Women faces challenges in a field environment

1. Promoting Women’s Health in
Austere Environments
Portions of this Presentation have been adapted from the USA MEDCOM INITIAL MILITARY TRAINING REPRODUCTIVE HEALTH
EDUCATION PROGRAM

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• Describe the field training/deployed environment
and related feminine hygiene issues
• Discuss methods to promote personal hygiene and
prevent disease
• Illustrate how austere environments can affect
menstrual symptoms and cycles
• Discuss treatments available to assist with
menstrual symptoms
• Demonstrate how to use the articles in the
Feminine Hygiene Toolkit
OBJECTIVES

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THE AUSTERE ENVIRONMENT
• Challenges to staying clean
– Heat, dirt, sand, dust
– Port-a-potties
– Lack of hand washing
capability
– Inadequate shower facilities
– Lack of laundry facilities
– Physical and emotional stress

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EFFECTS OF THE ENVIRONMENT ON YOUR
HEALTH
• Challenges in the environment can lead to
changes in personal hygiene practices
– Holding urine
– Unable to adequately wash or stay clean
– Difficulty tending to feminine hygiene during
cycles
• Can lead to urinary tract infections and vaginal
infections
• Can lead to changes in menstrual patterns

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• How your body works:
– Bladder stores urine, it is
sterile - it does not contain
bacteria.
• Infection is caused by bacteria
entering the urinary tract
– Bacteria lives on the skin near
the rectum or in the vagina
and enters through the
urethra.
• Symptoms
– Pain, burning, urgency,
frequency of urination
• Infections can spread to all parts
of the urinary tract
See a HCP if you have any symptoms. When untreated, UTIs
progress and get worse.
URINARY TRACT INFECTIONS

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PREVENTION OF UTIs
• Practice good personal hygiene
– Wipe from front to back after a bowel
movement or urination
– Wash around and between
the rectum and vagina daily
– Wash and urinate before
and after sex
• Empty the bladder as soon as the
urge to urinate occurs
• Drink plenty of fluids each day

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FEMALE URINARY DEVICES
• Use for bladder relief while
undertaking lengthy outdoor
activities
• Enables females to urinate
through the fly of the uniform
while standing or sitting
• Allows avoidance of
unsanitary restrooms
• Minimizes body exposure in field
• Stock number for the current one used in SW Asia and Europe
is on the USAMMC-SWA TAMMIS, # 4510-01-470-2805
• Other brands/styles available through the internet or at
outdoor/sports supplies stores

8. FEMALE URINARY DEVICES
• To use the FUDD:
 Stand with your back to the wind or facing the toilet.
 Pull the extension tube through the spout until it stops.
 With your feet apart, adjust your clothing so that the top of the cup fits snugly against your
body and the tube is out front of your pants.
 Urinate. To avoid a leak, do not tilt the cup forward while using.
 When finished, use a flick of the wrist to remove remaining droplets, then wipe dry. Slide the
tube back into the cup.
 Rinse, clean and dry when you can. Use the plastic bag to hold the FUDD between uses.
 You may want to practice a few times in the shower to get the hang of it before you need to
use the FUDD in the field.
• To order, use NSN 4510 014702805: Female Urinary Diversion Device
• Commanders can order Health & Comfort Packs:
http://www.dla.mil/TroopSupport/Subsistence/Operational-rations/hcp/
8

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FUDD Video
Link for FUDD Video
http://phc.amedd.army.mil/PHC Resource
Library/FUDD_Video_April2013_WMV480p(16x9).wmv

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• How your body works
– The vagina is normally “acidic” (has a low pH)
– Normal vaginal discharge is clear to cloudy
• Infection can occur when it becomes “basic,” or the pH is raised
– Allows bacteria or yeast to grow
– Most common types of vaginitis
• bacterial vaginosis (BV)
• vulvovaginal candidiasis (Yeast Infection)
• Symptoms
– Vaginal itching, burning, pain, odor, and abnormal discharge
• Some common causes of vaginitis
– Stress, contraceptive use, menstrual blood, and any product that raises
the pH in the vagina such as soaps, douches, scented menstrual
protection products, tampons, and other feminine hygiene products
VAGINITIS

