title: Voluntary and involuntary childlessness in female veterans: associations with sexual assault.
abstract: OBJECTIVE
  To assess associations between lifetime sexual assault and childlessness in female veterans.
  
  
  METHODS
  Cross-sectional, computer-assisted telephone interview study.
  
  
  METHODS
  Two Midwestern Veterans Administration (VA) medical centers.
  
  
  METHODS
  A total of 1,004 women aged ≤52 years, VA-enrolled between 2000 and 2008.
  
  
  METHODS
  None.
  
  
  METHODS
  Sociodemographic variables, reproductive history and care utilization, and mental health.
  
  
  RESULTS
  A total of 620 veterans (62%) reported at least one attempted or completed sexual assault in their lifetime (LSA). Veterans with LSA more often self-reported a history of pregnancy termination (31% vs. 19%) and infertility (23% vs. 12%), as well as sexually transmitted infection (42% vs. 27%), posttraumatic stress disorder (32% vs. 10%), and postpartum dysphoria (62% vs. 44%). Lifetime sexual assault was independently associated with termination and infertility in multivariate models; sexually transmitted infection, posttraumatic stress disorder, and postpartum dysphoria were not. The LSA by period of life was as follows: 41% of participants in childhood, 15% in adulthood before the military, 33% in military, and 13% after the military (not mutually exclusive). Among the 511 who experienced a completed LSA, 23% self-reported delaying or foregoing pregnancy because of their assault.
  
  
  CONCLUSIONS
  This study demonstrated associations between sexual assault history and pregnancy termination, delay or avoidance (voluntary childlessness), and infertility (involuntary childlessness) among female veterans. Improved gender-specific veteran medical care must attend to these reproductive complexities.
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa. Electronic address: Ginny-ryan@uiowa.edu.
authors.forename: Ginny L
authors.initials: GL
authors.lastname: Ryan
authors.affiliation: Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; VA Office of Rural Health, Veterans Rural Health Resource Center-Central Region, Iowa City VA Health care System, Iowa City, Iowa.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Mengeling
authors.affiliation: Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Booth
authors.affiliation: Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa; Department of Neurosurgery and Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: James C
authors.initials: JC
authors.lastname: Torner
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Craig H
authors.initials: CH
authors.lastname: Syrop
authors.affiliation: Comprehensive Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Sadler
mesh_terms: D000029:Abortion, Legal; D000328:Adult; D000367:Age Factors; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D005298:Fertility; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D016015:Logistic Models; D008603:Mental Health; D008875:Middle Aged; D015146:Midwestern United States / Q000453:epidemiology; D015999:Multivariate Analysis; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology*; D011275:Pregnancy, Unwanted / Q000523:psychology*; D043762:Reproductive Behavior / Q000523:psychology*; D012307:Risk Factors; D012737:Sex Factors; D012742:Sex Offenses / Q000523:psychology*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D013997:Time Factors; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health; D055815:Young Adult
keywords: Female veterans; childbearing; infertility; sexual assault