title: 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.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Breyer
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.forename: Raymond C
authors.initials: RC
authors.lastname: Rosen
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D003130:Combat Disorders / Q000150:complications / Q000453:epidemiology*; D015897:Comorbidity; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology* / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Combat; Military Service; Posttraumatic Stress Disorder; Sexual Dysfunction