When 35-year-old combat medic Tetyana Tsymbaliuk regained consciousness in the hospital room, she found her boyfriend waiting with a bunch of flowers. He proposed, but she declined. After a serious injury, her leg had been amputated; she worried about being a burden as a wife.
“I realized that before amputation, I was more attractive. I was not sure that I could find a way to fulfil my family role as a woman,” said Tsymbaliuk. It took her a long time to regain her confidence.
Tsymbaliuk says she was one of the first Ukrainian military amputees following the full-scale Russian invasion in 2022. Almost three years on, nearly 370,000 Ukrainian soldiers have been wounded. Thousands have lost one or more limbs.
While the government does not provide official figures on amputations, a state program issued prostheses to almost 20,000 people across 2023 and the first half of 2024, and many others were helped by private programs in Ukraine and abroad.
In the past two years, Ukraine has implemented protocols for physical and, to some degree, psychological rehabilitation for those injured in conflict. But sexual rehabilitation for people who have lost limbs or suffered other serious injuries has been largely overlooked.
Sex has long been a taboo topic in Ukraine. While modern Ukrainians are more open about sex than in the Soviet era, the topic is still an uncomfortable one for many.
“If I ask veterans about sex issues, they usually say that everything is okay. Only a few of them after a while, when they start to trust me, can talk about the problems they have,” Revunets said.
There are no protocols or recommendations for sexual rehabilitation on the official governmental level, she said, or even any mention of it.
“That’s important because the doctor is required to work according to protocol,” Revunets said. “Sexual rehabilitation is not specified anywhere, so the doctor can only take the initiative if he or she wants to do so. But most doctors aren’t ready to talk about it.”
It takes time even to persuade some doctors of its significance, Revunets said. “When I tell my colleagues about the importance of sexual rehabilitation, they look at me as if I’m crazy, (someone) who doesn’t understand what kind of serious injuries the patient has,” she said.
A good sexologist can help in many ways. Revunets is one of the very few sexologists in the country who works with the military. “I find out what exactly is wrong with the patient. I ask how the person feels. Depending on this, I give advice – it can be advice on how and what to do from a technical point of view, or what medications to take, or help psychologically.”
‘I was told to have sex, but no one told me how’
The war has resulted in an unprecedented number of people with injuries, a situation for which Ukraine was unprepared. The lack of any information on sexual rehabilitation has motivated the Ukrainian nonprofit Veteran Hub, which is specifically dedicated to supporting war veterans and their families, to study the topic.
In 2023, Veteran Hub researchers conducted 39 in-depth interviews with injured soldiers and their partners. Among other things, interviewees spoke anonymously about their sex lives after injury.
Researchers found that sex itself had changed for many. For example, after being injured, some respondents started to prepare for or plan sexual relations due to physical changes.
One of the veterans in a long-term relationship said of the doctors who treated him: “I was told to have sex, but no one told me how. If we’re talking about the technical part, it is very important.” He told researchers that without formal resources available to them, men were having to pass on information “by word of mouth.”
In response to the researchers’ findings, Veteran Hub created a guide for veterans on how to restore their sexual lives after being wounded.
“We saw that there was a great demand for this topic. After physical rehabilitation, people start asking themselves whether they will be able to swim in the sea, go skiing, go on dates, or have sex. And usually no one can answer these questions,” said Veteran Hub project manager Kateryna Skorohod.
Olga Serdyuk, the head of a sexual educational program at a network of rehabilitation centers called Recovery, said: “We need to understand that a wounded person works with different specialists – surgeons, physiotherapists, psychologists – on the way to rehabilitation. Because there is a lack of sexologists in Ukraine, those doctors must be ready for the person to open up to them and talk about sexual rehabilitation.”
To help widen their knowledge, Recovery launched a course called “Sexual Life” to train doctors and other professionals working with Ukrainian soldiers.
Serious injury changes the life of not only the veteran but also their partner, Serdyuk explained.
“For some reason, Ukrainian society believes that a good wife should take care of her husband on her own, even if there is an opportunity to get help. A woman becomes a carer. What kind of sex can we talk about then?” Serdyuk said, referring to how the pressures of full-time caring can lessen a couple’s capacity to explore paths to sexual fulfilment.
“Even if we are talking about complete dysfunction or missing genitals, a person (who’s been injured) can still have an orgasm with pleasure. You have to work with your fantasies, study your body.”
People need to learn to accept themselves in a new way, and believe in their integrity, their body, Serdyuk said.
Ukrainian ‘Bachelor’ stars double amputee
Discussions surrounding disabilities are increasingly cropping up in Ukraine as casualties rise.
Popular dating show “The Bachelor” has taken the discussion into the mainstream, with 26-year-old Ukrainian veteran Oleksandr Budko – who lost both his legs in the war – cast as the star of the latest season.
An episode with an intimate scene, shown in November, became one of the most popular in the season. According to data provided by Starlight Media, a Ukrainian broadcasting group, about 2.8 million people all around the country watched it, making it the most viewed program on the day it aired.
“We were concerned about how people would react to seeing a person’s body with visible amputations in such an intimate context. There is no representation of people living with injuries in Ukraine and we didn’t know how people would react to it. It was a big challenge. But it turned out well.”
Kalyna thinks the audience was interested, in part, because they realize that in this time of war their own loved ones could be injured at any moment.
On his Instagram page, Budko said he was not taking part in the show to convince anyone of anything or prove his “normality.”
“My prostheses or even sometimes a wheelchair are just a part of me, but not what defines me,” he posted. “The fact that I have a disability does not make me less worthy of love or a happy life. And this is important to understand.”
Budko also posted that his first experience of sex after injury “was not just sex, but a step back to life.”
Choosing life over suffering
Among those to attend Recovery’s “Sexual Life” course is Oleksandr Batalov. The unit infantry commander, who works as an osteopath in civil life, lost his leg in a fierce battle on the front line. He recalls that it took time for him to get used to his changed body.
“At the beginning, with such trauma, you want no one to look at you. But my wife gave me huge support. So, I got a grip. I chose life, not suffering,” he said. The psychologist helped a lot, he added.
There are very few sexologists in the hospitals, he said, but men who have experienced serious injuries are talking about sex with one another, and that’s important. However, “they need to have specialists they can talk to” as well, Batalov said.
That’s why he is starting this course. “If you survived, you have to live. Despite the injury, my life is full and interesting, I want to leave and study and share the knowledge,” said Batalov, who is now working again as an osteopath.
The same goes for Tsymbaliuk, the injured combat medic. She decided to live a fulfilling life no matter what. Her boyfriend did not give up and proposed again.
After months of rehabilitation in Germany, and later in Ukraine’s Superhumans Center, she finally married him, realizing “she was full of love that she wanted to fulfil.” Four months ago, they welcomed their first child together.
“I’m not hiding my prosthetic. I’m living a full life. And I’m happy,” she said.