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Experts: Sex Also a Casualty for War

WASHINGTON - When B.J. Jackson lost both his legs to an Iraq war injury, his doctors talked about a lot of things, but they didn't mention how it might affect his sex life.

Jackson's less-bashful wife brought it up. But even then the couple didn't get the answers they sought.

Jackson and his wife, Abby, say it's time to get the issue out in the open in both military medical settings and at home. And they got a lot of agreement at a conference May 21, billed as the first of its kind, that focused on wounded troops and intimacy with their partners - in the bedroom and outside it.

This is no minor matter.

About 3,000 of the troops wounded in Iraq and Afghanistan have suffered major physical impairment, said former Sen. Bob Dole, who served last year on a presidential commission that examined the treatment of wounded war veterans. Dole, who lost full use of his right arm to a combat injury during World War II, was among the speakers at the conference.

Vets who have lost a quality-of-life function, such as sexual ability, should be given quality-of-life compensation in addition to other payment, he said, because the magnitude of their disabilities will fully sink in as they age.

It's serious at any age, suggested Mitchell S. Tepper, assistant project director at the Center of Excellence for Sexual Health at Morehouse School of Medicine in Atlanta, which organized the conference.

Tepper said badly injured patients are extremely interested in the subject, even if they're shy about asking. He said studies of the general population of people with spinal cord injuries find that some rank the desire to have sex above the ability to walk again.

Healthy intimate relationships add meaning to life and can aid in recovery from other injuries, he said. And the loss of a relationship can be detrimental, even a factor in suicide.

As for injured troops, keeping feelings bottled up can be a problem for any couple, said Jackson, who is 26.

"My feeling is the sooner it's discussed and the more it's discussed, the more chance of having less arguments, less confusion, less frustration," he said in an interview. "The more you communicate among yourselves the better off you'll be, instead of well, 'I'm mad, so I'm just going to roll over.'"

The Jacksons' appearance May 21 underscored the painful aftermath of war and stood as a stark reminder this Memorial Day of the sacrifices borne by many Soldiers, veterans and their families. More than 30,000 troops have been wounded in Iraq and Afghanistan, more than half of them 24 and under at the time.

Said Dole: "Most of us go through this transition from able-bodied to disabled, and it's tough. And I worry about these young men and women ... who are 17, 18, 19, because I don't think it's really going to hit them until they're 20, 25, 30 years of age."

For the injured, questions of self-worth and a fear of rejection because of physical or other changes they've undergone can form barriers in their relationships.

Tepper said doctors often aren't bringing up sex, but patients aren't always asking about it either.

"There's this gap where the doctors know that it's an issue, but don't feel they're prepared or if it's appropriate to ask about it," Tepper said. "Patients, it's on their mind but they're not talking about it. They're afraid."

Experts say issues of sexual intimacy don't affect just the relationships of Iraq and Afghanistan veterans with physical wounds, but also those who come home with mental health problems.

A recent Rand Corp. study estimated that about 300,000 of the 1.6 million troops who have served in the recent wars have symptoms of major depression or post-traumatic stress disorder. About one in five said they might have experienced a possible traumatic brain injury while deployed.

Psychological and neurological disorders can interfere with behaviors necessary for successful intimacy, such as experiencing and expressing emotion and understanding someone else's needs, the study noted. And anger and aggression, including domestic violence, have been associated with mental disorders.

According to the Veterans Affairs Department's National Center for Post Traumatic Stress Disorder, sexual dysfunction tends to be higher in combat veterans with post-traumatic stress disorder than in those without.

Jackson, of Des Moines, Iowa, was injured in Iraq in 2003 while serving in the Iowa Army National Guard. In addition to losing his legs, he had burns, post-traumatic stress disorder, and he was heavily medicated. When his wife initially wanted to be intimate, he refused.

His wife said she felt rejected, and went to talk to his doctor with specific questions. She said the doctor just told her things would get better with time, and she wasn't sure what that meant. She said she and her husband kept talking and were able to work things out.

They now have four children and are adopting a fifth. Two of their kids were born after he was injured. He now works as director of event management for the nonprofit group Coalition to Salute America's Heroes.

She encouraged her husband to join her in publicly discussing the issue with the hope that it can be talked about more frequently.

"I think it's like the hidden secret that everyone wants to know the answer to, but are very fearful of even mentioning it," Abby Jackson said.

Dr. Harold Wain, chief of the psychiatry consultation liaison service at Walter Reed Army Medical Center, said staff at the hospital are encouraged to bring up questions about sex, but hearing speakers at the conference like the Jacksons convinced him even more needs to be done to address the subject matter.

He said it's common for patients to question how their appearance is perceived, whether they can perform sexually, and whether they will be loved again.

"What you want to do is give back to the injured person the sense that they are whole and they have appropriate behavior patterns and they can be loved for who they are," Wain said.



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