Note: I am not a doctor (yet). I am a fourth-year medical student at the University of Minnesota, intending to go into OB/GYN and begin my residency in June/July 2003. The following was prompted by questions and misinformation on a college discussion board. Enjoy!

1. Toxic Shock Syndrome (TSS) can be caused by superabsorbent tampons which are left in place too long. The hyperabsorbent ones that caused the majority of TSS cases are no longer on the market in the US. TSS can still occur (we had a case here in Minneapolis recently) but is *incredibly* rare. It occurs when bacteria normally found in noninfective numbers on you and in your environment set up camp in the perfect environment a tampon provides, and multiplies out of control. Regular tampon changing prevents infection for the overwhelming majority of users. TSS from tampons is now INCREDIBLY rare. Signs and symptoms are an all-over body rash, high fever, shaking chills, very low blood pressure/fainting, and getting very, very (think ICU for weeks on a ventilator and handfuls of medication to maintain any sort of blood pressure whatsoever) sick.

2. TSS is *not* associated with IUDs. IUDs do not have an absorbent friendly environment for bacteria. And while the Dalkon Shield may not have been sterilized, there is a difference between sterile technique and clean technique. Vaginal procedures are nearly NEVER sterile -- they are clean. When an IUD is inserted, it travels through the vaginal introitus, through the cervix, and into the uterus. It is then released from the applicator and changes in shape from a smooth long skinny cylinder to a "t" shape. The string attached (which is made of a plastic, no fibers at all) is clipped an inch or so outside the cervix (women are encouraged to check to see if they can feel them with fingers every now and then; some men claim the string is uncomfortable during intercourse without barrier methods). Because of how it is inserted, the IUD is exposed to ALL SORTS of bacteria. This is usually not a problem as cervical mucus helps prevent infection, as does menstruation. However, it is *much* more difficult and painful to insert one in a woman who has never had a pregnancy. It also tends to get spontaneously expelled (i.e., it falls out) in these women. While TSS can occur in a woman who has an IUD, the IUD is generally NOT the underlying cause of the infection. The infections they refer to are neither TSS nor STDs, but more like any other generalized non-uterine-specific infections. But the risk of this disease preventing future fertility is, in my opinion, an excellent and appropriate contraindication for nulliparous (never been pregnant) women who cannot say with 1000% certainty that they NEVER want children. If the answer is "I don't think I will ever want kids," that's not good enough, because other methods that don't reduce the chance of future fertility (at least to the same extent) are available. Once you've had a kid, general opinion changes -- plus the IUD stays in place easier and it's easier to insert.

3. Like all forms of pregnancy control, IUDs can fail. Pregnancies occur rarely with IUDs in place, and it's a sticky situation: the IUD must be removed for the safety of the growing fetus (the danger is it interfering with normal limb development, cord compression, and etc) but its removal can cause miscarriage. Really, it's up to the woman, and if she intends to abort, the point is moot. One failed IUD may or may not indicate future failure, and most often women choose another method (often tubal ligation) instead of another IUD.

4. IUDs are perhaps the most underutilized form of really great birth control we have. We got REALLY freaked by the Dalkon Shield, and as Americans we want instantanous reversibility of what we choose to do. In Europe they have a much better track record of IUD use and better data than we do.

5. Currently there are two IUDs on the market: one which is with hormone and one without. The hormone, like that in birth control pills, adds another layer of efficacy. It is unclear whether they are actually better than the hormone-free variety -- we'll get that data in a few years.

6. "Fiber Shedding" is largely part of a widely circulated urban myth about tampons containing asbestos and causing cancer, infections, and perhaps purple warthogs to grow from your skin. Yes, cotton and rayon products shed a little. However, so does the vaginal mucosa. It is all readily expelled from the body and does not hang around. It cannot implant into the vaginal wall. It cannot cause infection -- it's far too small a nidus for the bacteria. It cannot work its way into your bloodstream -- they are far too big compared to the size of a capillary, through which blood flows one red cell at a time. TSS was an absorbency/bug motel problem, not a shedding one. Shedding has never been shown to exist to any significant extent NOR has it ever been seriously postulated in any reputable forum to be the cause of disease.

--Lisa Dryer