Mr. Chairmen and Members of the Committees:

I would like to begin by thanking you for calling this joint hearing on Military Sexual Trauma.  I appreciate the opportunity to address both committees on this important and timely topic.  I am Phyllis Greenberger, the President and CEO of the Society for Women’s Health Research.  SWHR is a non-profit patient advocacy organization dedicated to improving women’s health through advocacy, education, and research of sex and gender differences. 

SWHR’s focus since 1995 has been to clearly demonstrate that sex and gender differences exist, and research needs to be done to explore conditions that affect women differently, disproportionately, or exclusively—to identify these differences and to understand the implications for diagnosis and treatment. 

Research into this area comes at a time of great need within the Department of Veterans Affairs (VA), as today over 10 percent of the military presence in Iraq and Afghanistan is female.  As the Department of Defense (DOD) continues to work to integrate an ever-larger female presence among active military, the VA sees a comparable rise in numbers of female veterans seeking care after their time of service, for both service-related and non-service-related care.  Women are the fastest growing sector of VA patients.  Over 450,000 women have enrolled with VA medical centers for care, and that number is projected to rise by 30 percent in the next 5 years.

The pressing issues that bring us here today are the risks and ramifications of military sexual trauma, or MST. 

The statistics on risk are well known.  MST victims are disproportionately and almost exclusively women.  A 2008 VA study reported that 15 percent of military women in Iraq and Afghanistan experienced sexual assault or harassment, and 59 percent of those were at higher risk for mental health problems.  This is just among those cases reported.  Many more, possibly more than half, of all MST cases go undocumented each year.

The ramifications of MST for women persist long after the initial assault.  While sexual assault in any setting is horrific, the combined insult of MST occurring while serving in a foreign setting, often in an active war zone, only exacerbates the effects.  By VA estimates, over 70 percent of women in the military have been exposed to combat.  Further, with most MST assaults being orchestrated by military personnel against military personnel, the environment of trust among those serving is broken, and a chain of command that fails to protect from and respond to MST further degrades unit cohesion.

Research in the area of MST and sexual assault has revealed some interesting sex-based differences:

First, women are more likely then men to contract a sexually transmitted infection, or STI.  STIs are often more difficult to treat in women and can have emotional and mental impacts over a woman’s lifespan.  Sexual assault can result in an unplanned pregnancy or conversely leave a woman unable to bear children in the future.  The impacts of MST are not limited to reproduction.  Infection with HPV after a sexual assault can result in cancer decades later in life.  Scientists studying HIV in women found the virus enters and infects the cells of the vaginal wall in a way different from how the virus is introduced into male cells. 

Second, sexual assault is a common trigger for post-traumatic stress disorder, months and even years after the attack.  Scientists are finding that women do not respond the same to some of the common medications prescribed for PTSD, often fairing worse than men taking the same medication for the same diagnosis.    

Third, multiple traumas can increase the likelihood of developing PTSD, and the combined impacts of working in a war zone, multiple deployments, MST, and for a disproportionate share of female military members, exposure to early life trauma, all raise the risk for an eventual PTSD diagnosis.  Females in the military have twice the levels of PTSD and depression as their male counterparts. 

Fourth, research suggests that the ultimate impact of a traumatic event on a woman may depend on hormone levels, and can vary based on where she is in her menstrual cycle and whether or not she uses medications that alter hormone levels, such as birth control.  The role of cyclical hormonal variations, as well as studies finding that during pregnancy PTSD symptoms decrease, may offer insight into which women develop PTSD after MST, and may further help discover more effective PTSD therapies for women—therapies that are responsive to sex-based hormonal differences. More research is critical for moving forward and determining targeted treatments for women and men.

The VA in 2010 is in a unique position to better serve its female veterans, at the same time becoming a leader in women’s health and sex based research.  Changes in care can only come from sound research, and investments in VA research often translate into new knowledge, methods, screenings, and treatments for women and men, military and civilian.  As discussed before this Committee one year ago today, the VA system faces staffing, organizational, and infrastructure challenges when updating to meet the needs of the growing female veteran population.    The VA still has a long way to go.  Reports as recent as March 2010 are still finding deficiencies in the availability of resources for female veterans.  From providing gender-specific care at all VA Medical Centers to including female subjects in the VA’s Health Services Research and Development, the VA with proper support and resources can transform to what is needed today and what is needed for the future.

SWHR would like to encourage the VA to optimize its interactions with female veterans, by offering women the option to participate in research projects—receiving a high quality of care while gathering information to help other female veterans.  The health information technology capabilities that link all VA medical centers, and each veteran’s medical and personnel charts, offers unmatched capabilities for research.  The VA is to be praised for its electronic medical records system, and encouraged to utilize it to its full capacity.  Further, increasing collaboration between the DOD and the VA would additionally offer an improved continuum of care, as women transition from active duty to veteran status.  A victim of MST during her time of service needs streamlined care after she returns, as well as a VA system that is equipped to meet her sex and gender specific needs.  For the female veterans who choose to seek care outside of the VA setting, private clinicians also depend on the research and clinical guidance only the VA can provide—capturing the nuances specific to military service, combat exposure, and MST faced by female veterans.  The VA alone can pull together these details and offer direction to help all clinicians make sound choices for their female veteran patients, and all women. 

While I hope that I have made clear the need for more investments in the VA and sex based research, SWHR further hopes that these recommendations will be acted upon quickly.  I encourage the VA and these committees to consider the potential impact of appropriate research into women’s health and the wide reaching results that could improve sex-based research as well as mental and sexual health for all.  The VA today has a unique opportunity to champion the cause of women’s health research—not only for veterans, but for all patients.

I want to again thank you for this opportunity to present to the Committee.  I would be pleased to answer any questions.