History Of Military Sexual Trauma Research Articles

Patterns of psychosocial functioning of treatment-seeking veterans following military sexual trauma: The differential association of functioning and identity.

Veterans with a history of military sexual trauma (MST) often experience poorer social, psychological, and physical outcomes compared with civilians and veterans who have experienced sexual assault outside of the military. Studies suggest some differences in endorsement of MST and its symptoms based on ethnoracial, age, sexuality, and gender-related factors. However, investigations into potential diversity-related patterns of functioning are sparse. This study examined the associations between identity factors and psychosocial functioning among veterans seeking mental health treatment following MST. During intake assessments, veterans (n = 144) completed semistructured clinical interviews and the World Health Organization Disability Assessment Schedule 2.0 as part of routine clinical care at a Midwestern Veterans Healthcare Administration hospital. Psychosocial functioning domains (cognition, mobility, self-care, getting along, life activities, and participation in society) were analyzed across veterans' race, age, sex, and sexual identity. Results revealed differences in participation in society based on sex and race and in mobility based on race and age. No significant differences were observed in functional domains for sexual identity. These findings highlight the importance of assessing salient identity factors and delivering culturally sensitive trauma-focused care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gender as a moderator of associations between military sexual trauma and posttraumatic stress disorder treatment utilization.

The present study sought to investigate whether gender moderates the relationship between military sexual trauma (MST) and posttraumatic stress disorder (PTSD) treatment utilization, among veterans with clinically significant PTSD symptoms. Participants were 2,664 veterans with probable PTSD from a nationwide, population-based survey. Participants reported sociodemographic information, history of MST (including military sexual harassment and military sexual assault), and lifetime receipt of PTSD psychotherapy and medication treatment. We found that gender significantly moderated relationships between (a) military sexual harassment and PTSD psychotherapy, (b) military sexual assault and PTSD psychotherapy, and (c) military sexual harassment and PTSD medication. For women, MST was associated with a greater likelihood of receiving treatment, but for men, MST was not associated with PTSD treatment. Future research is needed to better understand gender differences in how experiences of MST may affect engagement in PTSD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Longitudinal changes in the PTSD symptom network following trauma-focused treatment in military populations: Identifying central symptoms and the role of military sexual trauma

Posttraumatic stress disorder (PTSD) is a debilitating condition affecting military populations, with a higher prevalence compared to the general population. Despite the development of first-line trauma-focused treatments such as Cognitive Processing Therapy (CPT) and Prolonged Exposure Therapy (PE), a significant proportion of patients continue to experience persistent PTSD symptoms following treatment. This study utilized network analysis to explore the PTSD symptom network's dynamics pre- and post- trauma-focused treatment and investigated the role of military sexual trauma (MST) history in shaping the network. Network analysis is a novel approach that can guide treatment target areas. The sample was comprised of 1648 service members and veterans who participated in a two-week intensive PTSD treatment program, which included completion of evidenced-based individual therapy as well as skill-building focused group therapy. PTSD severity was assessed using the PTSD Checklist for DSM-5 at baseline and post-treatment. Network analyses revealed strong connections within symptom clusters, with negative emotions emerging as one of the most central symptoms. Interestingly, the symptom network's overall structure remained stable following treatment, whereas global strength significantly increased. MST history did not significantly impact the network's structure or its change relative to treatment. Future research should further examine whether targeting negative emotions optimizes PTSD treatment outcomes for military populations.

Posttraumatic cognitions about the self are associated with depression symptoms in veterans endorsing a history of assaultive military sexual trauma.

