Militarised masculinity and injured bodies

Feminist scholars have worked over several decades to highlight the ways in which the construction of ‘the soldier’ as a militarised ideal of the embodied subject is built, in part, through understandings of gender/sex/sexuality; arguing that the military (and particularly, for the purposes of this article, the US military) is based upon a set of ‘traditional processes and images of masculinity’.Footnote ⁶ Within military practices and discourses, scholars have shown how the creation of the solider-subject is achieved through a ‘self-consciously cultivated’ process of training through which citizen recruits are turned into ‘warrior-soldiers’, masculine subjects that are able to kill and follow orders that may well contradict civilian ethical norms and behaviours.Footnote ⁷ These training practices and the resulting military culture is, feminists argue, reliant upon the valorisation of ‘masculine’ values and ideals (strength, hardness, virility, aggression) against the devaluation of the ‘feminine’ (softness, emotionality, passivity, etc.). The hierarchical coding of masculinity over and against femininity is often very explicit; for example, the practice of insulting recruits through the use of terms such as pussy, ladies, cunt, as well as homophobic and racialised slurs.Footnote ⁸ Feminists have shown how soldiers are thus expected to perform the role of a hyper-masculine subject. This particular type of masculinity is often referred to as militarised masculinity. Feminists have argued that militarised masculinity is best understood in the plural, as the military requires the production of ‘different heterosexual violent masculinities’, from foot soldiers to officers, all of which draw upon hierarchies of race, ethnicity, and class.Footnote ⁹ This hierarchical understanding of gender constructs an image of the ‘ideal’ soldier, through a privileging of archetypes of masculinity.

Feminists have also pointed out how, much as with gender relations outside of the military, this is a shifting and unstable set of power relations. While telling a story about militarised masculinities, it is important to identify that such ideals of masculinity are unachievable. Not only can few of us embody this ideal constantly, but the lived experience of soldiering can rarely be so neatly categorised into binary divisions of masculine/feminine, heterosexual/homosexual, etc. Julia Welland, for example, argues that the ambiguity involved in defining and enforcing the boundaries of militarised masculinity works to both sustain and challenge the militarised masculine ideal (e.g., an exorcism of the possibility of queerness sits alongside routine practices of group nakedness).Footnote ¹⁰ Feminists have argued not only that militarised masculinities exist, but also that there is a danger in presuming they are ontologically stable. To do so is to (re)iterate and (re)produce such identities.Footnote ¹¹ Feminist scholars have therefore drawn attention to the knife-edge of failure that militarised masculinities continually dance upon. Militarised masculinities are not identities that are achieved once, and remain complete forever. Instead, militarised masculinities are best understood as a set of disciplinary practices that are consistently attempting (and failing) to produce the militarised masculine ideal subject. This article contributes to feminist attempts to highlight the instability of militarised masculinity. To do so, I offer an exploration of how bodies which threaten the militarised masculine ideal as a result of GUIs can come to be (re)incorporated into militarised masculine frames, through the excoriation of queer/trans ‘others’.

In addition to thinking about the construction and instability of militarised masculinity, feminist scholars have also offered powerful analyses of the relationship between militarised masculinity and injury. Jennifer Terry's work is particularly instructive in this regard, exploring the ways in which ‘[w]ar and medicine are in a relationship of mutual provocation’, as ‘wounding and illness generate biomedical knowledge and vice versa’.Footnote ¹² She dubs this the biomedicine-nexus, arguing that practices of militarism are (re)iterated through this relationship, resulting in the tacit acceptance of war and militarist practices in US society. Terry's work is vital in drawing together feminist science studies along with critical disability studies to outline how the biomedical practices that accompany warfare are profoundly political. Through an analysis of bionic prosthetics, pharmaceuticals, and regenerative medicine, Terry shows that the wounding and ‘repair’ of US service members works to sustain practices of militarism. This article thus extends Terry's arguments into the area of genitourinary injuries specifically to pull out in detail how the perpetuation of militarism through medicine (re)produces sexed and gendered dynamics of power.

Genital injuries themselves have been the subject of discussion by a small number of scholars in international politics. Henri Myrttinen and Chris Hendershot both do excellent work in pulling out the ways in which genitourinary injuries can be considered a form of sexual violence in conflict.Footnote ¹³ Myrttinen shows how violence directed against genitalia can be a form of sexual violence, with varied understandings of what this violence is intended to communicate dependent upon context and between various actors.Footnote ¹⁴ Hendershot's discussion of GUIs, while also rooted in a consideration of sexual violence, turns attention away from the violent act and towards the violent effects; namely arguing that the sexualisation of genital injuries ‘naturalise[s] what it means to be a man or boy’, problematically obscuring that the construction of ‘normal’ and ‘natural’ male bodies ‘is also an injurious process’.Footnote ¹⁵ In this article, I take up Hendershot's line of inquiry as to the relationship between ‘normal’ and ‘unnatural’ male bodies that is effected in the treatment of genitourinary injuries, taking this to a specifically US context to map closely which gendered and sexed ‘others’ emerge in treatment processes. I argue that an exploration of GUI treatments, and how these ‘others’ are both made manifest and banished, can help us to understand how something as unstable as militarised masculinity continues to (re)produce. Techno-medical interventions constitute one site through which militarised masculinity is able to stretch – to swallow threats to its ontological stability through medical practices that target (certain) body's capacities. This is, of course, not a new ability of masculinity, which has always been selectively malleable. The aim of this article, however, is to lay out in detail one of the processes through which this selective stretchiness is effected.

