Intimacy Post-Injury: Combat Trauma and Sexual Health

ISBN : 9780190461508

Elspeth Cameron Ritchie
248 Pages
156 x 235 mm
Pub date
Dec 2016
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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.


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

About the author: 

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.

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