Depressive symptoms are a commonly observed yet understudied mental health sequalae of military sexual trauma (MST). Prior research supports the relationship between negative posttraumatic cognitions (NPCs) and the onset and course of trauma symptoms more broadly. We hypothesized that NPCs would be associated with depression symptoms in veterans endorsing a history of MST, specifically assaultive type MST. Our clinical sample included veterans presenting for treatment related to assaultive MST (N = 158; 70.9% female, 65.2% White, 27.8% Black). Participants completed self-report measures of posttraumatic stress disorder (PTSD), depression, and NPCs during intake at a Veteran's Affairs specialty trauma clinic. Linear regressions were used to analyze the association between NPCs and depression symptoms controlling for PTSD symptom severity. PTSD severity and NPCs about the self were significantly associated with depression symptoms, explaining 46% of the variance severity, F(4, 153) = 33.16, R² = .46, p < .001. These findings newly demonstrate a relationship between NPCs about the self and depression in veterans with a history of MST. Clinicians may benefit from incorporating cognitive interventions into preexisting depression treatments to directly address NPCs in this population. Future study is needed to determine how these results may extend to other forms of MST or trauma types. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Differential Indirect Effects of Military Sexual Trauma on Posttraumatic Stress Disorder Symptom Clusters via Past-Year Intimate Partner Violence Experiences.

Women who serve in the military are at high risk for experiencing military sexual trauma (MST) and intimate partner violence (IPV), both of which are associated with symptoms of posttraumatic stress disorder (PTSD). To improve understanding of the psychological effects of experiencing multiple forms of interpersonal violence, it is important to identify the ways in which recent IPV experiences differentially increase the risk of specific PTSD symptom clusters for women with a history of MST. We aimed to identify if past-year IPV experiences mediate the relation between MST experiences and PTSD symptom clusters (i.e., intrusions, avoidance, negative alterations in cognitions/mood, hyperarousal) using structural equation modeling. A mail survey was administered to a sample of US female veterans at two time points 12 months apart. Among 198 participants, 108 women (54.5%) reported MST at Time 1, and 73 women (36.9%) reported IPV experiences in the past year at Time 2. PTSD symptom severity ranged from asymptomatic to beyond the diagnostic cutoff for a probable PTSD diagnosis. Past-year IPV experiences significantly mediated the association between MST history and PTSD avoidance symptoms, and MST history and PTSD negative alterations in cognitive/mood symptoms. No significant mediating effect was found for intrusion symptoms or hyperarousal symptoms. These findings can inform evidence-based practices for appropriate screening, assessment, detection, and intervention, including primary and secondary prevention efforts to instrumentally reduce future experiences of violence for female survivors of interpersonal violence.

Predictors of non-fatal suicide attempts among Veterans Health Administration (VHA) patients who experienced military sexual trauma.

Military sexual trauma (MST) has been identified as a risk factor for suicidal behavior. To inform suicide prevention efforts within the Veterans Health Administration (VHA), this study evaluates predictors of non-fatal suicide attempts (NFSAs) among VHA patients who experienced MST. For VHA patients in fiscal year (FY) 2019 who previously screened positive for a history of MST, documented NFSAs were assessed. Using multivariable logistic regression, demographic, clinical, and VHA care utilization predictors of NFSAs were assessed. Of the 212,215 VHA patients who screened positive for MST prior to FY 2019 and for whom complete race, service connection, and rurality information was available, 1742 (0.8%) had a documented NFSA in FY 2019. In multivariable logistic regression analyses, total physical and mental health morbidities were not associated with NFSA risk. Predictors of a documented NFSA included specific mental health diagnoses [adjusted odds ratio (aOR) range: 1.28-1.94], receipt of psychotropic medication prescriptions (aOR range: 1.23-2.69) and having a prior year emergency department visit (aOR = 1.32) or inpatient psychiatric admission (aOR = 2.15). Among VHA patients who experienced MST, specific mental health conditions may increase risk of NFSAs, even after adjustment for overall mental health morbidity. Additionally, indicators of severity of mental health difficulties such as receipt of psychotropic medication prescriptions and inpatient psychiatric admissions are also associated with increased risk above and beyond risk associated with diagnoses. Findings highlight targets for suicide prevention initiatives among this vulnerable group within VHA and may help identify patients who would benefit from additional support.

