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Interactive Toolkit Please download this PDF to your device and then open it using Adobe Reader. Depending on your browser, if you try to navigate through it in this browser window now, you may or may not have functionality due to browser variability. Click to start 2015 TOOLKIT Sex in the Military Toolkit: The Other Invisible Wounds RESEARCH OVERVIEW VIDEO VIGNETTES ACTIVITY HELP ATTENTION: Before proceeding, be sure you are using the most recent version of Adobe Reader to ensure you can access the videos and all functionality of this interactive toolkit. (Version 9.0 or above required) Please update your browser, as well if you are having difficulties. This course is most efficiently used on a desktop device. Mobile and tablet devices may not be fully supported. Thank you. Sex in the Military Toolkit: The Other Invisible Wounds RESEARCH OVERVIEW VIDEO VIGNETTES ACTIVITY HELP WELCOME BEHAVIORAL HEALTH PROVIDER! The Center for Innovation and Research on Students in an undergraduate or graduate Veterans & Military Families (CIR) of the social work or other behavioral health University of Southern California School of degree program are a secondary audience. Social Work is dedicated to strengthening the These materials are designed to be transition of veterans and their families into readily used by faculty in such academic the community. An important facet of this programs, and integrated with other transition involves the intimate relationship educational materials. and the integration of the service member back into family life. CIR developed this Focus. While sexual functioning toolkit to help behavioral health practitioners problems can occur in both military and address some of the sexual and intimate civilian populations, this toolkit focuses on relationship challenges that injured service the unique features within the military that members, veterans, and their spouse/partner can impact sexual functioning. Service may experience. members are exposed to physical and psychological challenges that can lead to or Target Audience. The toolkit materials exacerbate sexual functioning and intimacy were designed for social workers, but problems. While this toolkit does not provide are applicable to other behavioral comprehensive training related to sexual health practitioners, such as nurses and functioning and military populations, it aims psychologists, who work with or plan to work to increase your awareness and knowledge with military populations and/or those who of these issues so that you will be better are at risk for sexual functioning problems. prepared to address them in a clinical setting. WELCOME Page 1 Sex in the Military Toolkit: The Other Invisible Wounds RESEARCH OVERVIEW VIDEO VIGNETTES ACTIVITY HELP How the Toolkit Helps You Components. This toolkit includes the Thank you for your commitment to service (Learning Objectives) following main components. members, veterans, and military families! Using this toolkit, you should be able to: For additional information about this project, • Research Overview. A brief research-based please visit: • Recognize salient issues related to background of the issues presented. http://cir.usc.edu/research/research-projects/ intimacy and sexual functioning in military • Video Vignettes Activity. Three video sexual-functioning. personnel, veterans, and their intimate vignettes of a client/patient interaction partner. with supporting materials for background • Identify communication strategies for and discussion, as well as communication Sherrie L. Wilcox, PhD, CHES talking with patients about sexual and intervention strategies. Research Assistant Professor functioning. • CIR Policy Briefs. CIR’s recommendations Principal Investigator, Sex & the Military: The Other Invisible Wounds • Recognize intervention strategies for for policy change related to sexual patients with sexual functioning issues, and functioning issues in the military, and what when to refer to other clinical personnel. can be done to help effect change. • Recognize the need for policy change • Resources and References. Additional in the area of sexual functioning and resources for working with clients with the military, and identify strategies to sexual functioning issues, references used champion this change. to compile the toolkit, and suggestions for further reading. WELCOME Page 2 Sex in the Military Toolkit: The Other Invisible Wounds RESEARCH OVERVIEW VIDEO VIGNETTES ACTIVITY HELP RESEARCH OVERVIEW Importance of Sexual Functioning 2008; U.S. Department of Defense, 2014; & Gonzalez, 2013; Sharma, Webster, Warden, 2006). Recent research indicates Kirkman-Brown, Mossadegh, & Whitbread, Sexuality and sexual functioning have been that approximately 17-19% of service 2013; Woodward & Eggertson, 2010). described