{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:45:26Z","timestamp":1777934726167,"version":"3.51.4"},"reference-count":30,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Preventing illness and maintaining hygiene in the genital and anal regions are concerns when hikers spend extended time in the backcountry. This cross-sectional survey study assessed prevention and hygiene strategies used by female long-distance backpackers and whether these approaches are associated with an increased incidence of symptoms of diarrhea, urinary tract infection, vaginitis, and dermatitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 868 long-distance backpackers who hiked in 2021 completed a survey about the prevention and hygiene strategies they used, and results were divided by anatomic sex. Chi-squared and effect sizes were used to determine if any practices were associated with a change in the frequency of adverse health outcomes. Thematic analysis of open-ended comments facilitated interpretation of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 620 respondents reporting female anatomy. Reusable products often were used for menstrual management and for postelimination hygiene. Several hygiene management practices and some reusable products were associated with increased reports of ill health effects. Hikers with more on-trail experience and a consistent hygiene routine were less likely to report adverse effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-distance hikers use a variety of strategies to manage genital and perianal hygiene while in the backcountry, with reusable products being popular. Most strategies had little adverse effect on health. Maintaining a consistent hygiene routine appeared to be protective. More study is needed to understand whether the use of female urinary devices leads to more urinary tract infections or if minor modifications in their application could prevent such symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10806032251358161","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T08:51:42Z","timestamp":1753692702000},"page":"474-484","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating Hygiene: Genitourinary and Perianal Health Strategies Among Female Long-Distance Backpackers"],"prefix":"10.1177","volume":"36","author":[{"given":"Kelly","family":"Ray","sequence":"first","affiliation":[{"name":"Stanford Express Care, Stanford Health Care, Stanford, CA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynn","family":"Foster-Johnson","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine at Dartmouth College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Crockett","sequence":"additional","affiliation":[{"name":"The Geisel School of Medicine at Dartmouth College"},{"name":"Department of Emergency Medicine, Dartmouth-Hitchcock Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"issue":"5","key":"e_1_3_5_2_2","first-page":"521","article-title":"Health care needs of Appalachian trail hikers","volume":"36","author":"Crouse BJ","year":"1993","unstructured":"Crouse BJ, Josephs D. 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