Mindful self-compassion for veteran women with a history of military sexual trauma: feasibility, acceptability, potential benefits, and considerations

ABSTRACT Background: Military sexual trauma (MST) is reported by up to 74% of women veterans in the United States and is a driver of poor behavioural and physical health. Self-compassion is a transdiagnostic, protective factor linked with improved posttraumatic stress disorder (PTSD), depression, and health behaviours. Thus, Mindful Self-Compassion training (MSC) may help ameliorate MST-related impacts. However, MSC can also temporarily increase distress (i.e. backdraft). Delivering it with elective trauma-informed yoga (TIY), which regulates acute distress, may help address this issue. Objective: This VA quality improvement project examined feasibility, acceptability, and reported benefits and challenges of a manualized 8-week MSC including within non-randomized subgroups: MSC (n = 4) and MSC+ elective TIY classes (MSC+; n = 4). Methods: Nine women veterans with a history of MST at a Vet Center in the Northeastern U.S.A. enrolled; eight completed, excluding one MSC+ participant. Measures included attrition (n = 9), attendance (n = 8), weekly (n = 8) and posttreatment acceptability (n = 6), validated symptom severity assessments (n = 7), and an exit interview (n = 8). Results: Among completers, MSC attendance was excellent (89%) and higher among in MSC+ vs. MSC (94% vs. 84% sessions completed). On average across the two groups, depressive and PTSD symptom severity decreased by 21% and 30%, respectively. In exit interviews, participants across groups described improved coping with distress and psychiatric symptoms, reduced stress, and improved self-care and health behaviours. Although women in both groups reported backdraft during the programme, MSC+ also reported healthier coping and improved emotional processing. Conclusion: The results of this programme evaluation infer MSC may be feasible, acceptable, and beneficial for women survivors of MST in one Vet Center in the Northeastern USA. Further, temporary elevations in MSC-related distress may be ameliorated with adjunctive TIY. Given requests of women veterans in the USA. for additional complementary and integrative health treatment options, formal research on these approaches is warranted.

The mediating role of social support in associations between childhood adversity, military sexual trauma, and homelessness in a nationally representative sample of USveterans.

Among veterans, availability of social support and histories of military sexual trauma (MST) and/or adverse childhood experiences (ACEs) are particularly salient correlates of homelessness.Using path analyses, we investigated whether social support (i.e., interpersonal social support and community integration) would at least partially account for the relationships of MST and ACEs with any lifetime homelessness in a large, nationally representative sample of veterans (N = 4069, 9.8% female).Interpersonal social support and community integration partially explained the relationship between ACEs and any lifetime homelessness. However, they did not mediate the relationship between MST and any lifetime homelessness. Female veterans also reported higher trauma rates and lower perceived social support than male counterparts during correlational analyses.These results reinforce existing literature on the importance of research and interventions tailored to veterans with low social support and integration. Results have potential to inform interventions and policy for veterans experiencing and/or at risk for homelessness.

Negative posttraumatic cognitions about self potentially mediate the relation between sexual revictimization and suicide risk in a sample of military sexual assault survivors.

Military sexual trauma (MST) is a risk factor for suicide among service members/veterans. Research reported that around half of MST survivors were exposed to pre-MST, making MST a revictimization experience. Unfortunately, little is known about mechanisms of the association between revictimization and suicide risk among MST survivors. One possible mechanism is posttraumatic cognitions (PTCs), which include the survivor's (a) negative cognitions about themselves, (b) negative cognitions about the world, and (c) self-blame. The current study examined each of the PTC subscales as potential mediators of the association between sexual revictimization and suicide risk. Participants were 383 service members/veterans reporting a history of MST that involved assault (50.65% female). Participants completed self-report questionnaires assessing demographics, suicide risk, history of sexual victimization (MST and premilitary sexual victimization), and PTCs. Of these, 340 (88.8%) reported a history of MST and premilitary victimization and comprised the revictimization group. Parallel mediation analysis with suicide risk regressed on each of the PTCs subscales and covariates revealed that negative cognitions about self had a significant indirect effect on the association between revictimization and higher suicide risk, above and beyond negative cognitions about the world and self-blame. Targeting negative cognitions about self among sexual revictimization survivors may be a therapeutic strategy to reduce suicide risk most effectively. Cognitive processing therapy may be particularly useful given the focus on altering PTCs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pain and posttraumatic stress: Associations among women veterans with a history of military sexual trauma.

