The pathology of tampon usage and of the toxic shock syndrome.

Tampon usage is commonly associated with the development of transient, asymptomatic focal vaginal abnormalities such as dehydration, epithelial peeling and micro-ulceration. These abnormalities occur most commonly with superabsorbent tampons and are probably due to a fluid shift across the vaginal epithelium. Clinically apparent vaginal ulceration due to tampon usage is rare: these ulcers may develop from asymptomatic tampon-induced micro-ulcers. The pathological changes seen in the toxic shock syndrome are inconsistent but are, in general, due either to reduced tissue perfusion, or to the effects of a toxin. Cervico-vaginal ulceration in women with the toxic shock syndrome is probably a consequence rather than a cause of toxin entry into the systemic circulation.