It took Diane Pickel Plappert six months to tell a counselor that she had been raped while on duty in Iraq. While time passed, the former Navy nurse disconnected from her children and her life slowly unraveled.
Carolyn Schapper says she was harassed in Iraq by a fellow Army National Guard soldier to the extent that she began changing clothes in the shower for fear he'd barge into her room unannounced - as he already had on several occasions.
Even as women distinguish themselves in battle alongside men, they're fighting off sexual assault and harassment. It's not a new consequence of war. But the sheer number of women serving today - more than 190,000 so far in Iraq and Afghanistan - is forcing the military and Department of Veterans Affairs to more aggressively address it.
The data that exists - incomplete and not up-to-date - offers no proof that women in the war zones are more vulnerable to sexual assault than other female service members, or American women in general. But in an era when the military relies on women for invaluable and difficult front-line duties, the threat to their morale, performance and long-term well-being is starkly clear.
Of the women veterans from Iraq and Afghanistan who have walked into a VA facility, 15 percent have screened positive for military sexual trauma, The Associated Press has learned. That means they indicated that while on active duty they were sexually assaulted, raped, or were sexually harassed, receiving repeated unsolicited verbal or physical contact of a sexual nature.
In January, the VA opened its 16th inpatient ward specializing in treating victims of military sexual trauma, this one in New Jersey. In response to complaints that it is too male-focused in its care, the VA is making changes such as adding keyless entry locks on hospital room doors so women patients feel safer.
Depression, anxiety, problem drinking, sexually transmitted diseases and domestic abuse are all problems that have been linked to sexual abuse, according to the Miles Foundation, a nonprofit group that provides support to victims of violence associated with the military. Since 2002, the foundation says it has received more than 1,000 reports of assault and rape in the U.S. Central Command areas of operation, which include Iraq and Afghanistan.
In most reports to the foundation, fellow U.S. service members have been named as the perpetrator, but contractors and local nationals also have been accused.
Plappert, 47, said she was raped by Iraqi men in 2003 at a store in Hillah, when she got separated from her group.
By the time the Navy Reserves commander returned home, she felt like she was "numb."
"I didn't feel anything," she said during an interview at her town home in south-central Pennsylvania. When her kids, now ages 10 and 12, hugged her, "I felt like I was being suffocated."
Plappert's marriage eventually fell apart. She credits treatment at the VA - as well as her artwork depicting trauma and recovery - with helping her reconnect with her children. She left the military and is studying at Drexel University to become a psychiatric nurse practitioner while continuing to work as a civilian nurse.
She said it's hard for people outside a war environment to understand how living in high-stress, primitive conditions can affect your ability to make decisions. She didn't report the attack immediately, she said, because she felt an obligation to continue the mission and not burden others. She also wondered how the report would be perceived.
"What I've got to try to think is that there's got to be some reason why this has happened," said Plappert, who first recounted the assault to a VA counselor and eventually told her story to Defense Department and VA task forces. "I try to find something positive in the event."
Schapper, 35, of Washington, served with the Georgia Army National Guard on an outpost with few other women. She worked well as part of a military intelligence team with the men around her. It was in the down time that things got uncomfortable.
She shared a house with about 20 men, some of whom posted photos of scantily clothed women on the walls. She said her team leader, who lived in the house, frequently barged into her room and stared at her. The experience was unnerving, Schapper said, and she began changing clothes in the shower. But she never filed a formal complaint.
If she complained, Schapper figured, she'd be the one moved - not the other soldier.
"In military intelligence, you work with Iraqis on a daily basis you get to know, and to move me would disrupt the team I was working with as well as disrupt the work I'd already done," Schapper said. "I didn't want to be moved, and basically I'd be punished in a sense."
Schapper said other female troops she has spoken with described similar experiences. One had her picture posted with "Slut of Bayji" written underneath. Another endured having a more senior enlisted soldier ask her favorite sexual position over a public radio, said Schapper, who has met with members of Congress on behalf of the nonpartisan advocacy group Iraq and Afghanistan Veterans of America.