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ABNORMAL VAGINAL DISCHARGES
•A change in amount of discharge
•Cottage cheese-like vaginal discharge
•Foul odor with yellowish,
greenish, or grayish-white
vaginal discharge
•Presence of blood when not
having a menstrual period
•Treatment of vaginal discharge is dependent on
the type of infection which exists.
•See a healthcare provider if you have an
abnormal vaginal discharge.

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PREVENTION OF VAGINITIS
• Avoid the use of perfumed sanitary
products
• Avoid douching
• Daily change of cotton underwear
• Use baby wipes or personal wipes if no
soap and water are available

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THE MENSTRUAL CYCLE
• Hormones create the
menstrual cycle
• Usually 28 days long,
but can vary
• Day 1 is the first day of
your period
• Fertility occurs around
day 14, when ovulation
occurs

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THE MENSTRUAL CYCLE
• Menstrual periods
are the shedding of
the lining of the
uterus in the form of
bleeding.

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PRE-MENSTRUAL SYMPTOMS
• Backache
• Pain in inner thighs
• Bloating
• Nausea
• Diarrhea, constipation
• Headaches
• Breast tenderness
• Cramping
• Irritability, and other mood changes

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THINGS THAT CAN AFFECT YOUR
MENSTRUAL CYCLE
• Hormonal Contraceptives
• Mental or Emotional Stress
– Life events, acute stress, job stress, combat exposure
– Depression
– Sexual assault
– PTSD
• Physical Stress
– Extremes in diet and exercise
– Physical trauma
• Medical Condition

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CHANGES IN MENSTRUAL PATTERNS
• Irregular bleeding, spotting, heavy flow, cramping,
clots, skipping a period
“…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.”
• Hormonal contraceptives, like the pill or Depo-
Provera, can help avoid some of these symptoms
• Discuss with your health care provider prior to field
training or deployment

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DYSFUNCTIONAL UTERINE BLEEDING
(DUB)
• Heavy or irregular menstrual bleeding
– The menstrual cycle is shorter than 21 days
– Or is farther apart than 35 days
– Or your period lasts longer than 7 days.
• See a doctor if there is heavy or frequent
bleeding for three or more menstrual cycles

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“We can’t really say,
‘Oh, I’m on my period, I need a day off,’
- no.
You got to suck it up, and drive on.”
What female soldiers have said…

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TREATMENT & PREVENTION
• Non-steroidal anti-inflammatory drugs, such
as Motrin (Ibuprofen)
• Birth Control Pills
– Traditional use
– Continuous or Extended Use

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TRADITIONAL BIRTH CONTROL PILLS
• Pros
– Shorter and lighter menstrual periods
– Reduces menstrual cramps
– Regulates periods
– Can improve acne
– 97% effective if taken as directed to
prevent pregnancy
• Cons
– May cause nausea, breast tenderness,
spotting
– You may be ineligible for pills if you have
certain medical conditions or you are a
smoker

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CONTINUOUS BIRTH
CONTROL PILLS
• Pros
– Used for cycle control
– Can decrease painful periods, excessive bleeding, premenstrual
syndrome, and menstrual-related migraine headaches.
– May cause cessation of menstrual periods
• Cons
– Spotting, unpredictable bleeding
– May take 3 months for reduced bleeding
to occur
– Side effects may occur
• heavy bleeding, nausea, vomiting, bloating, mood changes, headaches
– May be difficult to tell if you are pregnant
For More Information:
www.arhp.org/Publications-and-Resources/Clinical-Proceedings/Reduce-
Menses/Counseling

