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Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking: Consensus From the Summits in Medical Education in Sexual Health


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Introduction: This article discusses a blueprint for a sexual health communication curriculum to facilitate undergraduate medical student acquisition of sexual history taking skills and includes recommendations for important elements of a thorough sexual history script for undergraduate medical students. Aim: To outline the fundamentals, objectives, content, timing, and teaching methods of a gold standard curriculum in sexual health communication. Methods: Consensus expert opinion was documented at the 2012, 2014, and 2016 Summits in Medical Education in Sexual Health. Additionally, the existing literature was reviewed regarding undergraduate medical education in sexual health. Main outcome measures: This article reports expert opinion and a review of the literature on the development of a sexual history taking curriculum. Results: First-year curricula should be focused on acquiring satisfactory basic sexual history taking skills, including both assessment of sexual risk via the 5 Ps (partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and prevention of pregnancy) as well as assessment of sexual wellness-described here as a sixth P (plus), which encompasses the assessment of trauma, violence, sexual satisfaction, sexual health concerns/problems, and support for gender identity and sexual orientation. Second-year curricula should be focused on incorporating improved clinical reasoning, emphasizing sexual history taking for diverse populations and practices, and including the impact of illness on sexual health. Teaching methods must include varied formats. Evaluation may be best as a formative objective structured clinical examination in the first year and summative in the second year. Barriers for curriculum development may be reduced by identifying faculty champions of sexual health/medicine. Clinical implications: Medical students will improve their skills in sexual history taking, which will ultimately impact patient satisfaction and clinical outcomes. Future research is needed to validate this proposed curriculum and assess the impact on clinical skills. Strengths & limitations: This article assimilates expert consensus and existing clinical guidelines to provide a novel structured approach to curriculum development in sexual health interviewing in the pre-clinical years. Conclusion: The blueprint for developing sexual history taking skills includes a spiral curriculum with varied teaching formats, incorporation of a sexual history script that incorporates inquiry about sexual wellness, and longitudinal assessment across the pre-clinical years. Ideally, sexual health communication content should be incorporated into existing clinical interviewing and physical examination courses. Rubin ES, Rullo J, Tsai P, et al. Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking: Consensus From the Summits in Medical Education in Sexual Health. J Sex Med 2018;15:1414-1425.
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Best Practices in North American Pre-Clinical Medical Education in
Sexual History Taking: Consensus From the Summits in Medical
Education in Sexual Health
Elizabeth S. Rubin, MD,
Jordan Rullo, PhD,
Perry Tsai, PhD,
Shannon Criniti, PhD, MPH,
Joycelyn Elders, MD,
Jacqueline M. Thielen, MD,
and Sharon J. Parish, MD
Introduction: This article discusses a blueprint for a sexual health communication curriculum to facilitate
undergraduate medical student acquisition of sexual history taking skills and includes recommendations for
important elements of a thorough sexual history script for undergraduate medical students.
Aim: To outline the fundamentals, objectives, content, timing, and teaching methods of a gold standard
curriculum in sexual health communication.
Methods: Consensus expert opinion was documented at the 2012, 2014, and 2016 Summits in Medical
Education in Sexual Health. Additionally, the existing literature was reviewed regarding undergraduate medical
education in sexual health.
Main Outcome Measures: This article reports expert opinion and a review of the literature on the development
of a sexual history taking curriculum.
Results: First-year curricula should be focused on acquiring satisfactory basic sexual history taking
skills, including both assessment of sexual risk via the 5 Ps (partners, practices, protection from sexually
transmitted infections, past history of sexually transmitted infections, and prevention of pregnancy) as well
as assessment of sexual wellnessdescribed here as a sixth P (plus), which encompasses the assessment of
trauma, violence, sexual satisfaction, sexual health concerns/problems, and support for gender identity and
sexual orientation. Second-year curricula should be focused on incorporating improved clinical reasoning,
emphasizing sexual history taking for diverse populations and practices, and including the impact of
illness on sexual health. Teaching methods must include varied formats. Evaluation may be best as a
formative objective structured clinical examination in the rst year and summative in the second year.
Barriers for curriculum development may be reduced by identifying faculty champions of sexual health/
Clinical Implications: Medical students will improve their skills in sexual history taking, which will ultimately
impact patient satisfaction and clinical outcomes. Future research is needed to validate this proposed curriculum
and assess the impact on clinical skills.
Strengths & Limitations: This article assimilates expert consensus and existing clinical guidelines to
provide a novel structured approach to curriculum development in sexual health interviewing in the
pre-clinical years.
Conclusion: The blueprint for developing sexual history taking skills includes a spiral curriculum with varied
teaching formats, incorporation of a sexual history script that incorporates inquiry about sexual wellness, and
longitudinal assessment across the pre-clinical years. Ideally, sexual health communication content should be
Received March 9, 2018. Accepted August 20, 2018.
