How to cure sexual dysfunction, ED, among veterans with PTSD?

Veteran

Is it possible to get better or even cure it? The answer is yes, but first lets go into some aspects of the diagnosis.

Table of content

What is an ED?

For an erection to happen, blood flows into the penis increases. The nerves discharge chemicals that cause blood to flow into the erection chambers, causing the penis to firm up. When the blood flow is limited, or the veins, nerves, or muscles are affected, men begin having erectile dysfunction symptoms.

But ED is not a “plumbing” problem. Viagra and those kinds of treatments can just do so much for the problem. It can’t do anything with things that are in your head.

Why do veterans have erectile dysfunction?

Two of the most taboo topics in our society: trauma and sex. Is it any wonder that when the two collide, we hesitate to talk about it? And it is often about another diagnosis: PTSD

Witnessing or experiencing a traumatic event is described as the source of PTSD symptoms. PTSD may be caused by combat, abuse, emotional loss, terrorist attacks, natural disasters, serious accidents, assault, and many other situations.

Soldiers suffering from post-traumatic stress disorder are significantly more likely than their civilian counterparts to have erectile dysfunction, ED, or other sexual problems.

The rate of erectile dysfunction was 85% in patients with PTSD and 22% in controls.

Read this blogpost for more information on PTSD, what causes it and how to deal with it.

Common symptoms of PTSD are:

  • Strong memories of the traumatic event
  • “Flashbacks”, where you relive the incident and nightmare about what happened
  • The body is constantly on alert, tense or nervous
  • Avoid people or places that are reminiscent of the event
  • Avoid talking about or thinking about what happened
  • Irritability and anger
  • Insulation
  • Low self-esteem
  • Dizziness
  • Nausea
  • Headache
  • Palpitations
  • Difficulty sleeping
  • Decreased concentration

It is important to open up to the therapist / doctor if you have symptoms of PTSD. Doctors may mistakenly believe that PTSD is caused by something else, such as depression. The condition can also occur at the same time as anxiety, pill and alcohol abuse.

The reason why PTSD leads to ED

Soldiers are often young people in the process of finding a sexual identity. The security that often comes with age thus makes them more vulnerable to problems when they are exposed to potentially traumatic events in a war situation.

This can happen even if the soldier or veteran has not been diagnosed with PTSD. Data on female veterans with combat-related PTSD are more limited, but indicate that they experience similar difficulties.

Post-traumatic stress syndrome involves anxiety, stress, and often, interpersonal communication problems and depression. Antidepressants and anti-anxiety drugs, which may be prescribed for veterans who develop PTSD symptoms, can cause erectile dysfunction, as can other medications.

You are not alone

Compared with the general population, veterans with post-traumatic stress disorder have an increased risk of sexual dysfunction. (Review study published online in the Journal of Sexual Medicine on February 9, 2015 confirms this.)

Although there was a lack of data on female veterans with PTSD, research suggests that they experience similar problems. Problems such as vaginal pain and low interest in sex were common among female veterans in the studies reviewed.

“Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality. It is a significant predictor of physical and emotional health and overall quality of life,” write the researchers, who were based at Michael E. DeBakey VA Medical Center and Baylor College of Medicine in Houston, and Argosy University in Chicago.

Given the negative effect of PTSD on physical and emotional health, it is not surprising that veterans with PTSD experience increased incidences of sexual dysfunction. What is surprising, the researchers write, is how quickly that dysfunction occurs.

Why do people (veterans) with PTSD avoid relationships?

In order to suppress angry feelings and actions, veterans may avoid closeness. They may push away or find fault with loved ones and friends. Also, drinking and drug problems, which can be an attempt to cope with PTSD, can destroy intimacy and friendships. Verbal or physical violence can occur.

How to deal with it?

There are many paths to the goal. Recovering from PTSD is difficult, but certainly possible.  As a rule, the path to recovery from ED is through recovery from PTSD, or at least accepting PTSD as a part of life.

The symptoms of PTSD can cause problems with trust, closeness, communication, and problem solving. These problems may affect the way the survivor acts with others. In turn, the way a loved one responds to him or her affects the trauma survivor. A circular pattern can develop that may sometimes harm relationships

You want to be alone at the same time as you need to know that someone who cares is present. Recognizing these two conflicting longings, and at the same time being able to communicate them effectively, is difficult. How can you tell someone you love, “I need you, but I do not want you – can not have you – near me right now,” without hurting the relationship?