In using the language of capacity, this article also draws upon critical disability studies. Critical disability studies is a body of literature that uses critical theories in order to interrogate the production of disability, eschewing binary models for thinking about disability and exploring the history of disability within wider sociopolitical and economic paradigms.Footnote ¹⁶ Critical disability studies has challenged rights based approaches to disability, arguing that while rights based activism has yielded benefits for disabled folks, it has also empowered some disabilities at the expense of those which ‘do not fit the respectability and empowerment models of disability progress’.Footnote ¹⁷ Critical disability studies authors have begun already to unpack how the bodies of disabled and injured service members are crucial sites for the (re)production of masculinity and heterosexuality, and the powerful effects this has for solidifying the masculinity of militarism.Footnote ¹⁸

To explore questions about how and why service members with GUIs can be (re)integrated into military masculinity, despite the fact their material bodies actively challenge cisgender heterosexual norms, I adopt critical disability studies’ emphasis on capacity/debility. Jasbir Puar's work on debility/capacity is particularly instructive for this article.Footnote ¹⁹ Puar introduces the terms debility and capacity to enrich conversations around disability. If disability can be understood as a mode of being, Puar looks to see how debility and capacity are created and governed within certain populations in order to produce disability.Footnote ²⁰ In doing so, Puar offers an understanding of biopolitical forms of governance as ‘capacitation’ machines.Footnote ²¹ Biopolitical governance operates as ‘an ableist mechanism’, which seeks to produce capacity as a property of some bodies through the debilitation of others.Footnote ²² The governance of capacity/debility are therefore essential to strategies of population control.

In drawing upon Puar's work, I am not attempting to argue that service members with GUIs can (or should) be understood or discussed as disabled subjects. Instead, I seek to understand how US service members with GUIs are capacitated as heterosexual, masculine bodies and subjects. Focusing on capacity rather than the body itself allows us to recognise the ways that GUI treatments produce normatively sexed/gendered masculine bodies through control of their bodily capacities – a (re)creation of these bodies as having certain possibilities, acquiring capacity through ‘circuits of … privilege’.Footnote ²³ Through this capacitation of service members, this article goes on to show how the challenge that the materiality of bodies with GUIs might pose to the sex/gender binary is neutralised through the concurrent debilitation of queer and trans ways of being.

Feeling whole again: The prevalence and impact of GUIs among US service members

Between 2001 and 2013, 1,463 US service members were identified as having a GUI, meaning an injury to the genitalia or urinary tract.Footnote ²⁴ The overwhelming majority of these service members were men – perhaps unsurprising given that the legal ban on women serving in combat roles was only lifted in 2013, meaning that in these years women were vastly outnumbered by male service members.Footnote ²⁵ Rates of GUIs among US service members has risen during recent years, particularly during the wars in Iraq and Afghanistan; this can be attributed to both improvements in military medicine and technology, reducing the mortality rate of ‘renal combat wounds’ and meaning GUIs are more survivable; and also to the prevalence of improvised explosive devices in this conflict, which account for the majority (75 per cent) of GUIs in male service members.Footnote ²⁶ GUIs comprise one of many possible injuries that can result from the use of ground level explosive devices, and in US service members they are often comorbid with other injuries. A survey of the 1,367 male US service members who sustained GUIs between 2001 and 2013 found that 40.2 per cent also suffered traumatic brain injuries, and 28.7 per cent required lower extremity amputations.Footnote ²⁷ This comorbidity is not unusual; Terry notes that polytrauma (within war-related medicine, multiple traumatic injuries caused specifically by explosive devices) is the ‘signature injury’ of the global war on terror.Footnote ²⁸ While this article focuses on the specific impacts and biopolitical management of GUIs, it is important to note that they exist within a much wider (and crowded) scene of war-related injury and disability.

The rising rates of GUIs have meant that these injuries have increasingly attracted the attention of the US Department of Defence (DoD) and various branches of the military.Footnote ²⁹ As a result, the US Army Medical Research and Development Command have sponsored the ongoing Trauma Outcomes and Urogenital Health project (with the fittingly masculine acronym TOUGH). GUIs are also included as a specific focus under the Armed Forces Institute of Regenerative Medicine's second programme (AFIRM II).

GUIs can impact toileting and sexual function as well as damaging service member's sense of self, and as such are often represented as ‘spiritually and emotionally debilitating’ injuries.Footnote ³⁰ The psychological impacts of these forms of traumatic injuries have not yet been fully explored in the wider literature.Footnote ³¹ However, preliminary research does indicate higher rates of PTSD, depression, and suicidal behaviours in service members with GUIs as opposed to service members without them.Footnote ³² Medical staff and service members report that the status of the external genitalia is often the first thing injured service members ask about.Footnote ³³ One service member with a GUI reports awakening from an impact blast, realising both his legs had been severed above the knee, and that his first words were ‘Hey! Check my nuts!’.Footnote ³⁴ This suggests that GUIs (and specifically genital injuries) are greatly feared among service members.Footnote ³⁵

The next section of this article explores what happens when the business of war fighting harms service members’ genitalia, throwing them into a space of sexed/gendered trouble. Before doing so a brief note on methodology is needed. As the TOUGH project notes, GUIs were ‘rare’ as injuries prior to the US invasion of Afghanistan.Footnote ³⁶ This does not mean that US service members had never before experienced injuries to this area of their bodies; rather, that these injuries were previously unlikely to be survivable. As such, many of the novel treatments developed specifically for GUIs are still in their infancy. This is particularly true of penile transplants, which I discuss at length below. In order to understand these treatments, in this article I look at both specific treatment cases as well as conducting a critical analysis of discourses from medical professionals, media outlets, and US military institutions around these injuries.

