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NRI 04-194 – HSR&D Study

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NRI 04-194
Sexual Violence and Women Veterans' Gynecologic Health
Anne G. Sadler PhD RN
Iowa City VA Health Care System, Iowa City, IA
Iowa City, IA
Funding Period: April 2005 - December 2008

BACKGROUND/RATIONALE:
The Women's Health Act of 1992 acknowledged women sexually victimized in the military as a priority-care population for the Department of Veterans Affairs (DVA). Subsequently, it has become a major health care provider for women whose reproductive health may be at risk. However, the long-term gynecologic health or health services utilization of military women or sexually assaulted women has not been well studied. In 2004 the American College of Obstetricians and Gynecologists recommended decreasing the frequency with which average women have gynecologic screenings. The applicability of this preventative health recommendation for women who have been raped is unknown.

OBJECTIVE(S):
The objectives are:
1) To determine if the odds of current gynecologic disorders are significantly greater for sexually assaulted veterans in comparison to non-assaulted peers.
2) To identify if the presence and frequency of cofactors known to be associated with cervical cytologic abnormalities is greater in sexually assaulted veterans when compared to non-assaulted peers.
3) To determine the frequency and types of gynecologic services used by sexually assaulted women veterans in comparison to non-assaulted peers.
4) To identify and compare type and frequency of gynecologic health risk behaviors in sexually assaulted veterans with non-assaulted peers.

METHODS:
A random sample of women veterans who sought care from the Iowa City and Des Moines VAMCs within the preceding five years was identified. They were mailed information summaries and asked to participate in a study assessing gynecologic health of women veterans. Consenting participants completed a telephone interview. This interview assessed socio-demographic variables; rape exposures; health history; gynecologic diagnoses, procedures and care utilization; health status; health risk behaviors post-rape care; post-traumatic stress; and access to care. Medical records were reviewed for documented gynecologic diagnoses, interventions and care utilization occurring during the preceding 5 years. Statistical analyses (descriptive statistics, multiple logistic regression) were performed with SAS.

FINDINGS/RESULTS:
1004 women participated. 1) Women with one or more lifetime sexual violence exposures (LSV) had significantly greater odds of cervical cytological abnormalities than peers without LSV. They were significantly more likely to report pelvic inflammatory disease, STDs, infertility, chronic pelvic pain, pre-menstrual syndrome, urinary incontinence, dysmennorahea, and abnormal bleeding between periods. 2) Women with LSV were found to have significantly greater odds of cofactors associated with cervical cytologic abnormalities (smoking, HPV, number of sexual partners). 3) Veterans with LSV didn't appear to use gynecological health care more frequently than non-assaulted peers, but reported more reasons to seek this care (e.g. more bladder and vaginal infections). 4) Women veterans with LSV demonstrated gynecologic health risk behaviors with greater frequency than non-victimized peers.

IMPACT:
This study identified that women with LSV appear to require more aggressive screening and interventions. The associations between gynecological health, LSV and gynecological services utilization indicate that resources should be considered to address the gynecologic health care needs for this priority population. This has direct implications for DVA policies regarding women's health care. These results suggest that subsequent population based and intervention studies are needed to address disparities in health care for women veterans. It is anticipated that our findings will improve evidence-based clinical practice.

PUBLICATIONS:

Journal Articles

  1. Pulverman CS, Creech SK, Mengeling MA, Torner JC, Syrop CH, Sadler AG. Sexual Assault in the Military and Increased Odds of Sexual Pain Among Female Veterans. Obstetrics and gynecology. 2019 Jul 1; 134(1):63-71.
  2. Goossen RP, Summers KM, Ryan GL, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Ethnic Minority Status and Experiences of Infertility in Female Veterans. Journal of women's health (2002). 2019 Jan 1; 28(1):63-68.
  3. Goyal V, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Lifetime Sexual Assault and Sexually Transmitted Infections Among Women Veterans. Journal of women's health (2002). 2017 Jul 1; 26(7):745-754.
  4. Ryan GL, Mengeling MA, Summers KM, Booth BM, Torner JC, Syrop CH, Sadler AG. Hysterectomy risk in premenopausal-aged military veterans: associations with sexual assault and gynecologic symptoms. American journal of obstetrics and gynecology. 2016 Mar 1; 214(3):352.e1-352.e13.
  5. Ryan GL, Mengeling MA, Booth BM, Torner JC, Syrop CH, Sadler AG. Voluntary and involuntary childlessness in female veterans: associations with sexual assault. Fertility and Sterility. 2014 Aug 1; 102(2):539-47.
  6. Cheney AM, Booth BM, Davis TD, Mengeling MA, Torner JC, Sadler AG. The role of borderline personality disorder and depression in the relationship between sexual assault and body mass index among women veterans. Violence and victims. 2014 Jan 1; 29(5):742-56.
  7. Booth BM, Davis TD, Cheney AM, Mengeling MA, Torner JC, Sadler AG. Physical health status of female veterans: contributions of sex partnership and in-military rape. Psychosomatic medicine. 2012 Nov 1; 74(9):916-24.
  8. Forman-Hoffman VL, Mengeling M, Booth BM, Torner J, Sadler AG. Eating disorders, post-traumatic stress, and sexual trauma in women veterans. Military medicine. 2012 Oct 1; 177(10):1161-8.
  9. Bradley CS, Nygaard IE, Mengeling MA, Torner JC, Stockdale CK, Booth BM, Sadler AG. Urinary incontinence, depression and posttraumatic stress disorder in women veterans. American journal of obstetrics and gynecology. 2012 Jun 1; 206(6):502.e1-8.
  10. Sadler AG, Mengeling MA, Syrop CH, Torner JC, Booth BM. Lifetime sexual assault and cervical cytologic abnormalities among military women. Journal of women's health (2002). 2011 Nov 1; 20(11):1693-701.
  11. Mengeling MA, Sadler AG, Torner J, Booth BM. Evolving comprehensive VA women's health care: patient characteristics, needs, and preferences. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2011 Jul 1; 21(4 Suppl):S120-9.
  12. Booth BM, Mengeling M, Torner J, Sadler AG. Rape, sex partnership, and substance use consequences in women veterans. Journal of traumatic stress. 2011 Jun 1; 24(3):287-94.
Conference Presentations

