Iʼm a woman, and I serve in the army. Whatʼs better to take to the trenches: tampons or pads? And when there is no water? Wonʼt the bulletproof vest hurt my breasts? The obstetrician-gynecologist explains

Nearly 37 thousand women defend Ukraine in the Armed Forces. A thousand of them are in command. Along with the nuances of military life, women also face specific problems — lack of running water, access to hygiene products, pain during menstruation. Babel spoke with gynecologist Victoria Bugro about whether menʼs boxers are suitable for women in the army, which is better — a tampon, a pad, or a menstrual cup, and which medications have to be kept in a first aid kit.

Iʼm sitting in a trench, Iʼm having a period, and there are problems with running water. What is the best to take care of myself?

If there is no water, you can use wet wipes, no matter which ones — for children, with fragrance, or with alcohol. Hygiene is necessary, it is important to clean the external genitalia from secretions and do it in the right direction, namely from the pubis to the anus and not vice versa, so as not to bring intestinal flora into the vulva.

Tampon or pad? What is better for combat outings?

It is better not to use tampons. They need to be changed every 4-8 hours, but these are normal conditions. In summer, in the heat and due to dehydration, the risk of bacterial infection increases. So it is better to change the tampon as often as possible. In war circumstances, this can be difficult, and a tampon left in the body for a long time can lead to complications. The worst of them is the syndrome of infectious-toxic shock. This condition is life-threatening and is accompanied by a drop in blood pressure, fainting. In milder cases, inflammatory diseases of the pelvic organs can occur, because blood is a very powerful nutrient substrate for microorganisms.

So it is preferable to use menstrual pads. However, access to the pads from the pharmacy or store wonʼt always be there on the frontline. In this case, any piece of fabric that absorbs moisture will do. They can be changed as needed. If possible, you can wash and dry the fabric, and in conditions donʼt allow this — discard or burn it. If you are very concerned about the state of the ecosystem, you can burn it in a Russian tank. In any case, a woman should take care of personal hygiene during menstruation and not think that it could somehow affect her image during the combat mission.

In peacetime, menstrual cups, reusable pads, and special menstrual panties were very popular. But in the field, it can be difficult to get them and take proper care of them. For example, itʼs inconvenient to use a cup: its contents should be poured out regularly, the cup itself should be washed and disinfected. If after the battle you will be able to wash your clothes properly, you can wear multiple menstrual panties. After use, they can be folded into a bag with a clasp and hidden in a convenient place for washing.

There is an open reservoir near us. Should I go to wash myself there or is it better to use wet wipes?

You can wash in the lake or a river. But in no case can you pee in the water, as this can lead to an ascending urinary tract infection.

In the first days of menstruation I have severe pain, and I have to carry a weapon and sit in the trenches. How to help myself?

The first aid kit should contain non-steroidal anti-inflammatory drugs, such as Nimesil or Ibuprofen. They effectively relieve intense pain. If you know that you have painful menstruation, and you have not yet got to the forefront, but plan to go there, you should consult a gynecologist. The doctor may prescribe combined oral contraceptives (COCs). They not just prevent pregnancy, but can also relieve pain.

Generally, women who suffer from painful menstruation, while taking COCs have no discomfort at all, or it is minimal. As a result of taking hormonal contraceptives, the amount of secretions is also significantly reduced. Bonus: if you take COCs continuously, there may be no bleeding at all. This refers more to single-phase drugs, which are usually taken in the mode of "21 + 7": 21 days of taking and 7 days off. There may be another mode, such as three packages in a row without a seven-day break, or even four or five. If you have chosen a continuous type of medicament intake and see that conditionally on the 40th or 50th day still appear a slight discharge of blood, it is desirable to take a seven-day break, and then open and start taking a new pack of pills. The secretion may not go away until you make a pause. It is best to talk to your doctor about this and stay in touch with him/her.

I have no menstruation at all now. Is this normal?

Many women during the war say that their last period was in February or early March. If you know for sure that you are not pregnant, then the disappearance of menstruation is a normal reaction of the body to stress. As soon as the situation calms down, everything will get back to normal, and then you donʼt need to see a doctor. But this is only if you donʼt have a risk of unplanned pregnancy, as well as no temperature, pain, unusual secretions. If you have such suspicions or symptoms, be sure to see a doctor.

In conditions of water shortage, daily pads are a godsend. Can I use them around the clock without compromising my health?

Daily pads are harmful. They can be used for several hours a day when there is a slight secretion before or after menstruation. If you use such pads constantly, you a violation of the vaginal microbiota can occur, which can lead to bacterial vaginosis or genital candidiasis.

What underwear is better to wear if I have a uniform and armor on me?