The fact that there are often a small handful of cases and sources to be discussed raises questions about whether we can safely generalise and infer wider attitudes from these cases. I would argue that such an analysis is valuable for two reasons. Firstly, these injuries form part of a broader historical pattern of the capacitation of US military bodies. GUIs map onto a wider history of select injured service members gaining capacity through techno-medical intervention, often at the expense of the debilitation of others.Footnote ³⁷ Secondly – and this relates specifically to the section of this article that discusses transplantation medicine – there is great debate within the medical field as to whether transplantations should be carried out if the transplant would not be life-saving. This is due to the complications of receiving a transplant, namely the need for lifelong immuno-suppressants. The discourse around penis transplant surgeries is therefore able to teach us much about what types of injuries we think are worth treating, and why they are deserving of treatment. In this article, I show that this justification is expressed through cisnormatives logics of gender, sex, and sexuality.

Troubling injuries and sex/gender capacity

In a social world where the penis and testes are the materialisation of masculinity upon the body, with the penis functioning as ‘a symbol of masculinity par excellence’, GUIs can lead to a fracture within both body and sense of self.Footnote ³⁸ The cultural link between gender, sex, and genitalia is so strong that these terms are often treated as synonyms. This is true of both popular culture and scientific literatures, which portray particular genitals as ‘male’ and ‘female’, something which trans, intersex, and (some) feminist scholars have worked to challenge.Footnote ³⁹ Even the language we have developed to discuss these experiences and wounds points towards the symbolic merging of masculinity with the penis. The physical process of losing the penis and testes are referred to as ‘emasculation’, a word that joins the Latin for ‘change of state’ with ‘male’. The genitalia is so central to constructions of gender and sex that sustaining damage to the penis or scrotum can also rupture a masculine identity, disqualifying the body from being able to achieve the ‘normal’ masculine shape.

Importantly, this ‘loss’ of masculinity refers not only to the loss of the physical tissue, but to the bodily capacities that are lost with it. The damage to the physical matter of the body is important, as it damages the bodily capacity to engage in the iterative acts/relationships that produce gender and sex identities. GUIs threaten men's ability to perform a range of ‘masculine’ bodily activities. These activities centre on the capacity of the penis: urinating standing up, maintaining erections, ejaculation, having penetrative sex, and fathering children. All these masculine bodily capacities are potentially disrupted by GUIs. This can leave service members with feelings of both physical and social emasculation, where they are no longer able to fulfil the corporeal roles and bodily expectations that are associated with masculinity and maleness.Footnote ⁴⁰

This surfaces in repeated narratives that these injuries stop men from feeling like men, common across literatures and media reporting on genital injury.Footnote ⁴¹ One service member reported that his GUI had left him struggling to view himself ‘as a man’.Footnote ⁴² The crises these injuries commonly portend for men are also frequently acknowledged by members of their medical teams who emphasise how these injuries wound gendered embodiments, damaging the physical (genital) seat of ‘your sense of self and identity as a male’.Footnote ⁴³ This damage to the body and to the sense of self has led to service members with GUIs being produced as fractured following their injury. As a doctor reported, ‘[t]hey say, “I want to feel whole again” … [i]t's very hard to imagine what it means if you don't feel whole.’Footnote ⁴⁴ It is genitalia in particular that damages a sense of wholeness, more so than other body parts. As the recipient of a 2018 penis transplant noted – who also underwent a double leg amputation as a result of his injuries – it was the acquisition of a penis that restored a sense of ‘wholeness’ to his body.Footnote ⁴⁵

As a result of this loss of genital capacity, the masculinity and gender/sex of these bodies is therefore less certain. It is not so simple as claiming that these bodies are feminised – rather, they are ‘reconfigured as “rootless, dismembered”’ by their GUIs, thrust into sex/gender ambiguity.Footnote ⁴⁶ They ‘upset’ binary logics of sex.Footnote ⁴⁷ As a result of these injuries, service members ‘[g]endered anatomies’ therefore become ‘hard to decipher’.Footnote ⁴⁸ GUIs challenge their gendered and sexed claim to being a recognisably ‘human’ subject, a recognisably ‘human’ life. As feminist, queer, and trans scholarship has argued, conforming to dominant norms of personhood requires us to conform to binary understandings of sex/gender that privilege cisgender subjects/bodies.Footnote ⁴⁹ This is amplified within the context of militarism, as decades of feminist work has shown us the ways in which militaries and the process of military training relies heavily on hyper-masculinised ideals, fetishising bodily strength, hardness, and heterosexual virility.Footnote ⁵⁰ In such a context, GUIs threaten to disqualify soldiers permanently from being able to occupy corporeal fantasies of the hetero-masculine soldier.

