For Veterans, Trauma Of War Can Persist In Struggles With Sexual Intimacy

Jan 1, 2017
Originally published on January 5, 2017 9:18 am

Much has been said about the physical and psychological injuries of war, like traumatic brain injury or post-traumatic stress disorder. But what we talk about less is how these conditions affect the sexual relationships of service members after they return from combat.

Since 2000, service members who were deployed received at least 138,000 diagnoses of PTSD. More than 350,000 have been diagnosed with traumatic brain injury since 2000. Evidence suggests the numbers are actually higher because many don't seek treatment.

These conditions cause their own sexual side effects, such as emotional numbness, loss of libido and erectile dysfunction. And the long list of medications used to treat PTSD, TBI and other medical conditions can worsen those side effects.

'He would sleep for days'

Chuck and Liz Rotenberry of Baltimore struggled with their own challenges when Chuck returned from Afghanistan in 2011. He's a former Marine gunnery sergeant who trained military working dogs. He left active duty in 2012. She is an Elizabeth Dole caregiver fellow, a spokesperson on issues chosen by the military caregiving foundation.

For Liz and Chuck, sex had never been a problem. They've been married for 14 years and they're still very much in love. Liz says she fell for Chuck in high school. He was that guy who could always make her laugh, who always had a one-liner ready and never seemed sad.

But when Chuck returned from Afghanistan, their relationship would soon face its greatest challenge. Baby No. 4 was just two weeks away; for sure, it was a chaotic time. But Liz noticed pretty quickly something was terribly wrong with her husband.

"I wouldn't be able to find him in the house and he wouldn't be outside, and I'd find him in a separate bedroom just crying," Liz says. "He would sleep for days. He would have a hoodie on and be just tucked away in the bed, and he wouldn't be able to get out of bed. He would have migraines that were so debilitating that it kept him in the bed."

When Chuck was in Afghanistan, an IED — improvised explosive device — exploded 3 feet behind him. Shrapnel lodged into his neck and back.

It would take three years for someone at the Department of Veterans Affairs to explicitly lay out for Liz that Chuck had developed severe post-traumatic stress and suffered a traumatic brain injury — and that she would need to be his caregiver.

The Marine self-image

During that three-year period, there were times Chuck estimates he was taking 15 to 16 different medications twice a day.

Sex was usually the furthest thing from his mind.

"I didn't think about it. I wanted to be with Liz, I wanted to be near her," he says. "When the desire was there, it was unique. It was rare, as opposed to the way it was before. And a lot of times, with the mountains of medication I was on, you know, in my head [it was] all systems go, but that message didn't go anywhere else."

Liz noticed that Chuck stopped initiating physical affection.

"The thought of him reaching out to me to give me a hug wasn't existent. It was like I had to give him the hug. I now had to step in and show him love," she says.

Sometimes months would go by before they would have sex.

"It started off as being pretty embarrassing, pretty emasculating," Chuck says. "It was like, 'Really? This too doesn't work?' You blame it on, 'Oh, it's just the medication,' or 'You're tired,' or whatever initially, and you don't realize it's stress or my brain just doesn't work like it used to."

Liz and Chuck had never really talked about sex in any serious way before. So they kept avoiding the conversation — until this year. That's when Chuck finally asked his primary care provider for help. The doctor prescribed four doses of Viagra a month. Liz and Chuck say the medication has improved things substantially — though they joke about how few doses the VA allots them every month.

But asking for just those four doses took Chuck three or four visits to the doctor before he could work up the nerve. He says it can be especially hard for a Marine to admit he's having problems with sex because it contradicts a self-image so many Marines have.

"You know, as a Marine, you can do anything. You believe you can do anything, you've been trained to do nearly anything," he says. "You're physically fit. You're mentally sound. Those are just the basics about being a Marine."

If he has any advice for a Marine going through the same thing he and his wife are facing, he says you need to talk about it. Bring it up with your spouse. Bring it up with your doctors.

"Marines always jokingly hand out straws. You got to suck it up. You got to do what you need to do to get it done," Chuck says. "It's just a different mission. ... Don't let your pride ruin what you worked so hard for."

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AILSA CHANG, HOST:

We're now going to talk about something pretty sensitive. So if you have small children around, you might want to listen to this later. We're going to hear about what happens to sexual relationships after servicemembers return from combat. It takes a lot for a couple to open up about this part of their relationship, so we were so grateful to meet Chuck and Liz Rotenberry and sit down with them at their home in Baltimore.

It's so nice and warm in here (laughter).

LIZ ROTENBERRY: 'Cause you know what? Our heat didn't work at all last night.

CHANG: Oh really?

L. ROTENBERRY: And I woke up this morning...

CHANG: Liz's husband, Chuck, is a former Marine gunnery sergeant who trained military working dogs. He returned from Afghanistan in 2011 and left active duty shortly after.

Much has been said about the physical and psychological injuries of war such as traumatic brain injury or PTSD. But what we talk about less is how these conditions affect sexual intimacy. Now, for Liz and Chuck, sex had never been a problem. They've been married for 14 years, and they're still very much in love. Liz fell for Chuck in high school because he was that guy who could always make her laugh.

CHUCK ROTENBERRY: I'm extremely handsome as well, so that's...

(LAUGHTER)

C. ROTENBERRY: I think that probably had something to do with it.

L. ROTENBERRY: That, too (laughter).

CHANG: But when Chuck returned from Afghanistan, their relationship would soon face its greatest challenge. Baby number four was just two weeks away. So for sure it was a chaotic time, but Liz noticed pretty quickly something was terribly wrong with her husband.

