A couple of years ago, I learned that some women insert makeup sponges in their vaginas, all the way up to the cervix, in order to have mess-free period sex. After some googling and consulting with women who’d done it, I decided to give it a try. It was a revelation—suddenly oral sex and clean linens were possibilities during my period. In July 2017, I wrote a short, dashed-off post on Lifehacker recommending the method, without consulting a scientist or gynecologist.


Big mistake. This is terrible, irresponsible advice, many wrote in the comments. Dangerous, stupid, untested, unsafe. Fall asleep with one of these inside you, and “toxic shock syndrome WILL follow.” What if the sponge gets stuck up there? What if it causes septic shock or internal hives? “You might as well tell people to grab extra drinking straws when they’re at the gas station, because they can be used as catheters,” one commenter scoffed. An escort called employing the hack a “work hazard” and not a method she would recommended in her personal life. Several commenters were horrified that we’d published this advice without the input of a gynecologist.

So I sought to correct that error. I was pleasantly surprised when a doctor I consulted didn’t seem particularly concerned about the myriad horrors raised in the comments—although, due to their lack of string and impressive ability to compress, she did agree with an ER doctor (and Lifehacker commenter) that makeup sponges are more likely than tampons to get wedged up inside the vagina. I updated my story with the doctor’s advice. I also learned an important lesson about consulting professionals and including disclaimers before proposing any sort of biohack.

But then Dr. Jen Gunter—the anti-Goop OB/GYN known for her vaginal reality checks—wrote a blog post wherein she called the makeup sponge a “potentially deadly hack.” (“Dippy women will surely screw up their vaginas AND possibly die,” a commenter concurred.) An infamous tampon called Rely, she wrote, was found to be associated with the toxic shock syndrome outbreak of the early 1980s. The Rely tampon was made of, among other things, polyester foam, a type of polyurethane—and so are many makeup sponges.

That’s when I realized: I didn’t know shit about TSS. Sure, I remembered the vague advice I’d heard when I was 13 not to leave a tampon in too long, lest I develop a disease whose name contained three of the scariest words in the English language (Toxic! Shock! Syndrome!). I knew TSS was rare, but I didn’t really understand what caused it. As for my makeup sponge technique, I figured since I didn’t keep sponges in my vagina for long, I probably wouldn’t die from using them “off-label.” But now I wasn’t so sure. I decided to investigate—for real this time.


More than a year later, I emerged from the complicated underworld of toxic shock syndrome science with far more than I bargained for, including a lecture from an elderly man on the “art of making love,” a possible TSS-related upside to having sex early and often, multiple accusations of collusion, and the story of a bitter, decades-long rivalry between two prominent microbiologists. I also learned that everything you think you know about tampons, period sex, and toxic shock syndrome is probably wrong.

What We Talk About When We Talk About TSS

Toxic shock was first identified in 1978 in a Denver-area hospital by Dr. James Todd, after seven patients ages 8 to 17 all became sick with the the same symptoms. Three of these patients were menstruating girls. Each of the patients had some combination of similar symptoms: high fever, confusion, shock, diarrhea, headache, and a rash. At least one of the patients was diagnosed with scarlet fever, but Todd eventually discovered it was something new. Because it was caused by toxins that rendered its victims in circulatory shock, Todd bestowed upon this previously undiagnosed disease the name “toxic shock syndrome.”

Three years later, scientists discovered that the disease is caused by a toxin called TSST-1. That toxin is produced from the bacterium Staphylococcus aureus, which can cause anything from pimples to food poisoning (or nothing at all—lots of people have it in their bodies with no ill effects). When the TSST-1 toxin crosses the vaginal mucosa and enters the bloodstream, it can result in low blood pressure, organ failure, and even death. Between October 1979 and May 1980, 55 cases of TSS were reported to the CDC. Virtually all of the cases affected women, and the large majority of those women were on their periods when the symptoms began.

