Maintaining Women's Health During Deployment, Tips for the female Soldier

By Col. Lori L. Trego, PhD, CNM, Women's Health Task Force and Retired Lt. Col. Nancy Steele, PhD, WHNP-BCMay 28, 2015

Maintaining Women's Health During Deployment, Tips for the female Soldier
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History has often demonstrated that the course of battle is influenced more by the health of the troops than by strategy or tactics. Health is largely a personal responsibility. A woman's personal hygiene habits while in the field environment, such as during a deployment or field exercise, can have a strong impact on her well-being. Good health does not just happen; it comes with conscious effort, good habits, and self-care practices.

Challenges in the environment can lead to changes in personal hygiene practice, and may result in negative health outcomes. Common problems reported by women during deployments were related to vaginal and urinary tract infections as well as menstrual cycle symptoms. Yet, many military women have felt illprepared to deal with the hardships that the deployed environment imposed on their health maintenance practices.

These reports from women in the field were compiled by The Women's Health Task Force, a program of the Army surgeon general, and have resulted in the development and implementation of a class in basic combat training programs as well as leader development courses to help women, their peers, and their leaders know what to look for. Here are some tips to be better prepared to experience a healthy, safe, and comfortable deployment.

*** What women say: "You manage but you're always dirty...hands were nasty, always constantly cleaning, [using] hand sanitizer, trying to stay clean, so you wouldn't have any type of infections or diseases or whatever or get sick."***

The Problem: The lack of privacy, and of hand washing, shower, and laundry facilities has been associated with urinary tract infections and vaginal infections. You may be unable to adequately wash or stay clean and have difficulty tending to feminine hygiene during menstrual cycles. Women also hold their urine because of dirty latrines or lack of latrines, lack of privacy, and the inconvenience of undressing in full battle gear. This can lead to urinary tract infections (UTI) and vaginal infections. It is hard to take care of yourself in a port-a-potty!

TIP: The most important tip to preventing UTIs is to practice good personal hygiene. Good hand washing will decrease chances of infection.

• You should wash your hands before, as well as after, using the latrine and changing menstrual products.

• You should also empty your bladder as soon as the urge to urinate occurs, do not hold your urine.

• Drink plenty of fluids, preferably water, every day to help flush bacteria out of the urinary system.

• Use a female urinary diversion device (FUDD), which is a device that allows females to urinate

through the fly of the uniform while standing or sitting, to eliminate the problem of holding your urine.

To prevent vaginal infections like yeast and bacterial vaginosis (BV), avoid the use of perfumed sanitary products and do not douche. Perfumed products and douching increase the pH of the vagina, which is unhealthy and encourages infection. Wear only cotton panties, as cotton allows moisture to escape whereas other materials may trap moisture and encourage the growth of yeast. Use baby wipes or personal wipes if no soap and water are available, but buy baby wipes that are perfume-free. A good idea is to carry supplies with you in a plastic ziplock, such as hand sanitizer and unscented wipes to help "keep it clean."

***What women say: "I would go like a couple of months, like three months, without having a period and then I had a period. It would be really heavy at times."***

The Problem: Servicewomen havereported changes in their menstrual cycles, such as irregular spotting and increased bleeding, which they have associated with increased physical and emotional stress during deployments. Research has shown that physical and emotional stress can contribute to both menstrual cycle changes and increases in vaginal infections. Many other things can cause your menstrual cycle to change, too. Extreme physical stress, like that of an elite athlete, for example gymnasts and distance runners, can upset the hormonal balance in your body. Extreme limitation of your caloric intake and extreme physical work outs contribute to the loss of the menstrual period.

Medical conditions such as the polycystic ovary syndrome, can also contribute to changes in your period, so always discuss any changes in your period with a provider.

TIP: As you can imagine, if you are having unexpected or heavy bleeding, it would be quite difficult to stay clean in an austere environment. Here are some tips for healthy menstrual hygiene practices during deployment or training.

• Wash your hands before and after changing sanitary products, and change products frequently. Be prepared: Always carry supplies!

• Have hand sanitizer with you, and a supply of one-time-use baby wipe packets are convenient to keep yourself clean.

• A 30-day supply of female hygiene products is recommended for deployments or if to an area without access to a post exchange.

• Choose types of sanitary products suited for the environment.

• Carry an assortment of sizes and absorbencies of sanitary napkins and tampons for unexpected bleeding, breakthrough bleeding, spotting, or for your peers who may experience the same symptoms.

• Take them with you in a quart-sized baggy, which will fit in your cargo pocket and keep the supplies clean. Plan for disposal of used products, carry extra Ziplocs with you.

TIP: There are ways you can manage, and even prevent some changes that may occur in your menstrual cycle.

Self-care involves taking over-thecounter medications to try to alleviate your own symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help to decrease the amount of bleeding and cramps that occur during your menstrual period. Taking hormones (estrogen and/or progesterone) is a way to regulate your menstrual cycles and decrease symptoms you might experience. You can change your cycle by using birth control pills, the patch, the ring, the progesterone IUD, or "the shot," depo-provera to try to avoid some of these symptoms. Servicewomen have said that they would like more information regarding uses and effects of contraception, as well as knowledge regarding which ones are ill-suited for environmental conditions

in theater. Make an appointment with your care provider at least three months prior to field training or deployment if you would like to try a hormonal method to control your menstrual cycle during deployment.

TIP: If you experience any of the following symptoms, whether deployed or not, you should seek healthcare.

• Heavy bleeding for three or more days in a row.

• Vaginal itching, burning, abnormal discharge or odor.

• Redness of the genital area.

• Pain or burning with urination.

• Excessive frequency or urgency to urinate.

Please do not hesitate to see a healthcare provider at your duty station or if you are deployed - seeking care for health problems is an important part of "selfcare." Taking care of yourself during field training and while deployed can prevent infections and reduce menstrual problems. It is up to you to maintain your own personal hygiene in the deployed setting, so that you will remain in optimum health. Whether you are a leader or a squad-mate of a female Soldier, it is also your responsibility to know how to best take care of your battle buddy or unit member. Everybody on a team should know how to prevent problems, recognize signs of illness, and recommend healthy actions for their teammates!

Reference: The quotes in this article are from the following publication: Trego, L.L. (2007). Military women's menstrual experiences and interest in menstrual suppression during deployment. Journal

of Obstetric, Gynecologic, and Neonatal Nursing, 36(4), 342-347.

Related Links:

Official Website of U.S. Army Medical Command

PRESS RELEASE: MERCURY, Special Edition on Women's Health

PUBLICATION: MERCURY, Special Edition on Women's Health