Why do veterans have issues with sex and intimacy?

Two of the most taboo topics in our society: trauma and sex.  Is it any wonder that when the two collide, we hesitate to talk about it? 

Intimacy between two people can be challenging even without the complicating factors of prolonged separations, the living of two wholly different lives during that period, and the reality that many service members report relationships with their comrades—not significant others–as being the closest in their lives.

Still, intimacy for veterans with psychological symptoms related to combat exposure is more than just challenging.  It can feel impossible.  And not just blanket intimacy, but sex. 

Male combat veterans with post-traumatic stress are significantly more likely than their civilian counterparts to experience erectile dysfunction or other sexual issues. Those with PTSD are 30 times more likely to have erectile dysfunction.

Source: U.S. Air Force photo/Airman 1st Class Nicholas Pilch/Labeled for Reuse

At the height of the Global War on Terror (GWOT) the average age of those deployed was roughly 27 years for active duty and 33 years for Reserve and National Guard. Half the deployed population in 2010, was between the ages of 25-34 years (72% were 25-44 years old), with 25% of the Marine Corps less than 25 years old. 

During the peak of, or just after, their sexual prime, men exposed to potentially traumatic events in a combat theater of operations may find it, or found it, difficult to sexually perform.  This may be true even if the veteran, or service member, doesn’t have fully actualized or diagnosed PTSD.  Data on female veterans with combat-related PTSD is more limited, yet it suggests they experience similar difficulties.    

Many PTSD symptoms prevent the feeling of pleasure, closeness, and trust.  The numbness and/or irritability that develops can result in a lack of desire for touch or emotional connectivity of any kind, even with someone they know loves them. 

There is a competing desire for being alone while also needing to know that someone cares is present.  Recognizing those two contradictory longings and simultaneously being able to effectively communicate them, is a tall order.  How might you tell someone you love, ”I need you but I don’t want you, I can’t have you, near me right now,” without causing damage to the relationship?          

For those not in a relationship, this need can manifest, conversely, as hyper sexual activity.  The longing for connection and alleviation from loneliness, especially in the age of dating apps and easy superficiality, is achieved temporarily with no actual reprieve.

Yet, sex acts as powerful reinforcement. The loneliness is both abated, even if just for a moment, and orgasm is a reward in and of itself.  Therefore, breaking the cycle, reconditioning, or interrupting this learning pattern poses a whole other host of challenges.  So yes, sex is great but it can eventually prevent the formation of a meaningful connection.           

The broken ‘vet’ stereotype aside, there are pronounced Western societal expectations of masculinity and virility when it comes to our fighting men (and women, for that matter). With PTSD already a highly stigmatized disorder and diagnosis, sexual dysfunction may feel particularly like insult to injury and impact already unstable self-esteem

Moreover, these changes in self-esteem can be enduring. Meaning, once the physiological reasons for the dysfunction resolves, the emotional and psychological damage accrued might persist, perpetuating the issue.  Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality, and good sexual health results in better quality of life.  The opposite is equally true.                                                                                                                                       For many veterans and service members, having a conversation about sexual performance is laden with shame.  Expressing difficulties with sex feels tantamount to acknowledging weakness, failure, and emasculation.  Conversely, the spouse might feel unattractive, unwanted, or undesirable.  The path towards healing appears fraught with opportunity to misstep and create more problems.  Yet, having that very conversation is the first step towards improving intimacy and connection.

To the service member or veteran: if you are struggling with sexual dysfunction, you are not alone.  What you are experiencing is a very real side effect, a cost, of war.  And, there is help and hope.  In a perfect world, the healthcare providers in your life would initiate the conversation.  In the absence of that perfection, embrace the mindset that led you to serve in the first place. Be bold. Get after it…so you can get after it.

To the spouse: it’s not you or about you.  Be patient and understanding.  This is not to invalidate your experience. You have your own burdens to bear which deserves its own post.  However, when your partner is struggling, attempt to be peace, instead of another battle to be fought.  A healthy sex life is essential. The first step towards that may be a gentle conversation during a calm moment about re-connection and seeking assistance together.           

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