Gender Specific Issues

in wilderness medicine

Uncomfortable Emergencies
A teenage girl on your expedition has been showing signs of discomfort and even some elevated internal pain over the last few days When confronted about the issue, claims everything is fine and withdraws herself from the conversation. It isnt until the issue becomes severe and the girl develops a fever that she finally comes to you with an admission of a problem

Just imagine this was you!

It is incredibly important to develop a relationship of trust with your participants. Many gender-specific issues can be embarrassing, frightening, and can become life threatening if left untreated. Many people may not be upfront and clear about these issues without this pre-existing trust. It helps to have someone of the same sex work with the patient.

Male Anatomy

Torsion of the Testes

Causes: Anything from violent physical activity to moving around inside a sleeping bag. The vas deferens and accompanying blood vessels are twisted, cutting off circulation to the testis. After 24 hours without blood, the testis is not likely to be saved.
S/S: Sudden, very intense pain in the testes. Patient may be unable to move. Scrotum becomes red and swollen, and one side may seem elevated. In some cases the pain will elevate slowly. Tx: Patient should be given a cold compress and pain medication. A bandage to elevate the testes may aid in blood flow. The patient themselves, or someone else, may attempt to rotate the testis free by rotating gently upward and outward. In all cases, reduced or not, a patient suffering torsion of the testes should be evacuated for further medical attention

Chafing/Jock Itch
Causes: Fungus or bacteria are presented with a hospitable environment thanks to tight clothing, the naturally warm environment, friction of the body parts, and multi-day use of synthetic underwear that harbors the fungus easily. S/S: An itchy area of redness will appear. Rash will become worse over time if left untreated. May present with raised red spots, pimples, and pustules. Tx: Keep genital area dry, exposed to air when possible, and avoid tight clothing. A small amount of hydrocortisone cream may be used. Keep the area as clean as possible. Sleeping with cotton underwear can help with hygiene

Inguinal Hernia
Causes: This is a very rare, but serious, condition. Part of the intestine pushes into the groin. Many times this is due to a birth defect, deformity, or trauma to the abdominal muscles. Pressure against the groin causes blood flow to the intestines to be cut off.
S/S: A lump/swelling in the groin, with sharp and steady pain. Groin muscles will become tender, and waves of abdominal cramps may follow. Patient may vomit. Tx: Attempt to reduce the hernia. Lie the patient on their back with the abdomen elevated above the head and chest. Apply steady, moderate pressure on the swelling. Hernia may reduce after ten minutes or longer. A hernia unable to be reduced, or a reappearance of a hernia needs immediate evacuation of the

Female Anatomy

Urinary Tract Infections

Causes: While uncommon in men, very common in women due to the short urethra. Pathogens are introduced to the bladder releasing toxins and causing infection. S/S: Increased frequency of urination with reduced output. Strong odor accompanies the urine. Blood or pus may be present. Patient may have a fever. If infection has moved to kidneys, likely to have point pain in the lower back when palpated. Tx: Have patient drink as much water as possible to flush the urinary system. Patient should get as much rest as possible to allow body to fight off infection. Patient should wash with mild soap and water daily. Antibiotics will help fight the infection if available. Infections lasting longer than 48 hours require evac for further treatment.

Vaginal Infections
Causes: Diets high in sugar, diabetes, cuts and abrasions on the genitals, inadequate hygiene. Those on birth control or antibiotics are more vulnerable. Due to a change in the bodys normally acidic pH. S/S: Excessive odor, redness, soreness, itching, painful (burning) urination. Tx: Acetaminophen (Tylenol) and a warm, moist compress to help relieve symptoms. Hydrocortisone cream for itching relief. Antibiotics if possible- many times required to heal the infection. If no improvement over 48 hours from emergence, patient must be evacuated for further treatment. *If left untreated, can lead to further serious problems involving inflammation of the fallopian tubes, ovaries, and uterus.

Toxic Shock Syndrome

Causes: A type of Staph Infection caused by improper tampon use. The Staphylococcus aureus bacteria, when introduced to internal tissues produces a toxin serious enough to result in fatality. S/S: Very abrupt onset. High fever, chills, muscle aches, sunburn-like rash, abdominal pain, sore throat, vomiting, diarrhea, fatigue, dizziness, and possible fainting. The rash will appear on the palms and elsewhere on the body. Compensatory shock is possible. Tx: Immediate removal of tampon. Person should be given plenty of water to flush their system and avoid severe dehydration. Evacuation for further medical attention is necessary.