While we might be able to see how service members with GUIs fit with common understandings of disability, the language of disability is often absent from representations of them. This may well be an attempt to keep service members away from the stigma and prejudice attached to disability and being disabled that permeates US society. Instead of the language of disability, discussions of service members focus not on whether the subject is disabled, but instead on what the subject's body can and cannot do. For example, rather than describing service members as having a physical disability, medical, media, and military actors refer instead to their ‘reproductive capability’, ‘reproductive function’, ‘sexual function’, ‘ability to have sex, father children [and] urinate normally’.Footnote ⁵¹ These representations of service members with GUIs frame the conversation not solely around the materiality of the body but focuses instead on questions of capacity, particularly cisgender heterosexual masculine capacities. The ways these bodies are often discussed attempts to focus attention away from what the body has/is (does it have a penis? Is it a male body if not?) and instead onto questions of what the body can do (does it have the capacity to do ‘male’ things?).

The importance of penile capacity is well understood by the US military, who have invested financially into producing the capacity for erection and ejaculation among its soldiers. In 2015, the Defense Health Agency spent around $84 million on erectile dysfunction medicines, $41 million of which was on Viagra alone.Footnote ⁵² While this makes up less than 1 per cent of the Defense Health Agency's spend for that fiscal year, it's worth noting that it dwarfs the estimated costs of $2.3–8.4 million associated with providing healthcare to trans service members, costs that a former president described as ‘tremendous’ and cited as a reason to ban trans service members from the military.Footnote ⁵³ Drugs classed as ‘genitourinary agents’ rank 13^th in terms of TRICARE's (the programme that provides healthcare for active service members) top drugs by days of supply, and 7^th for the Veterans Health Agency (which provides healthcare for veterans); Viagra is TRICARE's 15^th most supplied single source active ingredient, and the VHA's 9^th.Footnote ⁵⁴ Investment in the seminal capacity of soldiers is also not uncommon outside of the US. Jasbir Puar's work on the Israeli military points to the ways in which the seminal ‘capacitation’ of soldiers through reproductive services supports broader assemblages of militarism.Footnote ⁵⁵

Treatment options are often not about restoring damaged genitalia to their previous condition – indeed, this is often impossible – but instead with enabling the bodies of service members to perform as if they had normatively functioning genital and reproductive tissues. This is vital for understanding what military-medical assemblages attempt to achieve through treatments for GUIs. It is the capacity and potential of service members’ bodies to perform certain roles that is the object of governance in GUI treatments. The article shows that military-medical assemblages are concerned with producing certain penile capacities – the ability to ejaculate and biologically reproduce – in service members, regardless of whether this capacity is achieved through the material body alone, or in conjunction with medical technologies. GUIs show us that the importance of how these penile capacities are achieved matters less to the military than whom these capacities are assigned to.

In the next section, I look at how current treatments for service members with GUIs attempt to produce these bodies as having seminal capacity, in order to (re)produce service members as cisgender, heterosexual masculine bodies. I look first at developing technologies of penis transplantation, arguing that seminal capacity is achieved here at the debilitation of trans possibilities. I then explore fertility treatments for GUIs, showing how the production of seminal capacity through fertility support is reliant upon the debilitation of queer family arrangements.

Cis bodies, trans bodies, and ‘natural’ masculine capacity

Surgical treatment options may involve reconstructive surgery or transplantation surgery. Both offer different possibilities and outcomes. Reconstructive surgeries are heavily dependent on the extent of the injuries. Surgeons may attempt to reconstruct the shape of the penis, and can also insert prosthetic devices into the penis to allow erections to be achieved and sustained if this capacity has been lost.Footnote ⁵⁶ Penis transplants are a much more novel form of surgical treatment for GUIs. To date, there have been five penis transplants recorded worldwide, with two taking place in the United States. In 2018, surgeons from The Johns Hopkins Hospital performed the first penis transplant in the US for a wounded service member. This surgery was also noticeable for being one of the most extensive transplant surgeries to date, attaching not only a donated penis but for the first time including the scrotum and lower abdominal wall as part of the transplant.Footnote ⁵⁷

While to date there has been only one service member with a GUI that has benefited from transplant surgeries, the figure of the wounded soldier has been instrumental in penis transplant technologies and practices. At Massachusetts General Hospital, where penis transplant surgeries are also being developed, the transplantation programme came about as a result of a partnership between military urological surgeons with experience treating the ‘devastating genitourinary injuries of wounded warriors’ and cancer teams.Footnote ⁵⁸ The transplant programme at Massachusetts also cites one of the main aims of the programme as helping US soldiers who had sustained GUIs in Iraq and Afghanistan.Footnote ⁵⁹ Despite this interest in service members with GUIs, to date these surgeries are in their infancy and are not currently covered under existing military insurance schemes. The DoD has, however, financially invested in the research for penile transplantations, and the surgeons involved in the 2018 procedure were hopeful of the possibility of grants from the Pentagon to fund future operations, perhaps not unreasonably given GUIs new priority in AFIRM II.Footnote ⁶⁰

Assessing such surgeries through the lens of capacity/debility allows us to recognise two important points. Firstly, that these surgeries aim to (re)affirm the masculinity of service members through the use of transplants to create seminal capacity within the body. These surgeries aim ‘to restore a person's sense of identity and manhood’ according to the chair of plastic and reconstructive surgery at Johns Hopkins.Footnote ⁶¹ This restoration of masculinity is achieved through the acquisition of a normative penis, one that looks ‘right’ and has certain masculine capacities (or is presumed that it will acquire such capacities). These capacities are not only urinary but sexual and seminal, with the stated aim of restoring ‘spontaneous erection and orgasm’ to service members.Footnote ⁶² This treatment attempts to produce seminal capacity in service members through the curation of the ability to ejaculate, and for semen to exit the body ‘normally’. The penis here functions as an essential precondition for the possibility of semen, and whether semen is actually produced/expressed or not is secondary to the ability to mimic ejaculation. As the testes may have been damaged in the original GUI and penis transplants do not include the transplantation of the testes, the ability to physically produce and express semen may not be affected by these surgeries.

