Veterans Health Administration

Dr. Linda Mona counsels a Veteran family on their sexual relationship

Sex is a big deal, right? So if your sex life isn’t all that healthy, chances are the rest of your life — including your overall health — might not be anything to write home about either. At least that’s the theory being put forward by two VA health care providers who feel that VA may need to get over its shyness and start routinely asking Veterans about their sex lives. Delicately, of course.

A Struggle

“Every clinician should be asking their Veteran patients about sexuality,” said Dr. Linda Mona, who’s spent the last nine years running an intimacy clinic at the Long Beach VA. “There are many Veterans struggling with this part of their life, which means there are so many families struggling with this issue.

“When two people are having a mutually satisfying sexual relationship, it strengthens their connection,” she noted. “And it therefore strengthens the whole family.”

Apparently, however, people just don’t like to talk about it because it’s embarrassing.

“Providers don’t know how to talk about it,” Mona corrected. “Patients and providers don’t know how to bring up the subject, because it’s so personal. But if we’re going to provide comprehensive, patient-centered care, if we’ve going to treat the whole Veteran, then we need to broach the topic. And we need to broach it in a respectful way.”

Anxiety, Stress and Meds: a Recipe for Disaster

The psychologist said trouble in the bedroom seems to be fairly widespread in a lot of the Veteran population. And no wonder.

“We see both men and women coming back from overseas and having difficulties with their primary relationships,” she said. “As a Veteran, you might be dealing with depression, anxiety, or posttraumatic stress disorder. Then there’s perhaps physical and cognitive injuries such as traumatic brain injury or loss of a limb. On top of that, you’re trying to fit into your new life as a civilian. And while all that’s happening, you may be on several different medications for all these psychological or physical injuries. When you mix all this together, is it any wonder your sex life is suffering?

“To make matters worse,” she added, “your inability to reconnect sexually with your partner just adds to all these other stressors.”

Dr. Jessica Punzo, a psychology fellow at the San Diego VA, agreed that Veterans seem to have a lot more stressors to deal with than the general population.

“We screen for PTSD and depression. We need to screen for sexual health, too.”Dr. Jessica Punzo

Pushed to the Bottom

“When you transition from the military to civilian life, you have a lot of things coming at you,” Punzo said. “You’re trying to get to your therapy sessions, to your doctor appointments. You’re trying to reconnect with your wife or your husband, your kids. So sex is one of the things that gets pushed to the bottom of the list. But research shows that as sexual satisfaction increases, so does overall quality of life.

“If all is not well in the bedroom,” she warned, “it may possibly show up in other parts of your life outside the bedroom.”

And for some Veterans, there’s the additional complication of military sexual trauma (MST). “Many people who’ve had a sexual trauma have difficulty with sex later on,” explained Punzo, who provides individual and group therapy for Veterans who’ve experienced MST. “Even if a victim of MST wants to be intimate with their partner, they may not be able to. There tends to be a lot of shame that comes with experiencing a sexual trauma. Any kind of closeness or intimacy with another person can trigger flashbacks.”

A Touchy Subject

Punzo said it’s up to VA health care providers to broach the touchy subject of sexual health.

“It’s worth doing a sexual health assessment on all of our Veterans,” she said. “It should be standard. We screen for PTSD. We screen for depression, for suicidal tendencies. We need to be screening for sexual health, too. If our initial assessment indicates a sexual issue, we can start the process of addressing it.”

Linda Mona agreed. “Our job as VA clinicians is to create a forum in which to discuss sexuality,” she observed. “Veterans don’t have to talk about their sex life if they don’t want to. But if Veterans want to discuss the topic, we need to give them the opportunity. We need to train our providers on how to bring up sexual health as a routine part of any screening we do.

Problem? What Problem?

“I have patients who have good, solid intimate relationships with their partners,” Mona continued. “Their foundation is stellar. But that doesn’t mean they aren’t having problems with their sexual relationship. The VA can help them with that, but first we have to know there’s a problem. If we don’t ask them, chances are they’re not going to tell us.”

The psychologist noted that most Veterans go through at least one health screening every year.

“They’re seen by a team of professionals, including a primary care doctor, a social worker, a psychologist and others,” she explained. “At some point during the screening, there should be a question posed to them about their sexual health. Some member of the team should ask a question that goes like this: ‘To what degree are you satisfied with your sex life?’ Or maybe this: ‘Are there ways in which your other health issues might be interfering with your sex life?’

“It’s a way to open up a dialogue,” she continued. “If the Veteran answers that all is well in the bedroom, fine. If not, then we need to be prepared to refer them to the appropriate professional for follow-up.”