9th Jan 2017
Five months after his 32nd birthday, Aaron Causey stepped on a bomb. The newlywed from Alabama was on his second overseas Army deployment, working as an explosives technician in Afghanistan. That morning in 2011, Aaron was on the hunt, peering inside tunnels for improvised explosive devices.
Before he saw the small bundle of plastic and copper wires, he had stepped on it. The blast ripped off his legs and traveled through his groin. One testicle was destroyed, only two-thirds of the other remained.
Four days later in a German hospital, Kat Causey walked into her husband’s hospital room. “Don’t throw up. Don’t throw up,” she told herself. The words repeated in her head as she stared at Aaron. How can he still be alive, she wondered. Her husband was in pieces. Surely their plans for having a baby were shattered.
The blast from an IED hits from below. It can hollow out a soldier’s pelvis, shredding the shaft of the penis, obliterating testicles and destroying the bladder and the tubes that carry urine and sperm.
Fighting on the front lines in Afghanistan means hopping out of trucks to walk on foot in terrain too rugged for military vehicles. Experts say service members are more vulnerable to IED blasts than ever before.
That could explain why more than 1,400 U.S. troops suffered injuries to the penis, testicles or bladder from 2001 to 2013 while serving in Afghanistan and Iraq. Their average age was 24. Experts describe the rise of genital injuries from combat as “unprecedented.”
Blasts powerful enough to amputate legs and genitalia used to mean almost certain death. These days, advanced medical care in the field and quick evacuation to specialist trauma centers means soldiers who suffer severe blast injuries have a better chance of surviving.
Surviving means repeat surgeries, re-imagining relationships and wondering if you’ll ever enjoy sex or have children. And while there are more conversations about brain injuries and post-traumatic stress disorder in troops, experts and families say there’s not enough discussion about the men who return home with the most taboo of injuries.
Counting the injured
At his office in the San Antonio Military Medical Center, Army Maj. Steven Hudak tracks the number of wounded military service members. When he’s not treating the injured — Dr. Hudak is a reconstructive urologist — he studies the Department of Defense Trauma Registry to learn what kinds of injuries are afflicting military members across the services.
In a recent paper published in the Journal of Urology, Hudak and colleagues wrote that there are more U.S. service members surviving with genitourinary injuries than ever before in the history of war. They described the different types of genital trauma suffered by young military men and said the range of trauma to the penis and testicles is varied.
“There’s no characteristic pattern among the men who have penile injuries,” Hudak says. “Really every service member that I’ve treated for a penile injury had a different kind of injury.”
Of the more than 1,400 men who suffered injuries to the genitals while serving in Iraq and Afghanistan over a 12-year period, 75 men died from their wounds and were excluded from the analysis.
Hudak found that of the 1,367 wounded service members who survived, 3 out of 4 had injuries to the penis, scrotum or testicles. A third had injuries that were classified as severe and 84 suffered severe injuries to the penis.
In a separate study of soldiers injured in Operations Enduring Freedom and Iraqi Freedom between 2001 and 2011, Hudak’s team found 501 men suffered genital and urinary system injuries and that 1 in 5 of them had an injury to the penis.
Overall, the greatest number of severe injuries were among those who had testicular damage, says Hudak. “That obviously has a different set of ramifications with regards to long-term fertility potential.”