Rather, it is the capacity to ejaculate, the potential of performing this act – regardless of whether semen is present or not – that transplant surgeries attempt to restore. The positioning of penis transplants in particular as an exciting and innovate surgery for soldiers with GUIs produces non-normative phalluses as problems that require fixing. Through penis transplantations, this fix comes in the form of the surgical restoration of an ejaculating penis (or one that can mime this ability). This works to naturalise and solidify a particular genital configuration as ‘proper’ for masculinity. As the recipient of the 2018 transplant put it, penile transplants give soldiers an opportunity to have ‘the real thing’.Footnote ⁶³

Secondly, capacity/debility allows us to recognise that the creation of seminal capacity for cismen service members also entails a debilitation of other bodies whose penises have been created through surgical intervention, and specifically through the denial of similar capacities to trans people. That the genitals involved in penis transplantation are positioned as the ‘real thing’ establishes a hierarchy of genitalia, in which some bodies – and some masculinities – are perceived as more ‘real’ than others. Trans bodies in particular exist at the periphery of discourses around penile reconstruction and transplantation, often invoked only to establish the dominance of cis male bodies. When questioned about whether these surgeries may be developed in order to benefit trans people, a bioethicist at Johns Hopkins edged around how this would be managed in transplantation surgeries: ‘[w]hat do you say to the [next of kin of the] donor? A 23-year-old wounded in the line of duty has a very different sound than somebody who is seeking gender reassignment.’Footnote ⁶⁴ The inference here is that there is a hierarchy of deservingness, when it comes to penises; the romanticism of the patriotic, wounded soldier is more deserving of a penis than a trans person. Of course, this opinion is not unanimous among the medical profession. In 2020, for example, surgeons at Massachusetts General Hospital expressed interest in obtaining approval to carry out the world's first penis transplant for a trans man.Footnote ⁶⁵ However, transgender patients remain explicitly excluded from the so-called ‘Baltimore Criteria’ of ethical guidelines for penile transplantation.Footnote ⁶⁶ Developed by medical professionals from Johns Hopkins University and the University of Maryland, the ethical criteria restricts candidates for penile transplants to cisgender men, noting that not only is more researched needed into the feasibility of transplants for trans patients, but that substantial prejudice against trans people in the US could ‘pose problems in seeking donations in this setting’.Footnote ⁶⁷

Similarly, some service members have been recorded as rejecting any comparison between their bodies and those of trans people. As one article records, the referral of service members with GUIs at the Walter Reed National Military Medical Center to doctors who specialise in genital surgeries for trans people is ‘an option not well received in the ranks’.Footnote ⁶⁸ As a staff sergeant with a GUI is reported to have ‘growled’, ‘I ain't going to no sex-change doctor.’Footnote ⁶⁹ The use of ‘growled’ underscores the anger (as well as gruff and aggressive masculinity) generated by the suggestion that cis bodies would ever tarnish themselves by making use of resources designed for trans people.Footnote ⁷⁰

The creation of a hierarchy of penises here, where some surgical penises are ‘realer’ than others, demonstrates how the concept of phallic masculinity is able to adapt to encompass cis, heterosexual male subjects through the exclusion of others. That cis male bodies should have ejaculative penises is the natural order of things, requiring no justification, whereas trans bodies and surgeries are positioned as something insulting to compare service members with GUIs to. Cisgender male bodies are therefore produced as natural masculine subjects. Their masculinity is something that can be ‘restored’ to them, something that pre-existed their injury and naturally belongs to these particular bodies. As a result, the boundaries of the male subject allow service members with transplanted penises into the exclusive and privileged club of cis male masculinity.

This cements a particular distribution of capacitation/debilitation in these settings. The possibility of male bodies existing without penises and seminal capacity are refuted; the realness of penises that are not grown organically is denied. In this way, trans embodiment is excluded from the privileged position of ‘real’ male bodies, debilitated through attempts to deny their right to possess seminal capacity. The focus on establishing seminal capacity for service members with GUIs works to deny the possibility that men can and do live happy, fulfilling and sexual lives without penises, or with penises that look and function very differently to dominant sexual ideals. Through the focus on penis transplants and surgical treatments, trans bodies and bodily possibilities are rendered invisible, either explicitly devalued or implicitly excluded from being ‘real’, liveable bodies. This constitutes a form of debilitation for trans bodies and lives.

It is vital that we connect these forms of capacitation and debilitation with wider discourses of transphobia in international politics. Within a North American context, trans folk are subject to enormous and daily amounts of violence as a result of their transness, their perceived ‘failure’ to perform binary understandings of sex/gender/genitalia. Trans people face both acute and cumulative forms of violence, in terms of interpersonal as well as wider structural violences.Footnote ⁷¹ Trans studies scholars have demonstrated the ways in which Western healthcare often pathologises trans bodies.Footnote ⁷² Setting these militarised modes of debilitation into a wider, national scene of denial and debilitation of trans bodies reveals to us how not only trans bodies but also therefore trans lives and subjects are produced as less valuable than cisgender subjects and lives. Transplant surgeries reveal that this hierarchy of recognisable, liveable lives is established not only through medical technologies that directly engage with trans folk, but through medical technologies that explicitly do not engage with trans folk.