Rely Tampons advertisement, 1980

Several studies in the following years made connections between tampon use and TSS. There was a far higher incidence of TSS in women who used Procter & Gamble’s super-absorbent Rely tampon, which was first market-tested in 1974 and was gradually introduced across the nation. Rely was a teabag-shaped tampon that could expand to three times its original volume and absorb nearly 20 times its own weight in fluid— “It even absorbs the worry,” a marketing campaign chirped. It was made of polyester foam cubes and chips of a gelling agent called carboxymethylcellulose, both of which made the tampon super-absorbent; according to The Atlantic’s history of the tampon, some women were said to wear just one Rely tampon for an entire period, eventually extracting a gigantic, mushroom-shaped object from their vaginas.


TSS prevalence reached its peak in 1980, when 812 period-related cases were reported and the incidence of TSS was about 10 in 100,000 among menstruation-age women. The CDC concluded from a survey of select patients that Rely was the most commonly used tampon. After the CDC released a report in September 1980 linking the disease to the tampon brand, Rely was taken off the market. In the years that followed, tampon companies were required to put warnings about TSS on their product’s boxes, and by 1990, all tampons were made of cotton or rayon.



Nowadays, the rate of TSS is about 1 in 100,000. In 2017, according to the CDC, only 24 people in the U.S. contracted Staphylococcus aureus-related TSS (there’s also streptococcal TSS, caused by a different bacterium). Ask a modern woman what causes this bogeyman of a disease, and you’ll hear all kinds of things. My Facebook friends and female coworkers had interesting theories: “bacteria trapped inside vagina by an object,” “something about the tampon getting wet, then drying,” “chemicals in tampons being absorbed by sensitive vaginal tissue,” or even “doesn’t exist.” But most of their theories of what causes TSS were a version of: “tampon left in too long.”



Well, not exactly.

Image : Nona Willis Aronowitz

What Causes TSS?

Even during its peak in the early 1980s, toxic shock syndrome was a rare disease, because a number of things have to line up exactly right for a woman to develop it. At least 80 percent of the female population is immune to TSS by adolescence, no matter what their tampons are made of, because they have antibodies that recognize and can inactivate the toxin.


At least 80 percent of the female population is immune to TSS by adolescence.

One leading microbiologist, Dr. Patrick Schlievert, a professor of microbiology and immunology at the University of Iowa, explained it to me this way: Of the women who don’t have the antibodies, only 5 percent have the toxic-producing strain of S. aureus present in their vaginas. Then there has to be enough S. aureus for the TSST-1 toxin to develop—blood’s high pH exponentially multiplies S. aureus count, which is likely why TSS is associated with menstruation. In only two-thirds of those cases, where there’s a sufficient amount of S. aureus to produce TSST-1, will the toxin be able to cross a woman’s vaginal mucosa and enter the bloodstream—and only one-tenth of TSST-1 is transported. Also, while American women of Northern European descent seem to be especially susceptible, there are far fewer reports of African-American, Latina, or Asian women in the U.S. contracting it. Given all these factors—and rates of tampon use—the maximum incidence of menstrual TSS could only be, at its very highest, about 10 in 100,000 in the U.S.



Because TSS is so rare, it’s hard to get wide-ranging data on it. But several leading microbiologists who have studied toxic shock syndrome for years do have a pretty good idea of what causes TSS, although they can’t seem to agree. After Rely’s super-absorbent tampons were taken off the market, scientists conducted numerous studies to determine the root causes of the disease. Many of the studies sought to explain why, exactly, the Rely tampon was associated with so many cases of TSS. Was it the chemical composition of the tampon? Was it because Rely’s outer coating, known as Pluronic L92, increased toxin production? Or was it the tampon’s high absorbency, which permitted it to swell and grow, and trapped oxygen in the vagina, causing the bacteria to produce the toxins?

Team Polyester vs. Team Oxygen

Dr. Philip Tierno, a professor of microbiology and pathology at New York University School of Medicine, insists the material of tampons matters a great deal when it comes to toxin production. Tierno has testified against tampon companies in toxic shock-related lawsuits and is one of the most recognizable names in the world of TSS. Tierno’s influence looms large in tampon journalism; his work is cited everywhere from the New York Times to The Atlantic to Sharra Vostral’s 2008 book on the history of menstrual hygiene technology. He’s been insisting, to anyone who will listen, for nearly 40 years, that synthetic tampons are dangerous.