Since returning to the U.S. in 2006, Schapper has gotten help for post-traumatic stress disorder at the VA in Washington. Group therapy with other Iraq veterans has been helpful, she said, but she wishes there was a women-only group.
Connie Best, a clinical psychologist and professor at the Medical University of South Carolina who retired from the Navy Reserves, said people typically think of sexual harassment as someone making a comment about someone's appearance, but it goes well beyond that. In a war environment, living and working with someone exhibiting harassing behavior can potentially have long-term effects on troops' health and performance.
"There's automatically this thing that sexual harassment is not a big deal, it's not as bad as rape, and indeed it often is not as distressing as a completed sexual assault, but it still can be something that highly affects a person," Best said. Research also has found that working and living environments where unwanted sexual behaviors take place have been associated with increased odds of rape.
After high-profile attacks in Kuwait and Iraq, then-Secretary of Defense Donald Rumsfeld convened a 2004 task force on the treatment and care of sexual assault victims. One change that followed was the creation of a confidential component in the military's reporting system, so a victim can come forward to get help without necessarily triggering an investigation.
In the fiscal year that ended Oct. 1, 131 rapes and assaults were reported in Iraq and Afghanistan, said Kaye Whitley, director of the Defense Department's sexual assault prevention and response office. Comparing that to previous years isn't possible because of changes in the way data was collected, she said.
The actual number is likely higher than what's reported. Among members of the military surveyed in 2006 who indicated they had experienced unwanted sexual contact, about 20 percent said they had reported it to an authority or organization.
This summer, the Pentagon is bringing experts together to come up with a more aggressive prevention strategy. It also is working with the nonprofit group Men Can Stop Rape to help teach troops how to identify warning signs of problems around them.
When victims do complain, too often the perpetrator is not moved out or punished, said Colleen Mussolino, national commander of the Women Veterans of America.
"You have to be able to trust fellow soldiers and if you can't do that, you're basically on your own. So it's really rough, really rough for them," said Mussolino, of Bushkill, Pa.
A vast majority of women at war feel safe with their comrades in arms, "but for the ones who feel unsafe, it's hell," said Lory Manning, a retired Navy captain who directs the Women in Military Project at the Washington-based Women's Research and Education Institution.
At a recent women veteran's conference in Washington, Leanne Weldin, of Pittsburgh, who deployed in Iraq with the Arizona National Guard in 2003 as a 1st lieutenant, described arriving in the Kuwait staging area and seeing signs warning of rapes. She said she endured some minor sexual harassment while deployed and was groped by an Iraqi teen while sitting in a Humvee.
When her own daughter wanted to join the Army, Weldin said later in an interview, she didn't discourage her. But she offered some sobering advice.
"Watch out for yourself. Don't party with the soldiers in the barracks. You've got to watch out for date rape. Watch out for yourself. It's still a male culture. Don't let yourself get taken advantage of. Don't let yourself get sucked in. Don't let your guard down," Weldin said.
"But at the same time, go in there and show them what you're made of."
The VA now provides free care to any veteran from any era who has experienced military sexual trauma. That's a change from the 1991 Persian Gulf War and earlier wars. Since 2002, about 20 percent of female veterans from all eras and 1 percent of male veterans have screened positive for military sexual trauma.
"We believe that identifying people early and providing care early is going to be important and really make a difference in people's lifetime trajectory, but that story remains to be followed and told," said Antonette Zeiss, a psychologist who is the deputy chief consultant in the VA's Office of Mental Health Services.
It's unknown whether incidents of rape and assault are higher in the military population than the civilian population. One study, however, of 1991 Persian Gulf War veterans found incidents of assault, rape and harassment were higher at war than in peacetime military samples, according to the VA's PTSD center.
It's only in recent years that the military and VA have kept comprehensive statistics, and even the two agencies define military sexual trauma differently.
What is known is that the effects of a military sexual trauma can be long lasting - particularly for those who don't seek early help.
The VA still sees veterans who experienced sexual attacks in Vietnam - and even World War II.