Risks for Women Divers

It appears that from the best information and experience that it is as safe for women to dive as it is for men, using the diving safety guidelines which are standard for all national certifying agencies and the federal government. Dr. Caroline Fife, after considering all the experimental and survey data, had the following comments to make at a course given in 1993.

  • Normal, healthy females are at no greater risk for diving DCS than their male counterparts.
  • Menstruating women are at no greater risk for diving DCS than non-menstruating women. (This may not be true for altitude or saturation diving).
  • There is no conclusive data linking human birth defects to maternal diving.
  • The human fetus may be at greater risk of injury than the diving mother. The potential risk primarily consists of DCS, but hyperoxia and CO2 retention may also be problems.
  • There is insufficient experimental evidence to establish safe depth and time profiles for the pregnant woman.
  • Pregnant women who choose to dive should be informed that potential fetal risk probably increases as the no-decompression limits are approached, and as pregnancy progresses.
  • Women who discover they are pregnant after performing multiday or deep diving should not be counselrd to terminate their pregnancy. The odds are still in their favor.
  • Until further data are available, women who know that they are pregnant should not dive, just as they are advised against alcohol intake, radiation exposure, smoking and other environmental factors which may increase the risk of fetal injury.
  • There is no evidence that tampons or any other intravaginal objects are in any way dangerous from the effects of increased pressure. Not being a closed space, it does not suffer the effects of Boyle’s Law.

Maida Taylor, MD, MPh has the following comments about women and diving:

Technically the pelvis is most vulnerable to infection peri-menstrually, but there appears to be no correlation with bathing and infection, There is a correlation with douching, but that is water introduced into the vagina under pressure dependent on the gradient created by the height of the douching bag.

Diving and Menstruation

Sharks are not an issue — no evidence of increased attacks on menstruating female divers. Heavy flow and menorrhagia may be different than light flow. This may be an increasing concern as the female diving population ages. Most women with very heavy flow probably would skip diving on those days. Issues of hygiene, privacy and convenience. If the flow is very heavy with superimposed anemia, chronic or acute, that would limit potential O2 delivery, and impair circulatory dynamics.

There is some suggestion from aerospace literature and from dry chamber dives for medical hyperbaric therapy that women may be at increased risk for DCS during the first week of their cycle… that is during the menstrual week. This phenomenon has not been studied in open water divers. It might however suggest that due to changes in hormones, electrolytes, vasomotor reactivity and peripheral vasoconstriction, and other unknown variables, women might handle a gas load differently during the menstrual phase of their cycles. One might caution women who dive while menstruating to dive more conservatively …jumping tables, doing shallower dives, and prolonging safety stops.

Three papers now suggest that there is an increase in incidence of DCS during menstruation:

Rudge, aerospace DCS

Trainees, 81 females in 11 years, 62 pain only, 18 neurologic , more
days from LMP, fewer cases

Dixon, aerospace DCS, 100% DCS cases were menstruating, only 32% non cases menstruating

Dunford, chamber inside attendants but not scuba divers (report by questionnaire with extremely small numbers)

Recent study of 956 divers – of DCS cases 38% menstruating, but 85% were on OC (oral contraceptives)

ST LEGER DOWSE M, BRYSON P, GUNBYP, FIFE W: Scuba diving and the Menstrual cycle: retrospective data from a follow on prospective study of diving women UHMS Mexico 1997 Abstract at Ann Scient Meeting 93% of women dive while menstruating, 71% have symptoms of PMS, and 34-48% perceive some decrement in performance due to menstruation. Will publish data on effects and relation to DCS of prospective study in 2000 or 2001.


Ernest S. Campbell, M.D., FACS

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