As women assume more combat roles in the US military and continue to operate in austere environments with varied mission sets, the Department of Defense must rethink its approach to equipment and uniform development to accommodate female anatomical differences. This podcast analyzes the results of a study conducted during the Sandhurst Military Skills Competition at the United States Military Academy to determine the effectiveness of commercial off-the-shelf products the Army has adopted to aid female urination—products used by competition participants that may not be the best or healthiest options for women.

Read the original article: https://press.armywarcollege.edu/parameters/vol52/iss1/5/

Keywords: combat, women, inclusion, urology, female urinary diversion device

Episode Transcript

Stephanie Crider (Host)

Welcome to Decisive Point, a US Army War College Press production featuring distinguished authors and contributors who get to the heart of the matter in national security affairs.

(Guest 1 Andrea M. Peters)

(Guest 2 Michael A. Washington)

(Guest 3 Lolita Burrell)

(Guest 4 James Ness)

(Host)

Decisive Point welcomes Lieutenant Colonels Andrea M. Peters, Michael A. Washington, and Lolita Burrell, and Colonel James Ness—authors of “Rethinking Female Urinary Devices for the US Army,” featured in Parameters Spring 2022 issue.

Peters serves in the United States Military Academy Department of Behavioral Sciences and Leadership. She holds a PhD in industrial engineering FOS human factors engineering from University of Miami. Washington serves in the United States Military Academy Department of Chemistry and Life Science. He holds a PhD in emerging infectious disease from the Uniformed Services University of the Health Sciences. Burrell serves in the United States Military Academy Department of Behavioral Sciences and Leadership. She holds a PhD in medical psychology from the Uniformed Services University of the Health Sciences. Ness serves in the United States Military Academy Department of Behavioral Sciences and Leadership and holds PhD in developmental psychology from Virginia Polytechnic Institute.

The views and opinions expressed in this podcast are those of the authors and are not necessarily those of the Department of the Army, the US Army War College, or any other agency of the US government.

I’m glad you’re here. Our topic today is female urinary diversion devices, also known as FUDDs. Help us understand the issue

(Peters)

Absolutely, thanks Stephanie. The background of this study first came about when I was an (second-in-command officer or) XO for a engineer battalion with a infantry brigade. And so, during that time, when we were on convoys or we were jumping to a different site and we stopped within those locations, it was always a fight to find a place to urinate. And I had not felt that feeling of—not necessarily in that training environment—the lack of safety. But if I would have been deployed forward and how to do that, it would definitely be a sense of uncomfortableness, lack of safety, and then just concerned with what I was doing within that space of urinating in a host nation.

And it kind of goes back to some of the pilot studies that I ended up doing later on in life for my PhD, which started around 2018. And some of my colleagues were actually talking about how when they were in Iraq, they were exposing themselves in the middle of a busy street—how there weren’t facilities around. And, so, putting together from 2015 up into that 2018–2019 timeframe, where I was doing some of my pilot studies, I really didn’t know if it was just a “me” problem and . . . and very specific to the units that I was in, or did this problem span across the Army for women, whether they were in combat zones or whether they were in training-type sites.

And because of the feedback that we received, it was not just an exclusive, “me” problem. And, so, I desired to make it a little bit better for the women coming behind me. And so, with that, I’d like to pass it over to Colonel Ness if he’d like to jump in and hit the background as well.

(Ness)

Yes, I had the pleasure of being on Dr. Peters’s dissertation committee. She came and spoke with me, and she had numerous ideas.

And then she came on and said, “Well, you know, the Army has the FUDD.”

And I said, “Did they do field sanitation on this, or they just pull it off the shelf and give it to you?”

And she said, “Oh. I don’t believe they did.” And then she just took it from there and did a phenomenal job.

(Host)

So, in your article, the study team leveraged the United States Military Academy fall squad competition (autumn squad lane competition), Sandhurst, to address the lack of systematically focused field tests regarding female urination tools and practices.

The annual competition consists of 36 teams who face challenges that closely mimic real combat situations, and there’s usually one female cadet per team. What were your findings from this?

(Washington)

Yes, Colonel Peters approached me. I’m a microbiologist from the Department of Chemistry and Life Science at West Point. And she asked me if we can develop a study to look at whether or not pathogenic bacteria grow on these devices during military exercises.

As you mentioned, the Sandhurst is a two-day event. So, it encompasses a wide variety of military skills, including ruck marching, marksmanship, obstacle courses—so, it’s very physically intensive.

We took a group of female cadets. We issued them the FUDD devices. We swabbed them prior to use to determine what type of bacteria are normally present on the devices, and then we swabbed them after use to determine what type of bacteria grow on them in this intense physical environment.

And what we found was that, initially, there was very few bacteria on the surface of the devices. There was, mainly, normal skin bacteria that you would expect on something that’s being handled by people. And then, after usage, we found a lot more bacteria, and some of those bacteria were potentially urogenital.

(Peters)

That was the microbial side, but I’d love for Colonel Burrell to hit on the survey that we also use.

(Host)

Absolutely.

(Burrell)

Thank you. So, after they complete it—Sandhurst—they fill out a survey regarding their thoughts about the devices—specifically, factors that may encourage or discourage use and that ultimately play a role in health readiness and performance.

So, did they find them to be easy to use and clean? What about storing them? Were they durable? Was the design compatible with the unisex or alternate trouser? So, all of these things matter ’cause if the device exists, and they don’t feel comfortable using them for whatever reason, then they will sit on the shelf. And, thus, the health, the readiness, and the performance issues will continue to persist. And so, Colonel Peters, I think you were going to talk a little bit more too about the survey findings.