The exclusion of trans bodies from hierarchies of deservingness when it comes to seminal capacity reflects an active choice rather than a passive omission. When service members reject help from surgeons experienced in trans healthcare, when doctors privilege cis service members above trans people, they are not passively omitting trans people from the category of meaningful, recognisable, liveable human lives. Rather they are committing a ‘form of discursive violence’ against trans people, an act familiar within a military setting that has long sought to actively exclude trans folk, and a wider society that does the same.Footnote ⁷³ This violent relationship is effected through the governance of seminal capacity. In actively working to distribute semen among certain bodies, medical technologies are complicit in the eradication of trans possibilities, which are focused to occupy a subordinate position of artificial and unreal modes of living. In attempting to eradicate the spectre of the trans body within penis transplant surgeries, medical technologies that attempt to ‘fix’ the bodies of service members with GUIs are complicit in wider societal assemblages of transphobic dehumanisation. These assemblages do not afford trans lives the same value, the same easy congruence with ‘the human’, as cisgender bodies.

The logics at work in penile transplant surgeries thus must be understood as complicit in wider structures of power through which trans bodies are produced as perverse others, as not-normal bodies. These assemblages of penile transplant surgery are nested within wider relations of power that devalue trans bodies and trans lives. These power relations are (re)produced through phallocentric curations of service members’ semen.

No kids for queers

Having explored the relationship between surgical treatments and seminal capacity, I now turn to explore how medical treatments, specifically fertility treatments, engage with these dynamics. For soldiers with GUIs there is also the attendant risk of fertility problems. Fertility and virility have long been important to militarised masculinities, given the hyper-focus on the idealised masculine warrior figure as an ‘archetypal of heterosexual and rugged masculinity’.Footnote ⁷⁴ In Western societies, masculinity has long been associated with the ability to conceive children, with masculine ideals prescribing that a ‘real man can get the sex he wants and impregnate a woman when he so desires’.Footnote ⁷⁵ It is therefore unsurprising that ideas about the potency of sperm are important to militarised masculinity, as sperm is often constructed as the distillation of the masculine self into biological form.Footnote ⁷⁶ Through the capacity to father children, fertile semen allows men to perform the important masculine ability to ‘create’, to ‘extend power’ and their own corporeality through the bodies of others.Footnote ⁷⁷ Concerns and anxieties about the effect of war fighting on fertility and fatherhood have been common among Western militaries for years, surfacing most recently prior to GUIs in service members’ narratives of Gulf War Syndrome and fears that their military work damaged the fertility of their semen.Footnote ⁷⁸ The crossover between militarism and fertility is even captured in common colloquialisms for male infertility, such as referring to infertility as a man ‘shooting blanks’.Footnote ⁷⁹ Here, a fertile man is constructed as a warrior shooting semen (understood as live ammunition), while the infertile man is emasculated through his failure to possess (weaponised) fertile semen.

Whether a GUI impairs the ability to have penetrative sex and ejaculate, or the testes themselves are damaged, there are multiple ways in which a GUI may make biological reproduction difficult, if not impossible for service members. The military does offer some assisted reproductive services for service members who were injured on active duty. These include sperm and egg retrieval, IVF, artificial insemination, blastocyst implantation, and cryopreservation of embryos.Footnote ⁸⁰ For veterans, the VA covers hormonal therapies, ‘surgical correction’, artificial insemination, and IVF for veterans with service-related injuries and their spouses.Footnote ⁸¹

While there is a lack of data as to how service members with GUIs access these services (and indeed, whether they are able to in practice), it is important to note that these fertility treatments are all organised around heterosexual childbearing practices, and the nuclear family. Infertility health cover for those who sustained injuries while on active duty under TRICARE (the DoD's healthcare system) and the VA is only accessible if the partner has a ‘lawful spouse’.Footnote ⁸² That the provision of fertility cover only extends to married couples demonstrates that for the military, the nuclear family is the only type of familial arrangement that is worth financially investing in. While of course in the United States same-sex couples can marry, it is impossible not to note the heterosexist presumptions that underlie a decision to set marriage as the access bar for fertility services.Footnote ⁸³ LGB marriage rights were only secured across all fifty states in 2015 by the Supreme Court, meaning that prior to this decision access to fertility services for service members with GUIs were premised upon the exclusion of queer couples. Although it is now possible for married queer couples to fulfil the access criteria, that marriage is a requirement for fertility services entrenches heteronormative ideals of marriage as the most deified form of relationship arrangement, and the basic organisational unit of the family.Footnote ⁸⁴ This is exemplified in the Supreme Court's 2015 ruling in favour of marriage equality for LGB couples, which stated that ‘[n]o union is more profound than marriage, for it embodies the highest ideals of love, fidelity, devotion, sacrifice, and family.’Footnote ⁸⁵ The privileging of marriage within existing fertility provisions therefore not only practically speaking has excluded queer couples prior to 2015, but continues to devalue queer partnerships and childrearing arrangements that exist outside of heterosexist norms.

