The soldier's wife answered my "how are you doing" question with a mixture of sorrow and shame. Her husband had returned from Afghanistan with a traumatic brain injury and a missing limb. In an unguarded moment, she was mourning the loss of the emotional and physical connection they once enjoyed. Her achingly honest answer was my first glimpse into an aspect of war that no one really wants to talk about, sexual intimacy. Or lack thereof.
Thanks to 14 years of conflict in Iraq and Afghanistan, we've become versed at discussing the wounds of war. Most of us have heard of traumatic brain injury and amputation, or the hidden wounds like post-traumatic stress disorder that change personalities and behavior.
But the big shameful secret about coming home from war is what does, or what doesn't, happen when the bedroom door closes. That connectivity in relationships or marriages is both a private and a taboo subject in our society.
For many couples, once the acute healing is finished, the impact of combat injury on sexual health, intimacy and fertility is perhaps the biggest heartbreak. While sexual health is a huge contributor to overall mental health, this is an often overlooked and uncomfortable subject.
Until recently, VA physicians weren't required to include questions about relationships and sexuality in their checkups with injured patients. For many couples, starting that conversation without an entry point is impossible, laden with the shame of failure.
When my journalist husband Bob was critically injured in Iraq in 2006, it took a full year before I let my breath out. I was pulled in so many directions as a wife, mother and with work, that sleep was my only constant craving. The concept of sex felt more like summiting Everest. In those early days, I was almost afraid to touch him, horrified by the metal staples in his head and the trauma of life interrupted as he lay in a coma for five weeks.
Caregiving a spouse is about as "sexy" as crepe-soled nursing shoes. The yin and yang we enjoyed so effortlessly as a couple had veered wildly off course with his injury. I wondered every day if we would we ever be the same again, but I never once thought about walking away.
We had many points to connect us. We were older. We shared four children. We found intimacy again. Many of the couples I had met were in the early parts of their marriages or just beginning. For them, the road ahead without resources and sometimes supportive families was enough to break any bond. A vast percentage of these marriages don't survive.
This post-9/11 generation of warriors serves longer than any previous one, which means more than half of our servicemembers are married. According to the Department of Defense, the active and reserve military has 2.9 million spouses and children living alongside a total force of 2.4 million.
And mental health issues can be the wet blanket thrown over a healthy libido. According to Dr. Sherrie Wilcox and a recent "Sex & the Military: The Other Invisible Wounds" study, those with PTSD are 30 times more likely to have erectile dysfunction. Yet only 12% of those with sexual functioning problems sought treatment.
Improvised explosive devices are responsible for almost 1,300 urogenital injuries among American service members, according to the U.S. Army Institute of Surgical Research. I will never forget joining a conversation about Match.com with two above-the-knee double amputees. "Once they check out your photo, at what point do you tell them that you have a bag (ostomy) and no legs?" one asked the other.
I am ashamed to say that I had never contemplated that aspect of dating and romance. I had imagined the difficulties of navigating in a wheelchair, never the intricacies of wheelchair sex.
Last year, the Bob Woodruff Foundation held a convening in Washington, D.C., for servicemembers, health-care professionals and the VA to discuss military families' needs regarding the present intimacy and fertility landscape. The families shared frank and powerful stories.
Because the VA does not cover infertility treatments, many couples are forced to pay out of pocket for in vitro fertilization, something other insurance policies routinely cover in the civilian workplace.
But there is hope on the horizon. Support groups are becoming more common. We funded an explicit "Intimacy after Injury" manual that was one more step in helping to lift the lid off the conversation and hopefully pave the way for policy changes.
"Sex is part of a healthy lifestyle," says Navy Capt. Moira McGuire, at Walter Reed National Military Medical Center.
You bet it is. So let's keep talking.