If you've ever used tampons, you may have noticed the instructions on the box — established by the U.S. Food & Drug Administration (FDA) — that say you should change your tampon every four to eight hours.
But we're all a little lax with rules from time to time. Maybe you put a tampon in before bed and then slept through your alarm. Perhaps you were super busy during a light flow day and forgot to swap it out. Or maybe you totally blanked on bringing an extra with you before heading out of the house for the day.
You might wonder: What's the harm in leaving a tampon in for too long? Here, gynecologists get real about the risks.
You Could Get a Smelly, Itchy Infection
Like many parts of your body, your vagina has a microbiome of good bacteria that help keep it healthy and fight off infection. Altering the normal balance of these microorganisms can cause bad bacteria to colonize. This might happen when you insert a foreign object (like a tampon or unwashed sex toy), take antibiotics or douche.
Harmful bacteria can also grow when you use a tampon because the blood stays inside your V-zone longer than if you had let it stream out onto a pad.
"Bacteria love blood," says ob-gyn Mary Rosser, MD, PhD, assistant professor of obstetrics and gynecology at Columbia University Medical Center. So if a blood-soaked tampon is lingering inside your vagina, the bad bacteria have a better chance at overthrowing the good kind.
Too much harmful bacteria can lead to bacterial vaginosis, aka BV. "You might experience discomfort, a malodorous discharge and itching," Dr. Rosser says.
If you think you might have BV, take out your tampon and switch to pads for the rest of your cycle.
"By removing the tampon, you are eliminating the source of bad bacteria before it has a chance to colonize," Dr. Rosser says. "The vagina is a self-cleaning organ, and generally if you leave it alone, it will reset itself."
But if your bothersome symptoms stick around even after ditching your tampon, make an appointment to see your gyno. "Usually BV is just annoying, but it has been implicated in cases of pelvic inflammatory disease, or PID," Dr. Rosser says.
PID is an infection that causes inflammation of the pelvic organs, including the uterus, fallopian tubes and ovaries.
"PID can cause scarring, which may lead to chronic pelvic pain and difficulty getting pregnant in the future," Dr. Rosser says. "If untreated, you can get an abscess — which is a collection of pus — or an inflammatory infection through the rest of your body's organs."
Per the Centers for Disease Control and Prevention (CDC), signs of PID include pain in your lower abdomen, fever and a pungent vaginal discharge.
Untreated BV can also increase your chances of contracting an STI and cause premature birth or low birth weight if you're pregnant at the time of infection, according to the CDC.
Toxic Shock Syndrome Is Rarer These Days but Still a Danger
Do you remember first reading the toxic shock syndrome (TSS) warning insert inside a box of tampons as a teenager? You may have been freaked out to learn about this rare but life-threatening illness, caused by overgrowth of the bacteria staphylococcus aureus. It can result from leaving in a tampon too long, giving the bacteria ample time to multiply.
"As staphylococcus grows, it releases a toxin that spreads through the lining of the vagina, cervix and uterus," Dr. Rosser says. "It gets into your blood, at which point it starts affecting not only your pelvic organs, but all your major organs, including your kidneys and heart."
People suffering from TSS will experience flu-like symptoms.
"It creates a systemic response including fever, nausea, vomiting and a rash that resembles sunburn," says Tamika Cross, MD, board-certified ob-gyn and co-founder of Serenity Women's Health & Medspa in Pearland, Texas. "If it's not treated quickly enough, it can lead to organ failure and death."
Dr. Rosser adds that TSS may induce a state of shock (hence the name, toxic shock syndrome), which happens when your body is not getting enough blood flow. "Your blood pressure drops, making you feel light-headed and dizzy," she says.
If you have any of these signs, you should call a doctor.
The good news: TSS is uncommon these days. An August 2020 article in StatPearls reports that the incidence is somewhere between 0.8 and 3.4 per 100,000, and fewer than half of those cases are linked to tampon use, per the U.S. National Library of Medicine. This is down from 13.7 per 100,000 menstruating women in 1980, according to an August 2011 study in PLOS One.
The rarity of TSS these days is due to greater FDA oversight of the tampon industry, as well as improved consumer education about the importance of changing your tampon on the reg.
Back in February 1989, a study in Reviews of Infectious Diseases linked TSS to toxic materials that were at that time common in tampons, including polyester, carboxymethyl cellulose, polyacrylates and viscose rayon. Although many tampons still contain viscose rayon, the other concerning substances have been phased out. The FDA also began limiting the absorbency of tampons.
"Today, the FDA thoroughly evaluates the safety of tampons before they come to market," Dr. Rosser says.
However, manufacturers are not required to list ingredients on the packaging, according to the FDA, and an April 2014 article in Environmental Health Perspectives questioned the safety of chemicals currently used in tampons.
"You have to be careful with the chemicals and bleaching [products] in tampons," says Dr. Cross, admitting that she personally is not a fan of tampons and opts for pads instead.
What if You Can't Remember if You Took Out Your Tampon?
Gynos swear it's relatively common for people to forget they put in a tampon altogether.
