Intimacy & sexual health after service

Ways people feel close

• A hug, a hand on the shoulder
• Doing a chore so your partner can rest
• Laughing together
• Sharing a worry and being heard
• Sleeping side by side
• Sexual closeness, when it feels right for both

How injuries and trauma affect sexual relationships is an important part of recovery that often goes unspoken. Many veterans and partners think they are the only ones. They are not.

Military health experts note that with honest talk, compassion and creativity, couples can rebuild a loving relationship that may end up as close, or closer, than before deployment.

Some people avoid sex or certain kinds of touch, or only feel able to be close after drinking. Over time, avoiding can make the worry bigger.

Losing interest in things, feeling unworthy or not trusting others can lower desire and enjoyment. Depression often overlaps with PTSD here, especially for women.

Feeling constantly on guard can make it hard to stay present, relax and let go. Some people notice their body’s arousal feels tied up with threat.

When service members feel changed for the worse by their experiences, they may find it hard to share themselves physically, or worry they will pass that change on to a partner.

Some returning service members feel a strong pull toward frequent or intense sex, chasing a rush like the one they felt in danger. New sexual habits can also put sex ahead of emotional closeness. Partners can feel confused when this swings back and forth with disinterest.

Drinking and drug use can add to PTSD and brain injury problems and make it harder to enjoy closeness. Relying on them to get through intimacy can keep the real worry going.

Changes in sexual functioning are common after a TBI. People may have less desire, more desire or trouble with control, trouble with arousal, or difficulty reaching climax. Tiredness, low mood and changes in thinking play a part too.

Sometimes a brain injury brings less interest or motivation. Partners may need to start romantic moments, and often a simple show of interest is enough.

Pain can get in the way, and both partners may hold back for fear of hurting. Some treatments for pain can also affect desire, so talk with your clinical provider.

What helps

• Communication: say what feels OK and what doesn’t
• Consultation: physical or occupational therapists can suggest ways to reduce pain
• Creativity: try positions and activities that ease pressure on sore spots
• Timing: plan close time when pain is lower

An injury can make someone feel less attractive, ashamed, or unsure of their identity. Talking about these fears gives partners a chance to reassure each other.

When a body part is lost or no longer works, that is a real loss. Taking time to grieve it can help you move forward.

When one partner helps with wound care, hygiene or getting around, it can be hard to feel like lovers. Some couples ask someone else to handle care before time together. Others find creative ways to mix romance and care.

Couples who rebuild a satisfying sex life after injury often see sex as more than intercourse, focus on shared pleasure and love rather than performance, add variety, and keep talking about what feels good.

A partner may feel less desire because they don’t feel emotionally close yet, feel angry about being left alone so long, or are worn out by everything they carry.

Some partners have sex to keep the peace, or to prop up a partner who is struggling. Over time, this can send the message that sex is a chore. Honest talk works better.

Understanding why closeness has changed, whether PTSD, injury or low mood, helps you not read it as a lack of caring.

Respecting a partner’s need for time alone can actually help emotional and sexual closeness grow. Notice and thank each other for small efforts.

Survivors may notice

• Feeling distant from a partner, emotionally or physically
• Feeling disconnected from your body
• Memories or images coming up during sex
• Having more or less sex than before
• Finding it hard to say “no” or ask for what you want
• Only having sex after drinking or using
• Guilt, shame or helplessness when thinking about sex

VA offers free, confidential care for mental and physical health conditions related to MST, and sexual problems may be included. You can ask even if you are not sure MST caused them.

You can share what you need with a partner without sharing what happened. A word that means “stop” or “slow down” gives you back control.

Invisible injuries can make spontaneity harder. Scheduling time together when both of you are most likely to feel ready takes the guesswork out.

A quiet room without background noise can help, especially after a brain injury. Some people also prefer lights on, or a certain position, to feel safe and present.

• Intimacy & closeness
• Veterans & partners: talking, trust & closeness
• When sex is difficult

• “I’m concerned about my sexual health.”
• “I’m having problems with intimacy.”
• “I never want to have sex, and it’s causing problems in my relationship.”
• “I feel pain during sex.”

A provider can check your overall health and talk through whether any treatments you take might be playing a part. Women may need a gynecology visit, and men may need a urology visit.

Counseling can help with the emotional side. Couples therapy can help when the relationship is under strain. A certified sex therapist specializes in helping people with sexual problems.

Vet Centers offer free, confidential counseling, including for couples and families, for eligible veterans and service members.

Call 855-829-6636 (855-VA-WOMEN). It is open weekdays 8 a.m. to 10 p.m. ET and Saturdays 8 a.m. to 6:30 p.m. ET.

Some people lose relationships after an injury or find it harder to meet people. Joining a club or social group can widen your circle and open the door to closer relationships.

You don’t owe a new partner every detail of your service or health on a first date. Many people share bit by bit as trust grows.

After a brain injury, it can be harder to remember protection. Planning ahead, like always carrying protection or using phone reminders, helps.

Ask your VA provider for help with sexual health, including care related to MST. You can ask even if you’re not sure what is causing the problem.

• Vet Center Call Center: 877-927-8387, 24/7
• Women Veterans Call Center: 855-829-6636
• Military OneSource (within 365 days of leaving service): 800-342-9647, 24/7

Find a free, confidential helpline in your country at findahelpline.com.