And apparently, when it comes to tampon fibers and TSS, pretty much no other leading scientist agrees with him.


Two oft-quoted studies by Tierno and his NYU colleague, Dr. Bruce Hanna, from 1989 and 1994 target synthetic fibers like polyester foam and rayon as aiding in toxin production. The 1989 study states that “the greatest stimulation of TSST-1 was observed with polyester and carboxymethylcellulose,” in part because of the polyester’s high absorbing ability and because the carboxymethylcellulose encourages a gel-like viscosity that amplifies toxin production. The 1994 study found that all-cotton tampons put women at a lower risk of TSST-1 production than tampons with viscose rayon or contraceptive sponges.

“Polyester is a fiber that should never go in the vaginal vault,” Tierno told me over the phone with equal parts concern and urgency. “It provides the ideal chemical condition maximal for the production of toxins.”

After this phone call, my heart sank. Suddenly, makeup sponges were seeming like the worst possible thing to put in my vagina. Had I essentially had the second coming of the Rely tampon wedged up inside my body?

But four other scientists I called—all of whom are among the world’s leading experts on TSS (also all, incidentally, white and male)—told me in various diplomatic ways that they thought Tierno’s studies about tampon fibers and toxins were suspect, and that other scientists hadn’t been able to reproduce or confirm his findings. (Tierno believes they didn’t adequately attempt to reproduce the studies.)

Actually, the first scientist I called, Dr. Patrick Schlievert, wasn’t quite so diplomatic.


He’s “chasing rainbows,” he said of Tierno. He’s “wrong the vast majority of the time he publishes a study” on TSS.

“He’s chasing rainbows. He’s wrong the vast majority of the time he publishes a study on TSS.”

Schlievert has a caustic, supremely self-assured way about him that makes me want to both roll my eyes and write down everything he says. He’s an expert in S. aureus, and the scientist who—after Todd named toxic shock syndrome—first identified in 1981 the particular strain of staphylococcus bacteria that caused it. “Not many people know more about S. aureus than Pat Schlievert,” said one scientist I spoke to.

Schlievert says it’s long been accepted that the introduction of oxygen into the vagina is the principal factor in triggering S. aureus to produce the toxin—not whether a tampon is made of cotton, rayon, or polyester foam. Even non-Tierno studies have shown increased toxin production with the infamous Rely tampons that were made of, among other things, polyester foam, the key ingredient in many makeup sponges. But Schlievert says a woman on her period with S. aureus present in her vagina will have more than enough bacteria to produce the toxin regardless of what her tampon is made of. “Menstrual blood can multiply Staph. aureus organisms from 1,000 to 10 billion,” he said. But in order for all that bacteria to result in TSS, “you just need something to turn on the toxin.”

That something, Schlievert said, is air.


Anytime a woman inserts a tampon—or anything else, like a menstrual cup or a diaphragm—she risks introducing oxygen into the normally anaerobic vagina. As a general rule, Schlievert says, the higher the absorbency and expansion rate of the tampon, the more oxygen is trapped. There are two reasons for this, he explained: Even before insertion, high-absorbency tampons are larger than lower-absorbency tampons, so to bacteria, nooks and crannies in the tampon “look like the Grand Canyon”; the outer edge of bigger tampons have more exposure to the vaginal wall than smaller ones. And then, once inserted, tampons further increase in size, causing “immediate expansion and drawing in of air during insertion.” This is why the high absorbency of the Rely tampon was so key to the TSS outbreak, he said, and why the CDC recommends using a tampon with the lowest possible absorbency rate.

Tierno vehemently disagrees. He concedes that oxygen is a factor in determining whether S. aureus will produce TSST-1 toxins, but not necessarily the main factor. He maintains that the key factor would still be synthetic materials.

