In a war, both men and women will suffer from trauma. But researchers are finding that the way women hurt is different from men, especially when it comes to veterans who reported military sexual trauma.

The experience of being sexually assaulted or harassed during their service put them at twice the risk of men for developing post traumatic stress disorder. But women with military sexual trauma (MST) also had more and longer lasting symptoms than their male counterparts.

Often they take out their pain on their bodies through substance abuse and eating disorders, especially women who saw combat and had to worry about their safety under fire as well as being attacked by their brothers-in-arms.

Sometimes military standards were also at fault.

During her service on board the USS Essex, former Navy operations specialist Kelly Carlisle gained 25 pounds after ship medics prescribed Depo-Provera, a form of birth control whose side effects can involve weight gain.

To shed the extra pounds, she turned to laxatives and drastically reduced what she ate after failing a physical. Carlisle said she didn’t see herself as having an eating disorder because she wasn’t throwing up. “There were some of those women on board,” Carlisle said. She could hear them vomiting.

She also described how men called the women on board “navahos,” indicating they were promiscuous by virtue of being female. Carlisle said she and other women felt pressure to have sex to ward off accusations by men of being gay, which until recently could ruin a military career. The accusation could saddle someone with an other than honorable discharge, depriving her of veteran benefits.

“MST gave a name to what happened and how I felt,” Carlisle said.

The challenges to helping women transition successfully to civilian life have been a wake-up call for the Department of Veterans Affairs. The VA responded by launching a campaign to make women in the Armed Forces more visible and address their needs after their service. They also established the Center for Women Veterans and set up women’s clinics at every VA hospital.

But there is still a long way to go, as a 2011 Government Accountability Office report about homeless women veterans pointed out.

“While VA is taking steps, such as launching an outreach campaign, to end homelessness among all veterans, it does not have sufficient data about the population and needs of women veterans to plan effectively for increases in their numbers,” the GAO wrote.

“Further, without improved services, women, including those with children and those who have experienced military sexual trauma, remain at risk of homelessness and experiencing further abuse.”

Older female veterans and women in rural areas – about 200,000, a 31 percent increase since 2006 – are even more isolated and invisible.

“Women who joined the military for good reason are suffering,” said Jeeni Criscenzo of Amikas, a nonprofit that serves homeless veterans in San Diego. “We as a society should find that unacceptable and fix it.”

The lack of awareness among the institutions serving them raises a red flag because the number of women veterans enrolled in an already struggling VA health-care system is expected to double in the next five years.

The effects will be felt in California, already home to nearly 200,000 women veterans, second only to Texas in the nation but not by far.

“Gender-specific needs will become a priority,” said Lindsey Sin, deputy secretary for Women Veterans Affairs at the California Department of Veterans Affairs, or CalVet.

Those needs will put demands on institutions “and those institutions are not ready for us,” she said. “They’ve made great strides but they’re still not ready.”

In fact, those institutions only began recognizing women veterans in 1980 and providing services for them was not a priority until the wars in Iraq and Afghanistan, in which some 400,000 women have served. There are nearly 2 million female veterans nationwide, about three-quarters from pre-9/11 conflicts.

Recent veterans are accessing services more than their predecessors, Sin said.

But others stay away because they believe only combat veterans have access to services or don’t feel worthy.

“There were people coming back from war. I didn’t want to take the attention from them,” Carlisle said.

When she did seek services, Carlisle was confronted by a system that alienated her. She had to rely on her father, a Vietnam-era Navy veteran, for advice navigating the VA clinic in Oakland when she went for the first time for back pain in about 2007. They assigned her the same doctor who saw her father and she never received the results of the X-rays. “No word, no follow-up, nothing,” she said. The same was true for a thyroid check. A weight-loss group she joined was filled by elderly men.

Carlisle’s male counterparts will still recognize anecdotes like hers – the VA system has been wracked by scandals involving mountains of backlogged records, as well as delayed or substandard care.

However, the third time Carlisle went to the VA clinic, she asked for a pregnancy test. Staff yelled out, “Where do we keep the pregnancy tests,” in a room filled with men. While waiting for the results, a nurse lectured her about not having an abortion.

Despite significant improvement since 2007, such experiences are common.

“We are woefully under-equipped to understand how women are affected by combat,” said Gerard Choucroun, director of veterans health and integration program at the Veterans Health Research Institute. “And the models are based on men.”

That has led to alarming instances of women veterans being prescribed drugs that can cause birth defects, as researchers reported in a series of new studies by military and academic researchers focused on women veterans and sponsored by the VA.

They also found one group of women were prescribed benzodiazepines despite concerns about the class of drugs commonly used to treat anxiety, insomnia and depression and a decrease in prescriptions for men. Among the best known benzodiazepines are Valium and Xanax. “Caution must be used when prescribing benzodiazepines to patients with a current or remote history of substance abuse,” as a study in the American Family Physician journal put it.

Other problems originate during their service, beginning with gear fitted and sized to men. Urinary tract infections are also prevalent because women can’t relieve their bladders as easily as men and aren’t willing to urinate in front of men.

Such examples are an extension of a bigger issue, said Christine Carter, vice president of scientific affairs at the Society for Women’s Health Research. The organization released the 2012 report, “Current challenges in female veterans’ health.”

Studies have long been male-focused, she said, “and women were very much an afterthought.”