(Peters)

Yeah, absolutely. One . . . one of our major takeaways from the survey—obviously, the qualitative side of understanding some of the experiences of the women. I know my (science, technology, engineering, and mathematics or) STEM folks out there, they are wrapped around numbers, right, always want to hear numbers. But I think we’re—we really start understanding the problem is when we start listening to people. That ties into what we do here at the academy and engineering psychology. And it’s not just about engineering a device, but it’s about knowing what the person is going to actually use and how that’s going to accommodate them and relieve whatever issue it is that we’re trying to address.

And so, within the survey, we had a seven-point Likert scale, and it went from extremely satisfied to extremely dissatisfied. And this talked about KPI—so, “key performance indicators”—related to the device. So, it could have been the ease of use, it could have been the carrying case—you know, multiple different things as it concerns the device.

And what we found was overarching. Women wanted the device versus not having that device. But they were dissatisfied with the device based off of the basin size being too small because there was overflow when they attempted to use it. Also, the carrying cases with the two devices that are in the (General Services Administration or) GSA inventory leave a bit to be desired, based off of them being places to grow bacteria more than not so.

Again, the size. Anything that deals with something below the belt—and, especially, in this realm, people want something that is smaller and compact, but it’s also easy to get to. And there was no place really to carry these devices, which also turned into somewhat of an issue.

And the last thing that I’ll hit on is as we looked at the trousers—so, we have the unisex trouser and we had the alternate trouser. Well, prior to actually doing this study, the fly on the unisex trouser was actually shortened. Which makes it a whole lot harder to use a device like this that is now in the inventory. If we are further being limited—if you would, like, if you could hit on—one is a most concerning bacteria that we actually found on this device that would be great.

(Washington)

Yeah. So, one of the most concerning pathogens we found was this pathogen known as a Pseudomonas aeruginosa. That can cause urogenital infections, so it can ascend in the urogenital tract, and it can actually cause bladder infections. Uh, we also found an organism known as Proteus that’s concerning because Proteus has flagella, so it could actually swim. So, there’s a potential that if the device comes into contact with the skin, that it can migrate into the urogenital tract. Those are the two of the most concerning pathogens we found. But we also found the variety of normal skin flora and bacteria that are present in the soil.

(Host)

What recommendations did you come up with for the Army and its leaders?

(Peters)

We kind of took this a few different ways. You know, if the Army wanted to continue to move forward with the devices, there’s definitely certain things that we can do because we don’t believe that the devices need to be pulled off the shelf or anything like that. We’re definitely not saying that. What we do want people to understand is that there’s an increased risk as you use these devices if you’re not cleaning them correctly.

So, some of the recommendation is that, yes, these devices be issued to women. And it might be—the best place that this may be appropriate for is basic training. And then, also the women who are currently in the military right now, that becomes an issued item where they can go to (the Central Issue Facility or) CIF and pick it up. But with those issued items, they also need to have appropriate cleaning protocol for the devices.

There’s another piece that we talk about in the article and that’s really wrapping our heads around urination needs and really normalizing that this is a normal occurrence in a male or a female. And Colonel Ness is going to hit on this a little bit more, but there has to be a change in the attitude towards, I would say, hygiene, in regards to field sanitation as it relates to urination.

It happens. We do it. But how do we make it a little bit easier for women to be able to do so and not feel as though people are judging them because they’re using this device? And I will surrender my time to Dr. Ness.

(Ness)

We have to embrace diversity. That’s really what the overall point is, because it provides us a tactical advantage of adapting to emerging, tactical environments. And the reason why I say that is because Mother Nature can’t predict the future. She does it with diversity. With species and within species. You just can’t have a, sort of, poster child,

whatever, right? That’s not how it works. And so, if we expect to meet the challenges of the future, which we can’t predict, we need diversity ‘cause it is our necessary and sufficient cause for winning future things. So, diversity of soldiers means that groups of soldiers will have unique experiences. And those experiences have to be put to words, and, sometimes, they’re hard.

We have to attend as leaders to the health and well-being of the soldiers. That’s foundational for our readiness. It’s also foundational for us to be able to then meet those environmental types of things ’cause they all have special types of accommodations, physiologically.

Like, in particular, women generally aren’t as prone to high-altitude pulmonary edemas as men are. And, so, let’s say you have to do a quick recon in the Hindu Kush. I’ll send the women—until we get the men to work the acclimation.

But that helps us with being agile. And we can’t make it a woman problem or whatever, you know, the . . . the group of individuals are. We need to listen, we need to get them involved. And this is an Army problem because the Army needs diversity to win.

(Peters)

I’ll finish up with—in the article, we have a lot of recommendations. And those recommendations were very thought out. And it is to help the Army not to beat up the Army, but to help us move forward and to help women be force multipliers versus reducing that force that, you know, that we always talk about. And it’s also to build that cohesion. And so, I’ll echo as well with what Colonel Ness is saying that this is an Army problem. This is not a female problem, and we have to embrace this along with many other things that we need to begin to look at that, in the past, has been taboo. And it needs to be addressed. And the education needs to be there, and people need to become more comfortable with this topic. Let’s normalize it, and let’s make sure that we take care of all of our soldiers.

(Host)

I’m afraid we have to end it here. Thank you so much, though, for joining me today and for your contribution to Parameters.

(Peters)

Thank you so much, Stephanie.

(Host)

If you enjoyed this episode of Decisive Point and would like to hear more, look for us on Amazon Music, Spotify, Apple Podcasts, Stitcher, or any other major podcasting platform.