Pelvic Health and Military Occupations: A study of Australian servicewomen and veterans

Background: Pelvic health issues, such as urinary incontinence (UI) and urinary tract infections (UTI), are significantly more common in female than male military personnel. Of concern is that some of the identified strategies used by servicewomen to manage their pelvic health, particularly in the field and when deployed, may be associated with negative health consequences. In addition, a range of environmental, equipment, and cultural factors have been reported to challenge the ability of servicewomen to manage their pelvic health at work.
Aim: The aims of this investigation were to explore the relationships between female pelvic health and military occupations, and ascertain how women maintain and manage their pelvic health in military occupational settings.
Method: A mixed methods study, including an anonymous online survey followed by a series of individual interviews, was conducted in adult biological females who had actively served in the Australian Defence Force (ADF) for at least six months.
Results: A total of 575 active servicewomen (60%) and veterans (40%) participated in the survey (50% Army, 26% Air Force, and 24% Navy), and seven women consented to an interview. Pelvic health was reported to have a mild to moderate impact on work performance. Key areas where pelvic health influenced work performance to a small degree or more were physical training, maintaining work focus, working without needing breaks, adhering to routines, and carrying loads/equipment. Slightly more women reported a negative impact of military tasks and roles on their pelvic health. However, it is notable that some women did report a positive impact. Physical training, lifting/carrying, field activities and managing personal equipment were work tasks most often linked to pelvic health symptoms.
Strategies to maintain and manage pelvic health at work commonly included manipulating menstrual cycles, regular medical check-ups, maintaining hydration and hygiene, diet and weight management, and pelvic floor exercises. Fluid restriction and pad use were common strategies used to manage symptoms of UI. Fluid restriction was also used to minimise the need to void, particularly when toilet access or ability to take work breaks was limited. Surgery, pelvic floor exercises and pelvic floor physiotherapy were the most common management interventions for pelvic organ prolapse; whereas antibiotics, increased hydration, and urinary alkalinizers featured in the management of UTI.
Whilst a proportion of women reported their ADF career had no perceived impact on their fertility, some expressed concerns about chemical and radiation exposures, prolonged contraceptive use, and high levels of physical and emotional stress. Delays in starting a family were common due to long periods away from partners; lack of long-term relationship opportunities; the logistics of timing pregnancy around work; and perceptions that starting a family would negatively impact career prospects and promotion.
Discussion: Preliminary analysis suggests a bi-directional relationship between pelvic health and military occupations. Physical training, lifting and load carrying tasks were commonly reported to influence, or be affected by, pelvic health. A range of strategies are utilised by female military personnel to maintain and manage their pelvic health at work, and these strategies vary depending of the work context and nature of issues.
Conclusion: This is the first study to explore the relationships between female pelvic health and military occupations in the ADF. Further analysis of survey and interview data is required to gain greater understanding of the factors influencing these relationships, and identify the types of prevention and management supports that would benefit women serving in the ADF.