Servicewomen’s experiences of managing their pelvic health

Background: The growing female representation in the Australian Defence Force (ADF) necessitates a focus upon health areas where men and women differ to ensure appropriate prevention strategies and healthcare are provided. Genitourinary health is one of these areas.

Aim: The aim of this investigation was to explore the impacts of genitourinary health issues on ADF women, and their experiences of managing their pelvic health in occupational settings.

Method: The study was part of a mixed methods study which explored the genitourinary health issues experienced by biological servicewomen in the ADF. Semi-structured telephone interviews were conducted in 2020. Six servicewomen and two veterans took part. This presentation focuses on the findings from the interviews with the six currently serving servicewomen. A systematic thematic analysis of the interviews was conducted by identifying and coding responses in each interview transcript that addressed the study aim. Codes were then refined into themes by identifying commonalities and differences in responses across the data set.

Results: Servicewomen reported moderating their fluid consumption and manipulating their menstrual cycle because they worked in contexts where toilet access and privacy were limited. They described occupational contexts where, due to operational requirements, service personnel were expected to work without access to toilets or time for breaks for four or more hours. Some servicewomen discussed how they had little knowledge about maintaining pelvic health when they joined the ADF, and how the predominantly male environment stifled opportunities to identify norms of female pelvic health. A workplace culture where women felt they could not ‘be seen as a girl’, low levels of insight into norms, and limited prevention education and strategies to support management of female pelvic health issues in the ADF contributed to some servicewomen self-managing significant pelvic health conditions prior to seeking treatment. They utilised strategies to self-manage their symptoms in the workplace, including some that may have negatively impacted their health and wellbeing, such as restricting fluid intake and limiting their physical activity levels. Servicewomen reported that the doctors they saw in the ADF were keen to provide access to specialist care. This was beneficial, as it was not until they consulted with medical specialists and physiotherapists that they appreciated the possible impacts of their occupational requirements on their pelvic health, e.g. bladder desensitisation from long hours without access to toilet facilities. The servicewomen were keen to provide practical suggestions to improve experiences of their fellow service personnel in maintaining pelvic health in the ADF, such as introducing questions about pelvic health into health questionnaires and education programs.

Discussion/conclusion: This study suggests workplace culture, low levels of insight into pelvic health norms, and limited prevention and health care strategies within the ADF have contributed to servicewomen self-managing pelvic health issues using approaches that may have had significant impacts upon their health and wellbeing. Servicewomen identified several practical suggestions to highlight and improve managing pelvic health within the evolving culture in the ADF, including increased monitoring and education. Specific education suggestions included developing greater awareness of the impacts of bladder desensitisation which can result from operational demands restricting toilet access for four or more hours. Educating the entire workforce to ensure they take prompt toilet breaks when their bladder is full, when not restricted by operational requirements, may lead to procedural changes that benefit the health and wellbeing of all service personnel.