Investigating what fertility treatments are available to service members with GUIs further underscores the profound privileging of normative, cisgender heterosexual families. The available TRICARE and VA treatments, such as artificial insemination and IVF, presume that a married couple can between them supply both sperm and egg. For many queer couples wishing to have a child that is biologically related to them, a third party is needed to either supply sperm or act as a surrogate for the pregnancy. No provision is made for the acquisition of donor sperm or forms of surrogacy under TRICARE, and there is no provision made for adoption fees or support for couples electing to parent a child that is not biologically related to them (which includes both queer and heterosexual couples). Existing fertility treatments are therefore premised on an understanding that out of a married couple, one partner has ovaries and eggs and one partner has testes and sperm. These treatments thus rule out many queer couples even if they are married, along with a number of heterosexual couples where one partner may be trans, intersex, or otherwise unable to provide the necessary biological material (for example, as a result of a GUI).

The types of treatment offered also exclude a number of childbearing arrangements familiar to many queer couples, such as surrogacy, which TRICARE takes the time to make explicit that it does not cover, or adoption.Footnote ⁸⁶ As such, fertility treatments offered under the VA and TRICARE do not work to enable veterans simply to raise children. Were this the case, the acquisition of donor sperm, forms of surrogacy, and adoption fees would be covered under existing insurance programmes. However, it is only forms of reproductive technologies that involve sperm and egg from married, cisgender couples that are covered. It is only heterosexual, cisgender modes of living that are granted seminal capacity under existing fertility treatments. Through the production of seminal capacity in certain cishetero couples only, fertility treatments debilitate queer couples and queer modes of childrearing through (re-)enforcement of nuclear, cishetero couples as the natural, normal, and dominant family.

Privileging heterosexual nuclear families within the military fits into a wider historical pattern of governance. As David Serlin argues, the 1944 GI bill and its mortgage provisions constituted ‘a mechanic to promote and privilege family life’ and to help in ‘sustaining heteronormative bliss’.Footnote ⁸⁷ Fertility treatments work in the same way, to ease the pressures infertility brings to bear upon military couples and to conserve the conventional nuclear family.Footnote ⁸⁸ That fertility treatments for service members with GUIs are premised upon the heterosexual couple and the nuclear family demonstrates how the military is highly invested in the governance of service members’ semen in particular ways, and in heterosexual orientations. As this article has already argued in regards to surgical treatments, the military medical-bureaucracy invests in endowing soldiers with seminal and ejaculative capacity. This capacity is granted with particular heterosexual goals in mind, as this two-pronged strategy of surgical intervention/fertility treatments demonstrates. The governance of service members’ semen revolves around an image of the soldier as a heterosexual, cisgender male; this is who the treatments cater to, and these are the bodies and sexualities that occupy the central place in discourses of GUIs.

In doing so, queer bodies and queer lives are debilitated, produced as unworthy of similar levels of support through their total exclusion from such treatments. The governance of soldiers’ semen in the case of fertility treatments validates and reproduces heterosexual biological reproduction and heterosexual forms of life and living as the dominant norm. Queer lives and families are rendered invisible in these discourses. The governance of seminal capacity for the purpose of heterosexual reproduction instantiates family, reproduction, and future as the property of heterosexuality.

This feeds into a wider politics of anti-queerness that associates queerness not with temporal futures, but with the end of them. As Lee Edelman argues when he reminds us that queerness ‘is understood as bringing children … to an end’, queerness is often figured within dominant heterosexual cultures as anti-life.Footnote ⁸⁹ The exclusion of queer bodies and childbearing/parenting arrangements common to queer communities enacts and supports wider processes of heterosexist debilitation that attempt to deny the possibility of a future to queer communities and lifestyles. Under existing TRICARE and VA frameworks, queer families are debilitated through the restriction of their access to the financial, medical, and technological support it takes to produce a family when a parent has a severe GUI.

By looking at fertility treatments through the lens of capacity/debility, we are able to see how again the boundaries around militarised masculinity are able to be stretched to encompass some masculine bodies, but not others. When a GUI leaves a service member without the masculine capacity to father children, military healthcare systems attempt to offer some remedy to this ‘problem’, (re)affirming the masculinity of service members with GUIs through producing masculinity capacity. This capacity may not be exercised according to dominant rubrics of masculinity (e.g., fathering children through medically unmediated, penetrative heterosexual sex) but the capacity to biologically reproduce is still supported and enabled. This process is concurrent with the debilitation of other family arrangements, including fertility arrangements common to families with queer parents. This demonstrates that the boundaries of military masculinity can stretch to encompass a select few who fail to meet the criteria. While heterosexual service members with GUIs may be unable to fulfil the fertility and virility requirements of militarised masculinity, their heterosexuality and nuclear family configuration allow the military to (re)masculinise service members, through the technological creation of masculine capacity.

Fertility treatments for GUIs thus partake in a distribution of capacity/debility that protects and values heterosexual forms of life and family at the expense of queer possibilities. This article has argued that surgical treatments for GUIs necessitate the debilitation of trans possibilities in order to protect embodied cisgender forms of life. Fertility treatments perform the same function within the broader parameters of queerness. These treatments actively attempt to distribute and perpetuate heterosexual life, through the replication of heterosexual families. In order for this to happen, queer possibilities and queer forms of family and kinship must become invisible. They are made to fade away from fields of possibilities through an active distribution of resources that prioritises heterosexual capacity.

