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The Sexual Consequences of Polytrauma
Stanley Ducharme, Ph.D.

Polytrauma is the most commonly observed medical condition among our returning soldiers from the Iraq war. Some researchers have estimated that up to 10% of all returning soldiers have symptoms associated with this disability, which often includes some degree of brain injury. As we have heard so often in the media, polytrauma has been described as the signature injury of the war against terror. However, in spite of its frequent occurrence, few professionals and few rehabilitation centers seem knowledgeable in addressing the sexual and relationship issues associated with Polytrauma.

On the battlefield, polytrauma typically occurs when soldiers are exposed to high-pressure waves, explosive fragments and falling debris from explosions. The affect on the brain is similar to that of shaken baby syndrome where delicate nerve endings and neurons are smashed against the bony prominences of the skull. For the soldier, these blasts often result in a wide range of clinical symptoms typically associated with post concussive syndrome. These include headaches, dizziness, impulsiveness, social inappropriateness, blurred vision, diminished organizational abilities and memory deficits.

Polytrauma also has sexual implications! It is a devastating condition affecting multiple bodily functions including those systems that are responsible for physical intimacy, communication and emotional well-being. Although seldom reported, male soldiers who have suffered from polytrauma, have significant difficulties in their sexual functioning as well. In addition to the profound neurologic issues and severe psychological distress, they experience changes in their enjoyment of sex, altered sexual drive, poor erectile functioning and a lack of ability to experience orgasm.

For any man, this combination of problems can lead to feelings of inadequacy and failure. Typically however, additional issues complicate the situation. Other factors such as depression, fatigue, pain and medications can exacerbate the sexual effects. Finally in addition to brain injury, these same individuals often have other serious medical conditions such as amputations, paralysis, burns or post-traumatic stress disorder. All are certain to interfere with sexual functioning, body image and emotional stability.

To my knowledge, no research has been done on the sexual effects of polytrauma on returning female soldiers. However, there have been some reports on the sexual consequences of brain injury on women. One study, conducted by Dr, Mary Hibbard at Mount Sinai Hospital in New York, has reported that women also experience sexually related physical and psychological difficulties after brain injury or post-concussive syndrome. For these women, diminished sexual drive, poor lubrication and an inability to experience orgasm are commonly reported as well. Sexual activity can be painful, lacking in pleasure and unsatisfying to both members in the relationship.
Relationship Issues

Wounded soldiers and their partners are increasingly finding themselves adjusting to the impact of these symptoms on their relationships and marriages. Although genitals may not be injured in cases of polytrauma, damage to the brain can lead to problems both in sexual functioning and interpersonal relations. As a result of the brain injury, expressing sexual feelings is often confusing, awkward and sometimes inappropriate. For example, sexual needs can either be ignored or demanded from their spouse or partner. At other times, there may be a lack of sensitivity and caring.

Many partners feel that their husband or boyfriend has changed after experiencing the symptoms of polytrauma. Often, returning to work or helping with the family can be major challenges. For the couple, these devastating injuries make communication, physical intimacy and emotional closeness all daunting experiences. Many men report that they don’t enjoy sex after injury since their sexual performance is so unpredictable. In such situations, most men would rather avoid sex than experience a failure. As a result, statistics have shown that divorce rates in this population are far above the national average.

In December of 2007, I joined other professionals and organizations at Walt Disney World in Florida, where a special program was held for wounded soldiers and their families. Our goal, as rehabilitation professionals, was to assist couples in the transition back to civilian life. Fortunately, educational workshops on sexual adjustment after polytrauma were on the agenda and were well attended by wounded soldiers and their partners.

In the sexuality workshops we conducted, soldiers and their partners repeatedly expressed difficulties in their relationships and the inability to discuss these matters. Communication about sexual concerns is a universal problem. In addition, behaviors such as inappropriate sexual demands and sexual pre-occupations were described as frightening to most partners and spouses.

For other soldiers, there was little interest in sex. Time after time, these couples described feeling alone in trying to rebuild a relationship that had been shattered by physical and emotional trauma. Not surprisingly, most couples just didn’t know where to begin. They felt embarrassed and overwhelmed.

Information about sexuality has always been difficult to obtain after spinal cord injury, brain injury or any disability. Sexuality has always been a private matter in which professionals feel uncomfortable and have little training. For veterans suffering from polytrauma, it is no different.

Quality of life, relationship and sexuality issues are still not, being addressed within most service connected and private rehabilitation facilities. Individuals with polytrauma seldom hear anything about these issues. Early after injury, while individuals are still in rehabilitation centers, sexual concerns are simply not perceived as a priority. As a result, couples face these issues alone, long after professional services have ended.

The sexual consequences of polytrauma are slowly becoming recognized. Although difficult to find, there are programs and professionals who are familiar with the psychological, relationships and sexual problems associated with polytrauma. Increasingly, rehabilitation programs for wounded returning soldiers are realizing that sexual and relationship issues must be addressed.

As services are being mobilized, family members need to be proactive in demanding and locating professionals who can diagnosis these problems and can provide medical, services, counseling and medications for the sexual side effects of polytrauma. These intimate relationship issues are too important to ignore.

Contact: Readers may send questions anonymously to Dr. Ducharme via the contact page of this web site.

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