MichaelMoore.com

Intimacy an issue for wounded vets

Associated Press

WASHINGTON - When B.J. Jackson lost both his legs to an Iraq war injury, his doctors talked about a lot of things, but they didn't mention how it might affect his sex life.

Jackson's less-bashful wife brought it up. But even then the couple didn't get the answers they sought.

Jackson and his wife, Abby, say it is time to get the issue out in the open in military medical settings and at home. And they got a lot of agreement at a conference last week, billed as the first of its kind, that focused on wounded American troops and intimacy with their partners - in the bedroom and outside it.

For many Americans, this is no minor matter.

About 3,000 of the 30,000 troops wounded in Iraq and Afghanistan have suffered major physical impairment, said former Republican Sen. Bob Dole of Kansas, who served last year on a presidential commission that examined the treatment of wounded war veterans. Dole, who lost full use of his right arm to a combat injury during World War II, was among the speakers at the Washington conference.

Military veterans who have lost a quality-of-life function, such as sexual ability, should be given quality-of-life compensation in addition to other payments, Dole said, because the magnitude of their disabilities will fully sink in as they age.

The problem is plenty serious at any age, said Mitchell S. Tepper, assistant project director at the Center of Excellence for Sexual Health at the Morehouse School of Medicine in Atlanta, which organized the conference.

Tepper said badly injured patients are plenty interested in the subject, even if they might be shy about asking. He said that studies of people with spinal cord injuries indicate that some rank the desire to have sexual relations above the ability to walk again.

Healthy intimate relationships add meaning to life and can aid in recovery from other injuries, Tepper said. And the loss of a relationship can be detrimental, even a factor in suicide.

As for injured American troops, keeping feelings bottled up can be a problem for any couple, said Jackson, 26.

"My feeling is, the sooner it's discussed and the more it's discussed, the more chance of having less arguments, less confusion, less frustration," Jackson said in an interview.

"The more you communicate among yourselves, the better off you'll be, instead of, 'Well, I'm mad, so I'm just going to roll over.'"

The Jacksons' appearance Wednesday underscored the painful aftermath of war and stood as a stark reminder this Memorial Day of the sacrifices borne by many soldiers, veterans and their families. More than 30,000 troops have been wounded in Iraq and Afghanistan, more than half of them 24 years old and under at the time.

"Most of us go through this transition from able-bodied to disabled, and it's tough," said Dole. "And I worry about these young men and women … who are 17, 18, 19, because I don't think it's really going to hit them until they're 20, 25, 30 years of age."

For the injured veterans, questions of self-worth and a fear of rejection because of physical or other changes they have undergone can form barriers in their relationships.

Doctors often are not bringing up sex, Tepper said, but patients are not always asking about it either.

"There's this gap where the doctors know that it's an issue but don't feel they're prepared or if it's appropriate to ask about it," Tepper said. "Patients, it's on their mind, but they're not talking about it. They're afraid."

Experts say that issues of sexual intimacy do not affect just the relationships of Iraq and Afghanistan veterans with physical wounds, but also those who come home with mental health problems.

A recent Rand Corp. study estimated that about 300,000 of the 1.6 million troops who have served in the recent wars have symptoms of major depression or post-traumatic stress disorder. About one in five said they might have experienced a traumatic brain injury while deployed.

Psychological and neurological disorders can interfere with behaviors necessary for successful intimacy, such as experiencing and expressing emotion and understanding someone else's needs, the study noted. And anger and aggression, including domestic violence, have been associated with mental disorders.

According to the Veterans Affairs Department's National Center for Post Traumatic Stress Disorder, sexual dysfunction tends to be higher in combat veterans with post-traumatic stress disorder than in those without.

Jackson, who is from Des Moines, was wounded in Iraq in 2003 while serving in the Iowa Army National Guard. In addition to losing his legs, he suffered burns, post-traumatic stress disorder and had to be heavily medicated. When his wife wanted to be intimate, he initially refused.

His wife said she felt rejected, and went to talk to his doctor with specific questions. She said the doctor just told her that things would get better with time and that she wasn't sure what that meant. She said she and her husband kept talking and were able to work things out.

They now have four children and are adopting a fifth. Two of their children were born after he was wounded. He now works as director of event management for the nonprofit group Coalition to Salute America's Heroes.

She encouraged her husband to join her in publicly discussing the issue with the hope that it can be talked about more frequently.

"I think it's like the hidden secret that everyone wants to know the answer to, but are very fearful of even mentioning it," Abby Jackson said.

Dr. Harold Wain, chief of the psychiatry consultation liaison service at Walter Reed Army Medical Center, said staff members at the hospital are encouraged to bring up questions about sex, but that hearing speakers at the conference such as the Jacksons had convinced him that even more needs to be done to address the subject.

He said it is common for patients to question how their appearance is perceived, whether they can perform sexually, and whether they will be loved again.

"What you want to do is give back to the injured person the sense that they are whole and they have appropriate behavior patterns and they can be loved for who they are," Wain said.