Trigger Warning: This article discusses sexual trauma. If you have experienced sexual trauma and need assistance, you can call the National Sexual Assault Hotline at 800.656.HOPE (4673). A trained staff member will offer your confidential support.
Military service can lead to unexpected consequences. Some veterans find that physical and mental effects of military services result in changes to sexual function. Any sexual dysfunction brings emotional distress. In addition, it may impact veterans' relationships with their partners, their ability to have children, and their sense of who they are.
For female veterans, sexual dysfunction may have complex causes. There are situations where an underlying condition or injury affects the reproductive organs in a way that limits sexual activity. In other cases, veterans may have psychological responses to trauma that affect their sexual responses.
The VA offers guidance to veterans with female sexual arousal disorder (FSAD) or female sexual arousal/interest disorder (FSA/ID). Veterans may be entitled to disability compensation for conditions that cause sexual dysfunction.
VA Ratings for Female Sexual Arousal Disorder
The VA defines female sexual arousal disorder as the "continual or recurrent physical inability of a woman to accomplish or maintain an ample lubrication-swelling reaction during sexual intercourse." It is considered a physiological disability that a medical doctor must confirm.
The agency goes on to note, "[FASD] is not a psychiatric condition found in the Diagnostic and Statistical Manual, fifth version (DSM-5) for mental disorders. DSM-5 includes a female sexual interest/arousal disorder diagnosis, which is a different disorder and is not synonymous with FSAD. Therefore, a diagnosis of FSAD cannot be rendered or confirmed by a mental health examiner."
In practice, this means that lack of physical arousal response is the only sexual dysfunction the VA considers a disability. The dysfunction must have a diagnosable cause linked to something that happened during the veteran's service.
Direct injury to the reproductive tract may cause sexual dysfunction. Other medical conditions may affect how the productive organs function. Some of these conditions have been linked to military service, while service-related injuries or illnesses may have aggravated others.
Conditions that cause sexual arousal dysfunction include:
- Kidney failure
- Multiple sclerosis
- Heart disease
- Bladder problems
- Certain medications, including some antidepressants, blood pressure medications, antihistamines, and chemotherapy
If a veteran received a diagnosis of an underlying condition with an affirmative service connection, they could claim FASD as a secondary disability. The VA would then consider the FASD diagnosis as "loss of a creative organ," making the veteran eligible for special monthly compensation. This is like the way VA treats male erectile dysfunction.
Female Sexual Dysfunction as a Psychological Condition
Not all sexual dysfunction has a physical cause. Psychological and emotional factors can affect sexual function and relationships. Trauma is one cause of sexual dysfunction. Underlying chronic mental health conditions can also trigger female sexual dysfunction.
According to the Diagnostic and Statistical Manual, fifth version (DSM-5), the symptoms of female sexual arousal/interest disorder include:
- Absent or reduced interest in sexual activity
- Absent or reduced sexual thoughts or fantasies
- Reduced or no initiation of sexual activity
- Absent or reduced sexual excitement or pleasure during most sexual activity
- Absent or reduced sexual interest or arousal in response to internal or external cues, such as a partner's attempts to initiate sexual activity
- Absent or reduced genital or nonessential sensations during sexual activity
The psychological and emotional causes of this condition include:
- Negative attitudes about sexuality
- Relationship difficulties, including abuse
- Childhood stressors
- History of emotional or physical abuse
- Other psychiatric conditions such as depression and anxiety
- Medication side effects
- Stressors (job loss, bereavement)
- Alcohol use
Since the VA does not recognize the DSM-5 condition called female sexual arousal/interest disorder as a disability, there is no path to receiving benefits simply due to the condition. However, sexual dysfunction can be a symptom of other disabilities that qualify for VA benefits.
Depression, anxiety, PTSD, and other mood disorders can cause sexual dysfunction. They are all considered disabling conditions under the VA regulations. Veterans may be entitled to benefits if their mental health condition affects daily life activities or inhibits their ability to work.
To qualify for VA disability benefits for a mental health condition, veterans need to establish a link between military service and their current conditions. To demonstrate the service connection, a veteran must satisfy three essential criteria. The first is medical evidence of a current disability.
The second step requires medical evidence that something happened in service.
Finally, veterans must show a connection between in-service injury or disease and the present disability. This is called the nexus requirement.
Medical records from during and after services can demonstrate the onset of mental health conditions. A doctor can document how service-related activities contributed to the veteran's current disability.
Military Sexual Trauma
For many veterans, sexual dysfunction can result from military sexual trauma (MST). Almost 25% of female service members experience MST during their service. The effects of sexual trauma can be long-lasting and debilitating.
The VA provides treatment for any physical and mental health conditions related to MST. Even veterans who are not eligible for other care through the VA can access care associated with MST. They do not need to have reported the incident when it happened.
In addition to accessing MST-related care, some veterans experiencing mental health issues related to MST may qualify for disability benefits for PTSD or other mental health conditions such as depression or anxiety. The veteran must demonstrate that MST contributed to a current physical or mental disability to receive benefits.
While the VA does not consider most sexual dysfunction a disability, it can be considered proof of MST-related disability. The VA will consider behavioral changes at the time of the MST incident as proof of the event.
Relevant behavior includes:
- Change in work performance at the time
- Panic attacks
- Pregnancy tests
- Relationship issues, including divorce
- Requests for duty transfer
- Sexual dysfunction
- New or increased substance abuse
- Tests for sexually transmitted diseases
- Unexplained social or economic behavior
If the veteran reported the sexual assault at the time, those records could also be used as evidence that the MST contributed to psychological disabilities. The VA will accept military records of official reports and corroborating statements from friends, mental health professionals, medical providers, clergy, or rape crisis counselors.