with arms themselves (p = 0.04) than if they had not had these experiences. Deployed veterans with sexual dysfunction also reported more perceived psychologic stress during deployment than veterans without sexual dysfunction.

Simmons et al. (2004) used a mail questionnaire to survey all UK Gulf War veterans and demographically similar veterans who had served at the same time but were not deployed to the gulf. Of the 42,818 male veterans who responded, 24,379 had been deployed and 18,439 had not. Sexual dysfunction or a lack of sexual drive was reported by 0.8% and 0.2% of the deployed and nondeployed veterans, respectively, for an OR of 4.6 (95% CI 3.2-6.6, p < 0.001) adjusted for age and service status at the time of the survey, service and rank at the time of the war, alcohol consumption, and smoking.

Posttraumatic Stress Disorder and Reproductive Effects

One study examined the association between PTSD and sexual dysfunction in combat veterans. Cosgrove et al. (2002) administered the International Index of Erectile Function to 44 combat veterans undergoing treatment for PTSD at a VA clinic and 46 age-comparable combat veterans without PTSD. Of the veterans with and without PTSD, 85% and 22% had erectile dysfunction, respectively. Severity of PTSD was associated with severity of erectile dysfunction; however, more than half the PTSD veterans were using psychotropic medications compared with only 17% of non-PTSD veterans.

Summary and Conclusions

There is some evidence that deployed veterans of the Vietnam War and the Gulf War report more difficulties with reproductive function, such as increased rates of miscarriage and birth defects, than do nondeployed veterans, based on four primary studies. Several studies have examined the frequency of birth defects, as ascertained from hospital records or registries, in the children of deployed and nondeployed veterans; in general, the studies have not detected a higher rate of birth defects in the children of deployed veterans. The one study in Vietnam veterans and the three studies in Gulf War veterans found no increases in birth defects in children born to deployed fathers (or mothers for the Gulf War) compared to nondeployed fathers (or mothers), although the Vietnam veterans reported more miscarriages and birth defects. One study of Gulf War veterans found an increase in the risk for male children of deployed female veterans having hypospadia and infants of male Gulf War veterans were at increased risk of congenital tricuspid valve insufficiency and aortic valve stenosis. The studies did not examine the relationship between exposure to deployment-related stressors and such self-reported problems. Furthermore, virtually none of the studies has examined the potential influence of deployment-related stress.

One primary study in male Vietnam veterans did find theater veterans had lower sperm counts than did era veterans; there were no primary studies of fertility difficulties in Gulf War veterans. The two secondary studies found that Australian and UK Gulf War veterans reported more fertility difficulties than their nondeployed counterparts. One secondary study examined sexual dysfunction in deployed Danish peacekeepers and found it to be linked it to deployment-related stressors (Ishoy et al. 2001) and a second study found sexual dysfunction was also reported by UK Gulf War veterans.

The committee concludes that there is inadequate/insufficient evidence to determine whether an association exists between deployment to a war zone and reproductive effects.

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