women’s issues during deployment carla hawley-bowland col, mc, usa

WOMEN’S ISSUESWOMEN’S ISSUESDURINGDURING

DEPLOYMENTDEPLOYMENT

Carla Hawley-BowlandCarla Hawley-Bowland

COL, MC, USACOL, MC, USA

Issues for the female Issues for the female soldiersoldier

Health risks of deployment and Health risks of deployment and FTXFTX

Health maintenance during Health maintenance during deploymentdeployment

Sundry packsSundry packs Early pregnancy and deploymentEarly pregnancy and deployment Family plansFamily plans

Deployment and FieldDeployment and Field

Vaginitis - increased incidence with:Vaginitis - increased incidence with:– Scented soapsScented soaps

Ivory is the worst(99% pure; 1% perfume)Ivory is the worst(99% pure; 1% perfume) Chemical vaginitis, causing a change in Chemical vaginitis, causing a change in

pHpH

– Enzyme detergentsEnzyme detergents– Tight pantsTight pants

Short cut in the BDU’s crotch a problemShort cut in the BDU’s crotch a problem

– Menses - change in pHMenses - change in pH

Deployment and FieldDeployment and Field

Vaginitis - increased incidence with:Vaginitis - increased incidence with:– Deodorant tampons and padsDeodorant tampons and pads

deodorant and baking soda change pHdeodorant and baking soda change pH

– Tampons with plastic applicatorsTampons with plastic applicators sharp edges cause nicks in vaginal mucosa sharp edges cause nicks in vaginal mucosa

resulting in a nidus of infectionresulting in a nidus of infection

– Tampons with no applicatorsTampons with no applicators Dirty hands can soil tampon before insertedDirty hands can soil tampon before inserted

Deployment and FieldDeployment and Field Birth ControlBirth Control

– Oral contraceptivesOral contraceptives inadequate supply (6 cycles not equal to 6 mos)inadequate supply (6 cycles not equal to 6 mos) Emergency contraception? ( sex will happen)Emergency contraception? ( sex will happen)

– Depo-Provera Depo-Provera Availability; keeping to dosage scheduleAvailability; keeping to dosage schedule

– Barrier methodsBarrier methods Extremes of temperature can decrease the Extremes of temperature can decrease the

effectiveness of latexeffectiveness of latex Maintenance of supply of spermicide difficultMaintenance of supply of spermicide difficult

Health MaintenanceHealth Maintenance

GYN disorders GYN disorders – Work up and treat prior to deploymentWork up and treat prior to deployment

– Limited workup, treatment and follow-up Limited workup, treatment and follow-up in the fieldin the field

– If need chronic treatment, dispense If need chronic treatment, dispense enough for deployment and educate the enough for deployment and educate the patientpatient


Paps and mammogramsPaps and mammograms– Early rather than late, to Early rather than late, to

accommodate deployments and FTXsaccommodate deployments and FTXs– Follow up the abnormal Pap smearFollow up the abnormal Pap smear

Colposcopy before deployment and Colposcopy before deployment and establish therapy or needed follow upestablish therapy or needed follow up

One colposcope in theater could have One colposcope in theater could have saved many aerovacs to Germany during saved many aerovacs to Germany during Desert StormDesert Storm

Health MaintenanceHealth Maintenance Periods - how to live with themPeriods - how to live with them

– Adequate supplies of pads and tamponsAdequate supplies of pads and tampons Sundry packs modifiedSundry packs modified Unscented tampons, pads, panty linersUnscented tampons, pads, panty liners Tampons with cardboard applicatorsTampons with cardboard applicators

– protect from dirty handsprotect from dirty hands– biodegradablebiodegradable

Adequate hygiene-wet wipes if no showersAdequate hygiene-wet wipes if no showers– change pads and tampons frequentlychange pads and tampons frequently

– Adequate medication (Motrin,Naprosyn)Adequate medication (Motrin,Naprosyn)– Extra underwearExtra underwear


Periods - ah!, to live without themPeriods - ah!, to live without them– Continuous monophasic OCPsContinuous monophasic OCPs

Long term effects??Long term effects??

– Depo-ProveraDepo-Provera Maintain shot schedule in fieldMaintain shot schedule in field

– Endometrial ablationEndometrial ablation For the gung-ho with no desire for For the gung-ho with no desire for

fertility?fertility?