  1. McGee B, Mengeling M, Sadler AG, Booth B, Torner J. The Differential Impact of Most Traumatic Life Event on Posttraumatic Stress Disorder Symptoms in Women Veterans. Paper presented at: International Society for Traumatic Stress Studies Annual Symposium; 2015 Nov 6; New Orleans, LA.
  2. Abrams T, Mengeling M, Torner J, Booth B, Sadler AG. Lifetime Sexual Assault and Emergency Room Use: A study examining the temporal relationship of single and repeat assaults on ER use in women Veterans. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  3. Mengeling M, True G, Burkitt KH, Ono SS, Bayliss N, Holmes W, Zickmund S, Sadler AG. Veteran-generated definitions of military sexual trauma: implications for MST screening. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  4. Ryan GL, Summers KM, Mengeling M, Booth BM, Torner J, Sadler AG. Sexual Assault and Hysterectomy in Female Veterans. Paper presented at: AcademyHealth Annual Research Meeting; 2015 Jun 13; Minneapolis, MN.
  5. Goyal V, Mengeling M, Booth B, Torner J, Syrop C, Sadler AG. Lifetime Sexual Assault, High-Risk Behavior, and Sexually Transmitted Infections Among Women Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  6. McGee B, Mengeling M, Sadler AG, Booth B, Torner J. The Impact of Most Traumatic Life Event on Post-traumatic Stress Disorder (PTSD) Symptoms in Women Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  7. Sadler AG, Mengeling M, Booth B, Torner J. The Military Environment: Implications for Women’s Sexual Assault Risk and Sexuality. Paper presented at: Society for the Scientific Study of Sexuality Annual Meeting; 2013 Nov 15; San Diego, CA.
  8. Mengeling M, Sadler AG, Torner J. Medical Care Post-sexual Assault for U.S. Servicewomen: A Retrospective Cross-sectional Study. Paper presented at: American Public Health Association Annual Meeting and Exposition; 2013 Nov 6; Boston, MA.
  9. Booth BM, Cheney AM, Mengeling M, Torner J, Sadler A. Mental and Physical Health Correlates of Sex Partnership in U.S. Women Veterans. Poster session presented at: International Association for Women's Mental Health Biennial World Congress; 2013 Mar 7; Lima, Peru.
  10. Mengeling M, Sadler AG, Fraley SS, Torner J, Booth B. Correlates of Sexual Functioning in Women Veterans: Mental Health, Gynecological Health, Health Status, and Sexual Assault History. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 23; Orlando, FL.
  11. Sadler AG, Torner J, Mengeling M, Morcuende A, Booth B. Traumatic Events in Women Veterans: Patterns Associated with Depression, PTSD, Borderline Personality Disorder, and Comorbid PTSD and Borderline Personality Disorder. Poster session presented at: VA Clinical and Translational Science Awards Annual Meeting; 2011 Apr 28; Washington, DC.
  12. Cretzmeyer MT, Mengeling M, Booth B, Torner J, Reisinger HS, Sadler AG. Similarities and Differences in Perception of Sexual Harassment and Rape by Race among Female Reserve and National Guard Service Women. Poster session presented at: VA HSR&D Field-Based Equity Conference; 2010 Sep 13; Boston, MA.
  13. Mengeling M, Booth B, Torner J, Cretzmeyer MT, Sadler AG. Women Veterans: Race/Ethnicity Differences in VA Health Care Need, Perception, and Use. Poster session presented at: VA HSR&D Field-Based Equity Conference; 2010 Sep 13; Boston, MA.
  14. Sadler AG. Racial Differences in Childbearing Decisions Following Sexual Assault, Self-Reported Infertility and Associated Care. Poster session presented at: VA HSR&D Field-Based Equity Conference; 2010 Sep 13; Boston, MA.
  15. Cretzmeyer MT, Mengeling M, Sadler AG, Torner J, Booth B. Alcohol use by Female Veterans Receiving Antidepressant Therapy. Paper presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 16; Washington, DC.
  16. Mengeling M, Sadler AG, Torner J, Booth B. Women Veterans: In-military Rape and VA Health Care Need, Perception, and Use. Paper presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 16; Washington, DC.
