Invisible Warriors Health Care Advice

Invisible Warriors

Within this 1 percent is another invisible group: women. The recent conflicts are distinguished by the service of the largest ever presence of women deployed. While not yet officially in combat, the risks seem the same for women and men when an attack can come at any time, and when there is neither a “front” nor a “line”.

As the Pentagon explores changing the policy that bans women from official combat roles, the medical community cannot wait to advance. Women are coming back from deployments with the same conditions as deployed men, as well as some unique ones, and are lacking treatments that adequately factor in sex and gender differences.

One area includes the high number of musculoskeletal concerns from women who have deployed. Military women are holding their own in over 90 percent of military occupations. This is not a question of women’s strength or capability to serve. It is a research question needing a medical response. What impact does the current gear have on female joint alignment? What percentage of one’s body weight can be safely carried? What role does increased elasticity play in development of chronic back pain or osteoarthritis after a tour of duty?

The harsh environment and impact of enemy weapons can have both immediate and long term effects on the genitourinary organs, as well. Extreme temperatures and dehydration can contribute to startling rates of urinary tract infections in women. Injury to the sex organs from explosives can impact men and women, while frequent heavy weight bearing over time has been suggested as a contributor to urinary issues and possible pelvic floor prolapse later in life. Depending on the extent of the damage, sexual function and fertility may also be impacted.

Another area requiring more research is post-traumatic stress. In the civilian population, women are twice as likely to experience post-traumatic stress disorder (PTSD) than men. However, the types of trauma or exposure that cause PTSD differ between the sexes. Women develop PTSD more commonly after stressors of a personal nature, whereas men more often develop PTSD after natural disasters or accidents. These differences, again, are not a question of the strength or resiliency of women in the military. Quite the opposite. Reports just this month failed to find significant differences between men and women in postdeployment mental health the first year back after deployment. The question at hand is how to better anticipate, train for, and prevent some of these invisible war injuries, and to not assume that women will have the same needs or responses as men.

A third area to expand research will be in conditions affecting the immune system. Failing to account for sex-based differences in autoimmune disorders will result in inaccurate reporting and delays in finding optimal treatments. In the U.S., 8 percent of the population is affected by an autoimmune disease (e.g. lupus, rheumatoid arthritis, multiple sclerosis) and of those 78% are women. Many women with autoimmune diseases experience dramatic improvement during pregnancy, further suggesting sex hormones play an important role. Such stark differences in disease prevalence and outcomes need to be considered when reporting numbers or attempting to identify trends in military women, when defining problems and designing treatments.

Factoring in sex-based differences may mean changes to everything from the doses of vaccinations women get before a deployment to when and what evidence-based care a women veteran accesses at her VA or civilian doctor’s office. Our bodies delicately balance exposures and responses in ways that cannot ignore the influence of sex-specific hormones and other sex-based differences. However, failing to document these differences or to apply them to needed treatments and future prevention-based efforts will do just that.

Finally, VA and civilian health care professionals must have access to the latest research and training in the special care military women require. We cannot ignore the unique health issues of the women who don fatigues and whose exemplary courage and particular sacrifice merit more attention than we have given.

Virtual Health Center