Jacqueline Garrick, a former Army social work officer and Pentagon official, is the founder of Whistleblowers of America, a nonprofit that supports employees who have stepped forward to speak out against corruption and have suffered the psychosocial impact of workplace traumatic stress associated with retaliation, harassment, and discrimination.
Long after the sexual revolution of the 1960s, which challenged cultural and moral attitudes about human sexuality, sex is still a taboo topic for the U.S. armed forces. The military’s approach to sexuality and sexual health within its ranks has remained largely ineffective and reactive. Therefore, similar to other constructed Defense Centers of Excellence, a Military Sexual Health Center of Excellence (MSHCoE) could provide research and education to benefit members of the armed forces who are dealing with issues related to a range of sexual health and intimacy issues — including those that underlie mental health, substance abuse and suicide ideation challenges.
Discussions of sex in the service tend not to be proactive or informative. Instead, leaders primarily discuss sex with their troops as it relates to crimes and misbehaviors, such as assaults, fraternization, fornication and adultery -- which remains a court-martial offense under the Uniform Code of Military Justice despite being obsolete in most civilian courts. By maintaining this rigid approach, sexual activity remains a taboo topic for the military and fosters a command culture of denial and avoidance. Historically, women in the military ranks have been most harmed by these patriarchal regulations, which limited their ability to achieve full integration and equal status without being seen as a threat to unit cohesion. However, as women have broken down service barriers within the last few years, their rates of victimization have increased. And while Congress continues to debate whether military commands or civilian authorities should adjudicate sexual crimes, socio-sexual stigma remains.
As the Pentagon struggles with recruiting and retention issues, especially among women, it must review its outdated policies regarding human sexuality and sexual behaviors that are divergent from mainstream American adult socio-sexual attitudes. It should comprehensively research and address healthy physical intimate relationships so that it can be better positioned to support service members who have experienced sexual injury, illness or violence, and to provide care for those experiencing sexual health challenges. The Department of Defense should conduct or sponsor research to address human sexuality issues within the force and their impact on the quality of life of service members and their families. It already does this research with other health-related conditions, such as blindness, brain injury, or psychological health. And it should establish a MSHCoE that makes sexuality and sexual health a primary focus.
Overall, little to no attention has been paid to sexuality issues within the force, with the exception of sexual assault and sexual harassment, which remain high in spite of years of DoD policies and prevention strategies. In addition, there is still concern that military victims are less likely to report these crimes when they have experienced or perceive retaliation, so actual tracking is compromised. DoD has identified whistleblower retaliation as a primary reason for not coming forward, according to troops who are sexually abused, harassed, or assaulted. A 2014 RAND report documents the shortfalls of the DoD program as well, but makes no recommendation that would encourage healthy sexual contact conversations in a broader context for addressing sexual misbehavior. These reports’ finding that sexual violence is on the rise suggests that there is something amiss with the DoD approach to discussing unwanted sexual contact, which an MSHCoE could address by adding balance to the discussion on sexual behaviors and conduct.
In the Defense Advisory Committee on Women in the Service (DACOWITS) 2019 report, sex was mentioned 46 times, yet only in a negative context such as sexism or sexual assault. By comparison, DACOWITS found in 2014 that family planning education and contraception improve mission readiness and service members’ quality of life. Because of DACOWITS recommendations, the services continue to review their postpartum policies and practices, which an MSHCoE could further study. In addition, when the DACOWITS report discusses single servicewomen, it only does so in reference to single parenting; it also mentions dating partners only in connection to reporting domestic violence. The unspoken needs of service members to manage intimate-partner relationships are glossed over.
Further attention is needed regarding the reproductive health care needs of those in uniform, especially when military exposures have had an impact -- and that could be a task for MSHCoE as well. For example, studies show that there are in-vitro fertilization disparities for female veterans who report transition challenges between the military health system and Department of Veterans Affairs (VA) care. Similarly, the transition presents challenges in continuity of access to contraception and abortion. A recent War Horse article noted that some of the services are ending contraception education as part of their boot camp classroom curriculum. However, in spite of military rules and regulations prohibiting fraternization and adultery, intercourse does occur in the military environment, as evidenced by the number of women who are medically evacuated for pregnancy during deployments.
