AFTER Study: Armed Forces genital Trauma and psychosexual Experiences Research
Background
Patterns of conflict-related genital injuries have been reported after many conflicts, with an increased prevalence in recent years. This can be attributed to the evolving nature of warfare which resulted in the use of Improvised Explosive Devices and the increased survival rates of previously fatal injuries due to improved medical treatments. Research has traditionally focused on the medical perspective, while research to understand psychosocial and sexual impacts and any associated support needs for ex-service personnel with conflict-related genital injuries is lacking.
We do know from previous research looking into the psychosocial experiences during immediate rehabilitation that Servicemen who sustained conflict-related genital injuries may experience low self-esteem, sexual functioning difficulties, fertility concerns, loss of gender identity, high expectations for recovery, and that they attribute higher importance to the genital injuries compared to other injuries [1]. However, there remains a gap in understanding the long-term psychosocial and sexual impacts.
Researchers from the current team conducted a pilot study to investigate the long-term psychosocial and sexual experiences of ex-Servicemen with conflict-related genital injuries, understand support needs, and assess the necessity and feasibility of a larger scale study. Their research indicated that genital injury had long-term implications on psychosocial well-being, sexual functioning and intimate relationships, highlighting unmet support needs and the need for a larger scale study to better understand the support needs of this group [2].
To address this, the AFTER Study is now being conducted to explore the longer-term impacts of conflict-related genital injuries. The study is run by a collaborative team across King’s College London, RAND Europe, Manchester Metropolitan University, and Combat Stress and is taking a participatory approach. This means the study is conducted in collaboration with research advisors who have themselves experienced combat-related genital injury.
Aims of the study
1. Understand the long-term psychosocial and sexual impact of conflict-related genital injury, intimate scarring, or loss of function.
2. Develop evidence-based psychological interventions to address the long-term psychosocial and sexual impact of conflict-related genital injury, intimate scarring, and sexual dysfunction.
3. Assess the acceptability and feasibility of any developed interventions.
What will we be doing?
A mixed methods design will be taken to address the aims of the project by conducting the following six interconnected components:
1. Two literature reviews of existing international evidence (1) about the experiences of those affected by conflict-related genital injury, intimate scarring, or loss of function, and (2) about interventions that are used to help alleviate psychosocial and sexual difficulties for those with genital injuries, including non-combat-related genital injuries.
2. A quantitative survey with ex-Servicemen with conflict-related genital injuries, intimate scarring, or loss of function, to understand their psychological, relationship, and sexual well-being, and the factors associated with different outcomes and experiences.
3. A qualitative interview study with ex-Servicemen who have sustained conflict-related genital injuries, intimate scarring, or loss of function, to understand their experiences in terms of the challenges they experience, their mechanisms for coping, areas they would like support for, and their support preferences.
4. A qualitative interview study with the partners of ex-Servicemen who sustained conflict-related genital injuries, intimate scarring, or loss of function, to understand the experiences of partners in terms of the challenges they experience, their mechanisms for coping, areas they would like support for, areas they would like their partner to receive support for, and their support preferences.
5. Co-create possible evidence-based interventions or support materials, with those with lived experiences and subject matter experts, based on the newly generated evidence from studies 1-4.
6. Acceptability and feasibility test any developed interventions or support materials with expert feedback from ex-Service personnel with conflict-related genital injury, intimate scarring, or loss of function, partners of ex-Service personnel, support organisations, and other relevant stakeholders.
The project is participatory, meaning it takes a collaborative approach where people directly affected by conflict-related genital injuries are involved as Advisors throughout the research process. Research Advisors will meet with the team online approximately every 4 – 6 months across the duration of the 2-and-a-half-year project to share experiences and insights to inform the development of research materials, the conduct of the study, analysis of results, and co-creation of possible new interventions/support materials.
What’s next?
· The research team are in the process of gaining ethical approval from King’s College London and are hoping to begin recruitment for ex-Servicemen who have sustained genital injuries, intimate scarring, or loss of function, for the survey and interview components of the study in Autumn 2025.
· Interviews with the partners of ex-Servicemen who have sustained genital injuries, intimate scarring, or loss of function are expected to begin in Spring 2026.
· Recruitment of an intimate partner of an ex-Serviceman who sustained a conflict genital injury, intimate scarring, and/or loss of function to be a Research Advisor to assist with the development of the study throughout the process to the end. This will involve online meetings with the team to inform the conduct of the study and any materials we develop. If you are interested, please contact us at afterstudy@kcl.ac.uk.
· To contribute to this research and help support those affected by conflict-related genital injuries, keep an eye out on this website for updates about how to get involved.
Contact us: afterstudy@kcl.ac.uk.
Funding: This research is supported by The Scar Free Foundation via funds from the Armed Forces Covenant Fund Trust.
Authors: Ophelia Chi-Yin Lieng, Samantha K. Brooks, Mary Keeling, Natalie Hammond, Nicola T. Fear.
Image: UK MOD © Crown copyright.
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