Sexual Health Problems among Service Men: The Influence of Posttraumatic Stress Disorder

ABSTRACT

Military operational stressors, such as combat exposure, may increase the risk of sexual health problems. This study examined factors associated with sexual health problems, and tested the mediating effect of probable posttraumatic stress disorder (PTSD) on the association between stressors (i.e., combat deployment and sexual assault) and sexual health problems among U.S. service men. Using multivariable logistic regression (n = 16,603) and Cox proportional hazards models (n = 15,330), we estimated the risk of self-reported sexual health difficulties and sexual dysfunction medical encounters, respectively. Mediation analyses examined the effect of probable PTSD as an intermediate factor between high combat deployment and sexual assault on sexual health problems. Approximately 9% endorsed sexual health difficulties and 8% had a sexual dysfunction. Risk factors for these sexual health problems included older age, lower education level, enlisted rank, disabling injury, certain medical conditions, and higher body mass index. Probable PTSD significantly mediated the associations between high combat with sexual health problems and sexual assault with sexual dysfunction. Additionally, high combat was directly associated with sexual health difficulties. These findings indicate a relationship between these stressors and sexual health problems which suggests that treatment options should be expanded, especially to include psychogenic sexual dysfunctions.

Acknowledgments

In addition to the authors, the Millennium Cohort Study Team includes Satbir Boparai, MBA; Felicia Carey, PhD; Toni Rose Geronimo, MPH; Isabel Jacobson, MPH; Rayna Matsuno, PhD; Deanne Millard; Chiping Nieh, PhD; Teresa Powell, MS; Ben Porter, PhD; Anna Rivera, MPH; Rudolph Rull, PhD; Beverly Sheppard; Daniel Trone, PhD; Jennifer Walstrom; and Steven Warner, MPH. The authors also appreciate contributions from the Deployment Health Research Department, Millennium Cohort Family Study Team, Birth and Infant Health Research Team, and Henry M. Jackson Foundation. We greatly appreciate the contributions of the Millennium Cohort Study participants.

Disclaimer

I am a military service member or employee of the U.S. Government. This work was prepared as part of my official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. Report Number 20-88 was supported by the Military Operational Medicine Research Program, Defense Health Program, and Veterans Affairs under work unit no. 60,002. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government. The study protocol was approved by the Naval Health Research Center Institutional Review Board in compliance with all applicable Federal regulations governing the protection of human subjects. Research data were derived from an approved Naval Health Research Center Institutional Review Board protocol, number NHRC.2000.0007.

Data Availability Statement

The datasets analyzed during the current study are not publicly available due to institutional regulations protecting service member survey responses but are available from the corresponding author on reasonable request (may require data use agreements to be developed). Additional information available at https://www.millenniumcohort.org/research/collaboration.

Declaration Of Conflicting Interests

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

Funding

The Millennium Cohort Study is funded through the Defense Health Program, U.S. Department of Veterans Affairs Office of Research and Development, and the U.S. Department of Veterans Affairs Office of Patient Care Services under work unit no. 60002. The funding agency had no part in the study design, collection of the data, analysis of the data, or writing of manuscript. No financial disclosures were reported by the authors of this paper.