Genitourinary injuries can cause long-term physical, psychological scars in military service members


WASHINGTON (FRONTLINE MEDICAL NEWS) – Despite improved surgical procedures aimed at repairing severe genitourinary injuries sustained in the line of duty, such injuries still can have profound long-term psychological effects on military service members, according to a pair of experts who spoke Dec. 11 at the Bob Woodruff Foundation: Intimacy After Injury meeting.

Sherrie L. Wilcox , Ph.D., a professor in the School of Social Work at the University of Southern California, Los Angeles, and head of the school’s Sex & the Military program , said “sexual health” can be defined broadly as sexually related physical, emotional, mental, and social well-being, emphasizing both the absence of dysfunction and disease. Calling sexual health a “vital component of overall quality of life,” Dr. Wilcox cautioned that failure to adequately address those psychological issues can lead to long-term ramifications in service members’ civilian lives. Failure to address these issues predisposes the service members to sexual and marital problems, as well as to illnesses such as depression and posttraumatic stress disorder (PTSD).

Dr. Wilcox was one of two presenters who spoke during a session highlighting the steps necessary to mitigate long-term sexual dysfunction by focusing attention on physical and psychological health. The other presenter was Jean L. Orman, Sc.D., chief of statistics and epidemiology at the U.S. Army Institute of Surgical Research and the Joint Trauma System.

“The wars in Iraq and Afghanistan are distinctive for having the highest rate of survival of wounded combatants in any major military conflict,” Dr. Orman said. “But with that distinction comes an important price: larger numbers of service members surviving with multiple, complex, and often very severe injuries – including genital injuries.”

Citing a review of data from the U.S. Department of Defense Trauma Registry, Dr. Orman explained that 1,291 American male service members have survived genitourinary (GU) injuries sustained in combat; nearly 75% of these men were injured by contact with an improvised explosive device, and the average age of the population was 25 years.

A total of 965 men had injuries to their urinary tracts or genitals, of which 65 sustained severe damage to the penis or penile area. Three service members ultimately lost either their penis, testicles, or scrotum, while others sustained injuries of several other kinds, including bilateral lower extremity amputation and traumatic brain injury (TBI), which occurred in more than 40% of service members with GU injury.

“Injuries this extreme no doubt have a very strong impact on the person who experiences them,” Dr. Orman said. “Unfortunately, if you look for copious literature on any long-term effects [or] outcomes, there really isn’t very much” regarding the urinary, sexual, fertility, social, and psychological aspects of living with severe GU injuries.

Sharing statistics comparing psychological disorders in military service members before and after deployment, Dr. Wilcox showed that 16% of personnel reported psychological injuries predeployment, but that number nearly doubled to 30% of personnel after returning from their tours. Furthermore, 22.4% of male and female service members surveyed who joined the military after Sept.11, 2001, reported having sexual issues upon returning from active duty. More than 30% of male military personnel surveyed reported symptoms of erectile dysfunction (ED), with the probability of PTSD increasing by a factor of 30 in soldiers with ED.

Dr. Orman and her coinvestigators identified 301 service members with GU injury and more than 650,000 without in a study conducted jointly by the Department of Defense and the South Texas branch of the Department of Veterans Affairs (VA) that examined a database of information on all patients seen between 2001 and 2011 who were deployed as part of Operation Enduring Freedom or Operation Iraqi Freedom. TBI and PTSD were reported nearly twice as often by veterans with GU injuries than did those without: 21.9% vs. 9.7% reported having TBI; 40.1% vs 22.6% reported PTSD alone; 9.3% vs. 5% experienced TBI and PTSD, respectively.

Service members who sustained GU injuries more often had several physical afflictions than service members who did not: 46% vs. 27% reported experiencing chronic pain; 12% vs. 2% reported urinary symptoms; 15% vs. 6% reported sexual dysfunction; and 2% vs. 0.4% reported infertility, respectively. Psychological conditions also presented more in GU patients vs. non-GU patients: 19.3% vs. 7.1% reported suffering “major depression”; 19.6% vs. 9.3% reported substance abuse after returning from active service; 3.3% vs. 1.0% reported having a panic disorder; and 77.6% vs. 1.9% said that they had seriously contemplated suicide, respectively.

“We must put these results in perspective,” Dr. Orman stated. “As important as these results might be, they give us just an initial glimpse of the effects of GU injuries, [meaning] our results reflect perhaps just the tip of the iceberg.” Both Dr. Orman and Dr. Wilcox called for more study, particularly since only about 40% of military veterans seek help from the VA, and even within that population, not all who have GU injuries or related psychological conditions would be willing to come forward for help.

“We need to reduce the barriers to care and treatment; we need to close gaps; and we all have to work together to create new best practices in this area,” said Dr. Wilcox in her concluding remarks.

Dr. Wilcox disclosed that funding for the “Sex & the Military” project comes from the California Community Foundation’s Iraq Afghanistan Deployment Impact Fund. Neither presenter reported any other potential financial conflicts of interest.