Question: I am concerned about using tampons after reading about the toxic shock syndrome. Is this a significant risk for women, or can I still use tampons safely?
The toxic shock syndrome, despite all the publicity, is actually a very rare condition, and most general practitioners have never seen a case. The people who do develop the condition are extremely ill, and about 5% of them die, despite the best efforts of doctors. Some bacteria, and particularly one called Staphylococcus aureus (the golden staph) which is a common cause of vaginal and other infections, may produce a toxin or poison. Most people have antibodies to protect them from this problem, but in a very small number of people, the toxin may cause severe effects.
The symptoms of toxic shock syndrome are a high fever, dizziness, severe diarrhea, vomiting, muscle aches, fainting and sometimes a rash. An examining doctor will find the blood pressure to be low. The syndrome can occur in anyone, but seems to be more common in women and particularly in women who are menstruating. Treatment involves antibiotics to treat the bacterial infection, and hospitalization to replace the fluids lost with the severe diarrhea and vomiting. There is no specific antidote to the toxin, and so the earlier the diagnosis is made, the better the chances of recovery.
There is no reason why women should not use tampons, as the risk of developing toxic shock syndrome with them is infinitesimally small. Only if the tampon becomes infected is there any chance of developing the syndrome. To reduce the risk to a minimum, ensure your hands are clean before unwrapping and inserting the tampon; use the lowest absorbency tampon necessary for your flow; never insert more than one tampon; do not leave the tampon in for any longer than necessary; and pads may be a better alternative overnight. Make sure you don’t forget to remove the last tampon of your period. There is no evidence that any one brand or type of tampon is more likely to cause the syndrome than any other.
Relax and use the menstrual hygiene product that best suits your needs.

Question: I am 19 and have had three sexual relationships with men. Over the past few months I have had a thick white discharge from my vagina, and it is itchy and sore around that area. I am getting married in two months and am worried that I might have some sort of sexually transmitted disease, and I would feel embarrassed and dirty seeing a doctor about this. What can I do?
What you are describing is a typical case of vaginal thrush. Tight jeans, pantyhose, the contraceptive pill, nylon bathers, antibiotics and sex are the common aggravating factors involved in catching this modern woman’s curse. Thrush, also known as candidiasis or moniliasis, is a fungal infection caused by a fungus called Candida albicans, which lives in the gut where it causes little or no trouble. Usually when it comes out on to the skin around the anus, it dies off; but if that skin is warm, moist and irritated, it can grow and spread forward to the lips of the vagina (the vulva).
Entry of the fungus into the vagina from the skin outside is aided by the mechanical action of sex, and the alteration in the acidity of the vagina caused by the contraceptive pill. Once established, this fungus causes an unpleasant white vaginal discharge, intense itching of the vulva and surrounding skin, and often inflammation of the urine opening so that passing urine causes discomfort. You should see your doctor as soon as possible to confirm the diagnosis and obtain the correct treatment.
Your fiance must also be treated with a cream, because although he may show no signs of the infection, it may be present under his foreskin, and he can give the thrush back to you after you have been successfully treated.