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What do you get when you join an all-women ski expedition to the top of Mt. Baker? Good views, tired legs, sunburned noses, and a whole lot of talk on women’s health in the wild. This was for a fundraising campaign for SheJumps, an organization devoted to increasing female confidence in the outdoors. The pulse of the trip had a different beat than the usual man-heavy adventures I’m usually part of, and it was refreshing. We discussed the barriers we’ve faced, which spurred me to compile tips and tricks to help you take better care of patients with women-specific needs in the wild.

Photo by Monica Welcker

Urination

We all know women are more prone to urinary tract infections (UTIs) in general, but this is exacerbated in the wilderness. When you lose the convenience of toilets, urinating is one of the last things females want to do. Peeing standing up sounds like a recipe for disaster given our urethral anatomy. That leaves squatting, which is reasonable until you add in a harness, skis, and being attached to three other people on a rope team on an exposed glacier. This anxiety surrounding outdoor urination leads to dehydration, kidney injury, vulvovaginitis, and UTIs. Consider sanitation towels to keep things clean but remember anything you bring into the wilderness you should pack out. Pee funnels such as Shewee, Pibella, GoGirl, LadyP, P-EZ (the names alone are fantastic) can be a great addition to your pack for that added directional benefit. You can also consider a wide-faced Nalgene bottle for those cold, storming nights where the last thing you want to do is get out of your tent (a guide I know is a master of this and would dispose of it in the morning). As with any new tool, practice before you go. Your tentmate will thank you.

Menstrual Hygiene

Menstruation can be a huge deterrent for women to get outdoors. Menstrual cycle disturbances are extremely common in expeditions given the physical and mental demands. For example, a study showed 87% of women hiking the Appalachian Trail had menstrual abnormalities. Thus, be prepared to manage these complaints. Given limited storage and leave-no-trace policies, a menstrual cup may be the way to go (again, advocate for your patients to practice using it before the trip). If they prefer tampons or pads, realize these supplies can also be used for wound care or nose bleeds (score one for multi-purpose tools!). Once used, place in a thick double baggie system, like a WagBag , with other human waste to keep smells down and disposal tidy. If there is time before the trip, patients may elect to use hormonal contraception. Although each has its own risks/benefits, an arm implant or an intrauterine device allows the patient not to worry about taking a daily pill or time zone changes during prolonged travel.

Multiple uses of feminine hygiene supplies in the wilderness. Auerbach’s Wilderness Medicine. Salas, RN, Anderson, S. Dec 31 2016. Pages 2117-2149.e4.

Pregnancy

A pregnant patient adds another layer of planning for an outdoor trip. The second trimester is best for long travel periods given that the pregnancy is established and there is less risk of spontaneous abortion as opposed to the first trimester. However, patients will need to understand the risks of serious infections ( malaria, Zika, schistosomiasis, etc) if they are to travel to endemic areas. It’s important to have patients discuss the specific trip with their obstetrician prior to take off. But when talking about short local adventures, pregnancy isn’t an absolute contraindication to having fun outside. Exercise is good for baby. If the pregnancy is healthy and singleton then ACOG recommends at least 150 minutes of moderate-intensity activity a week. Low impact activities like walking, hiking, and swimming are safe. Diving is a no-go given concern for nitrogen bubbles entering the fetal circulation and the higher risk of decompression sickness given increased fat stores. The jury is still out on altitude and its effects on pregnancy, but it appears that short stays (1-2 days) at altitudes up to 8200ft without strenuous exercise are likely ok. As with everything in medicine, there’s some gray areas to exercise in pregnancy. Sure, taking a 20ft whipper in your third trimester is probably in the classification of “contact sports” that ACOG says to avoid. However, it’s common to see women top rope throughout the course of their pregnancy. It’s patient specific, but many times women can continue the skiing, surfing, kayaking, etc. they did before the pregnancy test was positive. It may just require a scale down and a discussion with their doctor.

First Aid Kit for Women

Finally, I wanted to leave you some medications and tools that you should consider bringing on your next trip; many of them require a prescription, so a discussion with your doctor is necessary. When it comes to testing, you can bring urine dipsticks to rule out a UTI, however this can be made usually on clinical grounds (eg, urinary frequency, dysuria, hematuria). Thus, you may just want to preemptively treat with antibiotics. One thing I wouldn’t skimp on is a pregnancy test (something like Pregmate that’s cheap and light). A female with vaginal bleeding and abdominal pain becomes a more serious issue with a new positive pregnancy test and will require urgent evaluation at an ER. On the other hand, your non-pregnant vaginal bleeder can be given pain medication and watched in the field. Below you’ll find my recommendations for medications for a variety of women-specific complaints with specific notations for pregnant or breastfeeding females.

First Aid Kit Medications for Women-Specific Complaints

*could also consider miconazole cream, especially for pregnant women given category C rating for fluconazole. However, I do feel a one-time pill is an easier addition to your pack than a whole cream.

Additional Reading:

RN Salas, S Anderson. Women in the wilderness. In: P Auerbach, TA Cushing, NS Harris, ed. Auerbach’s Wilderness Medicine. Elsevier; 2017: 2117-2149.

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