When you think of where people get their sexual health info, your mind might jump to 10th grade health classes, or friends, or even porn. Perhaps you think about social norms delivered through TV or the most recent Sunday sermon. However, when it comes to questions around sexual health, most adults are still asking their doctors. According to several studies done around the millennium, adults still see their physician as a primary source for addressing sexual health concerns (Metz & Seifert, 1990; Marwick, 1999). While this may change slightly with advancements made online, the physician is still a main-stay in sexual health concerns in the U.S. If you ask a medical student or physician, they may note how common sexual concerns are in a patient visit, often referring to sexuality questions as “hand on the door knob” questions. These “hand on the doorknob” questions suggest the real reason a patient comes to see his or her physician is to address some aspect of their sexuality, but are uncomfortable asking. In fact, a study conducted in 1999 found that while most people would ask their physician about a sexual health concern, they would feel uncomfortable doing it. More so, most people felt that their physician wouldn’t provide them with the information or treatment they were looking for (Marwick, 1999). For men in the 90’s, a study showed that while they wanted to get information from their doctor, they were embarrassed to do so and preferred that the physician initiate the conversation (Metz & Seifert, 1990). This attitude may not have shifted much even today.
One reason people may feel uncomfortable with addressing sexual health concerns with their physician may be that the physician him or herself is uncomfortable. A majority of 4th year medical students reported being uncomfortable with taking sexual histories from older and younger people in particular (Malhotra, Khurshid, Hendricks, & Mann, 2008). Physician attitudes, lack of comfort with sexual histories in general , and general communications issues also added to doctor discomfort (Tsimtsiou et al., 2006), A general discomfort with sexual health issues can make it abundantly clear to a patient that sexual health concerns are off-limits.
So what does all of this mean for us as educators?
1. We want to meet as many people as possible in addressing sexuality, so making sure doctors are just as informed as we are is a great way to do this.
2. Medical schools are obviously not giving the time to train students in taking sexual histories, in addressing student attitudes towards different aspects of sexuality, in working on communication around sexuality, and are probably not taking the time to talk about sexual pleasure or advances in sexual medicine.
3. Our place may be in providing sexual health training for medical students and ongoing education to physicians.
Training medical students or physicians has its pros and cons. Of course the pros are that we are able to make sure another source of sexuality information is on a positive track, but there may be some issues with having this come to pass.
1. First of all, medical students as well as physicians have a reputation of being slightly, umm, big-headed. Many medical students, as surely practicing physicians, may feel they already know everything and that, furthermore, no one outside of the medical community has a right to instruct them. Hopefully this is a rarer occurrence today, but it may be a small battle in organizing a training.
2. Time is an issue for any professional, but for practicing physicians in general, finding the time to enroll in a sexual health training program may be tricky. If you are attempting to add a sexual health training section to a medical school, it may be quickly shot down with the idea that there is already too much in the students’ schedule.
When organizing a program for training medical students, its best to first get the backing of a medical organization or medical school. That way, you have some sort of credibility behind you for the nay-sayers. More tempting would be setting up some sort of earned credit or certification if possible. This would help dismiss the previous concerns, especially if the class was an elective for credit. Furthermore, as Rebecca Bak and Alexis Light noted in constructing their Sexual Health Scholars Program for the American Medical Student Association, its best to approach a curriculum set up in a variety of steps. According to this duo, following these 7 steps will help when attempting to set up a sexuality training.
1. Identify a Need
2. Seek Help
3. Approach the Administration
5. Create the Curriculum
(Bak & Light, 2011)
It may be easy to identify the need for a training in any medical community by assessing their current classes, but it is also important to get student backing and document it. When you approach the administration, it will be much easier to set up a training if you can show student interest in the program. Bak and Light also make a strong point to not go it alone. Seeking help in this endeavor is needed for success. For educators, this might be someone with interest in the medical community or a medical student. Perhaps you team up with a few members of your Planned Parenthood community. Any way you do it, having help, and backing, is mandatory for success in such an unpaved route.
For those of us who have little experience teaching professionals, #5 on this list may be a bit baffling. What do we teach medical students about? Many, if not all, already have some basic information in STI’s and the reproductive system as well as contractive methods. In fact, some of them may know more than you do on the subject. Thus, when developing a curriculum, its best to assess what is needed and what strengths you can play to. If you are teaming up with someone, hopefully they bring another skills set to the table as well. All in all, though, do not attempt to teach over your head. While it may be helpful to explain the most recent sexual medicine to them and how it affects sexual wellbeing, we can’t all be Dr. Kellogg. It is just as important to facilitate on attitudes towards LGBT sexuality and older adult sexuality. However, the Sexual Health Scholars and Center of Excellence for Sexual Health have come up similar topic lists that may be helpful when developing a curriculum.
1. Value of Sexual Health in the Medical Field
2. Taking a Sexual History
3. Models of Sexuality
4. Sex and Language
5. Sexual Anatomy, Reproduction, Response Cycles
6. Sexual Function and Dysfunction
7. Body Image and Self Esteem
8. Sexuality Across the Lifespan
9. Sexuality and Illness and Disability
10. Common Sexual Concerns and Treatments
12. The Internet and Sex
13. Sexual Orientation, Attitudes and LGBT Health
14. Sexual Abuse
15. Sex Workers
16. Media, Culture and Religion
17. Behaviors, Values and Expressions
(Morehouse School of Medicine, 2011; Sexual Health Scholars Program, 2011)
The list could continue, but it should be obvious with this that there are multiple topics that could be and should be included in a sexual health training.
Advanced training in sexuality for medical professionals is a much needed thing. Hopefully this post inspires you to think about the connections that should be made between our field and the medical one. While only a starting point, this post attempts to give a good jump on initiating that connection. While I didn’t get around to writing about how to facilitate to professional groups, for those of you who have had experience training medical professionals or other professionals, please comment!
-Meg Augustin References:
Bak, R. & Light, L. (2011) Creating change, one elective at a time [PowerPoint slides]. Retrieved from
Malhotra, S., Khurshid, A., Hendricks, K.A., & Mann, J.R. (2008) Medical school sexual health curriculum
and training in the United States. Journal of the National Medical Association, 100(9), 1097-1106.
Marwick, C. (1999) Survey says patients expect little physician help on sex. The journal of the American
Medical Association, 281(23), 2173-2174.
Metz, M.E. & Seifert, M.H. (1990) Men’s expectations of physicians in sexual health concerns. Journal of
sex and marital therapy, 16(2), 79-88.
Morehouse School of Medicine (2011) Sexual health curriculum development. Retrieved from
Sexual Health Scholars Program (2001) Tentative Curriculum. Retrieved from
Tsimtsiou, Z., Hatzimouratidis, K., Nakopoulou, E., Kyrana, E., Salpigidis, G., & Hatzichristou, D. (2006)
Predictors of physicians’ involvement in addressing sexual health issues. Journal of sexual
medicine, 3(4), 583-588.