Equal but different: The specific health considerations of female combat soldiers

While serving on the front lines against Hamas alongside their male IDF comrades, women must contend with the medical realities of their biology

Renee Ghert-Zand is the health reporter and a feature writer for The Times of Israel.

Female members of IDF armored forces at a staging area in southern Israel near the border with Gaza, January 01, 2024.  (Tomer Neuberg/FLASH90)
Female members of IDF armored forces at a staging area in southern Israel near the border with Gaza, January 01, 2024. (Tomer Neuberg/FLASH90)

Late last year, the Israel Defense Forces saw a huge spike in female conscripts seeking to join combat units during the war in the Gaza Strip that began on October 7.

The number of women enlisting in combat units has increased in recent years as successful legal petitions to the High Court for more gender integration in the IDF have led to female recruits being allowed to compete for acceptance to some elite units historically closed to women.

While women are proving in many cases that they are men’s equals on the battlefield, health professionals say there is no getting around the fact that women’s biology and physiology differ from those of men.

A session during an online conference on women’s health during the war hosted by the Israeli nonprofit organization Nogafem on February 29 focused on the health and hygiene challenges particular to female soldiers, especially during long, intense periods of military engagement.

“Sometimes we are talking about women not being able to shower for a month,” said Dr. Tili Fisher Yosef, a primary care specialist with Maccabi Healthcare Services and a lecturer at Tel Aviv University Medical School.

Even when soldiers wear cotton underwear and try to stay as clean and dry as possible, itchy or painful vaginal irritations and discharges can happen.

Female soldiers during training, in an undated photograph published by the military on June 7, 2022. (Israel Defense Forces)

“With vaginitis in the field, you can’t take a swab as would be done in a doctor’s office and do a culture in the lab to see whether there is indeed an infection, and if so whether it is caused by yeast, bacteria, or something else,” said Dr. Itamar Netzer, a gynecologist and medical administrator with Clalit Health Services.

With yeast being the most likely culprit, Netzer recommended that female fighters in the field try treating it with one- or three-day courses of anti-fungal vaginal suppositories. These prescription treatments can be obtained through the military health service or a private doctor.

Netzer said that female soldiers who suffer from frequent yeast infections can take oral anti-fungal drugs, such as fluconazole tablets, as a preventive measure before heading into situations that make it hard to practice good, regular hygiene.

Yosef pointed out that what might feel like a vaginal or a urinary tract infection may only be a very uncomfortable external irritation caused by moisture and constant rubbing from the crotch area of the uniform.

“Before using prescription medications, it’s best to first try diaper cream, over-the-counter topical anti-fungal cream, or absorbent powder. These may be enough to clear up the problem,” Yosef said.

Soldiers of the mixed-gender IDF Caracal battalion carrying a fellow soldier on a stretcher at the end of a 16 km journey to complete their training course in Tel Nitzan, near the border with Egypt, September 3, 2014. (Hadas Parush/Flash90)

For fungal irritations that can show up under the breasts due to excess moisture, the doctors recommended cotton bras that breathe. The powder can soak up the sweat and anti-fungal cream used to treat a rash.

Regardless of the specific suggestions, the physicians’ underlying message was that soldiers should think and prepare ahead, making sure that they bring with them whatever supplies they may need.

While irritations and infections may not affect every female soldier, all must think about how they want to handle their menstrual period when they are heading into combat or training in the field.

“Depending on what a female soldier’s job is in the IDF, she needs to think about whether she wants to have regular periods, stop her period during her active service, or stop it only temporarily while it is inconvenient,” Netzer said.

These are decisions that a female soldier should make in consultation with her doctor.

“One option is to take combined contraceptive pills in a certain way, but this doesn’t always work and it isn’t for everyone. You have to think about side effects,” Netzer said.

Yosef suggested the option of taking a medication, such as norethisterone, to delay one’s period. Like birth control pills, this approach has pros and cons.

“It’s important to remember that the drugs that delay the onset of a period do not prevent pregnancy, and it is recommended that they only be taken for a few months at a time and then go off them,” she said.

Female soldiers of the Bardelas Battalion during training, July 13, 2016. (Hadas Parush/Flash90)

Having an IUD inserted is a possibility for a young woman wanting long-term birth control, no periods, or both. However, it is not something particularly relevant to a soldier who is looking to stop her period for only several months — usually, the amount of time that it takes to get used to having an IUD in the first place.

For some women, the two weeks between ovulation and menstruation are characterized by premenstrual syndrome (PMS), with symptoms such as bloating, headaches, and breast tenderness. These same women may also have premenstrual dysphoric disorder (PMDD), which causes severe anxiety, depression, and mood changes.

Soldiers who generally experience PMS or PMDD may want to consider a solution that would prevent these syndromes from interfering with their performance.

“Birth control pills can help alleviate the symptoms, but again, side effects need to be considered,” Netzer said.

Yosef said that low doses of drugs widely used to treat depression and anxiety, such as selective serotonin reuptake inhibitors (SSRIs) could be helpful if titrated properly and the right days in a woman’s cycle to take them determined.

“These are prescription drugs, and this must be done under the care of the soldier’s doctor in the community or an IDF doctor,” Yosef emphasized.

Yosef addressed the question of how the lifting of military equipment and carrying of heavy packs affects the health of women’s pelvic floor.

Female soldiers during training, in an undated photograph published by the military on June 7, 2022. (Israel Defense Forces)

According to Yosef, research conducted by the IDF found that there was no negative impact on female combat soldiers’ pelvises.

“It doesn’t appear that the weight has caused urine leakage. Interestingly, pelvic floor problems and urine leakage were found to be more of an issue among female surveillance soldiers, who sit for hours on end in front of computer screens,” she said.

It’s not just physically that female soldiers have proven their mettle in fighting alongside males.

“There is no data yet comparing PTSD in men and women IDF soldiers from the current war. However, past data shows that female soldiers adapt well psychologically,” Yosef said.

Times of Israel staff contributed to this report.

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