And why is it specifically related to tampons, but not linked with similar products like menstrual cups?
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To add a couple points to the ones already given: Vaginal Ph also adjusts a bit during menstruation, becoming less acidic and more hospitable to bacteria, which exacerbates that tampons themselves are a great haven for bacteria. The main issue with menstrual TSS in the past compared to now is that older tampons came in higher absorbancy, and there was no direction on the packaging to, essentially, use only an absorbancy that works for 4-6 hours of your flow. Because we didn’t know about TSS, and we didn’t know to direct people to do that. Using a tampon of too high of absorbancy for what you need, leads to the tampon leaching fluid out of the vaginal walls, and that dryness is what primarily causes the micro-cuts that allow the bacteria into your bloodstream, and then lead to TSS.
Now that TSS is known, there is direction to not use an absorbancy of tampons higher than what you need for 4-6 hours of flow, and certain materials that caused higher vaginal dryness were discontinued and barred from use in tampons. So TSS is considerably rarer now due to changes in regulation and changes in usage direction. It was a *very big deal* in the 70s/80s, but is a mostly solved problem at this point, but we still hear about it in large part because many of our parents or grandparents dealt with it when it was at its worst, and part of the solving of the problem involves action from the consumer in using the correct product, so it’s not something to be forgotten. You’re butting up against cost/convenience barriers telling someone they have to change their tampon out every 4-6 hours, and it can easily come across as ‘use more of our product and pay us more money!’ from manufacturers if the actual public health reasoning of avoiding TSS is not properly articulated.
Menstrual cups, in turn, do not ‘absorb’, and do not cause any dryness, *but*, the act of inserting/removing them can still cause abrasions, especially if the user has longer nails, so there does still exist some level of risk. The main reason you don’t hear about it with menstrual cups is that menstrual cups are pretty new, and old tampons were *very very bad* about causing TSS, so tampons get the bad rap for it, even if it’s a highly unlikely thing to experience from them now.
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