Before they went off to fight in Afghanistan, the guys of 3rd Battalion, 5th Marines talked quietly about their deepest fear. Not dying. Not losing a leg or an arm.
It was having their genitals ripped off, burned away or crushed in the fiery blast of an improvised explosive device.
This was no idle concern to young men bursting with testosterone. The makeshift bombs known as IEDs are taking a frightening toll in Afghanistan, the blasts shearing off arms and legs, ripping through soft flesh, crushing organs and bone, and driving dirt, rocks and filth deep into torn flesh -- often leaving the genitals shredded or missing. Some guys said they'd rather be dead.
Mark Litynski, a 23-year-old rifleman with Lima Company, knew the odds. He'd been married to Heather for almost a year, and children were in the future they planned together.
I ought to freeze my sperm so we could still have kids if something happened, he thought.
The idea nagged at him. But in the rush of last-minute training before they packed their sea bags and weapons and then took a few days of boisterous leave, he kept putting it off. Where do you go to freeze your sperm, anyway? Who would you even ask?
By the time they loaded on the buses at Camp Pendleton, it was too late. Should have done it, Mark thought as they boarded the plane in September 2010.
Weeks later, Mark was on a combat patrol in Sangin, southern Afghanistan, walking behind an engineer sweeping for IEDs, marking their path with yellow spraypaint. IED detectors aren't foolproof. There came a bright flash and searing heat, then the upward blast ripped off both of Mark's legs and most of his left arm, slashing into his remaining arm, shattering his pelvis and driving a rock and other debris up into his abdominal cavity.
Amid the bloody carnage, all the skin was ripped from his penis and his testicles were gone.
Days later, after trauma surgeons in Germany finished trimming and suturing his stumps and temporarily closing his abdominal wounds, he managed to say a few words to Heather on the phone.
"I'm so sorry," he croaked.
“I love you,'' she told him, blinking back tears. "We will pull through this together, as a team.''
'THEY WEREN'T PREPARED FOR THIS'
The decade of U.S. combat in Afghanistan has left Afghans and Americans with a seemingly endless series of woes. But among the most devastating are the blast wounds that have left more than 16,000 young Americans severely wounded.
Several hundred have suffered genital injuries in addition to amputations and burns, leaving them unable to father children and struggling to engage in something resembling the sex they used to have, often without the aid of what many view as the primary symbol of their manhood.
"Who's going to want to be with me now?'' wondered Marine Staff Sgt. Glen Silva, 39, after an IED blast shattered his leg, ripped open his lower torso and severed most of his penis.
It was a legitimate concern. Silva's girlfriend stayed with him at Walter Reed National Military Medical Center in Bethesda, Md., through many of his 42 surgeries. But one day he was wheeled back to his room to find she had gone, leaving a nine-word handwritten note: "I can't take this any more. I'm outta here."
Silva, the Litynskis and others agreed to share the painful and intimate details of their ordeals in order to spotlight what they feel is a life-altering but often hidden wound, one that is frequently given inadequate attention and care within the military health care system. Those who cannot regain their sexual function or drive are given little understanding or aid, they say. In Mark and Heather's case, it took the intervention of The Huffington Post to get them an appointment with Walter Reed's specialist in sexual dysfunction.
"They weren't prepared for this,'' Silva said of the Walter Reed staff.
Since 2005, more than 1,500 soldiers and Marines have been carried off the battlefield with genital wounds. But since late 2009, when President Barack Obama ordered a "surge'' of 30,000 combat troops into Afghanistan and approved a new tactic of increased foot patrols, the pace of genital injuries has accelerated.
In the year before the surge, 170 combat troops suffered genital wounds, mostly from IED blasts. In 2010, according to Pentagon data, that number leapt to 259. Last year, the Defense Department counted 299 cases of genital wounds that James Jezior, a urologist who does genital repair surgery at Walter Reed, characterizes as "devastating.''
"I remember lying on my side, dust everywhere, and I looked down and saw my arms were split open and squirting blood and I had just two bloody stumps above my knees," said Marine 1st Lt. James Byler, 26, who was blown up a few weeks before Mark Litynski. "My first coherent words to my Marines were, 'Hey! check my nuts!'" His genitals were severely damaged, but intact.
"It's the male instinct, the first thing you care about,'' Byler said. "In past wars, guys didn't live if they got injured as badly as me, but we've gotten so good at the medevac process now that guys who are catastrophically wounded are surviving. Now you have all these further complications -- like, you know, what's going to happen with my genital wounds?''
Military surgeons and specialists acknowledge that they often don't know the answer, because, until recently, they had little or no exposure to such injuries.
'I AIN'T GOING TO NO SEX-CHANGE DOCTOR'
In past wars, most casualties were head and chest wounds caused by shrapnel from mortars and artillery or from bullets. Walter Reed, the nation's premier military hospital, attracts some of the best talent in military medicine. But doctors there say their only relevant experience with sexual dysfunction had long been with older prostate cancer patients, who obviously have vastly different medical and psychological needs than young men with severe battle injuries.
During the past decade, IED blasts have become the primary cause of U.S. battle casualties, killing or wounding 34,360 American troops in Iraq and Afghanistan, according to the most recent Pentagon data. One reason for the increasing incidence is that modern body armor protects the chest but leaves the lower torso exposed to the upward blast of buried bombs, a vulnerability that insurgents have exploited.
Many victims end up at Walter Reed, where surgeons are able to repair some damage to the penis. Jezior uses tissue he cuts from inside the patient's cheek or lip to rebuild the urethra, which carries urine through the penis from the bladder. Oral tissue is used because it is hairless and used to being wet, Jezior explained, and is rolled into a tube to replace the damaged urethra. He grafts skin from the patient's thigh or groin to rebuild the outer layer of the penis.
But for guys like Staff Sgt. Silva whose penises have been partly or totally destroyed, options are few. Expertise within the military on penis replacement, or phalloplasty, is so limited that some Walter Reed patients have been referred to civilian surgeons who specialize in sex-change operations. It's an option not well received in the ranks.
"I ain't going to no sex-change doctor,'' Silva growled. Besides, he had seen photos of the penises they had made with surgical flaps from patients' forearms. "I could do better with Silly Putty," he snorted.