Department of Obstetrics and Gynecology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia, PA, USA;
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN,
Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA;
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill,
AccessMatters, Philadelphia, PA, Drexel University, Philadelphia, PA, USA;
Fay W. Boozman College of Public Health, University of Arkansas for
Medical Sciences, Little Rock, AR, USA;
Department of Medicine, Department of Psychiatry, Weill Cornell Medical
College, New York, NY, USA
Copyright ª2018, International Society for Sexual Medicine. Published by
Elsevier Inc. All rights reserved.
1414 J Sex Med 2018;15:1414e1425
incorporated into existing clinical interviewing and physical examination courses. Rubin ES, Rullo J, Tsai P,
et al. Best Practices in North American Pre-Clinical Medical Education in Sexual History Taking:
Consensus From the Summits in Medical Education in Sexual Health. J Sex Med 2018;15:1414e1425.
Copyright 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Key Words: Objective Structured Clinical Exam; Sex Education; Medical Education; Pre-Clinical Education;
Sexual Health; Sexual History
Sexual problems and sexually transmitted infections (STI) are
widely prevalent, and a comprehensive sexual history is an
essential component in the identication and treatment of these
Thus, conducting a sexual history is a well-
established fundamental element of the clinical interview that
is strongly recommended by the World Health Organization.
Given that most patients do not speak with their physicians
about sexual health concerns,
routine sexual history screening
improves detection without placing the responsibility on the
patient to bring up potentially uncomfortable topics.
Unfortunately, the majority of health care providers, ranging
from 60e100%, do not routinely ask patients about their sexual
This oversight may leave patients feeling dismissed,
ignoring treatable sexual problems, or at risk of contracting/
transmitting STI.
As such, acquisition of comprehensive and uid sexual history
taking skills is essential for undergraduate medical students. The
NIH stated that health care providers should have courses in
effective sexual history taking; and the International Society for
Sexual Medicine curriculum in international undergraduate
sexual health education recommended sexual history taking,
comfort with sexual language, and general communication skills
as specic skills that should be acquired during undergraduate
medical education.
Sexual history taking education, how-
ever, remains inconsistent, limited, or non-existent in the ma-
jority of North American medical schools,
and insufcient
training remains a prevalent barrier to adequate sexual history
In all, 44% of U.S. medical schools may have no
formal curriculum in sexual health.
Though the majority of medical students believe sexual history
taking is an important skill for future practice, over half of them
do not report adequate training in this area.
After grad-
uation, many resident physicians remain uncomfortable
addressing topics of sexual health and sexuality with
Sexual health education is effective in increasing
students, residents, and health care providerscomfort and
condence in taking a sexual history.
When students
perceive they have received adequate sexuality education, they are
more likely to be comfortable addressing patientssexual
Undergraduate medical school curricula for the education and
evaluation of studentssexual history skills are widely vari-
in part due to lack of consensus among schools
regarding standardized goals, objectives, and curricula.
Though 128 medical colleges in North America report teach-
ing students to ask patients, "Do you have sex with men, women,
or both," curricula typically remain largely focused on risk
stratication for STI and pregnancy prevention.
The ma-
jority of programs do not include clinical training on sexual
problems and dysfunction, and sexual history scripts provided to
students rarely include discussion of sexual problems.
Though efforts have been made to improve standardization in
medical education in sexual health and sexuality,
vast majority (92%) of U.S. schools with a sexual health cur-
riculum have developed their own curriculum rather than basing
the curriculum on established standards.
While individual
programs may have found site-specic success in teaching sexual
history taking, there has not yet been described a prescriptive
model detailing best practices for teaching and evaluating student
acquisition of sexual history taking skills.
The First Summit on Medical Education in Sexual Health,
organized in 2012 and hosted by the Program in Human
Sexuality, Department of Family Medicine and Community
Health, University of Minnesota Medical School, Minneapolis,
MN, called for national standards for sexual health education.
The Second and Third Summit on Medical Education in Sexual
Health, 2014 and 2016, were held to create recommendations
for improvement in specic areas of sexual health curricula,
including sexual history taking. Arguably, sexual history taking
is one of the most essential skills to addressing sexual health with
patients,according to experts of the summit.
Bayer et al
2017 identied consensus from the rst and second summits on
proper content for sexuality in medical curricula and outlined 20
sexual health competencies for undergraduate medical education
in North America. Education in effective sexual history taking is
essential to attaining the competencies outlined in the accredi-
tation domains of patient care, interpersonal and communication
skills, and professionalism.
In this report we identify the current decits in sexual history
taking education and describe a model pre-clinical curriculum for
teaching sexual health communication skills that can be incor-
porated into existing clinical interviewing and physical exami-
nation courses. We address methods for educating students on
sexual history taking, explaining diagnosis and treatment, and
counseling patients on sexual health problems. We articulate how
a spiral curriculum, one that circles back to these topics
throughout the pre-clinical years, can provide this training.
