DoD studies intimacy issues among combat vets

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Brannan Pedersen was 16, attending a young activists meeting in Alabama when she first spotted Caleb Vines, then 19, an enthusiastic organizer who wanted to change the world.

She fell hard: Three years after their first date, they married. Later, when they watched the World Trade Center fall, Caleb pledged to join the fight: He enlisted in the Army infantry.

He deployed twice to Iraq — a 15-month stint extended by the Battle of Fallujah, then a year filled with bomb blasts and small-arms fire. At one point, a rocket-propelled grenade blasted him through the door of a Humvee.

But he came home seemingly unscathed. During their first reunion, Brannan recalled, Caleb was distant but affectionate. The couple conceived a child.

After his second deployment, however, Caleb changed from easygoing and enthusiastic to withdrawn, angry and forgetful.

Diagnoses of post-traumatic stress disorder and, later, traumatic brain injury followed. It provided an explanation for his symptoms, but that didn't ease the emotional — and physical — gulf between the couple, Brannan said.

"Guys with PTSD have a much harder time being physically close, let alone emotionally close. And from a woman's perspective, you almost require that closeness to be invested in a sexual relationship," Brannan said.

'Elephant in the bedroom'

With an estimated 400,000 veterans of the wars in Iraq and Afghanistan thought to have suffered an injury — either physical or mental — in the combat zones, the Pentagon, civilian behavioral health specialists and military couples are starting to talk about what Brannan calls the "elephant in the bedroom": the fact that both visible and unseen combat injuries are wreaking havoc with the sex lives of service members and veterans.

"So many articles in the popular press tell heartwarming stories of reunion but never mention how these injuries are impacting their sex lives," said Michael Shelton, a sex therapist in Philadelphia who has begun blogging about the issue for Psychology Today.

Shelton has counseled 14 military couples and hopes to reach more through his blog.

"There's just not a lot of information out there," he said.

Sexual dysfunction in wounded warriors stems from various causes. Some troops — nearly 200 in Afghanistan in the past three years alone — have suffered severe or disfiguring injuries to their genitals and groins, making sex a painful physical challenge.

Brain injuries cause some troops to display hypersexuality, expressing inordinate desire and seeking out sex constantly. Yet experts say this often isn't a sign of drive — it's more a reflection of an impaired ability to be discreet.

Victims of PTSD often are disconnected emotionally from other people or feel guilty about aggressive feelings or natural urges, said Laurie Watson, a sex therapist in North Carolina.

On the other end of the spectrum, many medications given to service members to treat their injuries hamper desire.

Then there's the caregiver role. Often, when a spouse shifts from being a partner to caring for and nurturing a wounded warrior, libido drops for both.

"These couples need marital work, and that includes sexual functioning," Watson said. "We're talking about young people in their prime."

Research underway

The issues have military health care experts taking notice. Last year, the Center for the Study of Traumatic Stress in Bethesda, Md., launched "Courage to Talk," an effort to help military doctors and patients communicate on this sensitive topic.

Two studies also are underway at Brooke Army Medical Center in San Antonio and Walter Reed National Military Medical Center in Bethesda to help couples with intimacy issues associated with combat wounds, said Dr. Stephen Cozza, CSTS associate director.

Both studies focus on wounded combat veterans. One involves 30 couples, the other 40 couples.

Experts said couples having problems should first talk to a doctor to see whether a physical factor is involved — low testosterone or some other physiological issue.

Then they should consider talking to a therapist who can counsel them about expectations. If a regular therapist doesn't help, seek one who is a member of the American Association of Sex Counselors and Educators, Watson and Shelton advised.

"Often, men are used to having a sexual urge and satisfying it, while women have to start being intimate before desire kicks in," Watson said. "After an injury, a man's reaction is often similar to a woman's. They need to be taught that they should connect physically and the desire will follow."

Suffering in silence

Many couples often suffer in silence, a situation that experts find heartbreaking. Watson gave a class Jan. 10 at Camp Lejeune, N.C., to 12 therapists, discussing the topic, and said she wishes she could do more such sessions.

Shelton said it's a tremendous emotional and physical challenge for many young military couples to try to face the problems alone, recalling one particular young couple in their early 20s: "He'll have a colostomy bag all his life. She didn't plan to be a caregiver."

Cozza said he expects data and information from the CSTS intimacy studies to trickle down in the coming year, helping military physicians become better versed in helping their wounded patients develop deeper levels of intimacy.

"Many health care professionals have accessed information from CourageToTalk.org," Cozza said. "We're encouraged by that."

Brannan, founder of FamilyofaVet.com, a website for those who have a family member with TBI or PTSD, urged spouses not to give up.

Now 31, she admits there have been times when she wanted to leave, but she agreed to stay when Caleb, 34, promised to seek help. They're working on it — and it is getting better, she said.

"You have to give it time," Brannan said. "Definitely, we have less sex than we used to. But when we do, it's good sex."

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