Damming the flood at a toxic cost?

By Max Hermens, Veerle Melis, Jay Plaat, and Maranke Wieringa

Although a significant part of the planet’s female population uses them heedlessly, tampons lead a double life: both ubiquitous and concealed. Not only do we rarely hear about tampons, it is also hard to find out what their ingredients or precise dangers are. In this article, we focus on one of their many dark sides: Toxic Shock Syndrome (TSS). While medical science concentrates on the separate elements that are found when the disease occurs, we address the gathering of these elements through a cultural theorist’s lens.


Tampons & Toxic Shock Syndrome

tss1Even though tampons are seldom mentioned in historical and contemporary accounts, they have been used since the 15th century BC. Materials such as papyrus, sponges, moss, and grasses have been used as predecessors of our contemporary tampons made from cotton, rayon fibres, or a mixture of both. The two types of tampons that are used nowadays are applicator tampons (which expand lengthwise) or digital tampons (which expand in width). Since 1927 tampons have increasingly been linked to Toxic Shock Syndrome, which is commonly abbreviated as ‘TSS’.

While TSS can develop in both males and females of any age, it is most commonly seen in children and young adults who are otherwise healthy. James K. Todd, professor of paediatrics and epidemiology, notes that TSS is not exclusively limited to tampon usage, as public perception sometimes makes it appear. In all of Todd’s researched cases, TSS develops in what he calls a “complex microbe-host relationship”: a relationship between emerging bacteria and the host body. Symptoms of TSS include high fever, hypotension, rash, and organ failure. In extreme cases, when left untreated, it can even lead to death.

The tampon as a thing in and of itself is not harmful; it is the specific relation between the tampon, the female body, and particular microorganisms in and around the vagina that raises the risk of TSS. We focus on this specific combination, coming to an understanding of TSS as a convergence of four elements. We regard TSS as a process, rather than a product: central to its development are particular conditions bound by time (the gathering of bacteria) and place (the vagina). Furthermore, the elements that gather to form TSS influence each other to a point in which they can no longer be regarded as separate entities. Such a phenomenon, in which different entities transform into each other, has been termed ‘intra-activity’ by feminist theorist Karen Barad. Hence, removing a tampon when one has TSS does not necessarily reduce the disease’s symptoms, even over a longer period of time.

In the 1970s, researchers identified the bacteria that is usually present in the case of TSS: S. Aureus. However, this bacteria, as Todd further notes, can be present without resulting in TSS. In other words, the bacteria is not primarily at fault. In the early stages of TSS research, certain brands of tampons were blamed for facilitating the condition – and it would take researchers several years before discovering that, amongst others, the absorbent nature of the tampon itself helped foster TSS. To this day it seems researchers have not necessarily tss2discovered the cause of the identified bacteria, but have instead concentrated on the circumstances in which it was repeatedly found. By preventing the tampon from facilitating this disease, they, in turn, caused the occurrence of it to diminish. These bacteria can only pose a threat when they come into contact with other materials, like those the tampon is made of.

The sum and its parts

Barad’s term ‘intra-action’ serves to describe how certain phenomena, such as TSS, inspire us to rethink the ontological distinction between object and body, as well as between object and observer. Opposed to the more common ‘interaction’, intra-action should be understood as the complex relationship in which several entities influence each other irrevocably, becoming interlinked and changing one another to create phenomena which could not occur without their interlinkage. The phenomenon of TSS requires four entities to ‘fuse’. When the tampon, the female body, microorganisms, and time combine, they create new bacterial/organic structures. These, in turn, have different side effects – one of which might be TSS. Barad’s notion of intra-activity teaches us that TSS is something that comes into being because of this coming together of the different elements. Not a single element in itself is the cause of the potentially lethal disease; it can only come into existence in a complex microbe-host relationship.

The female body, the microorganisms present in it, the tampon, and temporality are not separate elements; they are one, and it is only during the intra-action that lethal amounts of the S. Aureus bacteria might occur. The subsequent removal of one element – such as the tampon – does not directly stop the existence of the bacteria; researchers note that TSS can occur over longer periods of time, induced by but not limited to the presence of a tampon. Both before and after the tampon-related formulation of TSS, its four elements do not necessarily exist as separate entities. They are constantly fusing, and cannot be regarded as existing in an ‘original’ singular state before, or afterwards. Instead, they can only be understood in their processual nature. Barad’s notion of intra-activity, of the blurred lines between supposedly different ‘entities’, encourages us to rethink the distinctions between human and non-human phenomena.


As anthropologist Igor Kopytoff has put it: “Biographies of things can make salient what might otherwise remain obscure.” The brief cultural biography of tampon-related TSS we have presented above makes apparent how the tampon is emphasised when dealing with the disease, while the tampon is merely one component related to TSS. By treating TSS as a material phenomenon to be biographed, we were able to point out the way in which various components intra-act to facilitate its development, and that it is this intra-action that matters; thereby countering the popular public perception that solely the tampon is to blame.


Max Hermens (1991) holds an MA in European Studies and an MA in American Literature and Culture. He has published on the work of Joseph Conrad. In his spare time, he writes fiction.

Veerle Melis (1990) holds a BA in Cultural Studies and an MA in Creative Industries.

Jay Plaat (1988) holds a BA in Cultural Studies and an MA in Creative Industries. He specialises in film and currently writes about film for online cultural magazine 8WEEKLY.

Maranke Wieringa (1992) is an rMA student of Media & Performance Studies at Utrecht University, and a junior researcher at the Utrecht Data School. She obtained her BA in Cultural Studies at Radboud University.



Barad, K. “Posthumanist Performativity: Toward an Understanding of How Matter Comes to Matter”, in: Signs: Journal of Women in Culture and Society 28, no. 3, 2003: 801–31.

Berkley, S. et al. ‘The relationship of tampon characteristics to menstrual shock syndrome’, in: JAMA Vol. 258, No. 7, 1987: 917-20.

Chesney, P.J. et al. “Toxic-Shock Syndrome – United States”, in: Morbidity and Mortality Weekly Report, Center for Disease Control, 23 May 1980, Vol. 29, No. 20.

Kopytoff, I. “The Cultural Biography of Things”, in: The Social Life of Things. Cambridge: Cambridge University Press, 1986: 64–91.

Todd, J.K. “Toxic Shock Syndrome: A Perspective through the Looking Glass”, in: Annals of Internal Medicine, Vol. 96, No. 6, Pt. 2, 1982: 839–42.

Weissfeld, A. S. “The History of Tampons: From Ancient Times to an FDA-Regulated Medical Device”, In: Clinical Microbiology Newsletter 32, no. 10 (2010): 73–76.

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