Can You Sleep with a Tampon In?

There seems to be two camps of menstruators in this world: Those who swear tampons are the most comfortable, stress-free period products out there and those who feel squeamish about sticking and stashing a piece of cotton in their vagina for hours.

And when it comes time to snuggle into bed for the night, members of the tampon-obsessed group often find themselves wondering: Can you sleep with a tampon in? Here Kelly Culwell, M.D., a board-certified ob-gyn known as "Dr. Lady Doctor," breaks down if it's actually necessary to pull out your tampon and replace it with another menstrual product before you slumber.

Is It Okay to Sleep with a Tampon In?

Whether or not you can sleep with a tampon in depends on how many hours you're planning to spend catching zzz's. "It's not recommended to leave a tampon in more than eight hours (four to six is usually preferred)," says Dr. Culwell. "So if you anticipate sleeping longer than this, it's best not to sleep with a tampon in."

The reason: Sleeping with a tampon inserted for more than eight hours ups your risk of developing toxic shock syndrome, a rare, life-threatening condition commonly caused by toxins from Staphylococcus aureus (aka staph) bacteria, according to the Mayo Clinic. Tampons left in the vagina for a long time may encourage the bacteria to grow, and the menstrual products can stick to the vaginal walls (particularly if you have a light flow), causing tiny cuts when they're pulled out, according to the State Government of Victoria, Australia's Department of Health. The bacteria can then enter the bloodstream through those minuscule openings, leading to toxic shock syndrome and symptoms such as a sudden high fever, vomiting or diarrhea, a sunburn-like rash, confusion, muscle aches, headaches, and redness of the eyes, mouth, and throat. But in the worst-case scenario, TSS can lead to organ damage, shock, and even death, according to the Food and Drug Administration.

That said, tampon-related TSS "is very rare these days due to a change in how tampons are made," explains Dr. Culwell. "But it can still happen, so you should never leave your tampon in more than eight hours." (

A Bit of Background On TSS

The sharp decline in menstruation-related toxic shock syndrome cases — from six per 100,000 women in 1980 to roughly one per 100,000 today — can likely be attributed to the decrease in tampon absorbency, according to the Centers for Disease Control and Prevention. "Highly absorbent tampons have been linked to toxic shock syndrome," says Dr. Culwell. And back in the '80s, it was pretty darn common to use this variety. In fact, in 1980, tampons on the market absorbed anywhere from 10.3 to 20.5 grams, and those with "very high absorbency" (meaning they soaked up at least 15.4 grams) were used by 42 percent of tampon users, according tothe CDC. Comparatively, only 1 percent of tampon-using menstruators used the "very high absorbency" kind in 1986, and tampons sold today sop up just 6 to 18 grams, according to the FDA, which regulates tampons as medical devices.

Although the drop in TSS cases coincides with the drop in absorbency, the relationship between increased risk TSS and high-absorbency tampons isn't totally understood, according to the CDC. "It is unclear if this is simply because women leave these types of tampons in longer than less absorbent ones, rather than anything specific to the more absorbent tampons," adds Dr. Culwell.

A change in tampon materials may have played a role in the drop in TSS cases, too. Back in the 1970s, some tampons — particularly those from once-popular, now-defunct brand Rely — were made of an ultra-absorbent combination of polyester foam and carboxymethylcellulose (an edible thickening agent typically used in puddings and ice cream — yum).And in 1980, a study conducted by the CDC found that use of Rely tampons — which were not approved by the FDA — was associated with a higher incidence of TSS than any other brand of tampon. Today, tampons are made of a cotton and rayon blend.

Researchers don't know the exact reason why Rely tampons upped the risk of developing TSS, but the unique combo of materials used in their products may have been to blame, according to the CDC. What's more, the CDC notes that when super-absorbent Rely tampons were pulled from the market in 1980 — and when menstruators began ditching high-absorbency ones in general — there was also a significant decrease in TSS cases.

Thankfully, the FDA now evaluates the safety of all tampons before they're sold in the U.S., and the main materials of those approved are cotton, rayon, or a combination of the two. FTR, companies can incorporate additives such as fragrances, anti-wicking agents, and ingredients that allow for "smooth removal" into their tampons. Those extra ingredients may not be ideal for folks striving to use as clean and minimally processed of products as possible, but again, tampons must get the FDA's seal of approval (meaning they're safe) in order to be legally sold. Simply put: You don't need to worry about inserting any sketchy, potentially harmful materials up your vagina today. (If you'd like to know exactly what's in your tampons, you can look up your product and check out all its ingredients on SmartLabel.)

Still, should you ditch your ultra-absorbent tampons and opt for ones designed for lighter flows? It's complicated. Reminder: Highly absorbent tampons have been linked with TSS, but that may be because consumers tend to leave them in longer than less absorbent versions, says Dr. Culwell. In any case, the FDA advises wearing a tampon with the lowest absorbency necessary to reduce your risk of TSS. So, if you can go eight hours straight (i.e. sleeping through the whole night) without needing to change your tampon, it's likely time to try one with a lower absorbency, according to the organization.

The Bottom Line On Sleeping with a Tampon In

If you must sleep with a tampon in overnight (say, you're camping and that's the only period product you brought with you), Dr. Culwell recommends inserting a fresh one right before bed and pulling it out immediately upon waking up, which will help limit the amount of time you're using the same tampon.

But your best bet is to opt for a pad, period panties, or, if you want an internal product,a menstrual cup, which can safely be worn for up to 12 hours, making it a better option than tampons for overnight protection, says Dr. Culwell. If you're a menstrual cup newbie, make sure to test the product — and how long it takes for you to fill it up — before you slip in between the sheets, as heavy flows can "overwhelm" the cup and cause messy leaks while you snooze, says Dr. Culwell.

And if you're really worried about the potential health risks of TSS, ditching your tampon for a few nights of peaceful shut-eye is a simple change worth making.