How Experience, Training Impact Students' Comfort With Patients' Sexuality
How Experience, Training Impact Students' Comfort With Patients' Sexuality
Purpose: To determine factors associated with students' comfort in addressing patients' sexuality in the clinical context.
Method: The authors invited students enrolled in MD-degree-granting and osteopathic medical schools in the United States and Canada to participate in an anonymous Internet survey between February and July 2008. The survey assessed ethnodemographic factors and sexual history. Respondents also completed the Center for Epidemiologic Studies Depression Scale. Male respondents completed the International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool. Female respondents completed the Female Sexual Function Index and the Index of Sex Life. The authors used descriptive statistics, ANOVA, and multivariable logistic regression to analyze responses.
Results: The authors' analyses included 2,261 completed survey responses: 910 from men, 1,343 from women, and 8 from individuals who self-identified as “other” gendered. Over 53% of respondents (n = 1,206) stated that they felt they had not received sufficient training in medical school to address sexual concerns clinically. Despite this, 81% of students (n = 1,827) reported feeling comfortable dealing with their patients' sexuality issues. Students with limited sexual experience, students at risk for sexual problems, and students who felt that they had not been trained adequately were less likely to report being comfortable talking to patients about sexual health issues.
Conclusions: Perception of inadequate sexuality training in medical school and personal issues pertaining to sex may be associated with students' difficulty in addressing patients' sexuality. Adequate training is preeminently associated with feeling comfortable addressing patients' sexuality and should be a priority for medical education.
Medical education is a rigorous process that may exact a significant toll on those who wish to become practicing physicians. There has been a great deal of recent interest in the psychological and physical well-being of medical students and postgraduate medical trainees (i.e., residents and fellows). Federal regulations have recently been passed to limit duty hours and to otherwise attend to the mental and physical health of individuals in medical training. While these interventions have been welcome and have indubitably led to improvements in the quality of students' lives, the process of becoming a physician certainly is (and will remain) a demanding undertaking that has numerous effects on other spheres of an individual's life.
Sexuality is a critical component of life; despite this, few researchers have investigated the role of sexuality in the quality of life of medical students. Sexual problems are common among people in their 20s, the age at which the majority of aspiring physicians enroll in medical training. That the significant stressors of medical education (or any other type of intense training) may produce or exacerbate sexual problems in this population is a logical hypothesis. Other investigators have further speculated, and more than 50 years ago Sandler reported, that an individual student's sexual mores, experiences, and/or difficulties may impact his or her capacity to relate to patients with sexual health concerns.
The famed psychiatrist and sex therapist Harold Lief conducted pioneering investigations into sexuality and sexuality education in U.S. medical students in the 1960s and 1970s. In a psychodynamic profile of medical students at Tulane University (New Orleans, Louisiana), published in 1960, Lief and his colleagues reported that 70% were “sexually inhibited,” and 10% were “sexually promiscuous.” While these are no longer recognized psychological disturbances, issues of sexuality were apparently prevalent in that cohort of students. In more concrete terms, Lief reported that 15% of male and 35% of female medical students were virgins and that 25% of men and 23% of women had had just one sexual partner whereas 31% of men and 19% of women had had more than five partners. These last figures for medical students were similar to the mean number of partners from the general population of age-matched men and women of the same era. Importantly, Lief emphasized that sexual problems and behaviors were likely to influence students' interactions with patients who presented with a sexual concern. Furthermore, he posited that many students who have the greatest need for training in how to sensitively approach issues of sexuality may avoid opportunities to gain these skills during their training if such courses are not mandatory.
Lief's contributions are of great value. However, little investigation on this topic has occurred since his work in the 1970s. A more recent study using contemporary instruments for the assessment of human sexuality reported that rates of erectile dysfunction (ED) and female sexual dysfunction (FSD) were relatively high in medical students. This 2008 study took place at a single institution and had a relatively small sample size, and both of these factors limited its results. Furthermore, the study did not assess participants' psychological sources of morbidity and therefore did not explore the potential influence of psychological problems on an individual's capacity to care for patients with sexual concerns. To gain an accurate understanding of the prevalence and associations of sexual problems among medical students, a larger and more representative sample is required.
The primary purpose of the current study was to determine the incidence of comfort addressing sexuality in the clinical context among students enrolled in U.S. and Canadian MD-degree-granting and osteopathic medical schools and to explore ethnodemographic and sexuality-specific factors associated with being comfortable with patient sexuality. Our secondary goal was to assess students' perceptions of the quality of training in human sexuality they had received and the impact this training had on their level of comfort addressing sexuality with patients. Our hypothesis was three-fold: (1) U.S. and Canadian medical students exhibit sexual behaviors that are generally congruous with the general, age-matched population, (2) sexual dysfunction is prevalent among medical students, and (3) an individual student's personal sexual mores, practices, and function influence his or her comfort in addressing patients' sexual concerns.