Chronic pain and posttraumatic stress disorder (PTSD) are two highly prevaxlent and comorbid conditions common within veteran populations. Notably, those with comorbid pain and PTSD tend to have more severe presentations and poorer quality of life than those with either disorder alone. Despite this well-established relationship, limited research has examined the association between pain and PTSD symptom severity among women veterans with a history of military sexual trauma (MST). The current study included 107 women veterans presenting for psychological services to an MST specialty clinic at a large southeastern Veterans Affairs (VA) hospital in the United States. Findings indicated a significant relationship between pain and overall PTSD symptom severity, as well as the intrusions and arousal and reactivity symptom clusters. Contrary to prediction, there was not a significant relationship between pain interference and PTSD symptom or cluster severity. Results highlight the importance of inquiring about pain when working with women veterans with a history of MST. Future research aimed at disentangling the casual relationship between pain and PTSD symptoms is crucial to enhance our understanding of these constructs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Factors associated with receipt of minimally adequate psychotherapy for PTSD at the Veterans Health Administration

BackgroundDespite Veterans Health Administration (VHA) efforts, many Veterans do not receive minimally adequate psychotherapy (MAP) for posttraumatic stress disorder (PTSD). It is important to understand factors associated with receipt of PTSD MAP (at least eight sessions) so that we may tailor efforts to increase treatment utilization for those who experience the greatest barriers to care. MethodsParticipants were 2008 post-9/11 Veterans who participated in a nationwide survey and had a PTSD diagnosis documented in the VHA electronic health record (EHR) before 2018. Participants self-reported sociodemographic information and trauma history. Service utilization data (e.g., PTSD MAP) were obtained from EHR. Logistic regression was used to model factors associated with PTSD MAP. ResultsOnly 24% of Veterans (n = 479) received PTSD MAP. Veterans who reported that they were not employed and had reported history of military sexual trauma were more likely to have received PTSD MAP. ConclusionsUnderstanding and addressing barriers to PTSD care for Veterans who are employed could help improve PTSD treatment utilization for this group.

Cervical Cancer Prevention Among Veterans: What Is the Impact of Military Sexual Trauma, PTSD, and Women’s Health Primary Care Providers on Screening and Prevention?

Women veterans are more likely to receive cervical cancer screening than their civilian peers. Among veterans, those with mental health conditions are less likely to receive timely screening as compared to veterans without mental health conditions. The current study aimed to investigate whether a history of military sexual trauma, with or without concurrent PTSD disorder, and care from a provider with advanced training in women’s health (WH-PCP) altered the likelihood of cervical cancer screening among veterans. We conducted crosssectional analysis using a cohort of 89,249 women veterans, aged 21 through 64 years, who received outpatient care at any VHA medical center between FY13 and FY16. We used multivariable logistic regressions to examine variation in screening rates. The current study found that cervical cancer screening rate was higher among women assigned to WH-PCP (69.5% vs 61.2%). In the multivariable model with adjustment for patient characteristics and provider assignment, women veterans were more likely to receive cervical cancer screenings if they had a history of MST (OR = 1.14, p < 0.001), did not have a diagnosis of PTSD (OR = 1.06, p < 0.05), and were assigned to WH-PCP (OR = 1.48, p < 0.001). A statistically significant interaction effect was detected between MST and WH-PCP (p < 0.05). Veterans with a history of MST assigned to a WH-PCP were more likely to receive a screening than veterans with a history of MST not assigned to a WH-PCP. There is a complex relationship between MST and provider status, indicating a need to understand barriers and facilitators to cancer screenings.

Associations among military sexual trauma, positive alcohol expectancies, and coping behaviors in female veterans.

Military sexual trauma (MST) is prevalent among female veterans and is associated with deleterious health outcomes. Adaptive coping strategies (e.g., emotional support) are associated with more positive outcomes, while maladaptive strategies (e.g., substance use) are associated with greater impairment. However, research on factors that influence specific coping strategy use is limited. For women with a history of MST, expectancies about the effects of alcohol may enhance the use of maladaptive and reduce the use of adaptive strategies. The present study tested this hypothesis. Associations among MST status and two coping behaviors (emotional support, substance use) in female veterans were examined and the mediating role of positive alcohol expectancies on these relationships was tested. A secondary analysis was conducted using self-report survey data from 186 female veterans in a Northeastern region. Measures included a brief screen for MST, the posttraumatic stress disorder (PTSD) Checklist for DSM-5, the Brief Cope, and the Brief Comprehensive Effects of Alcohol Questionnaire. Among all respondents, positive alcohol expectancies were significantly associated with greater substance use coping, while PTSD symptom severity was negatively associated with emotional support coping. Though women with MST reported greater positive alcohol expectancies and PTSD symptom severity, the direct effects of MST on coping were not significant. Mediation was not supported in our sample. Alcohol expectancies may be a viable target for intervention to reduce alcohol use as a maladaptive coping strategy among female veterans. Similarly, treatment targeting PTSD symptoms, regardless of MST status, is important for enhancing the use of adaptive coping strategies. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Between Moral Injury and Moral Agency​: Exploring Treatment for Men with Histories of Military Sexual Trauma

