Toxic Shock Syndrome from a Menstrual Cup

A menstrual cup sits in the vagina and can, in rare circumstances, be associated with conditions that allow toxin-producing bacteria to cause illness. A cup does not prove that TSS is the cause of symptoms, and many other infections can produce fever or discomfort. Risk-reduction habits include washing hands before insertion and removal, cleaning the cup according to its instructions, checking the recommended wear interval, and not using a damaged cup. Avoid inserting it when you have significant vaginal irritation or injury unless a clinician advises you to do so.

Remove the cup and seek urgent medical care if you develop sudden fever, vomiting, diarrhoea, dizziness, rash, muscle aches, or unusual weakness while using it or soon after. Tell the clinician when the cup was inserted and how it was cleaned. Keep the cup available if staff want to examine it, but never delay travel for that reason. Suspected TSS is treated in hospital with antibiotics, fluids, monitoring, and attention to any infection source.

Emergency help is needed for fainting, confusion, trouble breathing, a widespread red rash, repeated vomiting, cold or clammy skin, or very little urine. These are red flags for a severe whole-body illness. Do not wait to see whether removing the cup makes the symptoms settle.

Ask whether the symptoms suggest TSS or another infection, whether cultures are needed, how to clean or replace the cup, and when internal menstrual products are appropriate again. Mention any recent antibiotics, vaginal irritation, wound, procedure, or childbirth.