US military is beginning to turns its attention to sexual health too by way of rehabilitating wounded war veterans.
A pivotal conference, Wounded Troops and Partners: Supporting Intimate Relationships, was held in May last in Washington D.C. The conference was the first to embark on a national dialogue on how government leaders, U.S. agencies, healthcare providers, and communities can help wounded troops and their partners develop and maintain healthy intimate relationships. The conference was organized by The Center of Excellence for Sexual Health at Morehouse School of Medicine in Atlanta , under the leadership of former Surgeon General Dr. David Satcher.
According to Dr. Satcher, the issue of sexual health for people with disabilities tends to be a neglected area. "People suffer silently. Wounds are often invisible," stated Dr. Satcher during his opening remarks to the crowd of 70 public and private agency leaders, healthcare professionals, members of the armed services, veterans, and concerned civilians. Dr. Satcher reminded the audience, "We are all sexual beings - we need to spend more time dealing with that - it's an integral part of who we are."
The conference aimed to draw attention to the often overlooked links between mental and physical disabilities - like post traumatic stress disorder (PTSD), traumatic brain injury, and serious burns - with failed intimate relationships that contribute to suicide, divorce and other problems among servicemen and women. "Upward to 80 percent of army suicides can be attributed to failed intimate relationships. It can be the straw that breaks the camel's back," said Dr. Mitchell Tepper, Assistant Project Direct for the Center of Excellence for Sexual Health at Morehouse School of Medicine. "Healthy intimate relationships contribute to recovery from physical and mental trauma, while lack of a satisfying intimate relationship contributes to ongoing mental health problems and suicide," he said.
In a heartfelt keynote address, Lee Woodruff spoke of her husband Bob Woodruff 's recovery from injuries similar to the ones acquired by members of the armed forces in Iraq and Afghanistan . She spoke about the importance of family and faith in healing. Two brave veterans, Dave Roever, a Vietnam War Veteran, and Robert "BJ" Jackson, a double-amputee of the Iraq war, spoke candidly to the attendees about the importance of sexual health and the often awkward process, filled with trial and error, of re-establishing intimate relationships with their spouses.
According to BJ and his wife Abby Jackson, communication is the key to recovery. Early in BJ's recovery, he wondered, "Is my wife going to love me for who I am?" BJ was sedated for several weeks, and said of Abby, "She was right there [for me] when I woke up." According to Abby, BJ's recovery would have been faster if the doctor would have given her a better answer than simply, "It takes time" to her direct question about her husband's hesitation to engage in a sexual relationship with her again. Abby added that intimacy was also hampered by the limitations of BJ's hospital room, including a small bed and a lack of privacy. "People are constantly coming and going from your room. We didn't know the boundaries. Are you allowed to close the curtain?" Abby pointed out that some hospital rooms now have double beds.
Attendees also discussed how important it is to de-stigmatize the need for mental health care, strengthen initiatives around intimate relationships for persons with disabilities, and develop and expand enduring networks of people to serve these populations, according to a press release.
Former Surgeon General Richard Carmona spoke of his experiences of being wounded in Vietnam . Although Dr. Carmona's physical wounds were addressed, "There was no consideration of mental health." Dr. Carmona's son served in Iraq , and "came home devastated." Carmona called for immediate Congressional action so that mental health care has parity with physical health care.
A recent RAND Corporation study estimates that 20 percent of military service members returning from Iraq and Afghanistan experience major depression or post traumatic stress disorder, but due to looming stigma of mental illness, only about half of those seek treatment. The same study revealed that 19 percent of returning troops report experiencing a traumatic brain injury while deployed.
An extensive online assessment tool called eHART has been developed by Sexual Health Network founder Dr. Mitchell Tepper and Chief Operations Officer Kelly J. Ace. It asks extensive and detailed questions about sexual functions, romantic relationships and general health history, then returns information tailored to you and a summary you can take to a health care provider -- if you want. None of the information is shared with anyone else unless you want to share it.
"People are more comfortable revealing sensitive information about sexuality to a computer than to a person," Tepper says. Especially when military approaches to sexual health are often delivered by people without any training in addressing sexual issues.
Tepper cites an example of a servicewoman hospitalized with a spinal injury who had lost her interest in sex. She was asked as part of a routine screening after deployment whether she had experienced sexual trauma during her tour. She said no, even though she had been raped, because she was asked in an impersonal manner in front of other men and women who could overhear her answer. She also did not mention the rape to her doctor -- nor did she receive any counseling or education about sex.
She eventually did tell a psychiatrist about the experience, who then helped her talk to her husband. But her reluctance to report the rape or to ask for sexual information after her injury is common.
Many service members worry that admitting to mental or sexual health issues will negatively affect their military careers. It's especially difficult for young people to publicly address sex, as you don't have a lot of practice in your early 20s talking about relationship and sexual issues with partners, much less with doctors.
Advances in prosthetics and other can provide more mobility and independence for those who acquire a disability during their service (assuming the government will fund this level of care), but no matter how sophisticated the devices, they cannot address the psychological issues that accompany the permanent injuries, writes Regina Lynn in website Wired.
"Technology is allowing us to provide more services and to make services available to more people," says psychologist Barbara V. Romberg, Ph.D., founder of Give an Hour, which matches soldiers and their partners with volunteer mental health professionals. "We can do so many wonderful things we couldn't have done a decade ago. Think of the veterans who came back from Vietnam; they were isolated and alone. Maybe they were lucky to find someone who could help them, but it was so much harder."
Romberg sees a number of ways in which technology is helping troops and their partners cope as they return home. She is talking with one organization that might partner with Give an Hour to create online communities where people affected by the wars can share their experiences and ask questions of others who have gone through similar events.
She also sees great potential in virtual worlds, which are already being used to treat PTSD in veterans, not just of Iraq and Afghanistan, but of Vietnam as well.
The Army has already begun offering telepsychiatry, which offers soldiers therapy over a private web videoconference. In addition to obvious privacy factors, it also enables them to receive therapy over long distances -- even in the field.
"One thing we're all calling for is more training up front, before deployment, to help people deal with this and build up emotional resilience," Tepper says. "I'd like to see sexual health services become more comprehensive, not just offered when someone has an STD or a pregnancy. It should include how people feel about themselves -- the touchy-feely aspects. That's quite important when people start thinking they're no longer capable to be in their role as (partner)."
I'm living proof that virtual spaces can be highly effective in treating sexual trauma, as it was cybersex that healed me from the effects of sexual abuse. They're also an excellent "practice ground" for transitioning back into life as a single civilian and for meeting potential partners who understand what you've gone through, says Regina Lynn.