Removing tampons before surgery is a strictly enforced safety protocol designed to protect the patient during and after the procedure. This rule applies to all types of surgery, regardless of whether the operation is near the pelvis or is a simple outpatient procedure. Patient safety is the primary concern, as a tampon introduces risks that the surgical team cannot manage effectively. These risks range from interference with necessary surgical monitoring to the potential for severe post-operative complications.
Immediate Interference with Surgical Monitoring
A primary concern is that an internal menstrual product can obstruct the surgical team’s ability to monitor a patient’s natural fluid loss. Anesthesiologists rely on visual cues, such as blood in the surgical field and fluid on the operating table, to accurately estimate blood loss and manage fluid balance. A tampon absorbs menstrual blood, masking this metric and leading to an inaccurate assessment of the patient’s circulating volume.
The presence of a tampon can also complicate the preparation of the surgical site or interfere with routine procedures. Many lengthy surgeries require placing a urinary catheter to monitor kidney function and urine output. An internal product can physically obstruct or contaminate the area where the catheter is inserted, delaying the operation or increasing the risk of introducing bacteria. Removing the tampon ensures accurate and unobstructed monitoring of the patient’s physiological status during the procedure.
The Danger of Fire and Electrosurgical Tools
The most serious risk associated with wearing a tampon during surgery is the potential for a surgical fire. Most surgical procedures utilize an Electrosurgical Unit (ESU) or cautery device to precisely cut tissue and stop bleeding using high-frequency electrical current. The ESU’s active electrode creates an ignition source that generates intense heat or sparks.
The materials used in tampons, such as cotton, rayon, or plastic applicators, are highly flammable and act as fuel in the operating room environment. If the ESU is activated near or accidentally touches an exposed tampon string or the product itself, the material can ignite. This interaction can cause a flash fire or thermal injury, especially in the oxygen-enriched atmosphere often present near the surgical field.
A surgical fire requires three components: an ignition source (like the ESU), an oxidizer (such as supplemental oxygen), and a fuel source (like a tampon). Since the surgical team cannot control the ignition source or the oxidizer in many cases, removing all potential fuel sources is a mandatory precaution. This measure prevents a rare but catastrophic event that can result in severe burns and other complications.
Post-Operative Infection and Toxic Shock Syndrome
The risk of post-operative infection, specifically Toxic Shock Syndrome (TSS), is another significant factor. TSS is a rare but severe condition caused by toxins produced by Staphylococcus aureus bacteria, which multiply rapidly when an absorbent foreign body is left in place for an extended time. Tampons are designed to be changed frequently, ideally every four to eight hours.
During and immediately following surgery, a patient is often unconscious, heavily sedated, or disoriented. The surgical procedure can last for many hours, and recovery time in the Post-Anesthesia Care Unit (PACU) adds several more. If a tampon is left in, the patient cannot track the time or change the product, creating an environment where bacteria can proliferate and release toxins into the bloodstream. This prolonged retention increases the risk of developing TSS or a localized infection during the recovery period.
Managing Menstruation During Hospital Stays
To mitigate these risks, hospital protocols mandate the use of external menstrual products, such as sanitary pads, during the surgical experience. Patients should inform their surgical team if they are menstruating or expect their period on the day of the procedure. This communication allows the team to make necessary preparations without compromising safety.
Hospital staff will provide soft, absorbent pads for use before, during, and after the operation. Unlike a tampon, a pad does not mask blood loss, does not pose a fire risk, and is easily managed by the nursing staff while the patient is under anesthesia or recovering. If heavy or unexpected bleeding begins during the surgery, the staff manage it with sterile pads and document the fluid loss accurately, ensuring patient comfort and safety.