Prevalence of pelvic health conditions in Australian servicewomen and veterans

Background: Pelvic health care and support needs vary between sexes given differences in pelvic anatomy and function. Genitourinary infections and urinary incontinence have each been reported to affect up to one third of United States servicewomen. However, other pelvic health conditions, such as pelvic organ prolapse (POP) or the co-existence of pelvic health conditions, have received minimal attention. No pelvic health data exists for Australian Defence Force (ADF) servicewomen. Aim: The aims of this investigation were to determine the types, prevalence, severity, and onset of pelvic health issues experienced by ADF servicewomen and veterans. Method: An online, anonymous cross-sectional survey was developed for biologically female adults who had actively served in the ADF for at least six months. Data were collected October – December 2019 and February - June 2020. Results: In total, 575 active servicewomen (60%) and veterans (40%) participated in the survey (50% Army, 26% Air Force, and 24% Navy). The majority (88%) served in a full time capacity during their ADF service (length of service range: 6 months to >25 years). Over two thirds reported concerns about their pelvic health, and of those 85% reported that their concerns began during service. Frequent episodes of urinary urgency were reported by 29% of women, and almost two thirds experienced urinary incontinence. However, of those experiencing leakage, most (70%) reported it occurred once per week or less. Almost half the respondents had experienced a urinary tract infection, with the majority of these occurring for the first time during ADF service. Frequent episodes of flatal (9.7%) and faecal (2.2%) incontinence were less commonly experienced by servicewomen. Symptoms of POP were reported by 40% of women, but only 15% had an actual diagnosis. Regular episodes of pelvic pain during service were reported by one quarter of women, and over 20% of all respondents had a diagnosis of endometriosis. Injuries to the pelvis had occurred in 15% of women, and of those over 80% had been during and related to their work in the ADF. Pain associated with menstrual cycles occurred about half the time, and was rated as moderate. Over 70% of women participating in the survey had been pregnant, and approximately 40% reported that pregnancy, birth or complications associated with it did impact on their return to work. Over one third of women had undergone gynaecological surgery whilst serving in the ADF, and 20% had experienced delays in returning to work due to the surgery or its complications. A range of other pelvic symptoms, such as vulvovaginal irritation, sexual issues, nocturia, and incomplete bladder emptying were also reported. Discussion: A range of pelvic health issues were reported by female military personnel, most commonly mild to moderate urinary incontinence, and urinary tract infections. Prevalence rates for urinary incontinence were higher than for the general population but similar to female athletes. Despite the majority of women reporting their symptoms developed during their time in the ADF, these findings need to be interpreted with caution as risk factors unrelated to service, such as pregnancy and aging, may be contributing factors. Further analysis of the data is required in order to explore risk factors, and variations that may exist between Services as well as between active servicewomen and veterans. Conclusion: This is the first study to examine the pelvic health of Australian female military personnel and veterans. Similar to the general female population, pelvic floor dysfunction is common. Further understanding of the pelvic health needs of servicewomen, risk factors, and impacts on occupational performance are required to optimise prevention and management interventions.