War Wounds and Sexual Intimacy: A Less Reported Consequence of the Ukraine War

The World Health Organization estimates that 15 million Ukrainians currently grapple with mental health issues. It’s a stark reminder that Russia’s full-scale invasion has significantly altered the landscape of mental health in Ukraine. Among the mental health issues Ukrainians are up against are war-related problems with sexual intimacy. 

These issues have grown more prevalent due to factors such as amputations, disfiguring scars, and the traumatic experiences of sexual assault. For individuals who have lost body parts or have severe scars, the fear of being perceived as "damaged" or the belief that a partner couldn't be attracted to them can be overwhelming. 

Others may grapple with debilitating performance anxiety resulting from fear about how their partner will react to a missing body part or disfiguring scar. Survivors of sexual assault may find the idea of sexual intimacy nightmarish.

A Need for Connection and Intimacy

The obstacles to sexual intimacy are real, but the need for connection and intimacy is equally real. Without meaningful human connections and intimacy, individuals are all-too vulnerable to painful feelings of loneliness, depression, anxiety, and worthlessness. Alicia Pinkston, a New York AASECT Certified sex therapist, knows this and acknowledges the insecurities that often surround sexual intimacy in a time of war.

Fortunately, in her practice she has approaches that can help individuals regain the intimacy they’re capable of, whether they’ve endured war-related trauma or not. She employs several strategies to assist individuals, such as inviting them to create a "self-esteem pie chart" that highlights their positive attributes beyond physical appearance. It’s about helping the individual identify and reconnect with all their positive traits and interests to build self-esteem.

The Self-Esteem Pie Chart

Here’s a hypothetical example of how she might talk with a veteran who lost a leg after stepping on a landmine. “Talk with me about how you are feeling and what concerns you have,” Pinkston would begin.

 “I'm scared that no one would want me like this,” he’d state, pointing to the stump of his leg. “They’ll see me as damaged goods.” 

Pinkston would be aware that this is hard for the young man even to bring up, so she would muster all her caring and compassion and gently invite him to process his emotions, such as grief or anger, to help gain acceptance and ultimately confidence in his body. She’d then invite him to inventory the things that make him feel good. 

He might answer, “I’m good at playing the guitar. I love playing at the local coffee shop.”

As he speaks, Pinkston would fill in a wedge in a pie chart. It would say, “Good at playing guitar.”

As they continue talking, he might add, “Some of my friends say I’m smart. I’m proud, proud, proud that I served my country. My Mom is really special to me, and I know she loves me no matter what.” 

Soon the pie chart is close to full. Pinkston would then invite him to focus on it, and would point out, “Those things are all still there! That is still who you are. Your amputation is only a part of you and does not define you!”

The Sexual Menu

Reframing and putting things in perspective helps, but the young man may still have an overriding concern. “I don’t think I can, uh, do it. That’s the biggest thing that keeps me even from dating.”

It would now be time for Pinkston to tell him about the Sexual Menu approach to intimacy. “Sex isn’t just about being penetrative,” she would point out. "It includes kissing, caressing, nibbling and connecting with your partner. It's about feeling special, heard, and understood.

She’d go on to explain that intimacy includes the whole relationship and everything about the person, like maybe a partner is someone to watch television with, to share a meal with, to laugh and joke with.

Let’s suppose our hypothetical young man can get beyond feeling damaged and he’s up for dating again. But he’s still as anxious as a person can be as to whether he can perform or not.  

Pinkston would recommend that he talk about his performance concerns with his partner, including his needs, and that he should reassure his partner that it’s not her. He can explain if it’s a medication, or even if it’s just that he’s feeling unsure of himself.

Pinkston encourages vulnerability and open communication. She would reassure the young man that being open about his fears and insecurities can foster  connections that are deeper than ever, when it’s the right person for the right reasons. 

She would emphasize that sexual pleasure should be the focus, not ejaculation and orgasm.   The point is pleasure, including different kinds of touching, communication, connection, and most of all, closeness. “Tremendously fulfilling and meaningful experiences can happen without ejaculation and orgasm,” she would tell him.

Russia’s war on Ukraine takes a toll in so many realms.  The war-related issues that affect sexual intimacy are real, but with understanding and reframing and by working at communication, it’s an area where restoration to sexual intimacy is both possible and likely.