Trauma, whether physical or psychological, can affect the emotional and sexual relationships of wounded warriors and their partners. As a caregiver, you may get so wrapped up in meeting the needs of your wounded warrior that your spouse/partner role becomes overshadowed. The caregiver role and the role as partner demand differing mind-sets and attitudes that often offset each other.
According to the National Spinal Cord Injury Association, sexual intimacy is one of the first areas of a relationship to suffer when a nondisabled spouse takes on a caregiving role. Understanding sexual changes and challenges that your wounded warrior may experience can reduce your anxiety and feelings of inadequacy, hopelessness, and allow you to improve your sexual relationship.
New definitions for sexuality and sexual expression
Redefining your understanding of sexuality and sexual expression can instill hope for reinventing your sexual relationship with your wounded warrior.
- Talk to a sex counselor about methods you and your wounded warrior can use to give and receive pleasure.
- Increase your awareness of your wounded warrior’s body areas not affected by paralysis; some of these areas may be more sensitive and erotic.
- Realize that cuddling and massaging can be highly pleasurable.
- Be creative. Research adaptive equipment.
Sexual challenges of those who have physical and psychological injuries
Depending on the combat injury, sexual behavior, capabilities, and desire differ. Certain injuries may demand changes in sexual habits that require the wounded warrior and his or her partner to be creative.
- Amputation If your wounded warrior has lost a limb or limbs, you both may need to learn to accommodate these injuries.
- Posttraumatic stress disorder (PTSD) Sounds, sights, and smells associated with sex can trigger flashbacks that remind wounded warriors of combat. These symptoms of PTSD can cause wounded warriors emotional distress that may hinder an intimate relationship or sexual activity or lessen the ability to sustain arousal.
- Severe burns Burns can cause painful scarring that may make sexual intimacy challenging for some. Joint immobility or the inability to contract certain lower limbs may cause discomfort for the wounded warrior and his or her partner.
- Spinal cord injury (SCI) After a spinal cord injury, sexual satisfaction usually decreases. When a wounded warrior sustains a SCI, he or she may have to relearn bodily functions. In some instances, sexual responses may diminish, disappear altogether, or become cross-wired with other pelvic responses, such as perspiration or bladder and bowel function.
- Traumatic brain injury (TBI) Certain areas of the brain are important for regulating and controlling particular aspects of sexuality. Wounded warriors with TBI may seem preoccupied with sex, talk about sex at inappropriate times, or demonstrate inappropriate sexual behavior. Although the wounded warrior may appear to have a greater sex drive, the reality may be that the part of the brain that helps hold back these impulses or urges is damaged.
Sexual side effects of medicine
Medications used to alleviate pain associated with physical or psychological injuries can affect sexual desire and performance. According to the American Journal of Nursing, patients who suffer from PTSD or other injuries requiring the use of antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs), may experience sexual dysfunction, specifically in the areas of arousal and orgasm.
Analgesics (also known as painkillers) or psychoactive drugs that stimulate the mind and alter one’s behavior, mood, and consciousness can cause fatigue and have other adverse effects for individuals using the drug.
Excessive alcohol use or any other form of self-medication for wounded or traumatized warriors can significantly affect arousal, desire, erection, and orgasm.
In many cases, medical professionals can assess sexual functioning in post-combat military personnel in the acute or chronic stages of rehabilitation and recovery. During this time, you may wish to talk to your wounded warrior’s doctors and nurses about the adverse effects that your wounded warrior’s medications may have on his or her sexual function.
The importance of communication
The demands that come with caregiving may make it difficult to balance your roles as caregiver and partner. Caregiving can be emotionally, intellectually, and physically challenging. It is normal for these challenges to affect the intimacy of your relationship. You may lack interest in sex due to feelings of fatigue or stress and the emotional pull of what the sexual relationship was before your partner was injured.
According to the Journal of Rehabilitation Counseling, the essence of all relationships, and a necessary component in any mutually satisfying sexual relationship, is communication, especially when one partner has a disability.
Effective communication can be achieved by knowing what is and is not comfortable for your wounded warrior, what capabilities and limitations your wounded warrior may have, and what his or her subsequent problems and tensions are. Do not hesitate to ask questions for fear of offending your wounded warrior. Talking about your concerns with your wounded warrior offers support and provides an opportunity to reassure each other.
When a physical injury affects self-image and the ability to be sexually intimate, your wounded warrior may question his or her identity as a man or a woman. Communication is crucial to overcoming these negative self-images.
Communication with professionals is important too. Talk to your wounded warrior’s doctors, nurses, social workers, and counselors about the possibility of participation in sexual or couples therapy, sexual rehabilitation, and counseling to learn alternative methods of sexual intimacy and to enhance your relationship with your wounded warrior.
Coping with changes in the family with clear communication
For more information about sexual intimacy for military family caregivers and wounded warriors, contact your local Military Chaplain’s Office or Soldier and Family Assistance Center (SFAC). Contact your local Army installation’s SFAC for information about support groups and caregiver support services. For additional information on caregiving, visit the VA Caregiver Support website.
- Center for the Study of Traumatic Stress. Physical Injury and Intimacy: Helping Wounded Warriors and Their Loved Ones Manage Relationship Challenges and Changes. Department of Psychiatry, Uniformed Services University.
- De Rios MD, et al. 1997. Sexual dysfunction and the patient with burns. J Burn Care Rehabilitation, 18(1 Pt 1): 37-42.
- Elliott, S. 2006. Problems of sexual function after spinal cord injury. Progress in Brain Research, 152, 387-99.
- Farrow, J. 1990. Sexuality counseling with clients who have spinal cord injuries. Rehabilitation Counseling, 33(3): 251-59.
- Katz, A. 2008. Postcombat Sexual Problems. American Journal of Nursing, 108(10): 35-39.
- Kotler M, et al. 2000. Sexual dysfunction in male posttraumatic stress disorder patients. Psychother Psychosom, 69(6): 309-15.
- Rehabilitation Research and Training Center on Aging with Spinal Cord Injury. Intimacy, Relationships, Aging, and Spinal Cord Injury. The National Spinal Cord Injury Association.
Photo 1 provided by the U.S. Department of Defense; photo 2 provided by the Fort Hood Sentinel.