What have we learned about teaching human sexuality within psychiatry? As noted in this special issue of Academic Psychiatry, patients value discussing their sexuality with physicians who are both knowledgeable and comfortable doing so. However, educators have clearly not prepared competent professionals for this task, and the foundation for doing so is weak, as evidenced by the state of teaching human sexuality in U.S. and foreign medical schools and in residency training programs.
Fewer than half of U.S. medical schools provide a formal sexual health curriculum (1), and U.K. undergraduate medical education in sexual health also has minimal hours dedicated to formal curriculum (2). Only one professional organization (the Association of Directors of Medical Student Education in Psychiatry) has published extensive objectives for teaching the topic (3).
Residency education also leaves much to be desired. In one survey of U.S. residents from various specialties, 66% had no previous formal education in sexual health management, and only 48% were satisfied with the teaching they received on the subject (4). Our international colleagues appear to be in a similar predicament. Postgraduate training in medicine and other health specialties is “either avoided or taught with limitation” (2).
Fortunately, in the aforementioned survey (4), psychiatric residents had the best mean score among the specialties in comfort discussing sexual health and perceived importance of the topic. Waineo et al. (5) and Dunn and Abulu (6) comment that psychiatrists are uniquely positioned to approach sexual health with patients. Because sexual dysfunction is intrinsically intimate and often encompasses both biological and psychological disruption, our field should theoretically be most prepared to handle these difficulties. How we integrate human sexuality education into psychiatric residency education is discussed in several articles. Levine (7) suggests “vertical integration,” which encourages sexual health to be addressed in every year and in all rotations. Although it is rare for departments to offer required clinical rotations in human sexuality and its impairment, several authors describe well-received electives (7–10).
Many authors emphasize the need for collaboration with sexual health experts within psychiatry and outside the field. At the University of Michigan, sex therapists contribute to the education of physicians beginning in medical school (9). Dunn and Abulu (6) write about the importance of psychiatrists as sexual health “experts” who can disseminate knowledge to physicians in other fields.
About 27% of residents and fellows in Accreditation Council for Graduate Medical Education programs are international medical graduates (IMGs), as are 32% of psychiatric residents. Cultural considerations must be addressed as sexual health curricula are developed (11). Survey results confirm that residents from different cultures may feel uncomfortable talking to patients about sexuality (4).
Psychiatrists are specifically trained to assess and treat biological and psychological mechanisms, and psychiatric educators should be at the forefront of education in sexual health and dysfunction. Because most physicians will likely encounter patients with issues related to sexual function and dysfunction, the ADMSEP objectives (3) could be used as a template for medical school curricular development on the topic. At a minimum, all graduating medical students should be prepared to comfortably and knowledgeably assess normal and disordered sexual function through a comprehensive sexual history. Residency education, particularly in fields where patients most often present with sexual health complaints (e.g., family practice, internal medicine, obstetrics-gynecology, psychiatry, and urology) should be held to more rigorous standards, with the minimal goal of comfortable and knowledgeable assessment and treatment of concerns related to sexuality. The development of required clinical rotations, if possible, or at least specific sexual health electives, should be encouraged. Alternative learning sources, such as grand round presentations or computer-based learning, should be offered. These educational opportunities will require the involvement of sexual health experts from various disciplines and must be conscious of cultural barriers to be effective forms of teaching.
As Stevenson and Elliot (12) note, “Sexuality is not a life style issue; it is a quality-of-life issue.” All medical disciplines should focus on helping patients achieve a good quality of life. Psychiatrists need to be guiding this effort in sexual health, and we as educators should be leading the way for our field.
At the time of submission, Dr. Morreale reported no competing interests. Disclosures of editors are published in each January issue.