cup but it’s important to note that in both recorded cases the women left their cups in far longer than the maximum time mandated by cup manufacturers (7 days versus 10-12 hours).

A study recently that has been making the round in articles published by click bait websites such as Daily Mail references a study conducted by a French university University Claude Bernard. The study uses plastic bags which is a far cry from the biome of a vagina.

“…they do claim that menstrual cups are more likely to increase the production of Staphylococcus aureus – the bacteria that causes toxic shock syndrome.”

Far more testing needs to be done before this claim can hold water. I take full comfort and peace in the fact that of the thousands of cases of TSS reported, only two cases have been connected with menstrual cups. Cups have been in use for decades and have been steadily rising in use over the last 10 years, so if they were more likely to cause TSS there would be far more reports in line with the number associated with tampons. But this hasn’t been the case.

“Every so often a clickbait article headline graces our newsfeeds which admittedly can be difficult to ignore. It’s important to note, that this study… is being performed on bags. NOT humans. As with any period care product the most important thing is to keep it clean, don’t leave it in too long and use a trusted brand. More on this can be found in our blog post: Menstrual Cups and Toxic Shock Syndrome: What You Need to Know.” -Cathy Chapman, Lunette

Using Menstrual Cups Safely

For menstrual cup users following proper cleaning procedures is important- remove your cup every 10-12 hours and wash well. If you are worried about TSS or other infections you can boil your cup before or after each menstrual cycle for sterilization but this is not required (see our video on how to clean your menstrual cup), though many manufacturers recommend doing so. Wearing a cup in the vagina for more than 12 hours is not advised but it’s something that has happened accidentally to many users who have reported nothing catastrophic happening other than a very smelly cup of blood upon removal. We have heard of people forgetting their cups for a full year and 14 days and both lived to tell the tale on Reddit. Again- this is NOT advising anyone to wear their cups longer than 12 hours.

“The Food & Drug Administration is very particular about Class II Medical Devices (menstrual cups and tampons both fall in this category) and how their suggested usage is communicated to consumers. The required labeling is based on FDA-reviewed scientific studies and is intended to protect consumers from harm. As I understand it, the FDA currently allows for the language that menstrual cups can be worn up to 12 hours while tampons must be changed every 4 to 8 hours. That said, Tampon-Related Toxic Shock Syndrome is absolutely deserving of more study! In my opinion, not enough studies have been done for scientists to fully understand this rare syndrome in particular and vaginal health in general.” -Tracy Puhl, GladRags

Menstrual Cups Are The Better Choice

Menstrual cups are far healthier than tampons in ways that make a difference in your daily life and comfort. Tampons will absorb your body’s natural moisture leading to personal dryness and a potentially less satisfying sex life. They also leave behind microabrasions in the vaginal canal, especially when removed before they’re fully saturated (using tampons on light flow days is a risky choice for this reason, use liners or a cup to be safe). Menstrual cups can be worn for any amount of flow, from light spotting to “changing a tampon every hour” days making them a more convenient option.

Image via CDC

8 Responses

  1. Hey

    I’m 30 with very high anxity,

    So I’ve just bought a menstrual disc for the first time and after wearing it 1 day and night I think I’ve figured out how to wear it without leaking and I’m quite happy about that.

    However I was starting to worry about TSS, as the dangours of this have been beaten in to me since the first day I started using tampons.

    I have read your artical about this and with statistics I am logically inclined to agree the risk is minimal, However (as I’m sure people are aware) anxity is an illogical bitch, and I was panicking about leaving it in so long after the first day so had to take it out.

    So basically my question is can you wear the disc day and a pad or something at night? It there a way to stabilise the disc overnight ready to wear in the day? or would just need multiple discs and then sterile them all at the end of the period or alternate them sterilising them between each use?and also it is ok to sterile them like that so frequently?

    Honestly, I am also having some fairly big anxity attacks right now anyway in hind sight properly a bad to switch lol believe it not I did do research before buying and thought I had the answers but I guess not

  2. Hi amazing ladies,
    I’ve been looking for the case study for the 2 confirmed cases of TSS linked with menstrual cup use, I can only find one, and nowhere did it say that the woman had the cup inside her for seven days? I saw that abrasion was reported on the first few insertions but nothing about keeping the cup in there for a week. I’m writing a blog and would like to site a credible source. I am spreading how the menstrual cup has changed my period life!

    Thank you!

  3. Mariah, I’ve worn cups for 7 years, both overnight and during the day, for a maximum of 8 hours. My first 2 days are SUPER heavy but I’ve never had a problem with overflowing or TSS. If the products are used properly, you shouldn’t have a problem.

  4. Thank you for this article! It was very informative and helpful. I’ve been trying to find a source/sources for the two cases of menstrual cup associated TSS you mentioned in the article. Are you able to provide any sources on these cases? I see that the FAQ section states that at least one case occurred when “when a woman scratched the inside of her vagina and the cup was not worn as directed.”

    Thank you again!

    1. Zaria,

      Here is the case study involving the woman who scratched herself (“mild abrasion” is the term used). I haven’t looked for the other case, although I think that as long as nails are properly trimmed the risk would be minimized. You could also switch to pads if you feel any irritation from insertion/removal, just to be on the safe side.

      1. I would love to hear your story! I have been using a menstrual cup on and off for a few months but am still hesitant to wear overnight (8 hours). How long was the cup in for when you had contracted TSS?

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