When compared with the general population, Veterans with posttraumatic stress disorder are at increased risk of sexual dysfunction. A review study published online in the Journal of Sexual Medicine on Feb. 9, 2015, found that male Veterans with PTSD were significantly more likely than their civilian counterparts to report erectile dysfunction or other sexual problems.
Though data were scarce on women Veterans with PTSD, the research does suggest they experience similar issues. Problems such as vaginal pain and disinterest in sex were common among women Veterans in the studies that were reviewed.
"Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality. [It] is a significant predictor of physical and emotional health and overall quality of life," write the researchers, who were based at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, and Argosy University in Chicago.
Given the negative impact of PTSD on physical and emotional health, it isn't surprising that Veterans with PTSD experience increased rates of sexual dysfunction. What is surprising, write the researchers, is the rate at which that dysfunction appears.
"PTSD impairs sexual functioning across multiple domains: desire, arousal, orgasm, activity, and satisfaction," the researchers wrote. The most commonly reported problems were erectile dysfunction, premature ejaculation, and overall sexual disinterest.
In one study, of male combat Veterans diagnosed with PTSD, for example, 85 percent reported erectile dysfunction, compared with a 22 percent rate among male combat Veterans without any mental health diagnosis. Another study of 90 male combat Veterans with PTSD found more than 80 percent were experiencing sexual dysfunction.
The researchers point out that while psychiatric medicines can play a role in sexual dysfunction, Veterans who were not prescribed medication still experience problems, according to the literature.
Military sexual trauma can heighten risk
Combat is not the only trauma experienced in the military. Nearly 24 percent of female Veterans seeking VA health care report a history of military sexual trauma, or MST. In the review study, this group of women displayed negative sexual consequences above and beyond the effects of civilian sexual assault.
Though the researchers say the reason for the differing rates is not yet fully understood, one explanation could be that unlike in civilian situations, survivors of MST often are required to continue working with their attacker. Researchers say this could compound the stress and make them more vulnerable to developing sexual dysfunction.
Moreover, Veterans with PTSD, whether as a result of combat, MST, or both, may also be more likely to misuse alcohol and other illicit substances. This further increases the risk of sexual dysfunction.
Broaching the topic with health care providers
Though the situation is far from ideal, the researchers write that there are avenues to addressing sexual dysfunction among Veterans with PTSD. A prerequisite, though, is that clinicians feel confident and qualified to address the problem.
"Some providers view sexual dysfunction as a medical issue, others as a psychological issue, leading providers to believe it is not within their purview to asses or treat such disorders," write the authors. "Moreover, there is controversy about the qualifications providers should have to treat sexual dysfunction. It has been argued that sexual problems should be addressed solely by those who specialize in sexual issues."
The researchers suggest clinicians and providers first educate themselves so that they feel more confident to treat patients' sexual concerns and, perhaps most importantly, to bring them up at all. While many providers may feel more comfortable waiting for patients to express their concern about sexual dysfunction, according to the research, Veterans consistently report the topic would be easier to broach if their providers initiated the discussion.