Bryn Mawr College Scholarship, Research, and Creative Work at Bryn Mawr College Bryn Mawr College Dissertations and Theses 2018 Combat-Related Reproductive Trauma: Implications for Quality of Life and the Reproductive Narrative Laura S. Covington Bryn Mawr College, [email protected] Follow this and additional works at: https://repository.brynmawr.edu/dissertations Part of the Social Work Commons Custom Citation Covington, Laura S. "Combat-Related Reproductive Trauma: Implications for Quality of Life and the Reproductive Narrative." PhD Diss., Bryn Mawr College, 2018. This paper is posted at Scholarship, Research, and Creative Work at Bryn Mawr College. https://repository.brynmawr.edu/dissertations/188 For more information, please contact [email protected]. Combat-Related Reproductive Trauma: Implications for Quality of Life and the Reproductive Narrative by Laura S. Covington March 2018 Submitted to the Faculty of the Graduate School of Social Work and Social Research of Bryn Mawr College in partial fulfillment of the requirements for the Degree of Doctor of Philosophy COPYRIGHT 2018 Laura S. Covington Copyright Notice: The dissertation submitted as part of the requirements for a degree is the property of the College. However, the author of the dissertation owns and retains the copyright in the dissertation, without further registration formalities. ii Abstract Little research exists on the experiences of a combat-related injury that impairs fertility. This dissertation is a qualitative exploration of the lived experiences of military members after a genitourinary (GU) injury. It addresses the biological, psychological, and social impact on quality of life during recovery and subsequent attitudes about family development and sexual functioning. Building on both the life course perspective and the reproductive story model, this dissertation reviews literature on military culture, GU injury, and infertility to give a context to further analyze the essences of the phenomenon (Elder & Giele, 2009; Jaffe & Diamond, 2011). This study is based on intensive interviews of 10 recent veterans from the post- 9/11 War on Terror. Through a phenomenological analysis approach, results suggest that the reproductive trauma is difficult to fully internalize, as it impacts many areas of life (i.e.-intimate relationship, sexual functioning, fertility). Yet, in the lived experience of these veterans, the GU injury is insufficiently addressed due to more critical health needs and the lack of medical resources to reverse testicular function. The reproductive trauma is often put aside until physical injuries are stabilized and some independence is regained. Finding meaning and purpose is a way to reconstruct the reproductive narrative. The results of this study have implications for social work policy and practice, as well as future research, for persons who have experienced military-related GU injuries. Approaching this trauma-based experience through a reproductive narrative provides clinicians a tool to reconstruct the life course and manage the unknowns of this trauma. Keywords: genitourinary injury; life course perspective; reproductive trauma; biopsychosocial; infertility; military iii Dedication To the U.S. military members, veterans, and their families, with combat-related injuries that have impaired fertility, for your service and the continuing sacrifices you make. May you successfully rewrite the next chapter of your reproductive narrative, whatever it may bring. iv Acknowledgments This research idea came to fruition over a beer and a chance encounter with a veteran who, after I mentioned my work in infertility, suggested that studying this area of research was much needed and nonexistent. I would first like to thank him for helping me to begin this path of investigation and passion. I would also like to thank all the veterans with these injuries who spoke to me, even those who did not participate in the study. I feel a privilege in you sharing your journey with me so that I could learn from your experiences. I hope I reflected the respect you deserved in my research and analysis. I would like to thank the MANY people that indulged me throughout this process and took the time to speak with me. I have kept a running list of those that helped, and I look forward to sharing the completion of this research, as well as the possibilities this has provided me moving forward. A few from the list I would like to particularly thank are Dr. Seth Messinger, Dr. Cam Ritchie, Dr. E. Scott Sills, and Suzanne Waddingham. I would like to thank Dr. Michael Hardy, Dr. David McLeod, and Dr. Robert Dean for helping provide the platform so that I am (hopefully!) able to expand my research. To Dr. Hardy, I appreciate your willingness to network and connect with colleagues to make it possible. To Dr. McLeod, I am grateful for your persistence and willingness to show me around and navigate the military system and bureaucratic challenges. I look forward to the future possibilities! I would like to thank Dr. Linda Applegarth, who has always been in my corner and helped to connect me to many useful contacts. I am lucky to have “chosen family,” per my mother, like you, and I love being able to now share this field with you, as well as v having your daughter as a friend since the womb. I would like to thank Dr. Susan Klock for reading my dissertation and providing helpful feedback. Your input was so incredibly useful, and it helps me to continue to grow as writer and researcher. I would also like to thank Dr. Mary Riddle. I am grateful to you for taking the time to talk with me when I was stuck and lost in the data analysis process, as well as the feedback on my writing and methodology. I appreciate the help and reassurance you provided me. I am truly lucky to work in a field with such outstanding colleagues, who are encouraging and actively willing to help me grow as a professional and as a researcher. To my closest and amazing colleagues, I would like to thank all my “SG Social Workers” (yes, this includes the psychologists!). I appreciate your willingness to step in and help cover when I pulled back my hours, as well as listen to the updates along the way. I feel blessed to have the support, encouragement, and advice to provide best clinical practice methods. I would like to say a special appreciation to Dr. Erica Mindes. You have been the best and most amazing cheerleader and mentor. You allowed me space and confidence to grow in this field as a clinician, researcher, and individual. To my dad, Barry Covington, your behind the scenes support and networking have helped me further my work and are deeply appreciated. Your love, willingness, and encouragement to always assist when needed, with studying and writing (among the many things) throughout my life, have brought me to a place where I have been able to complete a PhD program. I am also particularly grateful for your Jack Nicklaus skills, empathy, love, and generosity. You are a model for compassion and big-heartedness that I hope and try to emulate. vi To my mom, Sharon Covington, I feel so greatly blessed and lucky to work with you and even more so to have you as my mother. Even with growing pains of a mother/daughter working professionally together, I wouldn’t change anything. Your ongoing support and love for me have provided me with so many wonderful people in my life that have created countless possibilities. You have allowed me to grow individually as a social worker and as a woman, fostering my ability to find my own niche. Thank you for countless phone calls listening to me complain and moan, yet continuing to encourage me! I would like to thank Michelle and Scott Harmon and Brendan and Darlene Covington for their ongoing support, one way or another, throughout this process from applying to school to networking to BINGO! I would also like to thank my boyfriend, Thomas MacNevin, for your love, support, listening to the ups and downs, making me dinner, walking Tebow, and dealing with all the school papers I had (have) strewn all over the apartment. And not to forget my love bug, Tebow, for providing endless affection—thank you for being my writing buddy! There were also several behind the scenes supporters. Particularly, I want to acknowledge and thank my rock star editor, Lynne Denicola, who helped me wordsmith when I lost my way. To my PhD cohort, Dr. Guy Feldman, Dr. Patricia Flaherty- Fischette, and (almost Dr.!) Lemuel Yutzy—thank you for all the laughs, support, and encouragement you provided. Last but definitely not least, I would like to express my gratitude to my committee members Professors Leslie Alexander, Marc Schulz, and Janet Shapiro for all you have done to contribute to the completion and success of this dissertation process. Your vii wisdom, insights, and feedback were considerably helpful. Particularly, I would like to thank my dissertation chair, Professor James Martin. The guidance, support, and reassurance you gave provided me the confidence and perseverance to continue to “move forward” throughout the PhD program. I am so grateful to have had you leading me through, and I cannot fully express my deep appreciation for all the time, energy, and direction you gave me. viii Table of Contents ABSTRACT ........................................................................................................................... iii DEDICATION ....................................................................................................................... iv ACKNOWLEDGMENT