LANDSTUHL, Germany  –   In 2021, nearly 230,000 women were serving on active duty across the military services. Today’s global threats, radical terrorism, and projected future battlespace have led to a more lethal force requirement.

Historically, creating a more lethal force involved the male warfighter. The need for warfighters to operate in hostile environments, where it is culturally inappropriate for men to engage with women and children, in addition to recent legislation which diversified military occupations and specialties, has opened the door for qualified women to serve in combat - on special, small-mission warfare teams (i.e., Army Cultural Support Team [CST], Marine Female Engagement Team [FET]).

Serving as a female warfighter in any military branch and occupation/specialty necessitates robust training and high deployment tempos. Serving in austere environments presents sex-specific health challenges for female warfighters, which often cannot be addressed promptly for various reasons. These challenges commonly emerge as urogenital health issues.

To combat delayed care, a team of women’s healthcare providers and researchers at Landstuhl Regional Medical Center aim to develop Department of Defense-wide education and training for female warfighters in austere environments and also launch an innovative, self-test / self-diagnose and self-treatment kit to help women detect and treat urogenital infections.

Urogenital health issues include any health problem that affects the urinary and genital tract. It is not deployment which is associated with increased risk—rather, it is the austerity of the environment. Some environmental challenges for the female warfighter include diminishing to no availability of water, sanitation, and hygiene resources. The lack of resources may lead to changes in health, hygiene practices and behaviors. These changes are directly linked to increased risk for urogenital infections. Additionally, these health risks demand privacy and appropriate early detection and intervention which may be difficult to obtain in deployed environments. Other risks involve overcoming the demands of the body by depriving it of basic necessities such as intentionally dehydrating to avoid urination. Further, these deployed females report resorting to urinating in plastic bottles and bags, or wearing disposable briefs. These examples of poor health and hygiene practices and behaviors increase the risk for common urogenital infections such as urinary tract infections, bacterial vaginosis, and vaginal yeast infections.

From 2008 to 2013, these urogenital infections were reported as one of the top five reasons for all medical encounters and one of the top seven reasons for all medical evacuations from deployed locations. Female warfighters have also reported feeling embarrassed to seek healthcare for urogenital symptoms and describe fear and anxiety for being wrongfully accused of engaging in sexual activity or being promiscuous.

The proposed kit is an example of first-line medical care available to our female warfighters. It is anticipated such a Kit, containing diagnostic and other innovative components, would encourage and improve early detection and treatment of common urogenital infections in female warfighters. Early detection and treatment will maintain healthy, mentally prepared, and physically trained female warfighters. The innovative kit would also contain a self-detection rapid test designed to detect yeast infections of the vulva and vagina, a first of its kind in women’s health care.

To date, there is no such Food and Drug Administration-approved rapid test available on the U.S. market. Ongoing, high-visibility, multi-site clinical trials are currently being conducted to seek FDA approval for over-the-counter use. The following Military Treatment Facilities are participating in trials: Landstuhl Regional Medical Center (LRMC); Navy Medicine Readiness & Training Command San Diego (NMRTCSD); Womack Army Medical Center (WAMC); and Navy Medicine Readiness Training Command Portsmouth (NMRTCP).

At LRMC’s Women’s Health Clinic all beneficiaries scheduled for gynecological care meeting the study criteria will be offered the opportunity to participate.