WOMEN’S ISSUES DURING DEPLOYMENT

1. WOMEN’S ISSUESDURINGDEPLOYMENT Carla Hawley-Bowland COL, MC, USA

2. Issues for the female soldier • Health risks of deployment and FTX • Health maintenance during deployment • Sundry packs • Early pregnancy and deployment • Family plans

3. Deployment and Field • Vaginitis - increased incidence with: • Scented soaps • Ivory is the worst(99% pure; 1% perfume) • Chemical vaginitis, causing a change in pH • Enzyme detergents • Tight pants • Short cut in the BDU’s crotch a problem • Menses - change in pH

4. Deployment and Field • Vaginitis - increased incidence with: • Deodorant tampons and pads • deodorant and baking soda change pH • Tampons with plastic applicators • sharp edges cause nicks in vaginal mucosa resulting in a nidus of infection • Tampons with no applicators • Dirty hands can soil tampon before inserted

5. Deployment and Field • Birth Control • Oral contraceptives • inadequate supply (6 cycles not equal to 6 mos) • Emergency contraception? ( sex will happen) • Depo-Provera • Availability; keeping to dosage schedule • Barrier methods • Extremes of temperature can decrease the effectiveness of latex • Maintenance of supply of spermicide difficult

6. Health Maintenance • GYN disorders • Work up and treat prior to deployment • Limited workup, treatment and follow-up in the field • If need chronic treatment, dispense enough for deployment and educate the patient

7. Health Maintenance • Paps and mammograms • Early rather than late, to accommodate deployments and FTXs • Follow up the abnormal Pap smear • Colposcopy before deployment and establish therapy or needed follow up • One colposcope in theater could have saved many aerovacs to Germany during Desert Storm

8. Health Maintenance • Periods - how to live with them • Adequate supplies of pads and tampons • Sundry packs modified • Unscented tampons, pads, panty liners • Tampons with cardboard applicators • protect from dirty hands • biodegradable • Adequate hygiene-wet wipes if no showers • change pads and tampons frequently • Adequate medication (Motrin,Naprosyn) • Extra underwear

9. Health Maintenance • Periods - ah!, to live without them • Continuous monophasic OCPs • Long term effects?? • Depo-Provera • Maintain shot schedule in field • Endometrial ablation • For the gung-ho with no desire for fertility?

10. Health maintenance • Depo-Provera • Send medication with soldier and have medic administer (avoids stock and waste) • OCPs - take enough for 6 months! • 182 days = 6.5 28-day cycles • take 7 cycles + 2 extra for delays • continuous therapy = 8.6 21-day cycles • take 9 cycles + 2 extra for delays

11. Health Maintenance • Norplant • Easy - lasts five years; no maintenance • New site? (rolled BDU sleeve can irritate) • Ideal for potential POW as we increase combat roles for women • IUD • Easy - Paragard good for 10 years • PID risk with multiple partners or partner with multiple partners

12. Health maintenance • Emergency contraception • Must be initiated within 72 hours of unprotected intercourse • Ovral 2 tabs po q 12h x 2 • Lo/Ovral 4 tabs q 12h x 2 • Should every female soldier be issued one cycle of OCPs with instructions? • ACOG. Practice Patterns: Emergency Oral Contraception. Number 3, December 1996

13. Health Maintenance • Vaginitis - prevention • choose loose fit in BDUs • Change tampons or pads frequently • Clean with wet wipes if can’t shower • Vaginitis - treatment • Issue 1-2 regimens of OTC antifungal for self-treatment • Gentian violet impregnated tampons?? • Send to the rear for evaluation for failed self-treatment

14. Health Maintenance • Female urinary diversion devices • Allow urination through the trouser fly • No need to remove clothing or gear • Suitable cover not necessary • Two devices on the market • Lady J • Freshette Complete System

15. Health Maintenance • Lady J • Rigid plastic funnel and spout • Used in standing position

16. Health Maintenance • Freshette • Soft plastic funnel with attachable tube • Optional collection bag • Used in standing position

17. Lady J and Freshette • Previous problems in field testers (53) • Dehydration - 1 • UTI - 3 • Voluntary urinary retention - 1 • required catheterization due to overdistention

18. Lady J and Freshette • Prospective crossover clinical trial • 53 women enrolled • 35 tested devices • 16 controls • 10 dropped out • 4 only used one device

19. Lady J and Freshette • Testers • Tested both devices, each for one week • Urine culture - 3 • before, between devices, after • Questionnaires after each device • Controls • Urine culture - 2 • before, and one week later • Questionnaire on signs and symptoms

20. Lady J and Freshette • Preferred device • Freshette - 63.2% • Lady J - 0% • spout too short to clear BDU fly • Either - 5.8% • Neither - 21%

21. Lady J and Freshette • Results • Urinary tract infection • Controls - 1 • Field testers - 0 • Dehydration requiring IV hydration • Controls - 2 • Field testers - 0

22. Family Plans • Extended family is often not local • May require more than 24 hours to mobilize • Must fly dependents to U.S. • if overseas and • single AD parent or dual AD couple

23. Family Plan • DoD is set up for one plan per family • If dual AD couple, need three plans • You go • I go • We both go

24. Family Plan • Powers of Attorney • change with each exercise • good for one year • Issue - how to renew • If deployed? • If a prisoner of war?