Intimacy Post-Injury

Combat Trauma and Sexual Health

Elspeth Cameron Ritchie

The first volume to gather what is known about sexual health issues in returning military service members
Raises awareness of importance of clinician-patient communication about this sensitive and often taboo subject
Discusses sexual dysfunction in both male and female service members
Uses composite case studies, based on real human stories, to illustrate teaching points

Intimacy Post-Injury

Combat Trauma and Sexual Health

Elspeth Cameron Ritchie

Description

Since September 11 2001, or "9/11", approximately 2.7 US million service members have served in the wars in Afghanistan and Iraq. Many thousands have been wounded, with injuries ranging from mild to severe. PTSD (post traumatic stress disorder) and TBI (traumatic brain injury) have been called the "signature wounds" of war. The psychological injuries of war, PTSD and related co-morbid conditions, lead to feeling isolated from others, which directly affects intimate relationships. TBI (traumatic brain injury) is also a very common injury from these past decades of war. The treatment of PTSD and TBI involves medications that often have sexual side-effects, such as erectile dysfunction and loss of libido, weight gain, ejaculatory delay, and sedation.

The bomb blast has been the "signature weapon" of these conflicts. Service members wear helmets and body armor, which covers their torsos. Thus blasts primarily effect the lower exposed areas of the body, including the extremities and pelvic region. Numerous service members have lost one or both legs, and in some cases arms.
Because of the blast, many have lost part or all of their genitalia, their penis or testes. This loss directly impacts sexual functioning and fertility. The bomb blast or other weapons may also burn and scar faces and hands. Pain from these injuries and subsequent surgeries is a constant theme. Sexual difficulties contribute to relationship difficulties, domestic violence, and suicide.

Less well recognized is the impact of toxic exposures on sexual health. All wars are environmentally dirty. Agent Orange is the best known toxic agent from Vietnam. Anti-malarial agents, used in Iraq and Afghanistan, cause a host of neuropsychiatric effects. Sexual assault is another type of toxic exposure.

Thus there are a host of ways that exposure to combat can affect intimacy, sexual functioning and fertility. Fortunately there are many strategies to mitigate these negative effects, which are covered in detail in this book.

Intimacy Post-Injury

Combat Trauma and Sexual Health

Elspeth Cameron Ritchie

Table of Contents
Contributors
Introduction and Overview
1. A Brief Overview of the Effect of War Injuries on Sexual Health and Intimacy
Kathryn Ellis
2. Intimacy versus Isolation: A Psychodynamic Clinical Reflection on Physically Injured Military Patients
Joseph Wise
3. The Role of Sympathetic Nervous System in PTSD-related Male Sexual Dysfunction: Clinical Evidence and Related Interventions
Eugene Lipov
4. Sexual Health and Intimacy in the Military: A Contextual Framework
Glenn Parkinson, Martin Chin
5. Training Health Care Providers to Deal with Sexual Health and Intimacy Issues
Hani Miletski
6. Psychosocial Issues Related to Genito-urinary Injury
Suzanne Waddingham
7. Strategies, Modifications, and Adaptations for Intimate Relationships and Sexual Activity
Kathryn Ellis
8. PTSD and Sexual Intimacy
Jennifer Greenberg
9. Side-effects of Medications and Mitigation Strategies
John Burger
10. Psychological Aspects of Infertility Post-Injury
Laura Covington
11. Understanding Failed Relationships as a Factor Related to Suicide and Suicidal Behavior among Military Personnel
Jackie Garrick
12. Intimacy After Intimate Partner Violence
Glenna Tinney, April Gerlock
13. Intimacy After Sexual Violence
Glenna Tinney, April Gerlock
14. Toxic Exposures from Service in the U.S. Military: Effects on Reproductive and Sexual Health
Remington Nevin, Elspeth Cameron Ritchie
15. Genital Injury and the Psychiatric Consult Liaison Service
Harold Wain, Lisa Young
16. Evolution of Sexual Trauma Treatment in the Military: Experience of a Psychiatric Partial Hospitalization Program
Raymond Lande, Sawsan Ghurani, Cara N. Burton, Kerrie Earley
17. Way Ahead: Reconstructive Transplantation as an Emerging Option for Penile Restoration
Sami Tuffaha, Gerald Brandacher, Richard Redett

