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Voluntary and involuntary childlessness in female veterans: associations with sexual assault.

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.

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OBJECTIVE: To assess associations between lifetime sexual assault and childlessness in female veterans. DESIGN: Cross-sectional, computer-assisted telephone interview study. SETTING: Two Midwestern Veterans Administration (VA) medical centers. PATIENT(S): A total of 1,004 women aged = 52 years, VA-enrolled between 2000 and 2008. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Sociodemographic variables, reproductive history and care utilization, and mental health. RESULT(S): A total of 620 veterans (62%) reported at least one attempted or completed sexual assault in their lifetime (LSA). Veterans with LSA more often self-reported a history of pregnancy termination (31% vs. 19%) and infertility (23% vs. 12%), as well as sexually transmitted infection (42% vs. 27%), posttraumatic stress disorder (32% vs. 10%), and postpartum dysphoria (62% vs. 44%). Lifetime sexual assault was independently associated with termination and infertility in multivariate models; sexually transmitted infection, posttraumatic stress disorder, and postpartum dysphoria were not. The LSA by period of life was as follows: 41% of participants in childhood, 15% in adulthood before the military, 33% in military, and 13% after the military (not mutually exclusive). Among the 511 who experienced a completed LSA, 23% self-reported delaying or foregoing pregnancy because of their assault. CONCLUSION(S): This study demonstrated associations between sexual assault history and pregnancy termination, delay or avoidance (voluntary childlessness), and infertility (involuntary childlessness) among female veterans. Improved gender-specific veteran medical care must attend to these reproductive complexities.

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