Sexual Dysfunction Linked to PTSD

The incidence of sexual dysfunction is very high in men and women who are suffering from post-traumatic stress disorder.
The incidence of sexual dysfunction is very high in men and women who are suffering from post-traumatic stress disorder.

The relationship between post-traumatic stress disorder and sexual dysfunction has been studied for decades. However, the recent spike in the incidence of PTSD among veterans of U.S. wars in Afghanistan and Iraq has intensified academic interest in the topic.

In April 2015, the news carried reports of three reviews of the scientific literature on the PTSD-sexual dysfunction link. Of the three, two were published in April, and the third was previewed online that month in advance of publication.

In the first review of the literature about the link between PTSD and sexual dysfunction, a team of researchers led by Jana K. Tran, Ph.D., said the close relationship between the two makes it important to consider the integration of treatment strategies. That  review, published in the April 2015 issue of ¨The Journal of Sexual Medicine,¨ also calls for stepped-up efforts to more carefully research ¨this important topic.¨

Danish Review Published

The second review of literature relevant to the relationship between PTSD and sexual problems was conducted recently by a team of Danish psychiatrists. Led by Ida L. Bentsen, M.D., of Psychiatric Center Copenhagen’s Sexological Clinic, the Danish review was also published in April 2015, appearing in  ¨Sexual Medicine Reviews.¨

The third review, previewed online in advance of its eventual publication in ¨The Journal of Sexual Medicine,¨ found that 6 percent of men and 13 percent of women will experience PTSD at some point in their lives. Among the most common triggers for the condition are exposure to actual or threatened death, sexual violence, or serious injury. This review also found that seeing a loved one experience any of these traumatic events can also trigger symptoms of PTSD.

San Diego Study

Very likely included among the scientific literature considered for the three research reviews is a small-scale study conducted by urologists at the Medical Center of the University of California, San Diego, in the early 2000s. That study compared the incidence of sexual dysfunction in combat veterans both with and without signs of PTSD.

Combat veterans from the U.S. wars in Afghanistan and Iraq have a high incidence of PTSD and the sexual problems that often accompany the disorder.

To determine the level of sexual dysfunction among study participants, San Diego researchers administered the International Index of Erectile Function questionnaire to 44 combat veterans undergoing treatment for PTSD and 46 age-comparable combat veterans without PTSD. Men in both groups were also required to fill out questionnaires covering basic demographics and medical history.

Scores Differ Sharply

They found that the mean total IIEF score for men with PTSD was 26.38, sharply lower than the mean total score of 40.86 for veterans without this disorder. Looking at individual aspects of sexual function, researchers found that PTSD patients had poorer scores on orgasmic function and overall sexual satisfaction and showed trends toward poorer scores on erectile function and intercourse satisfaction. On sexual desire, the difference between mean scores for the two groups was not statistically significant.

San Diego researchers found that the rate of erection problems among PTSD patients was 85 percent, compared with a rate of 22 percent among patients without the disorder.

In the conclusion to their review of the relevant scientific literature, Danish researchers said that while there is increasing evidence of a correlation between sexual dysfunction and PTSD, ¨relatively few studies have addressed these questions.¨ The Danish authors of the review urge further studies into the link between these two, preferably research that takes into account the severity of PTSD symptoms. The review also recommended that future studies take into consideration such factors as drug and alcohol abuse, somatic illness, comorbid psychiatric conditions, and the use of psychotropic medications.

Women Affected Too

Although the San Diego study in the early 2000s looked only at sexual problems among male veterans with PTSD, such problems can show up in women with PTSD as well. And while the incidence of PTSD is obviously high among veterans of combat, men and women subjected to other forms of trauma often experience symptoms of sexual dysfunction as well.

Researchers seem to agree that the type of trauma experienced has very little to do with PTSD’s effects on sexual function.

In a recent article posted at MilitaryTimes.com, Bret A. Moore, a clinical psychologist who served two tours of duty in Iraq, looks at the various forms that sexual dysfunction can take. He notes that most manifestations of sexual dysfunction fall into one of three broad categories: disorders of desire, arousal, or orgasm.

Heightened Anxiety Levels

Of the link between PTSD and sexual dysfunction, Moore suggests that the heightened anxiety levels of most PTSD patients may account for a significant part of the problem. He notes that anxious people produce inordinately high levels of hormones and neurochemicals that can negatively affect sexual function by constricting blood vessels and blood flow, both of which are vital to sexual health.

Another cardinal symptom of PTSD is a feeling of emotional detachment from loved ones, says Moore. For many victims of PTSD, loving feelings for a spouse or partner are extremely limited or absent altogether, making it difficult to develop and maintain intimacy.

Some Drugs Exacerbate Problem

Ironically, notes Moore, some of the medications most commonly used to treat PTSD target brain levels of the neurotransmitter serotonin, a chemical that has a key role in sexual function. As a result of taking such medications, many PTSD patients — both male and female — report reduced interest in sex and delayed or absent orgasms. Among men taking these drugs, many complain of increased difficulty in getting and keeping an erection.

Moore notes that although the link between PTSD and sexual dysfunction can be extremely complex, a fix can sometimes be ¨relatively simple. It may include individual or couples therapy or a switch to a different medication. The first step is to talk with your health care provider.¨

Type of Trauma Irrelevant

Rachel Yehuda, Ph.D., lead author of the research review that was previewed in April 2015 but not yet published, said that the sexual difficulties associated with PTSD may occur when the brain connects feelings of arousal to aggression rather than healthy sexual function. Yehuda, a mental health researcher at the James J. Peters Veterans Affairs Medical Center and the Icahn School of Medicine at Mount Sinai in New York City, told Reuters that the type of trauma experienced seems to have little direct effect on the manifestation of sexual dysfunction that often accompanies PTSD.

“Although it makes sense that a person — man or woman — who experienced sexual violence would have sexual dysfunction, trauma survivors with PTSD from other experiences also have sexual dysfunction,” said Yehuda. “It does not seem to be the case that the problem stems from the type of trauma.”

Don Amerman is a freelance author who writes extensively about a wide array of nutrition and health-related topics.

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