Every woman chooses what is convenient for her. Itʼs unlikely that in war circumstances you will be comfortable in thongs or panties that get crumpled between the buttocks. Shorts, even menʼs boxers, are quite acceptable and comfortable. Itʼs best if they are cotton. But the lingerie must be selected accordingly to your size and in no case it should be too small.

I donʼt wear a bra at all in my daily life. Do I need to wear it if I walk/run long distances, even in a bulletproof vest?

Yes. In the conditions of military action, it does not matter what size of breasts a woman has — small or large. When you are wearing gear and can walk or run long distances, you should wear at least a T-shirt, and preferably a sports bra. Push-ups and lace should be forgotten. Girls who used to play sports, run and have experience wearing uncomfortable underwear, know what torn nipples are while running. Linen should not press. After all, for example, congestion due to impaired lymphatic outflow in the mammary glands can provoke edema, and breasts can increase and hurt.

Breast health depends not only on underwear. You should also pay attention to the use of deodorants with antiperspirant effect. You can not block the sweat glands under the armpits. If you use products that leave the skin dry for 48 hours or more, it can negatively affect the condition of the breasts. Sweating is extremely important — with it the body removes toxins and salts, and also cools down. Violation of the process can be harmful to health. To get rid of the smell of sweat, you can use special tabs or even ordinary cotton pads, which can then be burned. You can shave under the armpits and wipe them with a damp cloth.

Despite the war, it is important not to forget to visit a mammologist and do a breast self-examination. It should be done in vertical and horizontal positions, the hand on the side of the review has to be placed behind the head. With the hand of the opposite side you need to check the breast tissue clockwise. Then compress the areola and nipple and check for fluid. If itʼs there — itʼs a bad sign.

At the end of the examination, you need to check the areas under the armpits. Oval elastic formations — enlarged lymph nodes — need attention. Also be careful about the consistency of the mammary glands. If you have new sensations in the chest or you find something during the self-examination, see a doctor immediately. Stress raises the level of the hormone prolactin, and milk can be secreted from the breast, even if you are not pregnant.

Heavy plates of the body armor constantly press on the mammary glands. Can it hurt the breasts?

Any injury to the mammary gland can be dangerous for it, so you should avoid rubbing the nipples and any mechanical damage. But the bulletproof vest saves lives, and in war the priorities are completely different. Keep it on.

I was always told: do not sit in the cold. However, there is no choice in the trenches. Will I have inflammation?

Inflammation may be caused not by the fact that you are cold or there was wind somwehere, but because there is no normal hygiene and living conditions. Due to the weakened state of the body, the protective mechanisms, including mucous tissue, are reduced. Therefore, you can get vaginitis (inflammation of the vagina), salpingitis (inflammation of the internal genitals) and salpingoophoritis (inflammation of the uterine appendages). It is desirable to have antibiotics in the first aid kit, at least Azithromycin.

In everyday life, you can not routinely use antibiotics without examination. But in the field and with a sickness you often canʼt pay a visit to the doctor. In addition to Azithromycin, it would be good to have Fluconazole (a drug for genital candidiasis, or simply thrush) in the first aid kit. As well as universal vaginal suppositories — the ones with iodide. This iodine compound effectively fights fungi, protozoa, and bacteria. But thatʼs in case you are not allergic to iodine. Candles with chlorhexidine also have antiseptic effect. Fosfomycin helps with cystitis, as opposed to different herbs.

I had sex at the frontline, but I donʼt want to get pregnant. What contraceptives are best in such conditions?

War does not eliminate sexually transmitted infections. Therefore, if you donʼt have a regular sexual partner, you must use condoms.

When it comes to hormonal contraception, there are a few things to keep in mind. It is selected by a doctor because there are medicines that differ in the nature of the progestin component, and different drugs suitable for different conditions. Contraceptives in the form of pills are convenient: in addition to preventing pregnancy, they allow a woman to control the duration of the menstrual cycle. Actually, a woman can take single-phase hormonal contraceptives almost continuously. For example, for six months, then a break for a week and another for six months. However, the condition should still be monitored by a doctor.

Taking combined oral contraceptives can have side effects, such as an increased risk of thrombosis and worsening in women with varicose veins. This is rare, but your doctor should still monitor long-term use of such drugs, at least send you to make a coagulation test and liver tests. If you are at the frontline where there may be interruptions in drinking water, and if you smoke, the risks of side effects from hormonal contraceptives — including thrombosis — increase many times. Therefore, if you choose to take hormonal contraceptives, you should drink plenty of water and give up cigarettes.

If you are not taking combined hormonal contraceptives and there is some trouble with the condom, it would be a good idea to have emergency contraceptives with you. They are sold without a prescription and are widely available. The sooner you take one or two pills after unprotected sex (but no later than 72 hours after the event), depending on the drug, the more effective they will be.

Translated from Ukrainian by Anton Semyzhenko.

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