Sexual Dysfunction in Male Iraq and Afghanistan War Veterans: Association with Posttraumatic Stress Disorder and Other Combat-Related Mental Health Disorders: A Population-Based Cohort Study

Authors

  • Benjamin N. Breyer MD,

    Corresponding author
    1. Department of Urology, University of California, San Francisco, San Francisco, CA, USA
    • Corresponding Author: Benjamin N. Breyer, MD, MAS, Department of Urology, University of California, San Francisco, 400 Parnassus Avenue, A610, San Francisco, CA 94143, USA. Tel: 415-353-2207; Fax: 415-206-5153; E-mail: bbreyer@urology.ucsf.edu

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  • Beth E. Cohen MD,

    1. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
    2. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
    3. San Francisco VA Medical Center, San Francisco, CA, USA
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  • Daniel Bertenthal MPH,

    1. San Francisco VA Medical Center, San Francisco, CA, USA
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  • Raymond C. Rosen PhD,

    1. Department of Urology, University of California, San Francisco, San Francisco, CA, USA
    2. New England Research Institutes, Watertown, MA, USA
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  • Thomas C. Neylan MD,

    1. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
    2. New England Research Institutes, Watertown, MA, USA
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  • Karen H. Seal MD

    1. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
    2. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
    3. San Francisco VA Medical Center, San Francisco, CA, USA
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Abstract

Introduction

Mental health disorders are prevalent in the United States, Iraq, and Afghanistan war veterans. Mental illness, including posttraumatic stress disorder (PTSD) with or without psychiatric medications, can increase the risk for male sexual dysfunction, threatening quality of life.

Aims

We sought to determine the prevalence and correlates of sexual dysfunction among male Iraq and Afghanistan veterans.

Methods

We performed a retrospective cohort study of 405,275 male Iraq and Afghanistan veterans who were new users of U.S. Department of Veterans Affairs healthcare from October 7, 2001 to September 30, 2009 and had 2-year follow-up.

Main Outcome Measures

We determined the independent association of mental health diagnoses and sexual dysfunction after adjusting for sociodemographic and military service characteristics, comorbidities, and medications.

Results

Veterans with PTSD were more likely to have a sexual dysfunction diagnosis, be prescribed medications for sexual dysfunction, or both (10.6%), compared with veterans having a mental diagnosis other than PTSD (7.2%), or no mental health diagnosis (2.3%). In a fully adjusted model, PTSD increased the risk of sexual dysfunction by more than threefold (adjusted risk ratio = 3.61, 95% CI = 3.48–3.75). Veterans with mental health disorders, particularly PTSD, were at the highest risk of sexual dysfunction when prescribed psychiatric medications (adjusted risk ratio = 4.59, 95% CI = 4.41–4.77).

Conclusions

Among U.S. combat veterans, mental health disorders, particularly PTSD, increased the risk of sexual dysfunction independent of the use of psychiatric medications. Breyer BN, Cohen BE, Bertenthal D, Rosen RC, Neylan TC, and Seal KH. Sexual dysfunction in male Iraq and Afghanistan war veterans: Association with posttraumatic stress disorder and other combat-related mental health disorders: A population-based cohort study. J Sex Med 2014;11:75–83.

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