How to keep healthy overseas? Our resident doctor shares her best advice for female travellers
Certain travellers maintain that the best way to avoid mosquito bites is to bring along a woman. Just a chauvinistic joke? Not necessarily. There is actually scientific evidence to back up the bug claim: generally mosquitoes bite women in preference to men. Pregnant women are even more attractive to mosquitoes – perhaps because of their higher body temperature, as well as increased surface area!
Women, then, need to pack plenty of repellent and consider proofing their favourite travel clothes with permethrin. This is pleasant to use and if you have sensitive skin or are pregnant it is safer than DEET. It is best to take advice on which is the right antimalarial pill; note that doxycycline reduces the effectiveness of the combined oral contraceptive pill, although only for the first three weeks of taking these daily capsules.
One big concern for many travellers is developing a blood clot or deep vein thrombosis, and healthy women are more likely to develop this than healthy men.
Developing a clot is unusual; the risk for most people is low. Even so, anyone taking the female hormone oestrogen (as in the combined contraceptive pill or as hormone replacement therapy) increases their risk by four times.
Pregnancy makes women ten times more likely to develop a clot. Other factors that increase DVT risk include being very short, being over 40, cancer and recent surgery. If you’re concerned, make sure you exercise every hour or so on long journeys and consider buying a pair of flight socks. The ‘mini-pill’ and other progestogen-only contraceptives do not increase the risk.
The female bladder has a lot to answer for, and can make distracting demands in places where it can be difficult to find enough privacy for a pee. Wearing a long, full skirt can help.
Some unwise women deliberately restrict the amount of fluids they take in when travelling, but dehydration predisposes you to infections of the bladder or urinary tract.
Typically such bacterial infections increase the desire to ‘go’ to an unbearable urgency but only small amounts are passed, with deep pain. These symptoms will probably settle only on taking a three-day course of antibiotics, but if you can’t get to a doctor or pharmacist, taking plenty of fluids that change the pH of the urine may stop the attack or give you time to take that bus trip into town. A heaped teaspoonful of sodium bicarbonate (baking soda) in a big glass of water drunk every couple of hours will help, as will taking vitamin C (ascorbic acid) tablets with lots of water or juices – these infections need ‘flushing out’. Such attacks of cystitis are more likely if your sex life is on the up.
Women sometimes mistake the harmless fungal infection thrush for a urine infection. Vaginal thrush tends to cause itching and soreness, which can be made worse by peeing. However, the discomfort is more like a chemical stinging on the outside. Eating yoghurt helps replenish friendly bacteria – it is especially good to take some fresh yoghurt after completing any course of antibiotics. Thrush seems to be more common in the tropics and is improved by wearing skirts rather than tight trousers. Airflow is soothing and healing.
Almost anything can happen to monthly periods when travelling. It is probably not worth starting the contraceptive pill just to make periods more manageable and predictable – travellers’ diarrhoea will probably mess up any rhythm and may lead to troublesome ‘break-through bleeding’.
If you dread your period then think about starting a long-term progestogen contraceptive well before travel: an implant or a Mirena IUS will probably stop your periods altogether, but it may take six months to get complete control. Three-monthly Depo injections also stop most women’s periods. Pack enough tampons assuming you will bleed erratically.
When considering how to cope with menstrual loss remember that you may be in places where washing isn’t easy (making the use of Mooncups more challenging). Also, if using disposable sanitary wear in the wilderness pack it out or burn it.
When visiting a new region it can be easy to give out the wrong signals. In some orthodox communities, women who dress skimpily may attract more advances than they would wish, and this can lead to considerable unpleasantness, or even violence. It is worth covering up – to keep off mosquitoes, avoid skin aging and skin cancer, and deny lecherous eyes.
Dr Jane Wilson-Howarth got caught out with cystitis in the Pindos Mountains and can testify to the efficacy of the baking powder she bought in a mountain hamlet. There are more tips for women in her book Bugs, Bites & Bowels.