Pelvic health of Australian female military personnel: An exploration of key issues and association with occupational performance

Background: Women are increasingly assuming non-traditional, more physically-demanding and diverse roles within military forces. A larger female workforce necessitates comprehensive consideration of the unique health requirements for women working in a wide range of military contexts. Pelvic health is a key area where the care and support needs between sexes vary because of differences in genitourinary anatomy and function.

Pelvic health issues, such as pelvic floor dysfunction (i.e. incontinence, pelvic organ prolapse), affect approximately one third of Australian women compared with less than 5% of men1. Identified risk factors for pelvic floor dysfunction include childbearing, constipation, increasing age, joint laxity, high load carriage, and high impact physical activity2,3. The unique physical work requirements of many military roles mean that personnel undertake high levels of physical training and load carriage. For servicewomen this may place them at an even higher risk of pelvic floor dysfunction than women in non-military contexts, particularly during childbearing years and beyond. Similarly, other genitourinary conditions, such as urinary tract infections, are a more significant health issue for female military personnel, and can impact on their occupational health and performance4

Therefore, understanding the types and prevalence of pelvic health issues, as well as associated risk factors and impacts on occupational health, safety and performance, is essential to planning strategies that will support the ongoing success of female military personnel.

Aim: This presentation will explore what is currently known about the pelvic health of women working in military contexts, examine the specific risk factors for female pelvic health conditions, and consider the relationships between pelvic health and occupational health, safety and performance.

Method: Published studies of relevance to the aim were identified through searches of journal databases and consultation with experts in the field. Findings of relevance were extracted and synthesised to provide an overview of current knowledge on the topic.

Results/Discussion: Whilst reproductive health issues for female military personnel have been increasingly researched in recent years5, very few studies have investigated other aspects of female pelvic health. Genitourinary symptoms such as urinary tract infections are quite common, with reports that 30.4% of women in the US Armed Forces experience them compared with only 3.5% of men. Similarly, in a US military survey, 26% of female soldiers reported experiencing urinary incontinence during physical activity. In addition, one third of those who reported urinary incontinence also reported that they needed to modify or stop the aggravating activity, demonstrating that occupational performance is affected6. Of concern is that the most common strategies used to manage urinary incontinence - restricting fluid intake or postponing voiding - may lead to more serious health issues such as heat illness8.9.

Differences in genitourinary anatomy, poor sanitation conditions and more challenging toileting practices, particularly during field exercises or deployment, are likely to increase the risk of urinary symptoms and infections in servicewomen9. Female military personnel have also been reported to be less likely to seek medical attention for genitourinary symptoms because of limited women-specific health services and female medical staff, embarrassment and poor confidentiality10

Further research is required to more broadly investigate female pelvic health in military contexts, including the types, severity, prevalence and their coexistence in this population, the strategies used to manage these conditions in military contexts, and the impacts of female pelvic health conditions on occupational performance.

These findings provided background for the development of a survey on pelvic health for women in the Australian Defence Force. Preliminary findings from this survey will be discussed, if available, alongside the findings from published studies