Air Force Academy cadets studying menstrual toxic shock syndrome

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U.S. AIR FORCE ACADEMY, Colo. – Cadet group commanders lead the annual Run to the Rock during Recognition for the Class of 2025 at the U.S. Air Force Academy, March 12, 2022, in Colorado Springs, Colo. The Run to the Rock signifies the successful completion of Recognition events which formalizes their identity as cadets and allows them to wear the Prop and Wings insignia on their uniform. (U.S. Air Force photo/Joshua Armstrong)


David Bitton

The Gazette (Colorado Springs, Colo.)

Painful cramps, a stomachache and high blood pressure weren’t enough for a teen on her period to get medical care. Instead, the doctor dismissed her as an immature female new to periods.

After suffering for nearly a month, she was rushed to the hospital by her parents after nearly passing out. She was diagnosed with menstrual toxic shock syndrome, a rare but serious infection that is difficult to treat.

The experience had a major impact on high school friend Madelyn Duckworth, now a senior cadet at the Air Force Academy, who wrote about it for a grant-writing assignment as part of a final project in a microbiology class last spring.

“I realized that could happen to a lot of women,” Duckworth said. “A lot of women had stories on blogs about dismissal from doctors and fighting through symptoms because we’re told that we’re supposed to be in that much pain when we’re on our periods. It’s normal.”

Maj. Erin Almand, biology teacher at the academy, thought the grant-writing assignment was well thought out and small enough in scope that cadets could do the research. Almand worked with another cadet to reframe the information to fit grant guidelines before submitting it for the Air Force Research Laboratory’s Edison Grant Program.

The project was among 18 proposals that received one year of funding in the inaugural grant program, which is aimed at creating a pipeline of technically proficient airmen and guardians by allowing research and testing opportunities.

The academy received $19,000 and cadets have spent the fall and current semesters learning about menstrual toxic shock syndrome and conducting research. Students, working in small groups, designed the experiments and questions they wanted to answer.

“There is research on toxic shock but not a lot on menstrual toxic shock,” Almand said. “The official number is 1 to 3 out of 100,000 women but according to the OBGYNs I’ve talked to, it may be a low as 1 in 40. It is underreported.”

Duckworth agrees that menstrual toxic shock syndrome is underreported and added that the 1980s was the last time extensive research was done and that findings are contradictory, making it difficult to draw clear conclusions.

“I’d like to see more research done so that people are better qualified to speak about the risks of toxic shock syndrome,” said Duckworth, a behavioral sciences major from Choctaw, Okla., who is heading to Johns Hopkins University this fall to pursue a master’s degree in nursing.

“I’ve taken anatomy and psychology in high school and college and wasn’t taught about toxic shock syndrome. It’s not talked about.”

To help combat that, Duckworth created a menstrual and sexual education packet that introduces menstrual toxic shock syndrome. She would like to see that content shared in schools.

Women weren’t the only cadets researching and learning about menstrual toxic shock syndrome.

“It was really meaningful for me and some of the other guys to be able to make progress on this research,” said senior David Hatfield, a biology major from Framingham, Mass.

Hatfield and a fellow cadet were tasked with creating growth curves to characterize how bacteria grows in an oxygen-free environment. They used anaerobic jars to simulate a tampon in a vagina. Four tampon brands were tested with different amounts of bacteria to look at growth over time.

“Based on the growth curve, it indicated some of the key points of growth,” Hatfield said. “We looked if toxin production changed significantly at those significant time points.”

Junior Donovan Williams, a biology major from Columbus, Ga., and his teammate took the information from the growth charts on how much bacteria was being produced to measure how much toxin is produced from the bacteria.

“We had samples of one through eight, 12, 24 hours,” Williams said. “We wanted to know if the toxin production also increases in relation to the bacteria production. Of course, it would make sense that if there was more bacteria, there would be more toxin. But in certain cases, that might not be the case.”

Williams said doing lab work nearly every day was interesting.

“It was a pretty eye-opening experience because me as a male, I didn’t know a lot about toxic shock, he said.

“In regard to the Air Force … it is important to understand what people are going through in order to allow them the time and resources to take care of themselves.”

Senior Conley Walters, a biology major from McKenney, Texas, joined the project this semester before heading to Texas A&M for medical school this fall, where he hopes to focus on the OBGYN track.

“I wanted to dive into the menstrual-health side, because it is obviously a massive portion of the OBGYN field,” he said.

He’s been building from the research last semester in which cadets were beginning to categorize and understand how bacteria grows in the vagina.

“We know that during menstruation the pH within the vagina transitions from acidic to neutral,” Walters said. “I was looking at how pH differences impact growth and toxin production. So far it looks like, as the pH lowers, the growth does seem to be stunted, suggesting the transition to neutral during menstruation may promote harmful bacterial growth, that would normally be suppressed by the low pH of the vagina.”

Walters believes more research needs to be done because menstrual health products have changed, and new products and materials have been introduced.

The Institutional Review Board recently evaluated an additional aspect of the study, which looks at the prevalence of menstrual toxic shock syndrome or similar diseases within the active-duty population at the academy, to compare military trends with those of the general public.

Is this a problem in the Air Force? And if it is, why is this actually a problem? Is it because its underreported and it’s always been a problem? Or is it because of the shift in how we use menstrual products?

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