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 T rego, PhD , CNM AIs: COL Denise Hopkins-Chadwick, PhD, RN, Dr. Lori Loan, PhD, RNC, Dr. Maureen Shannon PhD, CNM, FNP Funded Grant: Sigma Theta Tau International Council for Advancement Nursing Science Vi d i hi i h f h h d d fl ffi i l li i i i f h D f hA Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 1 Vi ews expresse d i n t hi s presentat i on are t h ose o f t 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 f t h e A rm y , Dept of Defense or U.S. Government Women in the Military OBJECTIVES • Describe back g round, relevance, & p ur p ose gpp for genitourinary (GU) health research in de p lo y ed female soldiers py • Provide research questions and specific aims of current research study of 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 have nearly twice as many GU health p roblems as those at home p duty stations • Many female Soldiers are Many female Soldiers are not prepared for GU health & h yg iene challen g es yg g during deployment 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 activities Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 4 Women in the Military Deployed Environment Challenges cont…  Duties limit breaks (i.e., patrols, security) ii i“khif ”(i  Ur i nat i ng may requ i re “ ma k e s hif t measures ” (i .e., bottles, cans, plastic bags, layered pads, etc) Ul t tti t il l t i d/ d  U nc 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 (combat operations)  Shared environment (female/male) Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 5 Women in the Military Female GU problems in Deployed Environment Environment 1. Urination: increased rate of UTIs & symptoms (pain, urgency, frequency) urgency, frequency) • Holding urine • Poor feminine hygiene • Use of “make shift measures” to urinate • Dehydration (not drinking fluids to prevent urination) 2. Vaginal symptoms: Itching, burning, pain, & discharge 3. Menstrual complaints: Pain, heavy bleeding, missed or irregular periods, PMS Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 6 Women in the Military Relevance of Problem • Since Operation Desert Storm, women’s health experts have recommended tar g eted 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 ect i ons, (UTI s ) an d menstrua l symptoms are not routinely taught to women as part of the Soldier Readiness Process Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 7 Readiness Process . Women in the Military R esearch Q uestion Q • Does providing women with information on feminine hygiene and menstrual self-care practices lead to a decrease in genitourinary complaints during deployment? • Specific Aims  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 - deployment education Intervention includes 60 min pre - deployment education class, feminine hygiene tool kit, & Female Urinary Diverter (FUD) – Non-equivalent Control Group: Fort Hood, TX • Control group receives routine Soldier Readiness Processing (SRP) care (SRP) care Operational Obstetrics & Gynecology · Bureau of Medicine and Surgery · 2000 Slide 9 Women in the Military Pre-deployment Intervention • 30 min class on feminine self- 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 [...]... to avoid vaginitis, UTIs, and menstrual symptoms during deployment This study has potential of significantly contributing to improving female Soldiers’ readiness and filling a gap in military health care identified by experts over a decade ago Women in Bureau of Medicine Operational Obstetrics & Gynecology · the Military and Surgery · 2000 Slide 15 References • Bond, E F (2004) Women’s physical and... disorders and firsttrimester complications among active-duty women Womens Health Issues, 6(6), 353-355 Women in Bureau of Medicine Operational Obstetrics & Gynecology · the Military and Surgery · 2000 Slide 16 References  Hanna JH An analysis of gynecological problems presenting to an evacuation hospital during JH Operation Desert Storm Mil Med 1992 May;157(5):222-4  Hannoun AB, Nassar AH, Usta IM, Zreik... FUD Women in Bureau of Medicine Operational Obstetrics & Gynecology · the Military and Surgery · 2000 Slide 11 Measurements: 1 2 3 4 Women’s Feminine Health Assessment Questionnaire p y Q Deployed Menstrual Health Practices Questionnaire Brief Knowledge Survey y Military Women's’ Attitudes towards Menstrual Suppression Scale Data Collection Times: 1 Time 1: Baseline data collected prior to intervention. .. 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) Myths the 10th Annual Force Health Protection Conference,... (38%) – Pain/burning with urination (10%) • UTI incidence was 3/31 (10%) • FUD Freshette use: U es e e – 8/13 used FUD Women in Bureau of Medicine Operational Obstetrics & Gynecology · the Military and Surgery · 2000 Slide 14 Implications for Nursing • • • Findings can be incorporated into routine predeployment care for female Soldiers to promote well p y p being and health Preventive measures can be... 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: Accomplishments of the Defense Women's Health Research Program ( p g (DWHRP) Journal of ) f Women’s Health, 14(9), 764-802 • Hawley-Bowland, C (1996) Epidemiologic... 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... Description • Easy to use anatomically designed female contoured plastic funnel (6” retractable tube directs flow) t b di t fl ) • Permits urination through opening with no removal of clothing or gear • • Privacy: No need for cover Avoids unsanitary latrines, dirty terrain, & unsafe conditions • Reusable, Reusable light (1 oz), compact (5”x 3”x oz) 1”,) & reusable • Transport pouch fits into cargo pocket... TG, Abu Musa AA Effect of war on the menstrual cycle Obstet Gynecol 2007 Apr;109(4):929-32  IOM (1996) H l h Consequences of Service During the Persian Gulf War: Recommendations for IOM (1996) Health C fS i D i h P i G lf W R d i f Research and Information Systems from http;//books.nap.edu/books/0309055369/html/index.html  Lowe, N K., & Ryan-Wenger, N A (2003) Military women's risk factors for and... p ( % % ) – Mirena IUD (17%) • Menstrual Symptoms: y p – Irregular periods (39%) – Painful cramps (66%), PMS (66%) & heavy bleeding/clots (45%) • Vaginal Symptoms: – vaginal discharge (59%), odor (28%), itching (24%) i l di h (59%) d (28%) i hi Women in Bureau of Medicine Operational Obstetrics & Gynecology · the Military and Surgery · 2000 Slide 13 Current Findings cont… cont • Most common UTI symptoms: . 16 Women in the Military References  Hanna JH An analysis of gynecological problems presenting to an evacuation hospital during Hanna JH . An analysis . 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