L. ROTENBERRY: I couldn't find him. I wouldn't be able to find him in the house. He wouldn't be outside, and I'd find him in a separate bedroom just crying. And he couldn't understand why. He would sleep for days. He would have a hoodie on and be just tucked away in the bed, and he wouldn't be able to get out of bed. He would have migraines that were so debilitating that it kept him in the bed, and I kept saying to my mom something's wrong.

CHANG: When Chuck was in Afghanistan, an IED exploded three feet behind him. Shrapnel lodged into his neck and back. It would take three years for someone at the VA to lay out the long-term consequences of that blast.

L. ROTENBERRY: He has severe post-traumatic stress with a traumatic brain injury, and you are now his caregiver. And I didn't - it didn't hit me until then. It's definitely - those three years were the toughest times for us.

CHANG: So this is delicate, but I want to talk about sex. Was sex even something you guys were thinking about with all this other stuff going on?

C. ROTENBERRY: You know, I have a beautiful wife, and I'm a very fortunate person. So, you know, I definitely married up (laughter). And being a dude - yeah, dude - that's what I would normally think about all the time, but, no, I didn't think about it. I wanted to be with Liz. I wanted to be near her. And at times, I didn't want to be anywhere near anybody. When the desire was there, it was unique. It was rare as opposed to the way it was before, and a lot of times with, you know, the mountains of medication I was on, you know, in my head, it - all systems go. But that message didn't go anywhere else besides that. So it was difficult, you know, to not only be in the mood or, you know, have the desire, but, you know, to perform as well.

CHANG: How much medication were you on at this point?

C. ROTENBERRY: At that point within that three years, probably about 15 or 16 different ones.

CHANG: A day?

C. ROTENBERRY: Oh, yeah. A couple of times a day. It was quite a bit.

CHANG: What changed in your sex life from what you could observe, Liz, when Chuck came back? What was different?

L. ROTENBERRY: Well, I knew that emotionally he wasn't doing well. So I didn't want to have expectations for him because I didn't know what was happening, and I don't want to add any further stress. But even just being intimate with me in other ways was tough. You know, the thought of him reaching out to give me a hug wasn't existent. It was almost like I had to give him the hug. I now had to step in and show him love, and that's a tough understanding because usually the man, you know - the man is the one to initiate any kind of extra affection, especially from my husband. I mean, he's very affectionate for a man. He's always telling me how much he loves me, and he always wants to touch me in some way, you know, if it's just passing me and, you know give - bumping into me on purpose or nudging me a little or something. But, you know, we didn't have that.

CHANG: How long would the two of you go without having sex?

C. ROTENBERRY: It was probably months.

L. ROTENBERRY: Months, yeah.

C. ROTENBERRY: Yeah, sometimes it was months. It started off as being, you know, pretty embarrassing, pretty emasculating. You know, it's like, oh, really? This, too, doesn't work, you know? You know, you blame it on, oh, it's just your medication or you're tired or whatever initially. And you don't realize it's, you know, stress or, you know, my brain just doesn't work like it used to or, you know, do the same things. As much as I tried to say it, it was hard for Liz to believe. You know, it's not you, it's me kind of thing but it really - it's not even me. You know, it's not you. Certainly, it's me, but I'm not even me.

CHANG: Now, Liz and Chuck had never really talked about sex in any serious way before, so they kept avoiding the conversation until this year. That's when Chuck finally asked his primary care provider for help.

C. ROTENBERRY: She saw that I, you know - it was something that I had mentioned multiple times and said, well, you know, we can try, you know, Viagra. So I guess the way the VA works, it's four doses a month.

CHANG: Just four?

C. ROTENBERRY: Yeah, right? I was like dang that's like once a week.

L. ROTENBERRY: So (laughter)...

C. ROTENBERRY: It used to be like that wouldn't get us through today. You know what I mean?

CHANG: (Laughter).

C. ROTENBERRY: So...

CHANG: But it took Chuck three or four visits to work up the nerve to ask for just those four doses. He says it can be especially hard for a Marine to admit he's having problems with sex because it contradicts a self image so many Marines have.

C. ROTENBERRY: You know, as a Marine, you can do anything. You believe you can do anything. You've been trained to do nearly anything. You're physically fit. You're mentally sound. You know, those are just the basics, you know, about being a Marine that it's - everything is easy. You know, and we...

L. ROTENBERRY: We've had good friends - very close other Marine friends - ask him, hey, is everything working OK for you guys? And he'll be like, oh, yeah. It's great. You know, like two times a day, every day, you know. And then they just kind of joke about it, but they're - I think I - now I'm looking back on it, I feel like there was, you know, they were trying to reach out to each other to say is it just me or, you know, are you having the same problems, too?

C. ROTENBERRY: I've started to notice that, you know, talking with other people that when they bring it up, it's to see if like Liz said am I the only one? You got this going on, too? So I do take it serious and offer as much as I can.

CHANG: What would you tell a Marine who kind of - who's going through the same thing that you were going through with your wife? What is your advice?

C. ROTENBERRY: You got to talk about it. You've got to be able to honestly evaluate yourself. Marines always jokingly, you know, hand out straws. You got to suck it up. You got to do what you need to do to get it done. Right? This is a different mission. You know, the mission accomplishment is number one in the Marine Corps so don't let your pride ruin, you know, what you've worked so hard for.

CHANG: Thank you guys both so much.

L. ROTENBERRY: Yeah, no, thank you. I appreciate the opportunity.

CHANG: That was Chuck and Liz Rotenberry in their home in Baltimore. Transcript provided by NPR, Copyright NPR.