This Research Article deploys the frameworks of moral injury and moral agency to explore the experiences of veteran men who completed group therapy for military sexual trauma (MST). The article analyses ethnographically how veteran men with MST experience psychological growth via a replenishment of their sense of moral agency, thereby blending psychological theory about moral injury with anthropological theory about moral agency. It highlights how broader cultural experience can intersect and contribute to shame around MST, then depicts the ways that veterans recovered from a life characterised by pervasive shame, isolation, and compromised identity—psychological signs of moral injury—and made gains toward a life characterised by greater self-acceptance, an ability to tell one’s own story, and intimacy with others—signs of moral agency. In so doing, the article highlights the social and moral dimensions that can constitute psychological injury, and the way that addressing these dimensions can promote moral agency and thus mental health recovery.

Sex differences in the relation between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and National Guard soldiers.

Military sexual trauma (MST) is linked to a range of deleterious health outcomes. Extant literature has focused disproportionately on mental health sequelae of MST. Research is needed to better understand the extent to which MST contributes to alcohol misuse and related problems - key issues facing service members. Additionally, sex differences in the nature and prevalence of MST may impact sequelae. The present research examined (a) the prevalence of an MST history among female and male service members, (b) relations between MST history and risk for alcohol misuse and related problems, and (c) potential sex differences in these experiences and outcomes. Data from current and previous service members (334 males and 70 females) were drawn from Operation: SAFETY (Soldiers and Families Excelling Through the Years), a longitudinal study of U.S. Army Reserve and National Guard (USAR/NG) soldiers and their partners. Analyses examined the prevalence and types of MST experienced, relations between MST history and three alcohol-related variables (total consumption, heavy drinking frequency, and alcohol-related problems), and differences by sex. Approximately one-third (33.7%) of service members reported an MST history. Females (61.4%) reported an MST history at more than twice the rate of males (27.8%). Interactions between MST and sex were significant for all alcohol-related variables. Among males, an MST history was related to 70% higher alcohol consumption, 86% higher heavy drinking frequency, and 45% higher alcohol problem scores. An MST history was unrelated to alcohol-related variables among females. Findings suggest a higher prevalence of MST among USAR/NG service members than is often reported in the literature, particularly among males. An MST history was associated with higher and more hazardous/harmful current alcohol consumption among male service members, highlighting the need for greater screening, prevention, and intervention among a population already at high risk for problematic alcohol use. Results underscore that MST is an important and prevalent experience requiring greater study alongside more traditional notions of service-connected trauma.

The effect of military sexual trauma on competitive employment status following veterans health administration supported employment services.

Military sexual trauma (MST) is prevalent, and some initial evidence suggests it is associated with impaired employment outcomes. The Veterans Health Administration (VHA) offers supported employment (SE) and Community-Based Employment Services (CBES), which consist of individualized employment support integrated with mental health treatment. The objective of this study was to examine the prevalence and effect of MST on competitive employment outcomes following participation in SE or CBES. Participants were a national set of Veterans who participated in VHA SE or CBES services between 2015 and 2019 and whose medical record contained a completed MST screen (N = 12,689). Data were obtained from clinician-administered SE and CBES admission and discharge forms merged with electronic health records. One thousand five hundred fifteen (11.9%) Veterans reported experiencing MST: 6.2% (n = 676) of men and 47.8% (n = 839) of women. Veterans who experienced MST were significantly less likely to hold competitive employment at discharge, 568 (41.0%) versus 4,702 (47.4%) of those without MST history; χ² = 19.79, p < .001. In adjusted analyses, MST was associated with lower likelihood of competitive employment over and above psychiatric comorbidities and other variables associated with employment status, such as receipt of disability, previous unemployment, homelessness, incarceration, and medical comorbidity. Findings suggest that Veterans seeking employment services may represent a high-risk group for having experienced MST and reinforce the importance of trauma-informed care. Providers should assess for and incorporate MST into treatment planning and job development when indicated. More work is needed to inform employment support for Veterans who have experienced MST. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Characteristics associated with non-suicidal self-injury among veterans seeking military sexual trauma-related mental healthcare

