BETHESDA, Md. - In the list of problems that can confront servicemembers after a combat deployment, few can be harder to talk about or more devastating than the inability to resume intimate relationships.
Couples who have survived multiple combat deployments know the situation all too well.
"The first few years of the war, everybody thought they'd get off the plane and the honeymoon would start," Rebekah Sanderlin, an Army wife at Fort Bragg, N.C., and "Operation Marriage" blogger, told American Forces Press Service. "The first two weeks are good, then it's downhill for several months.
"We had a hard time just feeling like we knew each other," Sanderlin said of her husband, who has deployed several times. "It was like there was a stranger in the house. Even if we were physically intimate, we really didn't feel connected."
The Sanderlins are far from alone. "I haven't met anybody who just bounces right back," she said of redeployed couples.
While it's hard to quantify the problem, it is common enough that psychiatrists with the Center for the Study of Traumatic Stress, part of the Uniformed Services University of the Health Sciences here, are reaching out with information to health care providers, counselors and military families to help troops re-establish deep connections -- both emotional and physical -- upon returning home.
"Intimacy is an important part of post-deployment health care," Dr. Stephen J. Cozza, associate director of the center and professor of psychiatry at the university, told American Forces Press Service and the Pentagon Channel. Any couple separated for many months needs to be patient and give extra attention to their relationship after a deployment, he added.
But for those suffering from the current wars' signature wounds of post-traumatic stress or traumatic brain injury, "those conditions can have a profound effect on relationships, and especially intimacy," Cozza said.
People with post-traumatic stress sometimes experience personality changes, become emotionally distant or avoid people and feelings, he explained.
TBIs can further complicate relationships, and especially sexuality, depending on the injury, which may leave the person in physical pain and cause their partner to double as caregiver, he said.
Add to that possible side effects of medications, impulsive or violent behavior, or substance abuse, and many post-deployment problems can hinder intimacy, Cozza said.
All of this can be devastating to couples and seeking help can be difficult. "How do you bring that subject up?" Cozza asked. "Often, we just don't even have the words to express it."
The center has developed fact sheets and guidance for health care providers and families on issues of reintegration and intimacy. They cite intimacy as an often neglected area of care and urge people to talk about their problems - and for providers to bring up the issue.
Other guidance for health care providers includes:
- Educate patients and partners about implications of brain injuries, especially in areas that control sexuality, inhibitions and impulses.
- Encourage communication to work through redeployment changes, including self-image.
- Urge creativity in finding solutions to intimacy challenges.
"It's really important for people to have a sexual relationship that doesn't have to be all about sex," Cozza said.
Sometimes servicemembers return home more intense and aggressive than when they left, and they may have different attitudes about sex, Cozza said. Counselors can help them work through those changes, he added, and partners should refrain from sex until it's mutually enjoyable.
Many couples can work out their post-deployment intimacy problems within a few months of being back together, and even in the case of serious injuries, intimacy usually returns over time, Cozza said.
The center's tips for improving intimacy include:
- Find ways to be close that do not involve sex, such as showing affection in other ways.
- Spend quality time together.
- Talk about your feelings, hopes and desires when you're both calm and ready to listen.
- Respect your partner's need for space.
- Schedule intimate time.
Sanderlin and her husband discovered that a little professional counseling can go a long way.
"I recommend counseling for everybody," she said. "TRICARE pays for it, and all you have to do is call Army OneSource." But no matter how many times her husband deploys, Sanderlin said, reintegration always is a challenge.
"It seems to take several months to feel normal again," she said.