Okay, so you passed out cold while reading in bed (a.k.a., watching To All the Boys I’ve Loved Before for the 32nd time on your laptop)—before you even had a chance to remove your tampon.
Pretty harmless, right? Eh…not quite.
The problem: “We know that the longer [a tampon] is in place without being changed, the higher the risk for toxic shock syndrome (TSS) to develop,” says Ha T. Nguyen, M.D., obstetrician and gynecologist with McGovern Medical School at UT Health and UT Physicians in Houston.
TSS is a bacterial infection caused by the staph bacteria, Staphylococcus aureus, according to the National Institutes of Health (NIH). Model Lauren Wasser lost both of her legs after contracting TSS when she was 24. And the disease was also responsible for the death of a 16-year-old girl on an overnight school trip last year.
So uh, how long can I actually leave a tampon in?
You shouldn’t leave your tampon in for more than eight hours, according to basically every tampon maker.
Healthcare professionals agree; their consensus is to change your tampon every four to eight hours, says Nguyen.
So, technically, you can sleep with a tampon in—as long as you put it in right before you hit the sheets, get no more than eight hours of sleep, and take it out as soon as you wake up.
What about those super-absorbent tampons?
You shouldn’t keep a super-absorbent tampon in for any longer, says Obosa Nosayaba Osawe, M.D., an ob-gyn at Piedmont Physicians Obstetrics and Gynecology at Piedmont Newnan Hospital in Athens, Georgia.
The main issue here is, when your tampon becomes saturated with blood—even a small amount—and is left in the vagina for longer than eight hours, it becomes a breeding ground for the growth of bacteria associated with TSS.
“If you can wear a tampon for up to eight hours without needing to change it, the absorbency is likely too high, and you’re better off using a smaller tampon and changing it regularly based on your menstrual flow,” says Osawe.
Okay, so TSS is the worst that could happen?
Pretty much. But TSS is bad.
Toxic shock syndrome typically comes on fast, with flu-like symptoms, including headaches, high fever, and muscle aches, per the NIH—though, left untreated, it can progress rapidly to organ failure, seizures, and even death.
The infection also comes with a telltale rash—it’s flat, red, and appears on the palms of hands or soles of feet; if you have any flu-like symptoms, along with a rash, it’s best to get checked out by a doctor, ASAP.
But before you start officially freaking out, know that if you do accidentally leave your tampon in past the eight-hour mark, you’ll probably be fine. Though super-scary, TSS isn’t as big as a threat as it was 20 or 30 years ago, says Nichole Mahnert, M.D., ob-gyn at Banner University Medical Center Phoenix
“This changed especially after the removal of specific materials, like rayon, from some types of tampons,” she says. “Back in 1986, the risk was one in 100,000, and is potentially lower now. And the risk of fatality [from TSS] has also decreased to less than 2 percent.”
The bottom line: If you decide you absolutely need to sleep with a tampon in, your safest option is to put it in right before bed—and take it out as soon as you wake up, no more than eight hours later. But, if you want to be extra-careful, opt for pads at night.
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