SIGNIFICANCE OF THE PROBLEM: In the civilian environment, vulvovaginal pain, itching, burning, and vaginal discharge are the most common symptoms reported by women, resulting in 3.35 million office visits per year. Lower urinary tract infections (UTI) account for another 7 million office visits. If left untreated, symptoms from vaginitis and cystitis can significantly interfere with women’s quality of life, comfort, and concentration, and may have long-term negative effects on gynecologic and urologic health. Approximately 347,000 women serve in over 95% of all occupational areas of the Army, Navy, Air Force and Marines and regularly deploy with their units to austere military environments. Austere military environments are often characterized by extreme temperatures, primitive sanitary conditions, and limited hygiene and laundry facilities. It is proposed that the unique environment of deployment increases military women’s risk for development of genitourinary conditions such as vaginitis and UTI. Research has shown that military women report inadequate management of these common conditions due to unavailable or unacceptable health care resources for women. PURPOSE/AIMS: The purpose of this study was to describe the frequency with which military women experience behavioral and situational risk factors for and symptoms of GU infections when deployed to austere environments, and to identify risk factors that are unique to deployment. No empirical research has examined the relationships among these variables. DESIGN: A survey method was used for this descriptive study based on the pathophysiology of GU infections and epidemiologic principles. POPULATION/SAMPLE/SETTING/YEARS: The target population was active duty and reserve military women who had been deployed within the past 5 years in support of a military operation. The sample consisted of 841 women from a random selection of 88 different units in the Army (n=583, 69.3%), Navy (n=233, 27.7%), and Air Force (n=25, 3.0%) from January 1997 through December 1999. VARIABLES: GU infection risk factors and symptoms, austere military environments. METHOD: Content validity of the investigator-developed survey was supported by generation of items from literature on common GU infections and austere military environments, and by expert review. Surveys were sent to a random sample of military units. The surveys were completed and returned anonymously to the investigators. Frequencies, percentages, chi-square and logistic regression were used in the analysis. FINDINGS: Vaginal infections during deployment were reported by 253 women (30.1%) and UTIs by 155 women (18.4%). The most common GU symptoms included vaginal itching, heavier than usual vaginal discharge, thick white or thin grayish vaginal discharge, urinary frequency, urgency and pain during urination. Behavioral risk factors that distinguished women who reported having a GU infection from women who did not have an infection included holding urine, avoiding liquids, use of tampons, taking antibiotics, taking birth control pills, having sexual intercourse, wearing nylon/latex undergarments, using feminine hygiene sprays, and douching. Situational risk factors that distinguished the two groups included: no laundry facilities, limited or no hand washing facilities, increased stress, and not enough sleep. CONCLUSIONS/RECOMMENDATIONS: Nearly 1/3rd of women experienced vaginal infections and 1/5th experienced UTI during deployment, which is a higher prevalence than would be expected in a similar sample of women stateside. Some behavioral and all situational risk factors that distinguished women with and without GU infections were unique to the austere environment of deployment. Some of these risk factors can be changed to decrease the likelihood of developing GU infections. The most common GU symptoms were associated with candida vaginitis, bacterial vaginosis, and UTI. IMPLICATIONS: Nursing interventions could include pre-deployment briefings (educational sessions) on factors that increase women’s risk for GU infections, and behaviors to decrease that risk, revision of booklets that advise service members and unit leaders about hygiene in the field, and development of self-care kits for women to take with them on deployment to prevent GU infections, self-diagnose and self-treat these common, but distressing infections.
This project was funded by the TriService Nursing Research Program, Grant #96-N0029.
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