A mother-of-three had to have both her feet and parts of her fingers amputated after her menstrual cup caused an infection which spread to her kidneys, lungs and liver.
Sandrine Graneau, 36, from Loire-Atlantique in western France, suffered from toxic shock syndrome after using the cup and had to spend three weeks in intensive care.
Ms Graneau, a nurse, later claimed it was unclear from the cup’s packaging how long it could be kept in her vagina before needing to be taken out and washed.
She wasn’t sure but thought she had left it inside herself for several hours, she said, before she fell seriously ill in April last year.
She developed from toxic shock syndrome, also known as acute septicaemia, after the bacteria Staphylococcus aureus, which grows naturally in the vagina, entered her bloodstream.
Ms Graneau said she initially had pains in her stomach which started off mild but then became severe and she was later rushed to hospital when her blood pressure plummeted.
A mother-of-three had to have both her feet and parts of her fingers amputated after her menstrual cup caused an infection which spread to her kidneys, lungs and liver (stock image)
‘It is not so much the bacteria that are dangerous as the damage it causes to the organs.
‘The toxin spread to my kidneys, lungs [and] liver,’ she told French newspaper Le Parisien.
WHAT IS TOXIC SHOCK SYNDROME?
Toxic shock syndrome is a highly dangerous bacterial infection – but it can be misdiagnosed because the symptoms are similar to other illnesses and because it is so rare.
It occurs when usually harmless staphylococcus aureus or streptococcus bacteria, which live on the skin, invade the bloodstream and release dangerous toxins.
TSS’ prevalance is unclear but doctors have claimed it affects around one or two in every 100,000 women.
It has a mortality rate of between five and 15 per cent. And reoccurs in 30-to-40 per cent of cases.
Symptoms usually begin with a sudden high fever – a temperature above 38.9°C/102°F.
Within a few hours a sufferer will develop flu-like symptoms including headache, muscle aches, a sore throat and cough.
Nausea and vomiting, diarrhoea, feeling faint, dizziness and confusion are also symptoms.
Women are most at risk of getting toxic shock syndrome during menstruation and particularly if they are using tampons, have recently given birth or are using an internal barrier contraceptive, such as a diaphragm.
While tampon boxes advise to change them between four to eight hours, it is common for women to forget and leave them in overnight.
Treatment may involve antibiotics to fight the infection, oxygen to help with breathing, fluids to prevent dehydration and organ damage, and medication to control blood pressure.
Dialysis may also be needed if the kidneys stop functioning.
In severe cases, surgery may be required to remove dead tissue. In rare incidences, it may be necessary to amputate the affected area.
To prevent TSS, women should use tampons with the lowest absorbency for their flow, alternate between a tampon and a sanitary towel, and wash their hands before and after insertion.
Tampons should also be changed regularly, as directed on the packaging – usually every four to eight hours.
The infection then started to destroy the tissue in Ms Graneau’s arms and legs and surgeons had to amputate both of her feet and most of her fingers to stop it spreading to her vital organs.
Nine months later, she is now going through rehab to learn to walk with prosthetics.
Toxic shock syndrome is rare but is often life-threatening.
Many people know about it because of horror stories about women leaving tampons in for too long and developing gruesome infections.
The condition develops when bacteria gets into the body and releases harmful toxins into the bloodstream.
Cells get inflamed trying to fight the toxin, triggering symptoms that tend to come on very rapidly and include a drop in blood pressure, a sudden spike in temperature, body pain and headaches, confusion and diarrhoea or nausea.
In severe cases, this puts the body into a state of shock, causing kidney failure and seizures which can prove deadly.
There are around 40 cases in the UK each year, while in the US there are between 3,000 and 12,000 cases.
It is associated with tampon use, with previous studies showing that three-quarters of cases were among women who used them.
Menstrual cups, made from silicone, are an increasingly popular re-usable alternative to tampons and are inserted into the vagina to collect menstrual fluid.
But both cups and tampons can present a risk, with the fibres in tampons able to spur the growth of bacteria, while cups also allow enough air flow to encourage it.
Following the death of 17-year-old Belgian girl Laurance Hennuy last week from toxic shock caused by a tampon, Ms Graneau criticised a lack of clarity from manufacturers.
She said: ‘When I hear that the infection is linked to a misuse of cups and tampons by women, it puts me off, as the information we are given varies.
‘Take the cups, according to the manufacturer, it is written on the instructions that we can keep them 4, 6, 8 or 12 hours!’
She was unsure how long she had been using her own cup, but questioned why a clearer usage time was not listed.
On Monday, France’s national agency for food, environmental and occupational health (ANSES) asked manufacturers of cups and tampons to provide ‘clearer information’ on how long they could be used for.
They also recommended that any chemicals present in them be eliminated or minimised.
HOW TAMPONS AND MENSTRUAL CUPS CAN CAUSE TOXIC SHOCK
A study in 2018 showed that tampons and menstrual cups can cause toxic shock (TSS) no matter what material they are made from.
They put women at risk because they provide a breeding ground for bacteria.
Researchers at the University Claude Bernard in France investigated which products are safest against TSS.
But they found that anything a woman inserts in her body for hours at a time can be risky.
‘Our results did not support the hypothesis suggesting that tampons composed exclusively of organic cotton could be intrinsically safer than those made of mixed cotton and rayon, or viscose or tampons composed entirely of viscose,’ said study author Dr Gerard Lina.
The air between the fibers in tampons also spurred growth of Staphylococcus aureus, and a menstrual cup’s construction encouraged just as much airflow, and, therefore, bacteria growth.
‘Tampon use continues to be associated with menstrual toxic shock syndrome, and a case of menstrual TSS has been associated with a menstrual cup,’ Dr Lina added.