Abstract and Introduction
Abstract
Purpose: To determine factors associated with students' comfort in addressing patients' sexuality in the clinical context.
Method: The authors invited students enrolled in MD-degree-granting and osteopathic medical schools in the United States and Canada to participate in an anonymous Internet survey between February and July 2008. The survey assessed ethnodemographic factors and sexual history. Respondents also completed the Center for Epidemiologic Studies Depression Scale. Male respondents completed the International Index of Erectile Function and the Premature Ejaculation Diagnostic Tool. Female respondents completed the Female Sexual Function Index and the Index of Sex Life. The authors used descriptive statistics, ANOVA, and multivariable logistic regression to analyze responses.
Results: The authors' analyses included 2,261 completed survey responses: 910 from men, 1,343 from women, and 8 from individuals who self-identified as “other” gendered. Over 53% of respondents (n = 1,206) stated that they felt they had not received sufficient training in medical school to address sexual concerns clinically. Despite this, 81% of students (n = 1,827) reported feeling comfortable dealing with their patients' sexuality issues. Students with limited sexual experience, students at risk for sexual problems, and students who felt that they had not been trained adequately were less likely to report being comfortable talking to patients about sexual health issues.
Conclusions: Perception of inadequate sexuality training in medical school and personal issues pertaining to sex may be associated with students' difficulty in addressing patients' sexuality. Adequate training is preeminently associated with feeling comfortable addressing patients' sexuality and should be a priority for medical education.
Introduction
Medical education is a rigorous process that may exact a significant toll on those who wish to become practicing physicians. There has been a great deal of recent interest in the psychological and physical well-being of medical students and postgraduate medical trainees (i.e., residents and fellows). Federal regulations have recently been passed to limit duty hours and to otherwise attend to the mental and physical health of individuals in medical training. While these interventions have been welcome and have indubitably led to improvements in the quality of students' lives, the process of becoming a physician certainly is (and will remain) a demanding undertaking that has numerous effects on other spheres of an individual's life.
Sexuality is a critical component of life; despite this, few researchers have investigated the role of sexuality in the quality of life of medical students. Sexual problems are common among people in their 20s, the age at which the majority of aspiring physicians enroll in medical training. That the significant stressors of medical education (or any other type of intense training) may produce or exacerbate sexual problems in this population is a logical hypothesis. Other investigators have further speculated, and more than 50 years ago Sandler reported, that an individual student's sexual mores, experiences, and/or difficulties may impact his or her capacity to relate to patients with sexual health concerns.
The famed psychiatrist and sex therapist Harold Lief conducted pioneering investigations into sexuality and sexuality education in U.S. medical students in the 1960s and 1970s. In a psychodynamic profile of medical students at Tulane University (New Orleans, Louisiana), published in 1960, Lief and his colleagues reported that 70% were “sexually inhibited,” and 10% were “sexually promiscuous.” While these are no longer recognized psychological disturbances, issues of sexuality were apparently prevalent in that cohort of students. In more concrete terms, Lief reported that 15% of male and 35% of female medical students were virgins and that 25% of men and 23% of women had had just one sexual partner whereas 31% of men and 19% of women had had more than five partners. These last figures for medical students were similar to the mean number of partners from the general population of age-matched men and women of the same era. Importantly, Lief emphasized that sexual problems and behaviors were likely to influence students' interactions with patients who presented with a sexual concern. Furthermore, he posited that many students who have the greatest need for training in how to sensitively approach issues of sexuality may avoid opportunities to gain these skills during their training if such courses are not mandatory.
Lief's contributions are of great value. However, little investigation on this topic has occurred since his work in the 1970s. A more recent study using contemporary instruments for the assessment of human sexuality reported that rates of erectile dysfunction (ED) and female sexual dysfunction (FSD) were relatively high in medical students. This 2008 study took place at a single institution and had a relatively small sample size, and both of these factors limited its results. Furthermore, the study did not assess participants' psychological sources of morbidity and therefore did not explore the potential influence of psychological problems on an individual's capacity to care for patients with sexual concerns. To gain an accurate understanding of the prevalence and associations of sexual problems among medical students, a larger and more representative sample is required.
The primary purpose of the current study was to determine the incidence of comfort addressing sexuality in the clinical context among students enrolled in U.S. and Canadian MD-degree-granting and osteopathic medical schools and to explore ethnodemographic and sexuality-specific factors associated with being comfortable with patient sexuality. Our secondary goal was to assess students' perceptions of the quality of training in human sexuality they had received and the impact this training had on their level of comfort addressing sexuality with patients. Our hypothesis was three-fold: (1) U.S. and Canadian medical students exhibit sexual behaviors that are generally congruous with the general, age-matched population, (2) sexual dysfunction is prevalent among medical students, and (3) an individual student's personal sexual mores, practices, and function influence his or her comfort in addressing patients' sexual concerns.
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