“There is no justification for polyester under any condition,” Tierno said.

Illustration : Angelica Alzona/Lifehacker

The Cutthroat Politics of TSS Scholarship

Now I was really confused. These two TSS experts seemed eager to talk shit about each other to a reporter, and I wasn’t sure which one I should believe. Schlievert called Tierno “a broken record” who’s “not keeping up with current, generally accepted knowledge and publications.” Tierno shot back that he had no intention of getting into a “pissing match” with Schlievert, although when he hears his colleague’s name, “it just irks me,” he said, his Brooklyn accent thickening as his defenses rose. Schlievert “has befuddled many cases with nonsense.” Tierno wouldn’t get into the specifics of said nonsense, but “let’s just say that there are ancillary things at play—not just science. There’s also politics.” The “politics” of the TSS scholar community were proving to be far more cutthroat than I’d anticipated.


“He has befuddled many cases with nonsense.”

I needed more scientists to weigh in on whether polyester foam was a major risk factor in TSS. I independently identified other prominent experts based on how frequently their names were cited in studies and news articles about TSS, and got ahold of three of them. (Dr. James Todd, the Denver doctor who first identified the disease, declined an interview.) When it came to whether certain materials put a woman more at risk for TSS, every specialist I spoke with aligned themselves with Schlievert and Team Oxygen, saying air is the key factor, and that polyester foam itself was a secondary factor at best.

Dr. Vincent Fischetti, a professor of immunology, virology, and microbiology who’s been at the Rockefeller University’s Laboratory of Bacterial Pathogenesis and Immunology for decades, was the biggest Team Oxygen evangelist: “My view is that materials themselves don’t make any difference,” he said, unless that material has a better way of trapping oxygen. Back in 1989, he co-authored a study on the role of air in TSS toxin production, which convinced him that “whatever could bring oxygen into the vagina could cause a TSS event to occur”—regardless of whether it was made of cotton or rayon or polyester.



Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota and co-author on a pair of foundational tri-state studies on Rely and the root causes of TSS, mentioned that Rely did contain a surfactant called Pluronic L92 that amplified toxin production. But he still told me to trust Schlievert.

“His work has been replicated by others and is really cutting edge,” Osterholm said. He agreed that the absorbency as a measure of how much oxygen a product introduces in the vagina, not the material, was the major factor in determining whether S. aureus would produce the TSST-1 toxin. When Rely was taken off the market, the tri-state studies showed, other manufacturers of high-absorbency tampons like Tampax’s Super Plus and Playtex Super Plus still saw increased cases of TSS associated with their products.


Dr. Jeffrey Parsonnet—an infectious disease doctor and professor at the Geisel School of Medicine at Dartmouth, as well as a co-author on a 1996 study that found Rely “dramatically increased” TSST-1 production—wouldn’t commit to joining Tierno on Team Polyester, either. “Dr. Schlievert is usually quite confident,” he said with an affectionate chuckle, “but I tend to agree with him.” Parsonnet told me that the “jury was still out” on what exact chemical composition made the Rely tampon so dangerous. And he, too, brought up Rely’s Pluronic L92 coating, warning that we don’t know what makeup sponges are coated with. So he can’t advise putting anything that’s not a medical device in the body, but guessed that a makeup sponge during period sex would be safe for a short period of time.

These three doctors concurred with Schlievert’s theories over Tierno’s on a scientific level, but Schlievert also questioned Tierno’s political motives. He criticized Tierno’s involvement in TSS-related court cases, even implying that Tierno was chasing the money of plaintiffs suing tampon companies and that he “charged a lot for his time [testifying in court] so he could have some extra money to do studies.” Tierno denies this, and in fact charges that many leading doctors in the field are “bought lock, stock, and barrel by the tampon companies” and “paid for their daughters’ weddings” with the dollars of Big Tampon, although he declined to name names. These scientists testify “in favor of tampon manufacturers,” he said. “Whereas I testify on the side of the truth.” (For the record, as of 2014 Tierno was the “official medical advisor” for feminine hygiene company Veeda, which only sells 100% cotton tampons.)



