Julie Mazziotta
March 16, 2018 04:00 PM

In January, six years after nearly losing her life to toxic shock syndrome and undergoing one leg amputation, model Lauren Wasser chose to have her second leg removed.

Wasser, 29, developed the bacterial infection TSS while wearing a tampon. She had a fever of 107 degrees when she was rushed to the hospital with multiple health complications, including gangrene and severe damage to her foot.

Wasser is now fighting for legislation to research the chemicals in tampons with the help of Congresswoman Carolyn Maloney. She’s also warning other women about the dangers of tampon use. But TSS occurs in just one out of every 100,000 people. So are people who use tampons really at risk?

Lauren Wasser
Chloe Aftel

Dr. Mary Jane Minkin, an ob-gyn from Yale University and member of PEOPLE’s Health Squad, says no, explaining that TSS develops from toxins within the body.

“Toxic shock is an illness not directly caused by infection from an organism: it is caused by the toxin produced by an organism called staph aureus,” she tells PEOPLE. “In the whole United States, in the year 2016, there were only 40 cases reported, and about half were not related to menstruating women — guys, for example can get toxic shock syndrome from nasal packing [a medical procedure that involves inserting sterile tampons into the nose to treat nosebleeds]! So obviously, again when we think of the millions of tampon users in the U.S., it’s a really small number.”

To develop TSS, four things need to happen.

“The first is vaginal colonization with a strain of S. aureus, which can make the toxin; the second is production by the S. aureus of the toxin; the third is penetration across the vaginal epithelium of enough toxin to cause disease; and the fourth is a lack of adequate titers of the neutralizing antibody to the toxin,” Dr. JoAnn Pinkerton, executive director of The North American Menopause Society told PEOPLE in 2015.

But Dr. Pinkerton said that it is rare for this to happen at once. Only one to four percent of the population have reported vaginal colonization with toxigenic S. aureus, and almost 87 to 100 percent of the adult population has developed a serum antibody to the toxin that causes TSS.

She also says that age may be a factor in developing the condition.

“Younger women are more likely to get TSS, possibly because of more exposure through tampons or barrier contraceptive use,” Dr. Pinkerton said. “It may also be because they haven’t developed the antibodies yet.”

To reduce the already minimal risk of developing TSS, Dr. Pinkerton recommends changing a tampon every two to three hours, and to avoid sleeping with them in overnight. Dr. Minkin also advises women to use lower absorbency tampons to reduce dryness, which can make it easier for toxins to enter the body, and to switch off between tampons and pads.

“I encourage my patients to use a pad at least part of the day, so if you like to sleep with a tampon in place, then use a pad part of the day. If you like to use tampons while you are up and about, then use a pad at night,” she says.

Overall, though, Dr. Minkin says not to be too concerned about tampon use.

“The tampons themselves are not contaminated with bacteria,” she says. “The nasty staph organisms are unfortunately carried by us, not the tampons. So I would encourage all women to pay attention to their health, but not to worry.”

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