A Women’s Health Intervention
for Gynecological Problems in
the Deployed Environment
the

Deployed

Environment
Presenter:
LTC Nancy Steele PhD WHNP
Presenter:

LTC

Nancy

Steele
,
PhD
,
WHNP
European Regional Medical Command
PI
LTC L i T PhD CNM
PI
:
LTC

L
or
i

h
e aut
h
ors, an
d

d
o not re
fl
ect o
ffi
c
i
a
l
po
li
c
i
es or pos
i
t
i
ons o
f
t
h
e
D
ept o

current

research

study
• Discuss recent findings for ongoing study
Di i li ti f th t d
•
Di
scuss
i
mp
li
ca
ti
ons o
f

th
e s
t
u
dy
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 2
Women in the Military
BACKGROUND
• OIF/OEF deployed female
Soldiers have nearly twice
Soldiers

Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 3
Women in the Military
Deployed Environment Challenges
• Terrain: desert, barren
regions, dirty
regions,

dirty
• Climate: hot, dry, dusty
•
Compromised feminine
Compromised

feminine

hygiene practices
•
Difficult travel
Difficult

travel

• Lack of facilities (latrines)
to
p
erform h
yg
iene
pyg

l
ean por
t
-a-
p
o
tti
es,
t
ra
il
ers,
l
a
t
r
i
nes, or san
d/
mu
d

terrain

Safety issues (combat operations)

Safety

issues


p
revention of
GU

p
roblems
gp GUp
in deployed female Soldiers, yet the problem persists
• Militar
y

p
re-de
p
lo
y
ment
p
olicies do not endorse a
yp
py p
program to help female Soldiers recognize the impact of
the deployed environment on feminine health and
hygiene
• Preventive measures to avoid vaginal infections, urinary
if i (UTI) d l
tract
i
n
f

 To increase knowledge level about feminine hygiene in the
deployed environment
deployed

environment
 To determine the effectiveness of an intervention to
decrease:
• Vaginal & urinary tract symptoms
• Menstrual complaints
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 8
Women in the Military
Study Sample
• Two groups of U.S. Army Active Duty female
soldiers who will deploy to Iraq
soldiers

who

will

deploy

to

Iraq
.
– Intervention Group: Schofield Barracks, HI
•
Intervention includes 60 min pre

care, and prevention of UTI,
vaginitis & menstrual
vaginitis
,
&

menstrual

symptoms
• Feminine Hygiene Deployment
Toolkit: “Just in Case” baggie,
“Keep it Clean” baggie, and the
Freshette
Freshette

• 30 min hands-on with toolkit,
models, & various types of
menstrual cycle control
methods.
•
Q&A with NP
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 10
Q&A

with

NP
Women in the Military
FUD Description

terrain, &
unsafe conditions
•
Reusable light (1 oz) compact (5”x 3”x
•
Reusable
,
light

(1

oz)
,
compact

(5”x

3”x

1”,) & reusable
•
Transport pouch fits into cargo pocket
Freshette FUD
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 11
Transport

pouch

fits

2
Time 2:
>
Six months after movement into deployed
2
.
Time

2:

>
Six

months

after

movement

into

deployed

setting
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 12
Women in the Military
Current Findings: Intervention Group
Time 1: Pre-deployment: n=104
Time 2:

traditional use
,
11
%
continuous use
)
p(% ,% )
– Mirena IUD (17%)
•
M
enstrual S
y
m
p
toms:
yp
– Irregular periods (39%)
– Painful cramps (66%), PMS (66%) & heavy bleeding/clots
(45%)
• Vaginal Symptoms:
i l di h (59%) d (28%) i hi (24%)
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 13
–
vag
i
na
l

di

symptoms:

– Urgency (38%)
Frequency (38%)
–
Frequency

(38%)
– Pain/burning with urination (10%)
• UTI incidence was 3/31 (10%)
• F
U
D Fr
es
h
e
tt
e

use:
Ueseeuse:
– 8/13 used FUD
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 14
Women in the Military
Implications for Nursing
• Findings can be incorporated into routine pre-
de
p
lo

a

decade ago
Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000
Slide 15
Women in the Military
References
• Bond, E. F (2004). Women’s physical and mental sequellae of wartime service . Nursing Clinics of
North America, 39, 53-68.
• Christopher LA, Miller L. Women in war: operational issues of menstruation and unintended
pregnancy. Mil Med. 2007 Jan;172(1):9-16.
•
Cox K L (2007 August) Gender & Health in the Military: Facts and Myths Paper presented at
Cox
,
K
.
L
.
(2007
,
August)
.
Gender

&

Health

in

166
(2)
,
152
-
158
.
• DWHRP Research Publications List. Retrieved April 9, 2008, from
http/:www.mmorg.publications/DWHRP /PUB/LIST./DWHRP_PUB_LIST.pdf
.
• Edelman AB, Gallo MF, Jensen JT, Nichols MD, Schulz KF, Grimes DA. Continuous or extended
cycle versus cyclic use of combined oral contraceptives for contraception. Cochrane Database of
Systematic Reviews.
• Friedl, K. E. (2005). Biomedical research on health and performance of military women:
Accom
p
lishments of the Defense Women's Health Research Pro
g
ram
(
DWHRP
)
.
J
ournal o
f

pg()
f
Women’s Health, 14(9), 764-802.

hospital

during

Operation Desert Storm. Mil Med. 1992 May;157(5):222-4.
 Hannoun AB, Nassar AH, Usta IM, Zreik TG, Abu Musa AA. Effect of war on the menstrual cycle.
Obstet Gynecol. 2007 Apr;109(4):929-32.
IOM (1996)
HlhC fS i Di hP i GlfW R di f

IOM
.
(1996)
.
H
ea
l
t
h

C
onsequences o
f

S
erv
i
ce
D
ur

(6), 333
-
343
.
deployment.

Womens

Health

Issues,

10
(6),

333
343
.
 USACHPPM. A Guide to Female Soldier Readiness. Aberdeen Proving Grounds 2006.
 Trego, L. L. (2007). Military women's menstrual experiences and interest in menstrual suppression
during deployment. J Obstet Gynecol Neonatal Nurs, 36(4), 342-347.
 Thomson, B. A., & Nielsen, P. E. (2006). Women's health care in Operation Iraqi Freedom: a survey
of camps with echelon I or II facilities. Military Medicine, 171(3), 216-219.
 Wardell, D. W., & Czerwinski, B. (2001). A military challenge to managing feminine and personal
h
yg
iene.
J
Am Acad Nurse Pract, 13
(