Sex Impacts Your Health and Well-Being: So Why Aren't More Doctors Trained to Talk About It?

In a country like the United States, where comprehensive sex education is in a serious deficit, physicians are a chief point of reference for those seeking medical information about their bodies. Yet, a new report published in the American Journal of Sexuality Education claims there has been a dramatic drop in the sex health education requirements in medical residency programs across the country, impacting on the potential treatment a patient may receive and the overall quality of public health in the nation.

Sexual health, as defined by the World Health Organization, isn’t just concerned with the absence of disease or unwanted pregnancy, but rather encompasses a state of physical, emotional and social well-being in relation to sexuality as well as potential pleasure and safe sexual experiences. 

For medical students, learning about sexual health involves acquiring information and forming beliefs and values related to sex and sexuality. However, according to Megan Andelloux, a clinical sexologist who is co-author of the report, sex education in U.S. medicine is marred by a lack of conversation that is producing sexually ignorant adults.

“We find that patients want to bring up the topic of sexuality but are met with a cold silence from their providers. If they do bring up the conversation, providers often try to shut them down or put them on antidepressants. Physicians are hailed as knowing the most about the body. But from what I have seen as well as from evidence in the report, many physicians know less about sexuality than their patients,” she said.

The report reveals that a study of 500 adults showed that even though 85 percent said they would try to talk to their physician about a sexual problem, 71 percent felt their physician would dismiss their concerns and 68 percent thought their doctor would be uncomfortable discussing sexual problems. Only 9 percent of patients had been asked about their sexual health directly during a routine visit. This created barriers between doctor-patient relations and led many to search other sources like the Internet for sexual health answers, despite preferring to discuss concerns with educated professionals.

So if there is an obvious and increasing patient demand for sexual health care as a vital public health service, why are physicians hesitant to initiate this important discussion?

Research shows that the problem lies in the lack of education, training and practical skills physicians typically receive during medical school and residency, with studies showing many physicians don’t feel prepared, confident or equipped to discuss sexual health issues with patients.

“The number-one thing medical students and residents tell me is that they don't want to appear that they don't know what they’re talking about so they would rather be quiet about sexual health than mess up when talking to patients,” Andelloux said.

Such findings aren’t really a shocker when one considers that the average amount of time medical schools spend on clinical education of sexual health topics is just eight hours—and that’s only among the 55 percent of U.S. medical schools that actually have a sexual health curriculum.

Unfortunately, sexual health education at the residency-training level doesn’t fare much better. Researchers of the report claim that in the past three years, there has been a decline and variance in the sex education requirements in residency programs, particularly in pediatrics, which has removed sexual health requirements from the regulations altogether.

The key body responsible for establishing post-MD residency requirements for all specialties is the Accreditation Committee for Graduate Medical Education. Under the ACGME regulations, not all residency programs have standardized sexual health training or clinical skills experience. Only certain specialties, such as obstetrics and gynecology and family medicine, expressly set out individual components that residents must be trained in specific to sexual health.

Andelloux says that prior to the release of the report, co-authors discovered that ACGME had changed its baseline standards for residency programs without public announcement so that after July 2014 there will be even less standards with regard to sex education in medical programs.

“We don’t know why these requirements are dropping, but there seems to be a lack of transparency from ACGME with this decision and this is cause for alarm,” Andelloux said.

ACGME, however, rejects this contention. While not denying that changes have taken place, a spokesperson from the group told AlterNet that all modifications to its requirements are “dramatically transparent” and have been disclosed on its website which lists the reasons for the revisions and is generally open for public comment for 45 days.  

“The program requirements at ACGME are painted with a wide brush covering a lot of topics. When we look at the curricular requirements for pediatrics or for adolescent medicine you will see very broad categories. We don't list all of the requirements. We removed certain details from sexual health requirements, but that doesn’t mean residents won’t be taught that information. We’re changing the way we accredit programs so that we don’t require providers to follow such detailed processes. But not everything has been removed, just the details. The broad categories are still there.”

ACGME adds that there is a misperception that it alone is responsible for all residency standards, whereas in reality many other individuals, educators and organizations are involved in the sex health education process. This assertion appears consistent with the findings in the latest report, which suggests that the amount of time dedicated to teaching sexuality depends largely on the residency directors and faculty members of each program. 

Shannon Criniti, a co-author of the study who holds a Ph.D in human sexuality, explained this discrepancy to AlterNet: “If directors and faculty members are comfortable talking about sexuality and think it’s important to teach, then students think it’s important. If they do not, then residents don't learn about it. It’s so variable. Even if medical students express interest in learning more about sexual health, they are so overwhelmed as it is with subjects that they are hardly in a position to be advocating for more topics,” she said.

While it remains unclear as to precisely why there have been recent changes in sex education residency standards, there is sneaking suspicion that politics may be at play.

“Government bodies dictate what is important for these individuals to know.” Andelloux says. “There is a level of conservatism about how those individuals making the standards view sexuality. Students say they want more sex education. Most of the faculty members say it’s important but don’t have the time to implement it. Well, someone is sitting behind the fence not allowing that time to make it happen.”

On a grander scale, it seems our views on sex education in this country are still by and large dictated by our puritanical society, which limits the realms where sexuality is taught across all sectors in the United States, as Andelloux explains.

“Americans are uncomfortable with acknowledging that one of the main reasons we have sex is for pleasure. People have feelings associated with it and think we shouldn’t be talking about it or addressing it. Society likes to bury its head in the sand and pretend sex is not happening. This is fundamentally disrespectful to sexuality and impacts on public health by teaching students that sexual health is not valued in our society. People are increasingly ignorant about it so they turn to online sources like pornography which, for the most part, is not designed to be educational,” she said.

In response, researchers believe we need to reframe the way we perceive sexual health in medicine from a problem-based approach to a wellness-based model that includes sexual pleasure—which is frequently neglected—as a key component. They argue sexual health should be given the same priority as other factors of patient's overall health. This means training physicians on core sexual behavior patterns that patients commonly engage in, as well as providing skills to comfortably discuss sexuality issues like how our bodies typically respond during sexual activity.

There has been some notable success. The University of Minnesota has emerged as a leader in the field offering graduate level courses on sexual health that exceed the minimum requirements of the ACGME. Likewise, the Robert Wood Johnson Medical School of University of Medicine and Dentistry of New Jersey has an international recognized model for sexual health called Sex Week which is required for all second-year medical students. 

It is hoped in the future that more medical schools will follow suit to increase the amount of sexual health instruction received during medical training to better prepare doctors to address the real-world sexual health needs of patients.

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