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WOMEN’S ISSUES DURING DEPLOYMENT Carla Hawley-Bowland COL, MC, USA.

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Presentation on theme: "WOMEN’S ISSUES DURING DEPLOYMENT Carla Hawley-Bowland COL, MC, USA."— Presentation transcript:

1 WOMEN’S ISSUES DURING DEPLOYMENT Carla Hawley-Bowland COL, MC, USA

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

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

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

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

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

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

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

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

11 Health Maintenance l 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 l IUD –Easy - Paragard good for 10 years –PID risk with multiple partners or partner with multiple partners

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

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

15 Health Maintenance l Lady J –Rigid plastic funnel and spout –Used in standing position

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

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

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

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

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

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

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

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

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


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