Posttraumatic Stress and Sexual Satisfaction in Husbands and Wives: A Dyadic Analysis

Australian veteran sexual health: '…you are the first person I've spoken to about it.'

Background Sexual health and functioning outcomes have been shown to be poor among veterans due to factors associated with military service, as well as barriers to healthcare access. However, there is currently limited research attempting to assess the scope and extent of these issues in the Australian context. Methods Ten qualitative, semi-structured interviews were conducted with Australian professionals working within or adjacent to veteran sexual health and were analysed using inductive thematic analysis. Results Sexual health and functioning issues commonly develop among Australian veterans due to a variety of physical, psychological and social factors. Factors include mental ill-health, physical illness and injury, use of medication, and relationship strain. These contribute to physiological dysfunctions, poor sexual behaviours and difficulties in forming healthy, meaningful intimate relationships. Barriers, such as lack of awareness and understanding, stigma, and structural barriers, were suggested to interfere with healthcare access and worsen outcomes. Key informants recommended increasing provider training, research and military support, as well as de-stigmatising sexual health issues. Conclusions Veteran sexual health is not often on the radar of Australian health and research professionals. Our study is one of few studies in the Australian context, highlighting the need to conduct more research to better manage veteran sexual health and functioning needs.

An update of the Couple Adaptation to Traumatic Stress Model: Systematic research synthesis of the association between secondary trauma survivor functioning and couple functioning

Systemic theories addressing posttraumatic stress disorder (PTSD) in couples postulate associations between primary trauma survivor functioning, secondary trauma survivor functioning, and couple functioning. However, there is a lack of examination of the association between secondary trauma survivor functioning and couple functioning, which has clinical implications. Objectives of this study include informing clinicians of the evidence base for these associations and providing a synthesized review of research on PTSD in couples to inform future research. A systematic research synthesis screening 150 articles from three databases resulted in the inclusion of 15 quantitative articles to examine the quality of the available research addressing the association between secondary trauma survivor functioning and couple functioning. Correlation matrices in all studies and other partial evidence supported the current theory positing the relevance of secondary traumatic stress in interpersonal functioning for couples. Discussion includes the need for increased quality and diversity of systemic trauma research and treatment for couples.

Iranian Men's Sexual Life Issues After Their Wives' Burn: A Qualitative Content Analysis Study

Physical and psychological complications of burn injuries reduce the victims' sexual quality of life and challenge their partners' sexual satisfaction. There is no information about men's sexual issues and behaviors. Previous studies did not address the impact of women's burns on their husbands' sexual lives. Therefore, this qualitative study aimed to characterize the sexual experiences of Iranian men after their wives' burns. The study was performed on 16 men with surviving spouses of major burn using criterion-based purposive sampling. Semistructured interviews were analyzed using a qualitative content analysis approach. The results showed men's sexual issues with three main themes and eight subthemes: 1) sexual desire restrictors (annoying scars, imposing roles, and wives' sexual coldness), 2) degradation of marital sex (reduced frequency of sexual intercourses, temptation of extramarital affairs), and 3) effort to maintain sex (sexual self-sacrifice, sexual pretending, sexual precautions). According to men's experiences, female sexual coldness, temptation for extramarital affairs, and sexual pretense were related to couples' poor knowledge of sexual discourse. Thus, health professionals can use context-oriented educational program to promote the couples' sexual knowledge and health after burns.

Posttraumatic stress disorder and relationship functioning: Examining gender differences in treatment-seeking veteran couples

Posttraumatic stress disorder (PTSD) symptoms are robustly associated with intimate relationship dysfunction among veterans, but most existing research has focused on male veterans and their female partners. Links between PTSD and relationship functioning may differ between female-veteran couples and male-veteran couples. The current study used actor-partner interdependence models (APIMs) to test the associations between PTSD symptoms (i.e., veteran self-report or significant others' collateral-report) and each partner's reports of six domains of relationship functioning, as well as whether these links were moderated by the gender composition of the couple. Data were from 197 mixed-gender couples (N = 394 individuals) who completed baseline assessments for a larger randomized controlled trial of a couple-based PTSD treatment. Significant others' collateral PTSD reports were associated with their own ratings of relationship satisfaction, negotiation, psychological aggression, sexual pleasure, and sexual desire frequency, |β|s = .19-.67, and with veterans' ratings of negotiation and sexual desire frequency, |β|s = .20-.48. In contrast, veterans' self-reported PTSD symptoms were only associated with their own ratings of psychological aggression, β = .16. Gender moderated the associations between significant others' collateral PTSD reports and five of the six outcome variables; findings from exploratory subgroup analyses suggested links between reported PTSD symptoms and relationship functioning were generally more maladaptive for male-veteran couples, whereas female veterans showed more neutral or even helpful impacts of higher partner-perceived PTSD symptoms. These findings have implications for clinicians treating relational impacts of PTSD and emphasize the need for further research with female-veteran couples.

Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with sexual difficulties but the nuances of this relationship remain elusive. Research has increased in recent years, most notably following publication of several reviews in 2015.

AIM

This systematic review examines the relationship between PTSD and sexual difficulties in veterans/military personnel.

METHODS

A systematic review was conducted using PRISMA guidelines in PsycINFO and PubMed databases for studies examining a diagnosis of PTSD or PTSD severity in relation to a range of sexual difficulties. Forty-three studies were identified that met inclusion and exclusion criteria for this review.

RESULTS

PTSD was associated with increased risk of experiencing at least one sexual difficulty. PTSD was most clearly associated with overall sexual function, sexual desire, sexual satisfaction, and sexual distress. Results were mixed for sexual arousal, orgasm function, erectile dysfunction, premature ejaculation, sexual pain, and frequency of sexual activity. PTSD symptom clusters of avoidance and negative alterations in cognition/mood were most commonly associated sexual difficulties. Few studies compared results by gender and trauma type.

CLINICAL IMPLICATIONS

Clinicians should inquire about sexual health in relation to PTSD symptoms and target avoidance and negative mood symptoms by incorporating sexual exposure assignments and sexual activation exercises when appropriate.

STRENGTHS & LIMITATIONS

This systematic review synthesizes an extensive literature that has grown substantially in the past 5 years and includes studies with low to moderate risk of bias. Limitations of the existing literature include challenges differentiating between PTSD and depression, inconsistent measurement of PTSD and trauma histories, inconsistent operationalization and measurement of sexual outcomes, and largely cross-sectional study designs.

CONCLUSION

PTSD is linked to a range of sexual outcomes. The current literature suggests that PTSD is associated with sexual difficulties related to both the sexual response cycle (ie, sexual desire) and one's emotional relationship to sexual activity (eg, sexual distress). More research is needed to increase confidence in findings. Bird ER, Piccirillo M, Garcia N, et al. Relationship Between Posttraumatic Stress Disorder and Sexual Difficulties: A Systematic Review of Veterans and Military Personnel. J Sex Med 2021;18:1398-1426.