Racialised bodily hierarchies

While this article is focused on the way in which militarised masculinity stretches to encompass certain non-normative bodies through the exclusion of queer/trans others, it is also of vital importance to note how the management of service members capacities stands in sharp contrast to the lack of care extended to Iraqi and Afghan populations. As Terry notes, the US military has also deployed explosive devices of their own in heavily populated areas; both Iraqi and Afghan combatants and non-combatants have sustained serious levels of blast injuries, yet are often absented in discussions of the impact of blast injuries and genitourinary injuries.Footnote ⁹⁰ The gendered and sexed capacitation that operates upon service members with GUIs is also reliant upon a racialised distribution of life-death that constructs Iraqi and Afghan bodies as available for injury. As Puar notes, biopolitical governance operates through the production of certain populations as ‘available for maiming’.Footnote ⁹¹ While US service members are offered some (profoundly limited/limiting and inadequate) medical response to GUIs, the treatment of Afghan and Iraqi victims of GUIs has been inhibited by the destructive material and economic impact of war upon both countries.

Indeed, the impact of war makes it very difficult to identify the scope of these injuries among Iraqi and Afghan populations in the wake of both conflicts. The difficulty in estimating civilian and combatant casualty injuries is well documented due to the US-led coalition's reticence to release civilian casualty statistics; in a context where, as US General Tommy Franks told the press, ‘we don't do body counts’, injury and mortality estimates are the subject of much debate.Footnote ⁹² The closest we can get to an appraisal of the numbers of GUIs in Afghan and Iraqi populations, as a direct result of war, is to circle around the edges of the (estimated) number of injuries. In Iraq, around 56 per cent of civilians who were injured in 2014 experienced a disability as a result of these injuries; from 2008 onwards, the prime cause of war-related injuries were primarily blasts and explosions.Footnote ⁹³ Between 2003 and 2014, in Baghdad, injuries to the abdomen and pelvis accounted for 12.7 per cent of reported civilian injuries.Footnote ⁹⁴ In Afghanistan, the number of civilian casualties caused by IEDs has risen since 2009.Footnote ⁹⁵ The Afghan National Disability Survey estimates that around 17 per cent of all disabilities in the country are directly related to the war.Footnote ⁹⁶

None of these figures represent the number of GUIs. But based upon these estimates of civilian casualties, injuries, causes, and disability rates, it is very reasonable to suggest that there are likely substantial numbers of people in Iraq and Afghanistan living with GUIs. This is not including the numbers of Afghan and Iraqi people who would likely have lived with GUIs had their injuries not been fatal. Civilians and armed forces in both these countries are not likely to be wearing the protective body armour or riding in armed vehicles that US forces have access to, and are likely to lack access to a similar level of medical care and resource. Our inability to trace the numbers of people in both countries living with GUIs is not inevitable; instead, it is the result of a set of political choices to not collect and monitor these forms of data.

The US invasion of Iraq is particularly instructive here for highlighting that a lack of data is not an inevitable consequence of armed conflict. With regards to Iraq, the US Department of State and the Agency for International Development (USAID) signed contracts with both the World Health Organisation and UNICEF to implement a programme of health surveillance, training, and monitoring post-invasion; these responsibilities were then moved to the Department of Defense, based on the US presumption that US forces would be welcomed by the Iraqi people as ‘liberators’, and OEF would therefore be completed within three weeks, leaving no need for a prolonged health plan.Footnote ⁹⁷ Following this incredible presumption, the budget for humanitarian aid was cut in half, and various experienced members of the State Department were dismissed from their posts in Iraq following a drive for ‘ideological loyalty’; this included the interim minister of health, who was dismissed after declaring Baghdad to be a public health emergency.Footnote ⁹⁸ As a result of the Bush administration's imperial presumption that they would be welcomed as liberators of Iraq, the US rejected opportunities to systematically monitor and assess the health consequences of the US invasion. To this end, the WHO and UNICEF contracts were never implemented, and USAID did not receive any funds for conducting public health surveillance.Footnote ⁹⁹ The opportunity to gather data and information about the injury rates in the Iraqi population were not so much missed as refused.

Highlighting the lack of data in relation to GUIs among Iraqi and Afghan populations demonstrates that various bodily capacities are not being actively produced among Iraqi and Afghan populations in the way they are for US service members. It shows us that these bodies are actively debilitated through the infliction of injury, but also through the debilitation of healthcare systems that would address such injuries, and the denial of visibility to these injuries themselves. It is very difficult for us to even see GUIs among the populations most affected by war because choices have been made to render them invisible and silent within the relevant data. While this article focuses on issues of capacity and debility within US forces, it is vital to acknowledge that the hierarchy of bodies established is a profoundly racialised one. The governance and attention granted to US service members’ bodies is premised upon an understanding that the US soldiering body is one that is ‘worthy’ and ‘deserving’ of capacity. This is not a valuation that is extended to Iraqi and Afghan bodies.

The seminal capacity of US service members is therefore protected and promoted through the exposure of Iraqi and Afghan populations to higher levels of death and debilitation. The arguments about the unequal distribution of risk in both of these wars has been made thoroughly by other scholars, so I will not repeat them here.Footnote ¹⁰⁰ However, it is important to draw attention to the fact that the absence of information and data around GUIs effects an ‘elision’ of the role of US imperialism in producing GUIs, erasing a thorough consideration and critique of how wounding and injury similarly affects populations ‘over there’ in addition to populations ‘at home’.Footnote ¹⁰¹ This demonstrates how capacitation/debilitation in this context is premised upon a racialised hierarchy that situates Afghan and Iraqi bodies as ‘available’ for debilitation in contrast to the bodies of select US service members, which are produced as ‘available’ for (re)capacitation.