Posttraumatic Stress Disorder Symptoms and Gynecological-Related Distress in Trauma-Exposed Women Veterans

Sexual violence predicts both posttraumatic stress disorder (PTSD) and distress during gynecological health care. Yet sexual trauma represents only one event that can precipitate posttraumatic distress, and less is known about PTSD and gynecological-related factors in survivors of nonsexual trauma. We examined PTSD symptomatology and gynecological-related factors in 1,185 women veterans with diverse trauma histories.

This cross-sectional analysis leveraged data from a national survey. Women self-reported their lifetime history of sexual violence (any versus none); military sexual trauma (MST) exposure (no MST, harassment only, assault); PTSD symptoms; distress experienced during gynecological care; and gynecological health care-seeking. Analyses assessed whether associations between PTSD symptomatology and gynecological-related factors depended on lifetime or military-specific sexual trauma. Exploratory analyses considered whether certain PTSD symptom clusters (Criterions B-D: re-experiencing, avoidance, negative cognitions/mood, hyperarousal) particularly contributed to distress.

Greater PTSD symptoms were linked with greater emotional distress, physical discomfort, and fear during gynecological exams; these associations did not depend on lifetime sexual violence, though there was some variation by MST type. Greater Criterion D and E symptomatology uniquely accounted for distress across most indicators. Analyses considering health care-seeking largely yielded null findings.

Posttraumatic psychopathology is relevant to gynecological-related distress in trauma-exposed women veterans, regardless of lifetime sexual trauma, and certain symptoms-including negative thoughts/feelings and hyperarousal-may be especially pertinent. Further, MST may compound the effects of PTSD on gynecological care experiences. Findings support assessing gynecological-related distress in all trauma-exposed women exhibiting PTSD symptoms and emphasize the need for trauma-informed reproductive health care.