Schlievert counters that his studies on TSS were funded by the National Institutes of Health, not by tampon companies. But even that same 1996 study—one that Tierno would agree with and which showed that the Rely Super tampon allowed for more toxin production than cotton or rayon—was supported by a grant from Tambrands, Inc., the company that manufactures Tampax tampons (and as of 1997 is a subsidiary of Procter & Gamble, the parent company of Rely).



Regardless of perceived motives, though, here was one thing all the men agreed on: When there’s enough S. aureus in the vagina, oxygen could have some very, very dangerous effects.



What About Makeup Sponges?

So if oxygen is a key factor in getting TSS, where do makeup sponges fit in? Gunter acknowledged oxygen’s role in her blog post, and performed an informal experiment.


“I popped a makeup sponge in a beaker just to see how much air might be trapped and I was astounded at the amount of gas released,” Gunter wrote. “I did the same experiment with a super plus tampon and I saw no bubbles.” (After an initial follow-up interview, Gunter declined to participate in this article when Lifehacker’s fact-checker called this past summer, expressing her disapproval that I hadn’t followed up personally. When I followed up with Gunter after that, she expressed further disapproval and hung up on me.)

Schlievert called Gunter’s informal experiment “useless” and “unscientific”: “The beaker experiment depends on the amount of fluid in the beaker, the size of the [sponge], the total amount of trapped air [in the sponge] (not just visible bubble-producing), and too many other variables,” he said. But even if a sponge did trap more air relative to its size, most of the scientists I spoke to said the product’s TSS risk simply depends on its absorbency rate. A large, super-absorbent makeup sponge—just like a large, super-absorbent tampon—would increase the amount of oxygen in the vagina. Makeup sponges don’t advertise their absorbency, but there are certainly different sizes; this could mean that my original advice to use an oversized sponge for more protection may not have been wise.

What about time? It was here that I encountered perhaps the biggest revelation in all my research. Common wisdom has always held that TSS has to do with lazy tampon usage—leaving it in too long, or forgetting about it and discovering it days later. But despite the oft-repeated directive to change tampons frequently and avoid overnight usage, the doctors I spoke with were divided when it came to this issue.

Fischetti and Tierno said one’s risk of TSS goes down if tampons are changed within eight hours. But Schlievert and Osterholm said the onset of the disease might not have much to do with leaving in a tampon or sponge too long. In fact, changing tampons frequently and using them back-to-back during one’s period (as opposed to, say, alternating between tampons and pads or blood-absorbing panties like THINX) could even increase the chances of developing TSS, the scientists said, because every insertion introduces more oxygen. Parsonnet was noncommittal, but also raised the theory that back-to-back, “continuous use” of tampons could be a factor.

Changing tampons frequently could even increase the chances of developing TSS.


Yet despite the debate over how much wear time influences TSS risk, Schlievert, Parsonnet, Fischetti, and Osterholm all told me that they could confidently say using a makeup sponge once in a while for up to one hour during sex carried an extremely minuscule risk of TSS, equal to or possibly less than the risk of regular tampon use. I breathed a sigh of relief: My track record of swiftly removing makeup sponges after period sex was immaculate compared to all those times I’d forgotten to change my tampon for hours on end.

Tierno countered by saying I “could possibly fall asleep with [the makeup sponge in] given the scenario. Your deed is done. There’s a certain art to making love, so that art sometimes has to be expressed. As such, you may not immediately remove it.”

It might seem rude, in other words, to jump up and go to the bathroom right after sex to pop out your makeup sponge, rather than pillow-talking or falling asleep in your lover’s arms. (If you ask me, a male scientist’s paternalistic assumptions about grown women’s post-coital preferences had no place in the context of a scientific interrogation. And there are other doctor-recommended reasons for a post-sex bathroom run that do not deter us from having sex—just ask any UTI-prone woman.) Yet several doctors and researchers, including Tierno, said the TSST-1 toxin takes several hours to be produced in high enough concentrations by S. aureus in the vagina to cause TSS. Therefore, it seems logical that removing a makeup sponge within an hour of insertion, without back-to-back insertion of another sponge later, would reduce the already small risk of TSS.