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THE SHOT - DEPO PROVERA®
• Pros
– One injection every 12 weeks prevents pregnancy
– 97% effective
– Absence of period in most women
• Cons
– Irregular bleeding for the first 2-3 injection
periods
– Can cause blood clots
– Can cause bone loss
– Mood swings
– Weight gain
– You may be ineligible for the shot if you have certain medical
conditions
For More Information: www.depoprovera.com

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Hormonal IUD –
The Mirena®/Skyla®
• Pros
– 99.9% effective
– Lighter, shorter periods after 3-6 moths
– 20% stop periods by 1 year
– May stay in place for up to 5 years
– Decreased risk of a tubal pregnancy
• Cons
– Side effects
• irregular bleeding or spotting for the first 3-6 months
• Risk for cyst on ovaries
– Exposure to sexually transmitted infections can cause a pelvic infection
For More Information:
www.mirena-usa.com
www.skyla-us.com

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THE PATCH – ORTHO EVRA
• Pros
– Works the same as pills except the hormones are absorbed through the
skin
– 92% effective
– Only replace once a week
– Can place on waist, hip, buttocks or shoulder
• Cons
– Some women get a skin irritation
– Nausea, breast discomfort, headaches
– Should change on the same day every week
– Patches can fall off in extreme heat/sweat
– Only available in beige color
– Storage at room temperature (77F)
– You may be ineligible for the patch if you have certain medical conditions
or you are a smoker
For More Information: www.orthoevra.com/orthoevra/faq.html

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THE RING - NuvaRing
• Pros
– Flexible ring is inserted in the vagina and left in place for 3
weeks out of the month
– Only needs to be replaced once a month
– Ring releases hormones like the pill
– Is 92% effective
• Cons
– Side effects similar to the pill
– May cause increased vaginal discharge or
irritation, vaginitis
– Requires cool storage temperature
– You may be ineligible for the ring if you have
certain medical conditions or you are a smoker
For More Information:
www.nuvaring.com

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IMPLANON/NEXPLANON
• Pros
– Highly Effective
– Decreased Cramping
– Some women experience less bleeding
– 20% have no period after a year
• Cons
– Bleeding may be heavy and last many
days in a row
– Weight gain
– You may be ineligible for Implanon if
you have certain medical conditions
For More Information:
http://www.implanon-usa.com
www.nexplanon.com

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MENSTRUAL HYGIENE PRACTICES
• Wash hands before and after
changing sanitary products
• Change sanitary products frequently
• Choose type of sanitary products
suited for environment
• Plan for disposal of used products
• Be prepared: Always carry supplies

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The Feminine Hygiene Toolkit
• The Just in Case Baggie
– Assorted panty liners, sanitary pads,
tampons
– One time use baby wipe packet
• The Keep it Clean Baggie
– Baby wipes
– Hand sanitizer
– Ziplocs
– Female urinary collection device

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TAKING CARE OF YOURSELF DURING FIELD
TRAINING AND WHILE DEPLOYED
• Practice good self-care
– Prevents infections
– Reduces menstrual problems
• If you have any of the following symptoms, 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

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RESOURCES
•US Army Public Health Command Women's Health Portal
http://phc.amedd.army.mil/topics/healthyliving/wh/Pages/default.asp
x
•Association of Reproductive Health Professionals. (2008.) Health
Matters Fact Sheets: Understanding Menstrual Suppression
http://www.arhp.org/uploadDocs/understandingmenstrualsuppressio
n.pdf
•FM 4-25.10, Field Sanitation Team and Preventive Medicine Measures

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REFERENCES
• Contraceptive Technology, 17th Revised Edition, Hatcher, R., Trussel, J. et
al, Ardent Media. 1998
•Handbook of Women’s Sexual Health and Reproductive Health, Wingood,
G. & DiClemente, R.,2002, Kluver Academic /Plenum Publishers
•Hooah4Health website, www.Hooah4Health.com
•National Kidney and Urologic Diseases Information Clearinghouse
http://National Women’s Health Information Center, US Dept of Health and
Human Services
http://womenshealth.gov/faq/Easyread/uti-etr.htm
•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.