Mission Unaccomplished: Understanding the Health Needs of our Women Veterans

By: Jennifer Wider, MD
June 13, 2011

Women are the fastest growing segment in the US military, already accounting for approximately 14 percent of deployed forces. According to statistics from the Department of Veterans Affairs (VA), 20 percent of new recruits and 17 percent of Reserve and National Guard Forces are women. As the number of women continues to grow in the military, so does the need for health care specifically targeted to their unique concerns.

Historically, lower rates of female veterans have used the VA system. “Research has shown that women didn’t define themselves as veterans in the past, and this is changing,” said Antonette Zeiss, PhD, a clinical psychologist and Acting Chief for Mental Health Services at the VA Central Office in Washington, DC.

Now, “Women are among the fastest growing segments of new VA users with as many as 44 percent of women returning from Iraq and Afghanistan electing to use the VA compared to 11 percent in prior eras,” said Sally Haskell, MD, Acting Director of Comprehensive Women's Health, at the VA Central Office.

This change is due in large part to the wars in Iraq and Afghanistan, and the different military service opportunities available to women there. Although women are technically prohibited from participating in front-line combat, they have served in counterinsurgency operations in large numbers. Women are also often in convoys, which may be attacked, leading to serious injuries resembling those of their male counterparts.

“We found in the cohort of veterans of Iraq and Afghanistan using VA care in their first year after deployment that the most common conditions in female veterans were back problems, joint disorders, post traumatic stress disorder (PTSD), mild depression, musculoskeletal disorders, adjustment disorders, skin disorders, major depression, ear and sense organ disorders and reproductive health disorders,” said Haskell.

In addition, female veterans are more likely than their male counterparts to be confronted with childcare issues. “Women veterans may also need to reestablish childcare when they return home,” said Zeiss. “The VA is increasing family-oriented services and offering options to include the family in healthcare, if the veteran wants.”

According to a recent study in the journal Women’s Health Issues, female veterans had similar rates of physical conditions in the first year after combat, but higher rates of certain mental disorders, including depression and adjustment disorders. Men had slightly higher rates of PTSD.

According to the National Institute of Mental Health, PTSD is a condition that develops after a distressing ordeal that involved physical harm or the threat of physical harm. PTSD can cause a multitude of symptoms including: flashbacks, bad dreams, frightening thoughts, avoidance, difficulty remembering things, stress, anxiety, anger, being easily startled, and sleep and eating disturbances. Among military personnel serving in Operation Iraqi Freedom and Operation Enduring Freedom, more than 17 percent of service members screened positive for PTSD.

There are some notable gender differences when it comes to PTSD. According to survey results from PTSD in Women Returning From Combat – a report by the Society for Women’s Health Research, clinicians treating female patients reported more depressive symptoms in women, while men exhibited more irritability and anger, nightmares and flashbacks.

The report also revealed that female patients were more receptive to psychotherapy, while male patients expressed a stronger preference for medication. One key sex difference that almost 65 percent of doctors noted was that sexual trauma (previous or otherwise) was an issue in the treatment of their female patients but not at all for male patients.

Military Sexual Trauma (MST), a term coined by the VA, is the experience of sexual assault, or severe, repeated sexual harassment experienced during military service. MST can be experienced by both women and men and many VA facilities have designated a Military Sexual Trauma Coordinator to oversee the screening and treatment referral process.

When it comes to MST, “many women would like to have women providers,” said Zeiss. “Every facility needs to find out what gender providers are available, especially with sensitive topics. In my experience, men who experience sexual trauma also request women providers.”

Growing numbers of women in the military have posed challenges and sparked changes in VA services. “We are changing the treatment environment so women feel safe, supported and get the care they need,” said Zeiss.

Sources

Meehan S. Improving Health Care for Women Veterans Health Services Research and Development Service, Office of Research & Development, Department of Veterans Affairs, Washington, DC, USA.

Fihn S. Washington DC: Women's Health Conference; Women's Health: A Research Priority in VA. November 8–9, 2004.

Haskell S, et al. The Burden of Illness in the First Year Home: Do Male and Female VA Users Differ in Health Conditions and Healthcare Utilization, Women's Health Issues 21-1 (2011) 92–97.

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For more information on the Society for Women’s Health Research please contact Rachel Griffith at 202-496-5001 or Rachel@swhr.org.

Jennifer Wider, M.D., is a medical advisor for the Society for Women’s Health Research (SWHR) www.swhr.org, a national non-profit organization based in Washington D.C., widely recognized as the thought leader in research on sex differences and dedicated to improving women’s health through advocacy, education, and research.

Dr. Wider is a graduate of Princeton University and received her medical degree in 1999 from the Mount Sinai School of Medicine in New York City. She is frequently published in newspapers, magazines, and websites and has been a guest on the Today Show, CBS News, Fox News, Good Day New York, and a variety of cable channels. Dr. Wider hosts “Paging Dr. Wider,” a weekly segment on Sirius satellite radio for the Cosmopolitan magazine channel.