"Signs you have forgotten include resistance when you insert another one, when having intercourse or when using toys," Dr. Cross says. "You also might notice a foul odor or abnormal discharge."
Other tipoffs are itchiness, discomfort and pain when you urinate. If you put in a new tampon or have sex while the old tampon is still there, it can get compressed toward the top of your vagina.
How to Get a Stuck Tampon Out
Suspect you have a stuck tampon? Try to track it down using these steps from Columbia University:
- Wash your hands well and clip your nails if they're long.
- Find a comfortable position, such as sitting on the toilet with your feet on a stool to elevate your knees, squatting or laying on your bed.
- Bear down, as if you were pooping or pushing out a baby.
- Insert a finger into your vagina and circle it around until you feel the tampon and grasp hold of it.
If you can't locate or remove it, your gyno can assist. "When a tampon gets lodged up in your vagina, it can be difficult to retrieve," Dr. Rosser says. "This happens much more frequently than people think, so don't be embarrassed — we see it all the time."
In fact, one of Dr. Cross's patients accidentally left a tampon in for several months.
And remember that a tampon can't get "lost" in your body.
"The vagina is its own unit; there is no communication between the vagina and the pelvic or abdominal cavity," Dr. Rosser says. "The only other orifice inside the vagina is the cervix, which is much too narrow for a tampon to fit through." Phew!
5 More Tampon Safety Tips
Follow these guidelines to prevent bacterial infection.
1. Use the Right Size Tampon for Your Flow
You know that dry feeling you get when inserting or removing a tampon that's overly absorbent? The friction from repeatedly pushing in and pulling out too-big tampons could create microtears in your vaginal wall.
"This makes you prone to bacterial infection," Dr. Rosser says, pointing out that she has tampons and pads of all sizes in the house for her teenage daughters.
2. Only Use a Tampon During Your Period
Some women wear tampons even when they're not menstruating.
"People may feel like it keeps them cleaner because the discharge is absorbed by the tampon, or they're not sure when to expect bleeding," Dr. Rosser says. "But as soon as you put a tampon in, bacteria has room to grow and colonize around it, potentially leading to irritation, inflammation or infection."
3. Avoid Reusable Products
Although a July 2019 review and analysis in The Lancet found that menstrual cups are sanitary, a June 2017 study in Reproductive Health suggests that reusable pads may be associated with an increased risk of irritation or infection.
"Menstrual products should be singular use — there is too much room for yeast, bacteria and viruses to stay on [a reusable alternative]," Dr. Rosser says. "I am all for the environment, but I also want us to be safe."
4. Wash Your Hands
Suds up before and after using a tampon to curtail the spread of bacteria.
5. Remove Your Tampon Before Sex
According to Columbia University, your tampon can get pushed up the vaginal canal during intercourse, leading to pain, making it difficult to remove and increasing your risk of TSS.
So, How Long Should You Really Wear a Tampon?
Despite FDA guidelines to wear a single tampon for four to eight hours max, Dr. Rosser errs on the side of caution, suggesting you change it every three to five hours during the day. (You may want to put a reminder on your phone so you don't forget.)
You can stretch it to six to eight hours overnight, Dr. Rosser says, but if you sleep longer than that, either use a pad instead or set an alarm to put in a new tampon halfway through the night.
"The longer it sits in there, the greater the opportunity for bacteria to grow and cause an infection," Dr. Rosser says.
It's not the end of the world if you leave it in longer every once in a while, though.
"We are not robots, and sometimes life gets in the way — even if you have set an alarm for yourself, you might be stuck in a situation where you can't change your tampon in time," Dr. Rosser says. "It's OK as long as you remain vigilant overall."
Still, Dr. Cross urges caution.
"It is like playing with fire," she says, "and I certainly wouldn't do it."
Is This an Emergency?
- FDA: "The Facts on Tampons—and How to Use Them Safely"
- Centers for Disease Control and Prevention: "Bacterial Vaginosis – CDC Fact Sheet"
- Reviews of Infectious Diseases: "Ecology of Toxic Shock Syndrome: Amplification of Toxic Shock Syndrome Toxin 1 by Materials of Medical Interest [with Discussion]"
- U.S. National Library of Medicine: "Toxic shock syndrome"
- StatPearls: "Toxic Shock Syndrome"
- Centers for Disease Control and Prevention: "Pelvic Inflammatory Disease (PID) - CDC Fact Sheet"
- Reproductive Health: "A qualitative understanding of the effects of reusable sanitary pads and puberty education: implications for future research and practice"
- The Lancet: "Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis"
- Go Ask Alice: "Lost tampon"
- Go Ask Alice: "Sex with period and tampon?"
- FDA: "CFR - Code of Federal Regulations Title 21"
- Environmental Health Perspectives: "A Question for Women’s Health: Chemicals in Feminine Hygiene Products and Personal Lubricants"
- PLOS One: "Staphylococcal Toxic Shock Syndrome 2000–2006: Epidemiology, Clinical Features, and Molecular Characteristics"