FORWARD OPERATING BASE JACKSON, Afghanistan (AP) - It is a conversation, the military surgeon says, that every U.S. Marine has with his corpsman, the buddy who is first to treat him if he is wounded by an insurgent's bomb.
The Marine says, "'If I lose my manhood, then I don't want to live through it,'" according to Navy Lt. Richard Whitehead, surgeon for 1st Battalion, 5th Marine Regiment, which is fighting in one of the most treacherous combat areas of Afghanistan.
"They ask us not to save them if their 'junk' gets blown off," said Whitehead, using a slang term for genitals. "Usually, we laugh. We joke with them about it. At the same time, you know that you're going to treat them anyway."
This is a world of fear, resolve and dark humor that is mostly hidden from accounts of the human cost of the war in Afghanistan. American troops who patrol on foot in bomb-laced areas know they might lose a leg, or two, if they step in the wrong place. But for young men in their prime, most unmarried and without children, the prospect of losing their sexual organs seems even worse.
Whitehead said: "It's one of the areas we can't put a tourniquet on."
Sangin, the district of southern Afghanistan where the Marine battalion is based, was a Taliban stronghold for years. It has one of the highest concentrations of improvised explosive devices, or IEDs, in the country. Robust Marine operations in the past year have weakened the insurgency in Sangin, and troops now seek to build up the authority of local government and community leaders.
But elusive fighters routinely strike with booby traps on trails and around patrol bases. Lt. Col. Thomas Savage, the battalion commander, said there was a rough average of five IED strikes, finds or interdictions a day in Sangin, in Helmand province. Estimates vary, but some Marines say roughly one in 10 IEDs hits a target.
Sixteen of the battalion's Marines have died and at least 160 have been injured during a seven-month deployment that ends in October. Of those, about 90 were sent home because of the severity of their wounds, said Whitehead, the battalion surgeon. One lost both testicles, four Marines lost one testicle and two had penis injuries.
The U.S. military's Landstuhl Regional Medical Center in Germany said it has treated 134 servicemen with one or more amputated limbs through July 31 this year, about 80 percent of the number that suffered similar injuries in all of 2010. Ninety of the 134 also had genital injuries, according to the center. Virtually all the troops were injured in Afghanistan.
Several months into the deployment, the Marines in Sangin were issued so-called "blast panties" or "ballistic boxers," British-made underwear made of densely woven silk that ends above the knee. The black garb resembles cycling shorts and can't stop shrapnel, but it protects against infection and the tight fit compresses flesh and offsets the impact of a blast wave, which separates skin from muscle.
"We'll get guys in here with all of the skin on their legs pushed up like a pair of loose pants around their waist," said Whitehead, of Pascagoula, Mississippi. "All that tissue is going to die. With the compression down around their knees, the blast wave stops."
Early on, some Marines complained the heavy underwear was hot and uncomfortable. It is now mandatory clothing, deemed as essential as gloves, helmets, plastic eyewear and other protective gear. Before a patrol, squad leaders check to make sure their men have it on.
A flap hanging from body armor around the torso also offers Marines some protection to the groin, which has major blood vessels. The sweepers, those who lead patrols with a metal detector, wear extra padding that loops between the legs. Some call it a "Kevlar diaper."
One of the first things that Hospital Corpsman 2nd Class Richard Erfurth of Portland, Oregon does when he assists an injured comrade is check his groin. If all is well, he will reassure the wounded Marine by saying: "Your junk's still there."
Erfurth says the Marine usually appears relieved and says something like: "Sweet, dude."
This scenario, the medical specialists say, plays out even if an injured Marine has lost a foot or a leg. Troops in areas where IED attacks are common have become so accustomed to the prospect of extreme injury and amputation that a gruesome relativism takes over.
From one perspective, a Marine who loses a foot is lucky because he didn't lose the leg. If he lost the lower part of his leg, he's lucky because he didn't lose the knee, which enables an easier transition to a prosthetic leg. If he lost most of the leg, he's lucky because he still has the other one.
Losing genitals, however, is a "whole new ballgame," said the battalion's chaplain, Navy Lt. David Kim of Mineola, N.Y.
Marine Cpl. Robert Cole of Klamath Falls, Oregon, was blown up twice in this deployment, suffering a concussion both times and falling unconscious for a few minutes in the second attack. In each blast, men near him lost legs.
Cole said a close friend in his platoon lost a testicle as well as his legs in an IED strike in May, and is recuperating in the United States.
"He's dealing better with losing his legs than with losing his testicle," Cole said. He recalled that his friend, in a telephone conversation, paused awkwardly before mentioning his lost testicle. Two months after the blast, however, the injured friend had sex with his wife for the first time and they were both "bragging" about it, according to Cole.
The corporal said he once had tests for possible testicular cancer and that the results came back negative. After grappling with the private fear of losing his testicles, he believes more than ever that there should be open talk of a grievous, deeply personal injury that is often dodged in public discussions about casualties.
The topic has edged into popular culture. A fictional character in a U.S. television series, Sons of Anarchy, is called "Half-Sack" because he lost a testicle while serving in the Marines in the Iraq war.
Marines seem more likely to indulge in macabre humor about losing legs as a way to deflate the anxiety. At Camp Pendleton in California, a Marine scrawled "I am going to miss my legs" on the walls of a portable restroom before deploying to Afghanistan. Some Marines posted photos of their legs or feet on Facebook accounts.
There's a shorthand for the unfortunates now: "double amp," or "triple amp" if they lose an arm as well.
Such injuries are common in Afghanistan because insurgents bury bombs made with small amounts of homemade explosives. During the Iraq war, vast quantities of military-grade ordnance left over from Saddam Hussein's dictatorship were available to the insurgency. So massive bomb attacks there caused what medical specialists described as "total body disruption," instantly killing their targets.
"There's a mass of tissue laying there. ... You can't necessarily identify the head, shoulders," said surgeon Whitehead, a veteran of the Iraq war. "The charges here aren't meant to kill, they're meant to maim."
Dressed only in his protective underwear, tattoos across his torso, Staff Sgt. Rick Meyers of Riverbank, California, relaxed one evening on his cot at Forward Operating Base Jackson, the headquarters of the Marine battalion. He said men under his command don't succumb to fears of devastating injury.
"What is in your mind is making it not happen," he said.