The Vasovagal Response and Other Reasons Your Body Rejects a Tampon
Editor's note: Some of the sources for this article requested their full names and locations not be used.
When Sarah, a 26-year-old Reddit user who goes by u/One_Werewolf1090, tried inserting a tampon at age 18, she immediately felt dizzy and lied down, unable to speak. The second time she tried, at 22, she fainted.
Reddit user u/ZanyDragons, a phlebotomist in nursing school who lives in the southern United States, felt dizzy and nauseous while inserting a tampon—and using a dilator and getting a Pap smear. She noted that pain, discomfort, anxiety and contact with the cervix (which we'll get to more in a bit) can worsen those symptoms for her.
'If you experience pain, a pelvic floor therapist, pain management physician and/or acupuncturist may need to be on your team.'
Reddit is full of people with the same experience, an overwhelming majority of whom don't know why. Is it anxiety, vaginismus, toxic shock syndrome or something different? Can some people just not use tampons?
Unfortunately, there isn't one clear-cut cause behind the dizziness and nausea, but here are some potential reasons:
You had a vasovagal response
A vasovagal response is when a bodily trigger causes you to faint.
"For people with a sensitive cervix, this reaction is caused by the tampon touching the cervix," said Somi Javaid, M.D., a board-certified OB-GYN in Ohio and one of three founders of HerMD, a female-founded healthcare startup.
Symptoms of this type of episode include paleness, nausea, sweating and, yes, fainting. Treatment for a vasovagal episode can include trigger avoidance or medication.
Your sympathetic nervous system was engaged
You've probably heard of "fight or flight," your body's reaction to a stressful event. The sympathetic nervous system is activated, and as a result, you may sweat, feel nauseous and dizzy, and breathe quicker.
"When we insert a tampon, if our body perceives this as a threat, it will engage our sympathetic nervous system, which may produce the physical effects," explained Heather Jeffcoat, D.P.T., owner of Femina Physical Therapy in Los Angeles, president of the Academy of Pelvic Health Physical Therapy and an advisory board member of the International Pelvic Pain Society. Inserting something into your vagina, where you may have experienced trauma, pain or shame around penetration—could feel foreign or nerve-wracking.
People who experience chronic pelvic pain or high levels of depression and/or anxiety are more likely to have sensitive nervous systems, too, according to Jeffcoat.
"In other words, inserting a tampon may be perceived as painful, even though it is a non-painful stimuli," she said.
You have toxic shock syndrome
Toxic shock syndrome (TSS) is a less likely cause, but it's best to ascertain if you have it.
"It's also important to rule out toxic shock syndrome with your physician, as that can also make you feel hot due to a fever but has other potentially life-threatening symptoms of diarrhea, widespread sunburn-like rash, dizziness or fainting, headaches and bloodshot eyes," Jeffcoat said.
If toxic shock syndrome is the case, you'll need treatment.
"You'll likely need antibiotics and additional fluids, depending on the severity," Javaid said.
How to keep tampon insertion from disrupting your life
As uncomfortable as putting in a tampon can be, you may prefer them over pads or other products. So what can you do?
First and foremost, both Javaid and Jeffcoat urge you to see a provider.
"Do not wait to seek help," Javaid said. "As soon as you notice this reaction or recurring symptoms, we recommend seeing a medical professional."
A doctor can help keep you safe, ensure TSS isn't an issue and help you figure out the cause of your symptoms.
"To get at the root of what can help you avoid the effects of the nervous system, a team of providers may be necessary," Jeffcoat said. "If you experience pain, a pelvic floor therapist, pain management physician and/or acupuncturist may need to be on your team to reduce or get you out of your pain cycle."
If you don't feel pain, she continued, a psychotherapist or pelvic floor physical therapist can help with anxiety and nervous system regulation.
Steps such as these helped Sarah, the Reddit user. After finding out she had a micro-perforated hymen and vaginismus, she got a hymenectomy and started using a dilator. Now, she can use tampons with much more ease.
"I managed to insert the tampon, felt dizzy for a moment, but laying down helps," she said. "And the fact I am no longer that afraid of penetration reduced pain [and] decreased the level of my anxiety during this attempt."
Change the tampon you use and how you insert it
Javaid said a smaller tampon may decrease your symptoms. Additionally, you can play with how you insert the tampon.
"We recommend inserting the tampon in a different position; for instance, laying down or sitting on the toilet and bearing down to try to make the dizziness go away," Javaid added. Having a fan blowing nearby may help, too.
Try 'rainbow breathing'
Lastly, breathe it out.
"One essential function that can help reduce your feelings of anxiety or other unregulated nervous system effects is deep, lateral breathing, sometimes called 'rainbow breathing' in the pediatric population," Jeffcoat said.
To use this breathing technique:
- Get into a comfortable position.
- Inhale as deeply as is comfortable for you. Feel your rib cage expand forward, to the sides and back.
- As you inhale, reach your arms overhead, then bring them down to your sides as though you're making a rainbow with your arms.
After talking to professionals about your specific history and trying these tips, it's up to you whether you keep using tampons or not. While they can sometimes be necessary—hello, pool days—it's OK if you'd just rather not.