Military sexual trauma (MST) is a serious issue among Veterans; it is associated with increased rates of posttraumatic stress disorder (PTSD) and nonsuicidal self-injury (NSSI), both of which are correlated with poorer mental health outcomes, including increased suicide risk. Additional insight into the characteristics associated with NSSI among Veterans with MST can help identify individuals at increased risk for suicide and other negative outcomes and improve care for Veterans with a history of MST. The current study was comprised of 327 Veterans referred for MST-related mental health services at a VHA hospital. Participants completed a semi-structured interview for clinical symptoms, including NSSI behaviors. Results of a retrospective chart review revealed a high endorsement of lifetime NSSI (26.9%) with cutting behaviors identified as the most frequently endorsed method. Logistic regression showed personality features, history of cumulative sexual trauma, and younger age were uniquely related to lifetime NSSI. These results corroborate previous findings that show elevated rates of NSSI among Veterans with exposure to trauma. This study expands upon previous findings by examining risk factors specific to treatment-seeking Veterans with a history of MST, which can aid clinical care and risk management procedures in Veteran healthcare.

Differences in mental health care service utilization in older veterans with a history of military sexual trauma.

Differences in mental health care service utilization in older veterans with a history of military sexual trauma.

Sexual compulsivity, erectile dysfunction, and suicidality among male survivors of military sexual violence.

Although military sexual trauma (MST) is associated with an increased risk of suicide, suicide attempts, and suicidal ideation among service members and veterans, there is limited knowledge regarding the mechanisms of MST and suicidality among men. The current study examined whether MST was associated with sexual compulsivity and/or erectile dysfunction and if these, in turn, explained elevated suicidal thoughts and the likelihood of engaging in future suicidal behavior after accounting for mental health, military, and demographic characteristics. Service members and veterans who reported their gender as male (N = 508) were recruited via social media and completed online self-report measures assessing MST, erectile dysfunction, sexual compulsivity, suicidal ideation frequency, and the likelihood of engaging in future suicidal behavior. Path analysis was used to examine the study hypotheses. In total, 67 participants (13.2%) reported a history of MST; of these individuals, 27 (40.3%) reported suicidal ideation in the past 12 months, and 29 (43.9%) reported an increased likelihood of engaging in future suicidal behavior. MST was associated with increased sexual compulsivity, which, in turn, predicted more frequent suicidal ideation as well as a higher self-reported likelihood of engaging in future suicidal behavior. MST was associated with higher levels of erectile dysfunction, but erectile dysfunction was not associated with suicidal ideation in the adjusted model. Although the data were cross-sectional, precluding determinations of causality, the results support assessing and intervening with regard to sexual compulsivity to mitigate the risk for suicide-related outcomes among men who experience MST.

Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

BackgroundUnited States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans may be at increased risk for STIs due to high rates of sexual trauma. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans.ObjectiveTo examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the Veterans Health Administration (VHA) in 2019.DesignWe performed a retrospective cohort study of all women Veterans in VHA care between January 1, 2018, and December 31, 2019.ParticipantsWomen Veteran patients were identified as receiving VHA care if they had at least one inpatient admission or outpatient visit in 2019 or the preceding calendar year.Key ResultsAmong women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, correlates of testing in women under age 25 included Black race (aOR: 2.11, CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05, CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (chlamydia case rate: 265, gonorrhea case rate: 97/100,000) and those with mental health diagnoses (chlamydia case rate: 263, gonorrhea case rate: 72/100,000.)ConclusionsGonorrhea and chlamydia testing remains underutilized among women in VHA care, and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates.