FRIDAY, Feb. 21, 2014 (HealthDay News) -- The tools of war have
changed. With the increased use of powerful explosive devices, men
and women patrolling on foot in bomb-laced areas of combat are
increasingly suffering traumatic injuries to the groin and
genitals, experts say.
Those injuries can pose complex long-term sexual and
It is hard to even imagine having your genitals crushed, burned
or ripped off in a blast by a makeshift bomb, said Dr. Chris
Gonzalez, the lead author of a new review article published
The Journal of Men's Health. "For some, it's even worse than
losing a limb," he said.
The impact of so-called "improvised explosive devices" (IEDs) is
different from gun fire encountered in earlier combat, explained
Gonzalez, who is a professor of urology at Northwestern University
Feinberg School of Medicine, in Chicago.
"The energy comes from the ground up, so the first thing that gets hit is in the perineal [groin] area," he said.
The rising use of IEDs by enemies in countries like Iraq and
Afghanistan has led to a more than three-fold rise in the rate of
genital and urinary injuries to men and women in combat, according
to Gonzalez. In fact, IEDs are now the leading cause of all
combat-related casualties, accounting for about two-thirds of
genital-urinary injuries. These types of wounds can affect the
penis, testicles, bladder, urethra, vagina, ovaries, intestines,
and rectum, Gonzalez said.
Surgeries and subsequent problems and complications can often
string out over months, requiring a wide range of health providers,
support and help navigating the health care system, Gonzalez added.
Blast-caused problems often include post-traumatic stress disorder
and other serious psychological issues associated with the loss of
sexual function and fertility, he said.
Too often, these issues are not managed effectively by the
health care system, Gonzalez believes. "The VA [Veterans
Administration] has done a great job in dealing with limb loss and
traumatic brain injuries, but with these injuries, the care can be
fragmented," he said.
Patients also experience problems that impair their
relationships -- issues with intimacy, parenting and self-worth,
Dr. Janice Bray, chief of Central Texas Veterans Health Care
System, said in an editorial accompanying the review article.
Veterans with these type of groin injuries often have an increased
suicide risk, she said.
Silence is a big contributor. "People are uncomfortable talking
about these issues," said Bray. "There's a shyness about it.
There's not an open dialog, and there's a taboo about these parts
of our body."
As a result, Bray said patients don't want to broach the topic
of sexual function or relationship problems associated with their
injuries; they assume physicians would bring up the issues if they
thought they were important. And doctors too often believe that if
something were bothering patients, the patients would ask
The sheer scope of these wounds demands new, coordinated
approaches to care, Gonzalez believes.
He said medical disciplines have long been run in isolation,
with inadequate communication between various specialties. "We're
so super-specialized now and medicine has moved away from
coordinated care," he said.
To help these patients, health care providers need to identify
the broad range of problems these patients have, and work
collaboratively to address them, he added.
But Bray, a psychiatrist, said it's going to be difficult to get
physicians from different specialties to talk with each other. For
example, "I have no interaction with surgeons," she said.
"Communication is on paper or electronic, and you communicate
without having a discussion. There's not a lot of time built in to
interact and work together."
Isn't there some way to prevent these wounds in the first place?
It's tough, said Gonzalez. While there are several types of body
armor designed to help reduce the impact of IEDs, they typically
are not designed for the groin and are not widely used, he
As for fertility issues, some men and women who are deployed to
high-risk areas may have sperm taken and preserved before
deployment, just in case, said Gonzalez. There are also ways to
extract and preserve sperm after an injury has occurred, he
There may be some good news, however. In December, President
Obama signed the National Defense Authorization Act -- legislation
that contained an amendment that requires the Department of Defense
and the Department of Veterans Affairs to create a comprehensive
policy for treating service members with wounds to their
urinary-genital areas. Urological associations worked to advance
the issue of treating in Congress and to get the amendment into the
Act, Gonzalez said.
"This bill will look at the research, prevention including better body armor and what's the best way to manage these folks at the battlefield, stateside, and in rehabilitation," Gonzalez explained.
Learn more about explosions and blast injuries from the
U.S. Centers for Disease Control and
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