Gynaecological questions and women's fitness to dive

In principle, every diving medical examination follows the same basic rules. However, every "special group of divers" has their own needs and medical questions. It would for instance never cross a doctor's mind to ask a man if he was pregnant nor would one recommend a prostate screening to a woman. During diving fitness examinations of a woman, a doctor has to also look at the gynaecological history (hysterectomy, breast cancer etc.) and of course ask the obligatory question if she might be pregnant. The assumption that women are at higher risk for DCS than men (due to their biologically higher body fat percentage) has not been confirmed, although the menstrual cycle and hormonal imbalances have an impact on the susceptibility to DCS. Studies have shown a significantly higher number of DCS cases in women in their first menstrual week. Also, women show different symptoms. They for instance complain about breast pain more often than men (tension, swelling etc.).
The German Society for Diving and Hyperbaric Medicine (GTÜM) has taken the medical issues of women's diving into account and added according guidelines to the "checklist fit for diving" (see bibliography).

Specific issues and questions from a diving medical ambulance

  1. Can I dive when I have my period?

    YES. Just make sure to drink enough and dive with conservative profiles. If you do not feel well or have abdominal cramps, better give it a day or two and wait until you feel better.

  2. Can I use all the sanitary products that I normally use during my menstruation?

    Basically, YES. But diving while using menstrual pads in a wetsuit is not recommended from a hygienic point of view.

  3. Is there an increased risk of infection in the genital area during the menstrual period?

    NO – the usual hygiene measures are sufficient.

  4. Do I provoke shark attacks with traces of menstrual blood?

    Despite the input of Hollywood films, the answer to this frequently asked question is: probably NOT. Dr. Erich Ritter, shark expert: the topic of "menstrual bleeding as a blood source [for sharks]" has already been discussed in diving magazines several times – but mostly by people without any practical experience with sharks. Not having found women willing to test the theory while they were on their period, I haven't been able to do research on it. But since sharks are able to perceive even the tiniest blood concentration in the water (1:10 billion particles!), they will undoubtedly be able to locate menstrual bleeding and react to it. From my point of view, however, an intact 7 mm wetsuit will sufficiently prevent blood components from leaking into the water. If a woman wants to undertake a shark dive without a wetsuit or in a stinger suit only, I would recommend staying below the shark in the current and within a reasonable distance. I do not think that the shark would immediately see the woman as pray if it has detected blood components, but it might be more curious than it would normally be. With proper diving behaviour, menstrual bleeding is not a problem, but must still not be trivialised. Often, women who dive during their period are more nervous than usual – probably because they are uncertain of how the shark might react – and this can also have a stimulating effect on sharks.

  1. Can I dive if I'm on the pill?

    YES – the use of contraceptives does not increase the risk of diving accidents.

  2. Can I dive during pregnancy?

    NO – not even with strictly conservative diving profiles. Damage or abortion of the foetus/embryo cannot be excluded. However, there is no indication that diving during early pregnancy (when the woman is still unaware of being pregnant) can cause a miscarriage.

  3. When can I dive after the birth of my child?

    When the lochia has stopped and the woman feels physically well, she can restart diving. But don't forget: fitness to dive also includes sufficient rest and sleep. After a sleepless night, it might be more recommendable to rest while your baby is sleeping rather than to go diving. Same rules also apply after a Caesarean. In addition, all wounds must be healed well – including the inner stitches on the abdominal muscles. Stress or physical exertion (such as lifting heavy dive gear) too soon after can lead to suture insufficiency.

  1. Can I dive while breastfeeding?

    YES – nitrogen bubbles are fat-soluble and dissolve excellent in the breast milk. However – they are mostly desaturating while the baby is sucking. Further desaturation occurs in the child's stomach. Damage by nitrogen bubbles can therefore be excluded. Yet, the wide-open milk ducts pose an entry point for germs and you should therefore maintain a meticulous hygiene. If she has mastitis (breast infection), a woman is not allowed to dive. Since the mother has a significantly increased need for fluids during breastfeeding, an adequate fluid intake must be ensured. In case of a decline in milk production, there is usually a fluid deficit.

  2. Can I dive if I want to start a family?

    Women who desire to have children are usually very mindful of their menstrual cycle and know the approximate time when ovulation occurs. After ovulation and the attempt to conceive a child, one should wait until the first pregnancy test – just to be on the safe side. Modern tests are available as from 1 week after impregnation. If the test is positive – congratulations! Take a break from diving and read point 7 and 8.

  3. Can I dive with a silicone breast implant?

    YES – the modern implants are filled with liquid (saline or silicone oil) and thus not compressible in the normally reached ambient pressure while scuba diving. Damages could be caused by heavy or pressuring equipment. Rare reports of ruptured implants are usually due to improper materials. Hyperbaric chamber tests have shown a certain amount of nitrogen saturation (in silicone oil more than in saline). However, there was absolutely no damage to the implants.

  4. When can I restart diving after a hysterectomy or an ovarectomy (removal of the uterus or ovaries)?

    That depends on the type of surgery. If it is done endoscopically with an uncomplicated postoperative course, an 8 weeks break is usually enough. If the operation was performed with an abdominal incision, all wounds must be healed properly (skin, fascias and muscles). The recommended dive break after an operation is 3 months, assuming that the postoperative course is easy. In the case of a uterus / an ovary cancer operation, the ability to dive is determined by the necessary treatment of the disease and will require a decision on a "by-case basis". In any case, the treating gynaecologist has the last say after a complete examination. The woman should have no clinical complaints completing her daily tasks or while lifting things.

  5. When can I dive again after breast surgery?

    Like after every surgery, the recommended dive break depends on the type of operation and the healing course. Concerning implants or other cosmetic breast operations, one can dive after the healing process is complete, the swelling has disappeared and the arms can be moved without complaints. As a rough rule of thumb: when the woman can do sports, she is also allowed to dive. In the case of a breast cancer operation, the ability to dive is determined by the necessary treatment of the disease and will require a decision on a "by-case basis".

Women's diving quo vadis?

Women have caught up considerably in sports diving. Currently, at least 30% of all divers are female. To have a woman in the group of divers can dramatically defuse and ease certain situations, because women are generally more conscious of safety issues.

An interesting online questionnaire done on behalf of the diving industry association resulted in a total of 872 returned forms by October 2009. The numbers were extrapolated to the total membership numbers. Besides other basic data, it showed that nearly 50% of the women around 30-35 years quit active scuba diving, namely when they've had children, and do not restart later on. Does this explain the still higher quota of men and fathers in scuba diving?

Nevertheless, women are present in every field of diving – in apnoea diving, recreational diving, technical diving as well as in professional diving thus adding their special notes with a "female hand or fin".

 

 

Bibliography

  • Fife C., Dowse M,.  Woman and Pressure, Diving and Altitude, Best Publishing Company, Flagstaff, 2010
  • Muth CM (2007) Frauentauchen. In: Klingmann Ch, Tetzlaff K. (Hrsg). Moderne Tauchmedizin. Gentner Verlag, Stuttgart, Seiten 621 - 633
  • Tetzlaff K, Klingmann Ch, Muth CM, Piepho T, Welslau W (Hrsg) (2009).  Checkliste Tauchtauglichkeit – Untersuchungsstandards und Empfehlungen der Gesellschaft für Tauch- und Überdruckmedizin (GTÜM). Gentner Verlag, Stuttgart