as an “integral part of human life” members return home from combat with at (Satcher, 2001). An individual’s sexual health least one physical injury (Afari et al., 2009; Urotrauma encompasses not only the absence of disease and dysfunction, but also physical, emotional, Urotrauma involves injury to the genitourinary mental, and social well-being (World Health (GU) system, which includes the genitals, Organization, 2014). In military populations, bladder, urinary tract, and kidneys, and sexual functioning has been highlighted as an results primarily from IEDs. It is believed that important issue due to the increased exposure Approximately“ 17-19% of approximately 12% of war injuries sustained to risk factors and the high likelihood of service members return home during recent operations involved GU injury experiencing sexual functioning problems from combat with at least one (Woodward & Eggertson, 2010). Data (Mulligan & Moss, 1991; Wilcox, Redmond, physical injury. from the Joint Theater Trauma Registry has & Hassan, 2014). indicated that approximately 5% of battle trauma injuries involve GU injury (Serkin Combat and Physical Injuries et al., 2010; Waxman, Beekley, Morey, & Baker et al., 2009). The unique nature of the Soderdahl, 2009). Among men fighting in Advanced technology, medicine, and most recent conflicts in Iraq and Afghanistan, Iraq and Afghanistan, loss of genital or penile equipment have boosted military survival including the heavier reliance on dismounted tissue is of great concern and has been rated rates. Despite a lower death rate, many patrol and the overwhelming presence of by service members as more important than service members return home both physically improvised explosive devices (IEDs), has given other lower limb extremity injuries (Lucas, and psychologically injured (Gawande, rise to a substantial increase in the presence Page, Phillip, & Bennett, 2014; D. Rosen, 2004; Goldberg, 2010; Tanielian & Jaycox, of urotrauma (Ficke et al., 2012; Han, Edney, 2013; Wood, 2012). Although the American RESEARCH OVERVIEW Page 3 Sex in the Military Toolkit: The Other Invisible Wounds RESEARCH OVERVIEW VIDEO VIGNETTES ACTIVITY HELP Urologic Association (AUA) has recently disorder, primarily posttraumatic stress sexual functioning problems as a result developed detailed guidelines for the medical disorder (PTSD) or depression (Hoge et al., of psychological injuries among military 2004; Tanielian & Jaycox, 2008). Although personnel also lack adequate and widely treatment of these injuries (Morey et al., there is a dearth of research on sexual available treatment. Currently, treatment 2014), the long-term impact remains functioning in military populations, available strategies within the military and Department understudied, despite the potential effects on research indicates that approximately 80% of Veterans Affairs (VA) health care systems the service member’s psychological, sexual, of those with PTSD also suffer from sexual are largely focused on pharmacological and and reproductive functioning. Recent research functioning problems (Cosgrove et al., 2002; medical treatments for erectile dysfunction, indicates that male military personnel with a Letourneau, Schewe, & Frueh, 1997). The genital injury are 9-32 times more likely to rates are likely elevated in those who take have sexual functioning problems than those certain medications for depression and without a genital injury (Wilcox et al., 2014). PTSD, due to the side effects of reduced sexual desire and arousal difficulties (R. Psychological Injuries and Sexual 30% of male“ military C. Rosen, Lane, & Menza, 1999). Recent personnel report symptoms Functioning research indicates that over 30% of male of erectile dysfunction and In addition to the physical wounds of war, military personnel report symptoms of erectile 8.45% report symptoms of service members are at risk for psychological dysfunction and 8.45% report symptoms of sexual dysfucntion. injuries. Upwards of 30% of service members sexual dysfunction (Wilcox et al., 2014). return home suffering from a mental health Additionally, male military personnel with mental health problems, including PTSD, despite the presence of a variety of sexual depression, and anxiety, are 5-30 times functioning issues among men and women, more likely to have problems with sexual and the availability of various forms of functioning than those without mental health treatment. Military personnel with sexual problems (Wilcox et al., 2014). functioning problems are more likely to have Approximately“ 80% of those lower quality of life and lower happiness than with PTSD also suffer from Lack of Treatment those without sexual functioning problems sexual functioning problems. Similar to the lack of widely available (Wilcox et
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