Specific PTSD symptom clusters mediate the association of military sexual trauma severity and sexual function and satisfaction in female service members/veterans

Background: Sexual satisfaction and function are vastly understudied in female service members/veterans (SM/Vs). Military sexual trauma (MST) is associated with poorer sexual satisfaction and function, but the mechanism through which MST relates to sexual satisfaction and function is unknown. Posttraumatic stress disorder (PTSD) is one of the most frequent diagnoses following MST, and those with poorer sexual satisfaction and function experience higher PTSD symptoms, particularly numbing and anhedonia symptom clusters. In this study, we examined which symptom clusters (re-experiencing, avoidance, negative alterations in cognition and mood [NACM], anhedonia, dysphoric and anxious arousal) mediated the relationship between MST and sexual satisfaction and function. Method: Female SM/Vs (N = 1,189) completed self-report measures of MST severity (none, harassment only, assault), PTSD, sexual satisfaction, and sexual function, as well as a demographic inventory. Results: Anhedonia and dysphoric arousal fully mediated the association between assault MST and sexual satisfaction and function. NACM fully mediated the association between harassment and assault MST and sexual satisfaction. Finally, dysphoric arousal significantly mediated the association of harassment MST with sexual satisfaction and function. Limitations: Data was cross-sectional and based on self-report. Conclusions: The relationship between MST and sexual satisfaction and function may be mediated through specific PTSD symptom clusters. As there are no evidenced-based treatments to improve sexual satisfaction and function in female SM/Vs, additional research is needed to develop and pilot interventions. Among those with a history of MST, targeting NACM, anhedonia, and dysphoric arousal may be most effective in addressing sexual concerns.