Women currently make up 17% of active military personnel and make up the fastest growing segment of new Veterans Health users [1].  Post deployment health and readjustment issues among women veterans have been identified as a priority toward building a quality improvement research agenda for women. Military Sexual Trauma (MST), as defined by Federal Law (Title 38 U.S. Code 1720D), is “the psychological trauma, which in the judgement of a VA mental health professional, resulted from a physical assault of a sexual nature, battery of a sexual nature, or sexual harassment which occurred while in the Veteran was serving on active duty, active duty for training, or inactive duty training.” Cohort analyses of the civilian population have shown that there is an association between sexual abuse history and pelvic pain, interstitial cystitis, gastrointestinal complaints, vulvodynia, and vasomotor symptoms[2]. The purpose of our study is to investigate the relationship between MST and Lower Urinary Tract Symptoms (LUTS) in the female VA population.

This is a retrospective chart review utilizing VA electronic health records. We included all women who answered either yes or no to the standard screening question for MST as of 12/31/2014 and who had complete covariate data. We used logistic regression with LUTS diagnosis between 1/1/2010 and 12/31/2014 coded as the yes response and MST as the predictor along with possible confounding variables for adjustment (age, BMI, blood pressure, race, ethnicity, diagnosis of PTSD, HTN, diabetes, and history of mental health treatment visits). In each cohort we assessed for the following diagnostic codes commonly found with LUTS: interstitial cystitis/bladder pain syndrome, incontinence, over-active bladder, urinary urgency, urinary frequency, urge urinary incontinence, stress urinary incontinence, recurrent UTI, chronic UTI, fecal incontinence, dyspareunia, voiding dysfunction, urinary retention, dysuria. We will also queried for interventions related to LUTS: cystoscopy, prescription of OAB medications (oxybutynin, trospium, tolterodine, Flomax, elmiron), referral to pelvic floor physical therapy, or visits to a urologist.

In total we had 311,298 patients, with 31,952 of these screening positive for MST. After further analysis 10,360 of the 31,952 patients screening positive for MST were also determined to have LUTS. Based on this analysis patients reporting military sexual trauma have a 13.3% greater odds of having LUTS (95% CI for OR: (1.10, 1.17).  PTSD increases odds of LUTS by 21.8% (CI: 1.18, 1.26).

Female veterans with a history of MST have an increased likelihood of being diagnosed with LUTS compared to those without MST. This association could potentially guide proper treatment of LUTS in this population, leading providers to consider both medical treatment and psychological treatment.

This is the first study of its kind to investigate the association of military sexual trauma and voiding dysfunction in the female veteran population. A greater understanding of MST and its physical manifestations could have a tremendous impact on our understanding of the female veterans’ health care needs, both at a systems and an individual level.

Yano, E.M., et al., Using research to transform care for women veterans: advancing the research agenda and enhancing research-clinical partnerships. Womens Health Issues, 2011. 21(4 Suppl): p. S73-83.   2.	Seth, A. and J.M. Teichman, What's new in the diagnosis and management of painful bladder syndrome/interstitial cystitis? Curr Urol Rep, 2008. 9(5): p. 349-57.
Seth, A. and J.M. Teichman, What's new in the diagnosis and management of painful bladder syndrome/interstitial cystitis? Curr Urol Rep, 2008. 9(5): p. 349-57.