How to Assess Your TSS Risk

As I was researching this story, I uncovered other ways to discern your TSS risk—things that would have been awesome to know back when puberty books and tampon boxes were scaring the shit out of me when I first got my period. Several of the doctors I spoke with said teens and younger women are far more likely than older women to get TSS. (The average TSS patient, Osterholm said, is in her early twenties, and more than a third of women who contract it are teenagers.)

Graphic : U.S. Food and Drug Administration, 1985


Schlievert said that of the more than 8,000 S. aureus TSS cases he’s consulted on, nearly all were women of Northern European descent—which, he said, may explain the higher prevalence of the disease in the Upper Midwest, which was settled by Scandinavian immigrants. Tierno also said “cosmopolitan women” in New York City who have had more sex partners may be more likely to have developed the antibodies to TSS than “women in Cedar Rapids, Iowa.” (Was this a reference to a well-publicized 1982 case of Rely-associated TSS, for which Tierno testified, in Cedar Rapids? Or was Tierno throwing subtle shade at Schlievert, who is a professor at the University of Iowa? We can’t be sure.)



A test exists for these antibodies, but it’s well outside a typical gynecological routine—Schlievert claims he’s the only one doing it. And Tierno thinks the results wouldn’t be worth it, anyway; he believes that antibodies can develop over time, so a 15-year-old girl’s test might be useless by the time she’s 20. And he’s stated in the past that these results could possibly be used against TSS patients suing tampon companies. (Schlievert, unsurprisingly, disagrees with Tierno; he believes that if a woman doesn’t develop these antibodies by adolescence, she likely never will.)

So would any of these doctors straight-up recommend that one of their patients use a makeup sponge for period sex?

So would any of these doctors straight-up recommend that one of their patients use a makeup sponge for period sex? This is where they hedged. Nobody actually knows much about using makeup sponges during period sex. It has not been studied or approved for that use by the FDA. Even the supremely confident Schlievert said that in order to determine exactly how much oxygen the makeup sponge introduces into the vagina, it would need to be tested formally and scientifically.

In other words: Could I get an expert to endorse this hack for mess-free period sex? No. Do four of the world’s leading TSS experts have any reason to believe that a woman who uses this hack is at higher risk for contracting this disease than if she inserted a tampon? Also no.


After all was said and done, I knew in my heart that I was going to continue using makeup sponges for period sex. So I decided to plan for harm reduction, because, to me, the boons outweighed the potential risks. Employing the makeup sponge hack despite the miniscule possibility of toxic shock syndrome was a cost-benefit analysis akin to ordering a rare burger despite the risk of food poisoning, an affliction far more likely to occur than TSS.

Which is why I find it interesting that a similarly low-risk recommendation that provoked a startling level of online vitriol just happened to involve vaginas. Some comments seemed rooted in a prudish morality: “Fucking wait” until you’re not on your period, suggested Michael on Facebook. “No one is entitled to sex on demand.” Others reeked of plain old sexism: “I’m not a woman, and even I can tell this is horrible, horrible advice!” remarked a man who is physically incapable of taking said advice.

To be fair, this outsize reaction was also likely due to a lack of information about how rare the disease is, what causes it, and how much of the vagina-having population is immune. I began this accidental odyssey virtually clueless about the science of TSS, and emerged on the other side with a far better understanding of this plainly complicated disease. Here’s what we now know:

TSS occurs when a bacterium called Staphylococcus aureus produces a toxin called TSST-1 in high concentrations in the vagina and succeeds in entering the bloodstream. Menstrual blood’s pH causes S. aureus levels to skyrocket.



TSS is rare. Last year, only 24 cases of staph-related TSS were reported to the CDC. At least 80 percent of the population is immune because by adolescence they have developed TSST-1 antibodies.

