The AFTER Study: Armed Forces genital Trauma and psychosexual Experiences Research

During the most recent conflicts in Iraq and Afghanistan, genital injuries were reported among male military personnel at rates higher than previously. To date, research has focused predominantly on immediate medical management. The limited published research considering potential psychosocial or sexual outcomes indicates Servicemen who sustained conflict genital injury may experience challenges such as low self-esteem, sexual dysfunction, fertility concerns, and loss of gender identity. The AFTER study will address this gap in the literature by exploring the psychosocial, sexual and relationship impacts of conflict-related genital injuries and how ex-servicemen with genital injuries (and their partners) can best be supported. The research questions (RQ) to be addressed are: RQ 1: How have conflict-related genital injuries, intimate scarring, or loss of function affected ex-Servicemen and their partners’ psychosocial (including relationships) and sexual wellbeing in the long-term? RQ 2: What are the psychosocial support needs of ex-Servicemen and their partners affected by conflict-related genital injuries, intimate scarring, or loss of function, and how can they be addressed? The project will take a participatory research approach, drawing on the principles of community-engaged research, patient centred outcomes research, and user centred design research. To address the project aims, a mixed-methods design will be used. First (Work Package 1), we will undertake two literature reviews of existing international evidence about a) the experiences of military personnel affected by conflict-related genital injury, intimate scarring, or loss of function and b) how the psychosocial support needs of those with genital injuries can be affectively addressed. In Work Package 2, a quantitative survey (n=100) with UK ex-servicemen with conflict-related genital injuries, intimate scarring, or loss of function will collect information about psychological, relationship, and sexual wellbeing outcomes using validated measures. At the same time as the survey, Work Package 3 will involve undertaking qualitative interviews with ex-Servicemen (n=20) who have sustained conflict-related genital injuries, intimate scarring, or loss of function, to gather deep experiential insights into psychological, relationship, and sexual wellbeing experiences, and to explore support needs and preferences. Further qualitative interviews with current or former romantic/intimate partners of ex-Servicemen (n=20) who sustained conflict-related genital injuries, intimate scarring, or loss of function, will gather deep experiential insights into their psychosocial, relationship, and sexual wellbeing experiences, and will explore partners’ support needs and preferences (Work Package 4). The findings will inform the co-creation of evidence-based intervention(s) (Work Package 5). These will be acceptability and feasibility tested through a multi-pronged approach with ex-Servicemen, partners, and relevant stakeholders (Work Package 6). The AFTER study is funded by The Scar Free Foundation via funds from The Armed Forces Covenant Trust.