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Unprecedented study to support Veterans with genital injuries

Armed Forces Covenant Fund Trust grant will enable first large-scale research on psychosocial impact and support needs.

Four soldiers in camouflage carry a soldier in a stretcher to a dark green medical vehicle where another soldier waits.

A transformational grant from the Armed Forces Covenant Fund Trust will enable the UK’s first ever large-scale study on the psychological and social impact of conflict-related genital injuries.

The Armed Forces genital Trauma and psychosexual Experiences Research (AFTER) study, co-led by researchers from RAND Europe, Manchester Metropolitan University, King’s College London, and in collaboration with veterans’ mental health charity Combat Stress, aims to generate new, evidence-based interventions to support affected Veterans and their partners.

Armed Forces personnel have long been at risk of genital injury. The co-leads of the AFTER study noted that after conflicts in Afghanistan and Iraq, the treatment of these injuries shared a defining feature: despite the increasing prevalence of genital injuries in modern conflicts, psychological support remains limited.

The AFTER study will address critical gaps in care, create adaptable support models for military personnel and veterans, and, in time, be adjusted for civilians impacted by conflict, terrorism, illness, or accidents.

A derelict sandstone brick building in the desert, with mountainous terrain behind. Five soldiers patrol in the distance.

“Thanks to this substantial grant from the Armed Forces Covenant Fund Trust, we can support cutting-edge research with a potentially global impact, led by renowned experts.
The extensive effects of genital injuries reach far beyond the physical, and the AFTER study will pave the way to support Veterans through the psychological care they need, and the fulfilling life after service they deserve”.
Lt Gen Richard Nugee Rtd, former Lieutenant General and Chief of Defence People, now Chief Executive of the SFF

Genital injuries: the enduring taboo in conflict wounds

Conflict-related genital injuries have been historically overlooked, however, the available data suggests that such injuries have increased around the world – with global instability making this upward trend likely to continue.

The changing landscape of conflict, the use of IEDs (Improvised Explosive Devices), and increased survival rates of previously fatal injuries are all contributing factors. But while successful medical treatment has improved, comprehensive psychosocial support is lacking.

Previous research by the team indicates that Armed Forces personnel experiencing such injuries face low self-esteem, difficulties with sexual function, intimacy and satisfaction, fertility concerns, and identity challenges, all of which may come with long-term psychological consequences.

To the researchers’ knowledge, the AFTER study will be the first large-scale research in the UK to understand the needs of those affected, including the partners of injured Veterans.

Four soldiers rest under an orange overhang of rock. They sit on rocks and sandy shrubs, looking at a mountain in the distance.

The AFTER study will:

Assess the long-term psychological, social, and sexual impact of genital injuries.
Develop and explore the acceptability and feasibility of evidence-based psychological interventions.
Work with Veterans, intimate partners, and experts to create practical support resources.

Two armed soldiers wearing camouflage trek across grassy Welsh mountains as two chinook helicopters fly overhead.

“We are delighted and thankful to the AFCFT and the Scar Free Foundation, to be awarded the funding to conduct this much needed research. Our previous research demonstrated a need for this larger study to guide the development of support materials, and so we are extremely pleased to now be able to do this, alongside those affected, to develop suitable support and resources”.
Dr Mary Keeling, Research Leader at RAND Europe

Aiming for lasting impact

Researchers will survey 100 male Veterans, conduct in-depth interviews with 20 Veterans and 15 intimate partners, and collaborate with organisations who support these individuals, to explore the acceptability and feasibility of created support resources which will be developed in direct discussion with those they are intended to benefit.

The initial AFTER study will address male survivors of genital injury, as they are most likely to have been affected. A spokesperson from The Scar Free Foundation said:

“We hope it will open avenues for follow-on research to investigate the impact of genital injury and conflict-related scarring in women and LGBTQ+ Armed Forces personnel and veterans, who we acknowledge have unique needs and perspectives”.

The Scar Free Foundation have commissioned this project following consultation with Veterans, who revealed an unaddressed need for support in this area and the researchers will be working collaboratively with Veterans who have lived experience of conflict-related injuries.

“Sustaining a serious physical injury can be life changing. In the UK, as a result of the conflicts in Iraq and Afghanistan, research has focused on the health needs of physically injured Armed Forces personnel. However, little research has looked at the experiences of those who have sustained genital injuries.
These injuries are likely to have ongoing impacts on relationships, psychological health and wellbeing and someone’s identity.
The AFTER study will enable us to determine the long-term psychological, social, and sexual impact of genital injuries along with developing resources to ensure these needs are appropriately met”.
Professor Nicola Fear, Chair of Epidemiology and Director of The King’s Centre of Military Health Research at King’s College London

The team’s findings will inform policy recommendations for the Ministry of Defence and the Office for Veterans’ Affairs, and the NHS, while working towards further research.

Additionally, the Scar Free Foundation is committed to rolling out project materials, if effective, to Veteran groups and fundraising to train ‘buddies’, who will promote the outputs of this research to their peer groups.

“Emerging evidence suggests that conflict genital injury has a significant impact on identity, relationships and mental and physical health. However, there is limited information about the experiences or support needs of those affected. We’re pleased to be leading this significant investment by the AFCT that will change this.
By working together with those impacted, the AFTER study will help us to understand veterans’ needs and to develop appropriate interventions to support those who sustain genital injuries during their service.”
Dr Natalie Hammond, Senior Lecturer in Health and Social Care at Manchester Metropolitan University

Given ongoing global conflicts, there is potential in the long-term for this work to have international reach and extend to those in military and civilian communities who have been affected by genital injury.

The Scar Free Foundation would like to extend thanks to the Armed Forces Covenant Trust for enabling this work through their generous grant.

About the Armed Forces Covenant Fund Trust

The Armed Forces Covenant Fund Trust delivers high impact programmes that support the Armed Forces community. They are both a charity and a public body which administers the £10 million Covenant Fund each year, as well as other government funds that support the Armed Forces community. The Trust awards grants through robust funding programmes that meet or exceed government grant making standards.