PTSD / ED treatment

There are hope and solutions. If you are struggling with sexual dysfunction, you are not alone. What you are experiencing is a very real side effect, a cost, of war. In a perfect world, healthcare professionals would recognize this and start treatment automatically. But it is not so. I will come back to all the aids and possibilities further down in the text, but again, it is you who can address this.

The tired veteran stereotype does not exist

The stereotype of the “broken” veteran does not exist, but Western societal expectations of masculinity and virility have been created when it comes to soldiers. With PTSD, which is already a highly stigmatized disorder and diagnosis, sexual dysfunction can feel particularly offensive and stigmatizing to an injury that already has a devastating effect on self-esteem.

In addition, these changes in self-esteem can be lasting. This means that once the physiological causes of the dysfunction are resolved, the accrued emotional and psychological damage can persist and continue the problem. Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality, and good sexual health provides a better quality of life. The opposite is equally true.

For many veterans, having a conversation about sexual performance is fraught with shame. Expressing difficulties with sex feels tantamount to acknowledging weakness, failure and demasculation. Conversely, the spouse may feel unattractive, unwanted, or unwanted. The road to healing seems to be full of opportunities to make mistakes and create more problems. Still, having just the first conversation with a therapist is the first step toward improving intimacy and attachment.

What Are the Treatments for PTSD?

Therapy.
Conversation therapy with a psychologist using CPT or PET, or EMDR.
It is important that if the patient has a depression, you must treat it first before you can proceed with the treatment of PTSD.

Cognitive Processing Therapy.
Helps the patient understand what PTSD is and what it entails. The therapist then goes through with the patient what probably created the trauma. As far as possible, this review will be very detailed. The last part of the treatment is about repeating the story and through it making the emotional around the trauma harmless.

Prolonged Exposure Therapy.
Exposure-based therapies focus on confronting the harmless signals / triggers of trauma / stress to free them from the feeling of anxiety and stress. Prolonged exposure provides clinically significant improvement in approximately 80% of patients with chronic PTSD.
Eye Movement Desensitization and Reprocessing.

When we experience a trauma, our ability to deal with stress can be put out of play. The experience is stored in our consciousness in such a way that it is difficult to utilize our usual and otherwise well-functioning processing ability.

Even though we know that the traumatic event happened back in time, it can be difficult to think about the traumas without the emotions and memories becoming overwhelming. The reactions associated with the memories can be as strong as the reactions associated with the event itself.

EMDR integrates elements from several treatment approaches such as cognitive therapy and relaxation exercises. A central part of the therapy is the use of various forms of brain stimulation such as flashing lights, sounds or touch.

The goal of this is to stimulate the brain in such a way that natural processes for processing are activated. The goal is to reduce the degree of overwhelming stress so that you can relate to memories without being put off.

Stress Inoculation Training.

Stress Inoculation Training involves teaching coping skills to manage stress and anxiety. This may include training in deep muscle relaxation, cognitive restructuring, breathing exercises, assertiveness skills, thought stopping, role playing, and guided self-dialogue.

Medications/devices

There are a wide variety of medicines and devices that can help and linger the effects of PTSD an ED.

  • Oral therapy with sildenafil
  • Oral therapy with yohimbine
  • Intraurethral drug injection with alprostadil
  • Intracavernous drug injection therapy: phentolamine + papaverine + alprostadil; phentolamine + papaverine; or alprostadil alone
  • Surgical implantation of a penile prosthesis

At last: there are importent to know that there are a lot of medicines that can cause ED as a potential side effect:

  • Diuretics (pills that cause increase urine flow).
  • Antihypertensives (high blood pressure drugs).
  • Antihistamines.
  • Antidepressants.
  • Parkinson’s disease drugs.
  • Antiarrhythmics (drug for irregular heart action).
  • Tranquilizers.
  • Muscle relaxants.

Conclusion

First and foremost, it is important to know that there are help to find. My view is that the first step is to treat the PTSD and then the rest (ED) solves itself. If it does not, it can be treated in a number of ways. But it all starts with you being open about your PTSD problem with a therapist.

While many doctors may feel more comfortable waiting for patients to express their concern about sexual dysfunction, veterans consistently report that the topic would be easier to address if their providers started the discussion.

Therefor tell your doctor or therapist about the problem and you will get professional help to solve it.

Sources

https://www.research.va.gov/

https://www.psychologytoday.com/why-do-veterans-have-issues-sex-and-intimacy

https://www.research.va.gov/resources/

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