My Women's Health clinical assignment was at the Fort Hood, Killeen, TX Women's Health Clinic. Right now there are 2 upcoming deployment iterations preparing to head to Iraq (in September) and to Afghanistan (in December). I had the opportunity to provide care for many of the females going through their SRP's (Soldier Readiness Processing). Most of the females we saw were junior enlisted (E-1 to E-4) and very young (18-24 yrs old). Some of these females needed "SRP PAPs", or "SRP PAP F/U Colpos", or "SRP Birth/Menses Control", or, quite a few for "pre-deployment FTX vaginitis", in a very short period of time left before deployment, in order that they be medically cleared and qualified for mission accomplishment.
After having received our MCM/Bushmaster training (as well as our OB-Gyn classes), understanding how women manage in combat environments is important, both from the perspective of correcting inappropriate and perhaps dangerous practices, and from the perspective of using corrected practices to prevent infections and other potential illnesses. I believe we Providers have a responsibility to educate our female patients as well as make sure that the mostly-male units which these females belonged to here in "Cav Country" (and in other deploying units) understand the need to provide educational training programs about feminine hygiene issues to those commanders and supervisors who operate in field environments.
We were already treating many females for chemical vaginitis caused by the use/overuse of new "feminine hygiene products", such as sprays and douches, soaps and powders which caused irritation of the perineal and vulvar skin-all to "keep me from smelling like a man" they would say. Others suffered from BV and Candida-often from wearing the same sweaty underwear for more than one day, wearing spandex, not wearing cotton breathable underwear, wearing tight fitting uniforms, not cleaning the perineal area appropriately, and not washing/cleaning hands before and after urinating/defecating/changing menstrual pads or tampons. Some issues were pt education related, others were related to deficiencies in unit sanitation measures.
Although resources are available (see A Guide to Female Soldier Readiness for 1 example), including
many Health Care Providers in the medical community to assist leaders in maintaining unit readiness, the females we were seeing in the clinic had NO idea of the Do's and Dont's of "field female survival". Preservation of the force is our goal, and opportunity to reach service members at the unit level, with support from the leadership, is a golden one that needed attention here. Deployed military women have an increased risk for development of vaginitis due to extreme temperatures, primitive sanitation, hygiene and laundry facilities, and unavailable or unacceptable healthcare resources
Prior to unit deployment on an extended field exercise or to a contingency operation, a training session could/should be coordinated for unit females by the Community Health Nurse, Public Health, a representative of the Dept. of OB/GYN, or other experienced health care professionals. They can educate personnel about how to prepare themselves for the field, and how to maintain their health during deployment. They can also expertly answer questions and hold discussions-to decrease the "barracks grapevine" from serving as the "be all/know all" when it comes to Women's Health issues.
Some suggested topics for predeployment briefings are: 1) birth control and sexually transmitted infections (STIs); 2) female hygiene in field settings, to include advice on how to avoid UTIs and yeast infections; 3) female-specific health care services available in theater and ways to obtain these services; 4) guidance on packing sufficient female hygiene products and medications; 5) tips on staying healthy; 6) guidance on nutrition and dietary supplements; 7) sexual assault awareness information and/or training.
According to the comments of the female patients we were seeing, there was little to no information provided to them in their mostly-male units, pertaining to "female field hygiene", thus they were left on their own to maintain their health and readiness in austere environments. We can and must do better than this.