At least 80 percent of the population is immune because by adolescence they have developed TSST-1 antibodies. Studies have shown that teens and women in their twenties more commonly develop TSS.

Tierno suggests that women who have more sexual intercourse or live in densely populated areas are more likely to have antibodies to protect against TSS. (Schlievert, for the record, disagrees.)

Microbiologists agree that oxygen in the vagina is essential to trigger the production of the TSST-1 toxin, a reason why tampons are associated with TSS.

It’s still unclear whether the type of material or fibers in tampons or anything else inserted in the vagina has an effect on the TSST-1 toxin. Several leading experts think it’s at best not relevant to TSS at all, at worst a secondary factor. One leading expert I spoke to thinks it’s a major factor in causing TSS.

Several leading experts think it’s at best not relevant to TSS at all, at worst a secondary factor. One leading expert I spoke to thinks it’s a major factor in causing TSS. Regardless of material, higher-absorbency tampons have long been linked to TSS, probably because their size and expansion levels allow for more oxygen in the vagina.

Once oxygen is introduced in the vagina, it takes several hours for the toxin to develop.

While no doctor or microbiologist I spoke with would promote the “off-label” use of a makeup sponge during period sex, most of them agreed that the risk of TSS while using one is at least as low as that of using tampons—perhaps lower, since a sponge will probably stay in the vagina for less time.

“I don’t think that we teach people how to look at their own personal risk benefit ratio, and I think that it’s very easy for a scare story to run away,” Gunter remarked in a recent article about TSS in The Cut. I agree, so let’s look at my ratio: I’m a 34-year-old, fairly promiscuous New Yorker who evidently has a short vaginal canal, since I’ve never had a problem locating the makeup sponge after sex and fishing it out. My risk for TSS appears to be low. I’ve continued to use this period-sex hack since I started researching this article in the summer of 2017.

But I’ve definitely applied what I’ve learned to reduce my risk. I’ve been taking out the sponge within an hour of insertion to prevent toxins from having any chance of developing. I’ve been using only one non-oversize sponge at a time, for just one sex session at a time, to reduce the amount of oxygen entering my vagina. (And I have been alternating between blood-absorbing period panties and tampons during my period for the same reason.)


Sea sponges appear to be riskier than makeup sponges—even the more laissez-faire Schlievert advises against them for allergy-related reasons, and anecdotally they seem more likely to break apart—so I have avoided using them. Several Lifehacker commenters endorsed menstrual discs, a vaginal device specifically designed to catch menstrual blood, as an alternative for period sex. That was intriguing to me, until I read a recent study finding that menstrual cups might be even more likely to be associated with TSS than tampons. Menstrual discs aren’t the same as menstrual cups, exactly, but they trap blood in a similar way. (Schlievert, of course, remains loyal to Team Oxygen: He believes those findings are likely due to menstrual cups introducing more air into the vaginal canal than tampons.)

All these precautions aside, the risk of using a makeup sponge may not be worth it to some women. But for me, a risk of contracting TSS that amounts to a teensy fraction of the risk of dying in a car accident is worth occasional blood-free period sex. I sure wish I had known the risks and science behind TSS up front, so I didn’t have to spend my entire pubescent life worrying about it.

So here’s what I propose: Teach girls the scientific details of TSS in health class and sexual education—its minuscule risk, women’s high rate of immunity, how long it takes for its toxins to develop, and what exactly is believed to cause it. Push tampon companies to publicize that same information in their package inserts and on their websites. And, above all, funnel more money and effort into demystifying women’s sexual health. That means educating them about diseases, sure, but it also means taking their sex-related concerns seriously.

Bleeding for a week every month is strange, inconvenient and sometimes painful. The least we can do is not subject millions of women to scaremongering misinformation about a deadly disease, and then subject them to intense judgment when they propose ideas about how to improve “the art of making love”—like, say, a relatively low-risk (albeit off-label) way to fuck during their periods without bleeding all over their sheets.

This piece was edited by Melissa Kirsch, with assistance from Alice Bradley and Beth Skwarecki, and fact-checked by Jessica Corbett.