to the editor: In the article on sexual assault of women, we feel the authors incorrectly classified the military as an at-risk group. Current rates of sexual assault in the military are more likely representative of the age of those in military service (47 percent of all enlisted active duty service members are 17 to 24 years of age),¹ rather than a consequence of participation in military service itself. In addition, the military has robust prevention and response services for members.

The study that was cited in the article² measured the prevalence of military sexual trauma in military reservists activated primarily for training purposes, and it cannot be generalized to the active duty military population. The prevalence of military sexual trauma and assault in women was reported to be 60 percent and 23 percent, respectively; these terms are broad and misleading. In the study, military sexual trauma included sexual harassment,³ which is estimated to occur in more than 60 percent of all college-aged women.⁴ The study also defined sexual assault as any unwanted physical contact of a sexual nature. This differs from the definition provided by the authors of the article: “Sexual assault includes vaginal, oral, and anal penetration and is more broadly conceived than the legal definition of rape as nonconsensual penetration by a penis.” If the latter definition of sexual assault is used, prevalence in this study is closer to 11 percent.³

For purposes of prevention and reporting in the military, sexual assault is defined as “intentional sexual contact characterized by use of force, physical threat, or abuse of authority, or when the victim does not or cannot consent.”⁵ In 2008, there were 2,908 reports of sexual assault in the military. More than 70 percent of these reports occurred in members 16 to 24 years of age,⁵ the same group identified by the authors to be at increased risk of sexual assault in the general population.

As stated in the article, sexual assault is thought to be widely underreported. To improve reporting of sexual assault, the military has instituted two reporting options: restricted and unrestricted. Restricted reporting allows the survivor to report the sexual assault on a confidential basis and receive medical treatment and counseling, but does not require an official investigation. Unrestricted reporting provides for medical treatment, counseling, and an official investigation.

Victim advocates and sexual assault clinical coordinators are available to provide counseling on reporting options, forensic examinations (performed either by sexual assault nurse examiners or sexual assault forensic examiners), medical care, and available resources including mental health, social work, and other community services.

Health care professionals are designated to follow-up on injuries, specific physical problems, and related reproductive health issues (e.g., contraception, sexually transmitted infection screening and treatment) in sexual assault survivors; mental health and risk reduction counseling (revictimization prevention) are also available.

in reply: We appreciate the letter from Drs. Bode and Dawson addressing the issue of sexual assault of women in the military. They assert that women in the military are not at higher risk of sexual assault than their same-age peers, and that it is age and not military experience that confers higher risk.

We agree that it may not be possible to determine the actual cause of the increased risk of sexual assault of women in the military, and we apologize for any confusion regarding the statistics about military sexual trauma (which may include harassment, as well as physical or sexual abuse). However, we feel that regardless of the cause of the increased risk (i.e., from age itself or from being in the minority as a woman among young men in a stressful situation), the fact remains that women in the military are at increased risk of sexual assault. We applaud the work performed by the U.S. Department of Defense in increasing awareness and reporting of sexual assault.