  17. Sadler AG, Torner J, Booth BM. Women Veterans: Combat, Sexual Assault, PTSD, and Depression in Reserve & National Guard Compared to Regular Military Members. Paper presented at: VA HSR&D Field-Based Women's Health Meeting; 2010 Jul 16; Washington, DC.
  18. Mengeling M, Booth BM, Torner J, Sadler AG. Rural and Urban Women Veterans: Health Care Needs and Use of VA Care. Paper presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 29; Little Rock, AR.
  19. Cretzmeyer MT, Mengeling M, Booth BM, Torner J, Sadler AG. Women Veterans: Alcohol use by Female Veterans Receiving Antidepressant Therapy. Poster session presented at: VA HSR&D Field-Based Mental Health and Substance Use Disorders Meeting; 2010 Apr 28; Little Rock, AR.
  20. Booth B, Mengeling MA, Torner JC, Sadler AG. Agreement between women veteran's study interview self-report of military sexual trauma and VHA MST screening data. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  21. Syrop CH, Sadler AG, Mengeling MA, Booth BM, Torner JC. Sexual assault and women veteran's childbearing decisions. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 11; Baltimore, MD.
  22. Bradley CS, Nygaard IE, Mengeling MA, Kennedy CM, Torner JC, Sadler AG. Urge urinary incontinence and PTSD in women veterans. Poster session presented at: National Institute of Diabetes and Digestive and Kidney Diseases Annual Meeting; 2009 Jan 8; Washington, DC.
  23. Mengeling MA, Sadler AG, Booth BM, Syrop CH, Torner JC. The impact of military sexual trauma on women's needs and perceptions of VAMC care. Poster session presented at: VA QUERI National Meeting; 2008 Dec 10; Phoenix, AZ.
  24. Bradley CS, Mygaard IE, Mengeling MA, Kennedy CM, Torner JC, Sadler AG. Urinary incontinence, depression and PTSD in women veterans. Paper presented at: American Urogynecologic Society Annual Scientific Meeting; 2008 Sep 5; Chicago, IL.
  25. Mengeling MA, Sadler AG. Physical and mental health characteristics of women veterans and their use of VAMC health care. Poster session presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2008 Jul 23; Washington, DC.
  26. Sadler AG, Torner JC, Mengeling MA, Gillette PP, Cretzmeyer MT, Booth BM. Sexual assault, traumatic exposures, head injury and post-traumatic stress in women veterans. Poster session presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2008 Jul 23; Arlington, VA.
  27. Torner JC, Sadler AG, Mengeling MA, Booth BM, Gillette PP. Head injury prevalence and associated conditions among women veterans. Poster session presented at: VA MIRECC Annual Best Practices in Mental Health Conference; 2008 Jul 23; Arlington, VA.
  28. Mengeling MA, Sadler AG, Torner JC, Gillette PP, Booth BM. Characterizing the population of women veterans who use VAMC health care services and the services sought. Poster session presented at: University of Iowa Carver College of Medicine Annual Research Week; 2008 Apr 1; Iowa City, IA.
  29. Torner JC, Sadler AG, Mengeling MA, Gillette PP, Booth BM. Head injury in women veterans. Presented at: VA HSR&D National Meeting; 2008 Feb 14; Washington, DC.
  30. Hoffman V, Mengeling MA, Booth BM, Torner JC, Sadler AG. Eating disorders, PTSD, and sexual assault histories in female gulf war and OIF/OEF veterans: worrisome associations. Presented at: VA HSR&D National Meeting; 2008 Feb 12; Washington, DC.
  31. Vander Weg MW, Sadler AG, Mengeling MA, Booth BM, Torner JC, Rosenthal GE. Associations between post-traumatic stress disorder and substance use in female veterans. Presented at: VA HSR&D National Meeting; 2008 Feb 12; Baltimore, MD.
  32. Sadler AG, Booth BM, Mengeling MA, Torner JC, Syrop CH. Sexual assault and women's gynecological health. Paper presented at: VA HSR&D National Meeting; 2008 Feb 11; Baltimore, MD.
  33. Sadler AG. Reproductive health and sexual violence. Paper presented at: VA VISN 23 Mental Health in Aging Conference; 2005 Apr 3; Minneapolis, MN.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Pathology, Prevention
Keywords: Patient outcomes, Research method, Utilization patterns
MeSH Terms: none