Additionally, menopause generally occurs before the average retirement age among higher ranking career service members. Menopause can continue from five to fifteen years of a perimenopausal period before permanent amenorrhea. So, as the military branches work to retain and promote women through the ranks, some of those women are likely to experience perimenopause, menopause and amenorrhea (as a result of illness or injury rather than age) during their military careers. Treatments for the side effects of menopause, such as hormone replacement therapy, and symptom management, should be discussed and normalized as a component of a female military culture.
Half of the active force is married, with almost 13% of the 671,591 married military personnel married to other military members -- a figure that includes the LGBTQ population. By rank, those who are in dual-military marriages represent 80% of enlisted troops and 20% of officers. Since there are known tips to avoid being caught, it is likely that these service members were engaged in sexual activity while on active duty prior to being married, despite rules prohibiting this. While rules related to fraternization are important to good order and discipline within the ranks, military members meet and form attachments while serving in similar occupations, on deployments or during training. It is human nature to be attracted to those with whom we share common experiences, values and beliefs. The camaraderie and intimacy of military service can lead to affection and affairs — which the military is not prepared to handle because it lacks focus on sexual health research, education and supportive services.
Education and guidance on healthy relationships, contraception and sexual functioning would be beneficial to building these marriages and eventually to the service members’ planning, conceiving and raising families within a military environment. These couples need to understand the potential career impacts they face and understand their options. Women in dual-military marriages tend to transition out of the military sooner in order to raise families and co-locate more often with their husbands. Guidance developed through a MSHCoE could assist in better informing these marriages and offer expanded opportunities for premarital counseling information and family planning. Couples should not be afraid to come forward, acknowledge their situations and seek guidance from their superiors or chaplains who should have other recourse than prosecution and punishment.
Failed intimate partner relationships are a known risk factor for suicide, as identified in the annual DoD Suicide Event Report (DoDSER). Notably, however, while the DoDSER presents suicide data, it does not interpret results. Therefore, there is a need to peel back the layers of these failed interpersonal relationships to understand why they fail. Civilian and military spouses and significant others all too often feel blamed and vilified if they terminate dysfunctional or abusive relationships — or fearful of rules against fraternization. They, too, have died by suicide. Meanwhile, underneath the surface, the contradictory and confusing sexual identities and conditions that service members confront remain unaddressed and frustrating for them.
Issues related to sexual dysfunction are neither comprehensively researched nor translated into care and support for service members and their families. Service members who have suffered combat-related genitourinary injuries or illnesses that result in anatomical loss or loss of function deserve attention from DoD researchers, especially as greater numbers of them are returning to duty or seeking disability compensation from the VA.
Military sexual trauma victims, who suffer the emotional devastation and incestuous betrayal of assaults that occur within commands and rank structures, also may have lifelong complications from the physical violence inflicted during rape, such as prolapse, infection, scarring and unwanted pregnancies. Service members need help understanding how their illnesses or injuries could lead to impotency or other sexual dysfunction. Many are embarrassed to discuss their conditions with their partners, caregivers or VA examiners and would rather suffer silently than admit to any dysfunction or other issues, such as sexual fantasies, fetishes, sexting, pornography, masturbation, autoerotic asphyxiation or homosexuality. Sexual functioning is a predictor of suicidal ideation among female service members. Yet the overall paucity of such studies leaves a gap in effective suicide prevention and intervention strategies for a military cohort and their partners.
Sex while in the service is a human factor that contributes both to individual resilience and military readiness. But until it is acknowledged more emphatically as a quality-of-life issue that affects recruitment, retention and transition, the military culture around it will continue to be a detractor from the military mission. Consequently, the Pentagon should establish a MSHCoE for research, translation and education that can address the full range of human sexuality issues within the force.
-- The opinions expressed in this op-ed are those of the author and do not necessarily reflect the views of Military.com. Find more information on how to submit your own commentary.