Dr. Wider is a past managing editor of the health channel at iVillage.com. She writes a monthly news service article for SWHR and is the author of the consumer health booklet “Just the Facts: What Women Need to Know about Sex Differences in Health” and the book “The Doctor’s Complete College Girls’ Health Guide: From Sex to Drugs to the Freshman Fifteen.”

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SWHR Featured in New Nursing Textbook

Chapter covers SWHR’s work in advocacy, education, and research for women’s health

Washington, DC (May 18, 2011) – Society for Women’s Health Research (SWHR) Board member and leader in women’s and infants’ health and research, Irma Goertzen, RN, MA wrote an exciting chapter on SWHR in the newly published textbook, Policy & Politics in Nursing and Health Care, 6^th Edition.

The new textbook features current analysis of healthcare policy and how nurses can directly influence change in today’s health care environment. Policy & Politics covers the 2010 healthcare reform law, community involvement and activism, and chapters detailing innovative work in today’s health non-profits.

“We are very pleased with the inclusion of SWHR’s history and impact on health research in the new textbook Policy & Politics,” said Phyllis Greenberger, MSW, President and CEO of SWHR. “Former SWHR Board Chair Irma Goertzen and Suzanne Stone did a wonderful job including all relevant SWHR achievements in this enlightening book for today’s nursing students. Hopefully this book chapter will inspire students to consider sex differences in their chosen career fields.”

Policy & Politics is published through Elseiver Sanders and edited by Diana J. Mason, Judith K. Leavitt, and Mary W. Chaffee. Purchase your copy today from any online retailer or from your local book store.

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For more information on the Society for Women’s Health Research please contact Rachel Griffith at 202-496-5001 or rachel@swhr.org.

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Annual OSSD Meeting to be Held June 2-4

WASHINGTON, DC (May 17, 2011) — The 5^th Annual Meeting of the Organization for the Study of Sex Differences (OSSD) is June 2-4 in Oklahoma City. The annual OSSD meeting encompasses new research into sex differences by prominent US and international researchers. This is the can’t-miss research event of the year!

The OSSD Annual Meeting is the leading forum for scientists to explore aspects of sex differences research at the genetic, molecular, cellular, organ, and system levels in various model systems. The field of sex-based biology is growing rapidly. This meeting promotes the understanding and dissemination of novel findings about how sex differences translate into human physiological and pathological processes throughout the lifespan.

Rates for the 3 day meeting at the Skirvin Hilton Hotel in Oklahoma City can be found at ossdweb.org but space is limited so REGISTER TODAY!

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For more information on the Society for Women’s Health Research please contact Rachel Griffith at 202-496-5001 or rachel@swhr.org.

OSSD is a non-profit, scientific membership society. OSSD was established in 2006 by the Society for Women's Health Research (SWHR), with staffing provided by SWHR. Members include basic and clinical scientists from various disciplines who share an interest in exploring sex/gender differences in all areas of biological, medical, and behavioral science.

The Society for Women’s Health Research (SWHR), a national non-profit organization based in Washington D.C., is widely recognized as the thought leader in women’s health research, particularly as sex differences impact health. SWHR’s mission is to improve the health of all women through advocacy, education and research. Visit SWHR’s website at www.swhr.org for more information.

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6th Annual SWHR Medtronic Prize Winner Announced

Washington, DC (May 10, 2011) — The 6^th annual Society for Women’s Health Research Medtronic Prize for Scientific Contributions to Women’s Health was presented to Dr. Denniz Zolnoun from the University of North Carolina at the Society for Women’s Health Research (SWHR) 18^th Annual Gala Dinner on May 9, 2011.

The SWHR Medtronic Prize is given to a female scientist in her early to mid career who has devoted a significant part of her work to sex differences research and has served as a role model and mentor for both colleagues and students.

Zolnoun is a celebrated researcher at UNC specializing in women and gynecological pain. She received her BS in Biophysics from the University of California, her MD from the University of Illinois, and her MPH in Health Care Prevention from the University of North Carolina, where she is now an Associate Professor and Director of the Vulvar Pain Clinic.

Zolnoun’s area of research is pain mechanism, especially gynecological pelvic pain. Although persistent pain affects millions of women across the U.S., little is known about it in women. Zolnoun discovered that sensory nerves, perception, and dysfunction are well described and traced in men but not in women. Even anatomy books lack descriptions of these nerves, their point of origin, termination, and clinical perception, as they pertain specifically to women. Zolnoun has dedicated her research to closing this knowledge gap. She now strives to identify how sex differences affect sensory nerves in order to help determine the cause of women's pelvic pain and important clinical implications of this work.

“On behalf of millions of women with intractable pelvic pain I’d like to extend my heartfelt gratitude to SWHR for their support of sex difference research while championing a higher standard in women’s health,” said Zolnoun. “I am honored and privileged to be an SWHR Medtronic Prize winner and look forward to continuing my research into pelvic pain and closing the gender gap in medical research.”

