top of page
Search

Sexual function, the unexpected casualty


Some things in life you never expect to lose. Your orgasm is one of them.


I am a Research Associate on the “Armed Services Trauma Rehabilitation Outcome Study” (ADVANCE). Within the ADVANCE team, we research the impact of serious combat injury on life after service and the rates and experiences of sexual dysfunction for UK Armed Forces personnel.


Physical injuries and mental health can affect sexual function

Several injuries and mental health conditions can affect sexual function. For example, traumatic brain injury, spinal cord injuries and injuries to the pelvic region (e.g. genitourinary (GU) injuries) can cause neurological and structural damage to the body, such that the intricate array of physiological processes which feed into the sexual response are prevented from performing as intended. Similarly, mental health conditions such as post-traumatic stress disorder (PTSD), depression and anxiety can sometimes impair sexual function too, as can the medications prescribed to support people with these diagnoses.



Combat injuries

Some people lead lives which make them more prone to injury than others. For example, those who work in construction and transport are at higher risk of sustaining work-related injuries than those who work in office-based jobs. Similarly, those who serve in the military are at risk of injury both when they are in training and when they deploy to conflict zones.


During their deployment to the conflict in Afghanistan between 2002-2014, over 2,400 UK military personnel sustained injuries. The extensive use of improvised explosive devices (IEDs), which explode from the ground upwards, meant that limb loss was the “signature injury” of the war in Afghanistan. The use of IEDs also meant that both US and UK militaries recorded the highest ever frequency of GU injuries. The ADVANCE study allows us to explore the effects of combat injuries on UK military personnel extensively.



The ADVANCE study

ADVANCE is an ongoing longitudinal study set up to investigate the long-term physical and psychosocial effects of combat injury on UK military personnel who deployed to Afghanistan. In ADVANCE, there are approximately 1,200 male participants, of whom roughly 600 were injured and another 600 were deployed but did not sustain serious combat injuries. Women were not included in the ADVANCE study as they were only allowed to deploy in front-line combat roles from 2018, and the UK military had wound down its operations in Afghanistan by 2014.


ADVANCE participants attend clinical assessments with our clinical team, during which they are asked to complete a series of questionnaires about their health and wellbeing. Amongst these questionnaires is the “Arizona Sexual Experience Scale”, also known as “the ASEX”, which asks about sexual dysfunction. The ASEX asks participants about their sex drive, how easily they get aroused, how easily they can maintain an erection, how easily they can reach orgasm, and how satisfying their orgasms are.

 

Analysing ADVANCE data

My colleague, Dr Dan Dyball – whose own research explores the link between the mental health of UK Armed Forces personnel and their injuries – mentioned I might want to take a look at the data ADVANCE collects on sexual dysfunction. I think Dan knew that my statistical skills - which had been stored in a damp, dark cupboard since university – might need some sharpening and this dataset, in its simplicity, presented an ideal opportunity to do just that.


Furthermore, in 2022, we heard from ADVANCE participants during interviews that they did not know where to turn to get help for the anatomical and psychological challenges they faced in their sex lives post-injury. This gap in support services experienced by injured personnel was echoed by veteran-specific support service providers, who said that they did not routinely ask about sexual function when injured beneficiaries presented at their services.


As a team, we felt it was important to see if there was a difference in the rates between those participants who were injured and those who weren’t. As we can identify whose injury resulted in limb loss within the ADVANCE dataset, we thought that it would be useful to look at the rates of sexual dysfunction for those injured with and without limb loss.



What did we find?

Our analyses showed that those participants who had been injured were twice as likely to have sexual dysfunction as those who had not been injured. At this time, we did not know what was responsible for this difference, but the literature on this subject suggests that the aforementioned physical and psychological injuries, related surgeries, and medications play key roles. The rates of sexual dysfunction for those injured with and without limb loss were similar. This finding is in line with previous research studies, which have had mixed results when exploring the impact of limb loss on sexual dysfunction and our results don’t clarify this yet!

 

Our plans for the future

The gaps identified by UK support service providers and ADVANCE participants themselves, combined with the twofold increased risk for having sexual dysfunction for injured personnel, have catalysed my enthusiasm to help ameliorate this condition. 


Starting in February 2026, I shall undertake a PhD, funded by The Colt Foundation, to examine the prevalence rates of sexual dysfunction over the first ten years of ADVANCE and to find out what risks and outcomes are associated with these. I will interview ADVANCE participants with combat-injury-related sexual dysfunction about their experiences of this condition, how they have sought help, and what their ideal support service would look like. I’ll analyse this data in combination with qualitative data from a group of support service providers to discern intervention principles that can be implemented in the future. My goal with this PhD is to contribute to an evidence-based, population-centred health systems response, which will enable those living with sexual dysfunction caused by injuries to live the most fulfilling lives possible.


Any one of us could sustain an injury and find our bodies changed in fundamental ways that we had never imagined. Sexual function is an intrinsic yet susceptible aspect of life; efforts are warranted to support those who have experienced circumstances which have led to its demise.

bottom of page