Intimacy Post-Injury

Combat Trauma and Sexual Health

Elspeth Cameron Ritchie

Author Information

Elspeth Cameron Ritchie, Uniformed Services University of the Health Sciences, Georgetown University School of Medicine, Howard University College of Medicine, George Washington School of Medicine and Health Sciences

COL Ritchie retired from the Army in 2010 after a distinguished career, culminating with a position as the Army's top psychiatrist. She has written and lectured extensively on military mental health and women's health issues. She is now the Chief of Mental Health for the Community Based Outpatient Clinics at the Wash VA. She frequently serves as a subject matter expert on military and veterans mental health issues.

Contributors:

Gerald Brandacher, MD
Department of Plastic and Reconstructive Surgery
John Hopkins School of Medicine
Baltimore, MD, USA

John Burger, LCDR, MC, USN
1st Marine Regiment
1st Marine Division
Camp Pendleton, CA, USA

Cara N. Burton, LCSW
Walter Reed National Military Medical Center
Department of Psychiatry
Psychiatry Continuity Service
Bethesda, MD, USA

Martin S. Chin, MD
Sinai Hospital of Baltimore
Baltimore, MD, USA

Laura S. Covington, MSW, LICSW
Shady Grove Fertility
Rockville, MD, USA
Bryn Mawr College
Graduate School of Social Work and Social Research
Bryn Mawr, PA, USA

Kerrie Earley, LCSW
Walter Reed National Military Medical Center
Department of Psychiatry
Psychiatry Continuity Service
Bethesda, MD, USA

Kathryn Ellis, MOT, OTR/L
Department of Rehabilitation
Walter Reed National Military Medical Center
Bethesda, MD, USA

Jacqueline Garrick, LCSW-C
Department of Defense
Arlington County, VA, USA

April Gerlock, PhD, ARNP, PMHNP-BC, PMHCNS-BC
University of Washington School of Nursing
VA Puget Sound Healthcare System
Seattle, WA, USA

Sawsan Ghurani, MD, CAPT, USN
Walter Reed National Military Medical Center
Department of Psychiatry
Psychiatry Continuity Service
Bethesda, MD, USA

Jennifer H. Greenberg, LICSW, LCSW-C

R. Gregory Lande, DO, COL, USA (ret)
Walter Reed National Military Medical Center
Department of Psychiatry
Psychiatry Continuity Service
Bethesda, MD, USA

Eugene Lipov, MD

Hani Miletski, PhD, MSW
AASECT Certified Sex Therapist, Supervisor
Private Practice
Bethesda, MD, USA

Remington L. Nevin, MD, MPH
Department of Mental Health
John Hopkins Bloomberg School of Public Health
Baltimore, MD, USA

Glenn W. Parkinson, MSW
Private Practice
Washington, DC, USA

Richard Redett, MD
Department of Plastic and Reconstructive Surgery
John Hopkins School of Medicine
Baltimore, MD, USA

Patcho N. Santiago, MD, MPH
Walter Reed National Military Medical Center
Bethesda, MD, USA

Glenna Tinney, MSW, ACSW, DCSW, CAPT, USN (ret.)

Sami Tuffaha, MD
Department of Plastic and Reconstructive Surgery
John Hopkins School of Medicine
Baltimore, MD, USA

Suzanne M. Waddingham, RN, BSN
Navy Marine Corps Relief Society
Combat Casualty Program Visiting Nurse
Arlington, VA, USA

Harold J. Wain, PhD
Walter Reed National Military Medical Center
Bethesda, MD, USA

Joseph E. Wise, MD
Major, Medical Corps, US Army
Walter Reed National Military Medical Center
Bethesda, MD, USA

Lisa C. Young, MD
Walter Reed National Military Medical Center
Bethesda, MD, USA