Zolnoun has over 20 peer reviewed publications in journals including: The International Journal of Gynecology and Obstetrics, The Clinical Journal of Pain, and The Annual Review of Sex Research and has authored several book chapters. Currently, she reviews nine journals and serves on the North Carolina Medical Board as the Expert External Reviewer.

Along with the SWHR Medtronic Prize, Zolnoun’s research has been supported by grants from the National Vulvodynia Association, NC TraCS Institute, and the Center for Neurosensory Disorders.

SWHR congratulates Dr. Zolnoun on her accomplishments and her work advancing sex differences research.

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For more information on the Society for Women’s Health Research please contact Rachel Griffith at 202-496-5001 or Rachel@swhr.org.

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Bruised and Betrayed: Women and Domestic Violence

By: Jennifer Wider, MD

April 14, 2011

Domestic violence knows no boundaries: cultural, socio-economic, religious, level of education, gender or age. It can occur in any relationship and to anyone, but especially to women. In fact, roughly 25 percent of women will become a victim at one time or another during her lifetime.

Abuse is defined as any act used to gain power and control over another person, which can take on many forms. It can include physical, sexual, emotional, economic, coercion, threats, isolation and/or intimidation.

Domestic violence is abuse that occurs within interpersonal relationships and has become one of the top public health issues facing women in the United States. It is a leading cause of injury to women between the ages of 14 and 44 in this country.

There are risk factors that may increase the likelihood that a person becomes a victim to domestic violence. These can include: history of violence or abuse in a past relationship, physical or mental disability, unemployment, poor living situation, substance abuse, unplanned pregnancy, recently separated or divorced, social isolation and witnessed abuse as a child.

Men are not immune to victimization in relationships, but the patterns are different. “In many American surveys, roughly equal numbers of men and women report ever experiencing a violent act by their partner,” said Keera Allendorf, PhD, Assistant Professor, Department of Sociology, University of Illinois at Urbana-Champaign. “However, women experience more severe and more frequent violence than men.”

Marital status and the amount of time couples have been together seem to play a role as well. “Cohabiters have greater violence than married people,” reported Allendorf. “And there is a higher risk for violence earlier on in a relationship than later.”

Some victims report that they have difficulty recognizing the signs of domestic violence, especially if the abuse is not physical in nature. One woman reported to a worker at a local domestic violence crisis center, “Everyone has disagreements.” But domestic violence is not a disagreement; it is a pattern of behavior used by one partner to exercise power and control over the other. Oftentimes, the behavior may begin subtly and then quickly escalate in intensity and frequency over time.

There are serious and harmful long-term effects associated with domestic violence. Victims may experience physical injuries which range from bruises and broken bones to head injuries and internal bleeding. Women who are victims of sexual violence may contract sexually transmitted diseases and experience unwanted pregnancies. Studies show that pregnant women who are physically and emotionally abused are at higher risk for low-birth-weight infants, pre-term labor and miscarriage.

Not just physical, domestic violence takes an emotional toll as well. Women who are in abusive relationships are more likely to be depressed, anxious, experience post-traumatic stress disorder (PTSD), engage in substance abuse and attempt suicide. One study revealed that female victims of domestic violence have a 40% increased risk of developing postpartum depression.

Domestic violence touches the lives of thousands of people each year. In order to take meaningful steps to lower the number of victims, we need to make sure that people realize that domestic violence is not a private matter.

If you or someone you know is in immediate danger, the National Domestic Violence Hotline offers crisis intervention and provides information and referrals for victims of domestic violence. Call the hotline at (800) 799-SAFE or (800) 787-3224 TTY, or visit www.ndvh.org.

Sources

Family Violence Prevention Fund (2004). National Consensus Guidelines on Identifying and Responding to Domestic Violence Victimization in Health Care Settings.

Fact sheets, Domestic Violence Crisis Centers (DVCC), 2007-11.

Garabedian M, et al "Intimate partner violence and postpartum depression" SMFM 2009; Abstract 194.

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For more information on the Society for Women’s Health Research please contact Rachel Griffith at 202-496-5001 or Rachel@swhr.org.

Jennifer Wider, M.D., is a medical advisor for the Society for Women’s Health Research (SWHR), a national non-profit organization based in Washington D.C., widely recognized as the thought leader in research on sex differences and dedicated to improving women’s health through advocacy, education, and research.

Dr. Wider is a graduate of Princeton University and received her medical degree in 1999 from the Mount Sinai School of Medicine in New York City. She is frequently published in newspapers, magazines, and websites and has been a guest on the Today Show, CBS News, Fox News, Good Day New York, and a variety of cable channels. Dr. Wider hosts “Paging Dr. Wider,” a weekly segment on Sirius satellite radio for the Cosmopolitan magazine channel.

Dr. Wider is a past managing editor of the health channel at iVillage.com. She writes a monthly news service article for SWHR and is the author of the consumer health booklet “Just the Facts: What Women Need to Know about Sex Differences in Health” and the book “The Doctor’s Complete College Girls’ Health Guide: From Sex to Drugs to the Freshman Fifteen.”

Read more »