title: Sexual assault in the military and its impact on sexual satisfaction in women veterans: a proposed model.
abstract: OBJECTIVE
  Sexual assault in the military (SAIM) is associated with decreased sexual satisfaction. However, mediators of this association have not been fully described.
  
  
  METHODS
  Using a retrospective analysis of cross-sectional data collected for the national Veterans Affairs (VA) Women's Health Survey, we propose a mediator model to explain the association between SAIM and decreased sexual satisfaction among women veterans. Four mediators of the association between SAIM and decreased sexual satisfaction are tested: (1) emotional health-related quality of life, (2) physical health-related quality of life, (3) lack of a close partner, and (4) gynecological illness. These mediators were chosen to encompass independent domains potentially relevant to sexual satisfaction, including emotional, physical, and relational.
  
  
  RESULTS
  Of 3161 women (87%) who answered the sexual satisfaction question, the mean age was 45 (SD 15) years; 85% were white. Twenty-four percent reported a history of SAIM, and 39% reported sexual dissatisfaction. In age-adjusted logistic regression analyses, both SAIM and sexual dissatisfaction were strongly associated with each of the proposed mediators. However, of the four mediators, emotional health-related quality of life most strongly attenuated the association between SAIM and sexual dissatisfaction. After including all mediators, the association between SAIM and decreased sexual satisfaction was markedly attenuated.
  
  
  CONCLUSIONS
  SAIM's negative impact on sexual satisfaction in women veterans operates both directly and through its physical and mental health sequelae. Of the proposed mediators in this association, the most prominent is mental health-related quality of life; the other proposed mediators were minimally related.
authors.affiliation: Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Division of General Internal Medicine, 500 University Drive/MC: HU15, Hershey PA 17033, USA. jsm31@psu.edu
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: McCall-Hosenfeld
authors.forename: Jane M
authors.initials: JM
authors.lastname: Liebschutz
authors.forename: Avron
authors.initials: A
authors.lastname: Spiro
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Seaver
mesh_terms: D000328:Adult; D019548:Crime Victims / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D008960:Models, Psychological; D010549:Personal Satisfaction; D011788:Quality of Life; D011902:Rape / Q000523:psychology / Q000706:statistics & numerical data*; D012649:Self Concept; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*