Health maintenanceHealth maintenance

Depo-ProveraDepo-Provera– Send medication with soldier and have Send medication with soldier and have

medic administer (avoids stock and medic administer (avoids stock and waste)waste)

OCPs - take enough for 6 months!OCPs - take enough for 6 months!– 182 days = 6.5 28-day cycles182 days = 6.5 28-day cycles

take 7 cycles + 2 extra for delaystake 7 cycles + 2 extra for delays

– continuous therapy = 8.6 21-day cyclescontinuous therapy = 8.6 21-day cycles take 9 cycles + 2 extra for delaystake 9 cycles + 2 extra for delays


NorplantNorplant– Easy - lasts five years; no maintenanceEasy - lasts five years; no maintenance– New site? (rolled BDU sleeve can irritate)New site? (rolled BDU sleeve can irritate)– Ideal for potential POW as we increase Ideal for potential POW as we increase

combat roles for womencombat roles for women IUDIUD

– Easy - Paragard good for 10 yearsEasy - Paragard good for 10 years– PID risk with multiple partners or partner PID risk with multiple partners or partner

with multiple partnerswith multiple partners

Health maintenanceHealth maintenance

Emergency contraceptionEmergency contraception– Must be initiated within 72 hours of Must be initiated within 72 hours of

unprotected intercourseunprotected intercourse– Ovral 2 tabs po q 12h x 2Ovral 2 tabs po q 12h x 2– Lo/Ovral 4 tabs q 12h x 2Lo/Ovral 4 tabs q 12h x 2

Should every female soldier be issued Should every female soldier be issued one cycle of OCPs with instructions?one cycle of OCPs with instructions?

– ACOG. Practice Patterns: Emergency Oral ACOG. Practice Patterns: Emergency Oral Contraception. Number 3, December 1996Contraception. Number 3, December 1996

Health MaintenanceHealth Maintenance Vaginitis - preventionVaginitis - prevention

– choose loose fit in BDUschoose loose fit in BDUs– Change tampons or pads frequentlyChange tampons or pads frequently– Clean with wet wipes if can’t showerClean with wet wipes if can’t shower

Vaginitis - treatmentVaginitis - treatment– Issue 1-2 regimens of OTC antifungal for self-Issue 1-2 regimens of OTC antifungal for self-

treatmenttreatment Gentian violet impregnated tampons??Gentian violet impregnated tampons??

– Send to the rear for evaluation for failed self-Send to the rear for evaluation for failed self-treatmenttreatment


Female urinary diversion devicesFemale urinary diversion devices– Allow urination through the trouser flyAllow urination through the trouser fly– No need to remove clothing or gearNo need to remove clothing or gear– Suitable cover not necessarySuitable cover not necessary

Two devices on the marketTwo devices on the market– Lady JLady J– Freshette Complete SystemFreshette Complete System


Lady JLady J

– Rigid plastic Rigid plastic funnel and spoutfunnel and spout

– Used in standing Used in standing positionposition


FreshetteFreshette– Soft plastic funnel Soft plastic funnel

with attachable with attachable tubetube

– Optional collection Optional collection bagbag

– Used in standing Used in standing positionposition

Lady J and FreshetteLady J and Freshette

Previous problems in field testers Previous problems in field testers (53)(53)– Dehydration - 1Dehydration - 1– UTI - 3UTI - 3– Voluntary urinary retention - 1Voluntary urinary retention - 1

required catheterization due to required catheterization due to overdistentionoverdistention


Prospective crossover clinical trialProspective crossover clinical trial

53 women enrolled53 women enrolled– 35 tested devices35 tested devices– 16 controls16 controls– 10 dropped out10 dropped out– 4 only used one device4 only used one device


TestersTesters– Tested both devices, each for one weekTested both devices, each for one week– Urine culture - 3Urine culture - 3

before, between devices, afterbefore, between devices, after

– Questionnaires after each deviceQuestionnaires after each device ControlsControls

– Urine culture - 2Urine culture - 2 before, and one week laterbefore, and one week later

– Questionnaire on signs and symptomsQuestionnaire on signs and symptoms


Preferred devicePreferred device– Freshette - 63.2%Freshette - 63.2%– Lady J - 0%Lady J - 0%

spout too short to clear BDU flyspout too short to clear BDU fly

– Either - 5.8%Either - 5.8%– Neither - 21%Neither - 21%


ResultsResults– Urinary tract infectionUrinary tract infection

Controls - 1Controls - 1 Field testers - 0Field testers - 0

– Dehydration requiring IV hydrationDehydration requiring IV hydration Controls - 2Controls - 2 Field testers - 0Field testers - 0

Family PlansFamily Plans

Extended family is often not localExtended family is often not local– May require more than 24 hours to May require more than 24 hours to

mobilizemobilize

Must fly dependents to U.S. Must fly dependents to U.S. – if overseas if overseas andand– single AD parent or dual AD couplesingle AD parent or dual AD couple

Family PlanFamily Plan

DoD is set up for DoD is set up for oneone plan per plan per familyfamily

If dual AD couple, need If dual AD couple, need three three plansplans– You goYou go– I goI go– We both goWe both go

Family PlanFamily Plan

Powers of AttorneyPowers of Attorney– change with each exercisechange with each exercise– good for one yeargood for one year

Issue - how to renew Issue - how to renew – If deployed?If deployed?– If a prisoner of war?If a prisoner of war?

women’s issues during deployment carla hawley-bowland col, mc, usa

Documents

health maintenance

ph slide

health risks of deployment

usa slide

patient slide

maintenance of supply

spermicide difficult

desert storm slide