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1415
Further, in accordance with the consensus from these summits,
and unlike most previous sexual history tool kits that emphasize
sexual risk assessment and stratication,
this curriculum
also focuses on sexual problem screening.
While this is an ideal
framework and select elements will be more critical than others,
our hope is that programs can nd site-specic ways to include
elements of the curriculum described.
The Subcommittee on Sexual History Taking Education at
the Summit on Medical Education in Sexual Health consisted of
members with substantial research and clinical experience in
teaching and assessing sexual health communication skills. This
multidisciplinary group included multiple academic faculty and
resident physicians with specic expertise in medical education
and in sexual medicine spanning internal medicine, psychiatry,
and gynecology. This group also included representation from a
sex therapist, sex educator, and a nationally recognized leader in
public health. Participants extensively discussed both ideal and
critical elements of a comprehensive education in sexual history
taking at the second and third summits until consensus was
reached. Subsequently, a narrative literature review was per-
formed. The literature review involved a comprehensive English-
language search of several databases from 2006 to 2017, which
included MEDLINE In-Process and Other Non-Indexed Cita-
tions and Ovid MEDLINE, Ovid PsycINFO, and Ovid
Cochrane Database of Systematic Reviews. Key words included
sexual health history taking,”“sexual history taking,”“sexuality
history,”“sex history,”“sexual risk assessment,”“sexual problem
assessment,and medical history takingcombined with
reproductive healthor sexual behavior.Articles were selected
for inclusion based on authorscollective expertise and were
organized and consolidated by the rst, second, and senior au-
thors. Co-authors reviewed and revised this document for
consensus. The curriculum detailed below is developed from
those discussions and literature review.
Undergraduate medical schools should strive to provide stu-
dents with a longitudinal education in sexual history taking and
sexual health communication skills within a broader curriculum
in communication skills.
A spiral curriculum, one that revisits
the same topics repeatedly with increasing level-appropriate
complexity, can be utilized to this end.
At each stage of
learning, students should meet specic objectives and be evalu-
ated by standards consistent with their level of development.
Though here we have delineated these recommendations as a
traditional rst and second year of pre-clinical education, some
programs have modied their curricula such that there is no
longer a distinction between rst and second academic years or
such that there are no longer distinct pre-clinical or clinical
years. Non-traditional curricula wishing to incorporate these
recommendations may benet from identifying when students
are rst taught communication skills and when these skills are
Core communication skills that students should learn in the
pre-clinical years are to take a patient-centered sexual history,
build rapport with patients, express empathy, and utilize coun-
seling techniques for a sexual problem.
Objectives specicto
sexual history taking during pre-clinical years are outlined in
Table 1.
The teaching methods that should be implemented
include a combination of didactics, role play, and skills practice
with simulated patients (SPs) as a variety of learning modalities is
recommended to maximize adult learning.
General commu-
nication skills, sexual history taking skills, and these teaching
methods are all widely accepted educational principals.
This article does not address where and how to teach sexual
health content such as anatomy and physiology of sexual
response cycle, human reproduction, STI, contraceptive
methods, or specic treatment of sexual problems. Recom-
mended objectives for an entire sexual medicine curriculum can
be found in another summit consensus article by Bayer et al
2017. Additionally, given that the summits focused on North
American medical schools, these recommendations are written
for a North American curriculum. However, many of the prin-
ciples outlined here can be utilized for medical schools interna-
tionally. International recommendations are outlined in the 2
consensus reports on education from the International Consul-
tation in Sexual Medicine by Shindel et al
in 2016 and
Eardley et al
Fundamental to sexual health communication skills is the
patient-centered sexual history. Students should learn sexual
history taking skills in the context of a comprehensive sexual
health curriculum that addresses attitudes, knowledge, and
Basic Sexual History Interview
A primary education in sexual history taking must include
appropriate questions and how to phrase these questions so as to
be direct but also sensitive. This is best achieved by providing
students with a sexual history script that includes questions about
sexual problems or concerns.Students report that having a
Table 1. Pre-clinical objectives
1. Understand importance of discussing sexual health with patients
2. Demonstrate basic skills of sexual health communication
3. Explain key questions/topics for a sexual history
4. Practice taking a sexual history with peers
5. Include elements of counseling and education into patient encounters
6. Identify follow-up questions to specic sexual health concerns
7. Conduct personal reection on sexual history taking and comfort with
discussing sexual health topics with patients
J Sex Med 2018;15:1414e1425
1416 Rubin et al
written script improves ease of learning sexual history taking
Therefore, early during their rst year, students should
be given a sexual history script on which to model their in-
terviews. Currently, most sexual history scripts focus entirely on
sexual risk taking. Arguably the most common sexual history
script is the Centers for Disease Control and Prevention (CDC)
5 Ps (partners, practices, protection from STIs, past history of
STIs, and prevention of pregnancy).
This is a helpful
mnemonic that outlines the important elements of a sexual risk
assessment and can incorporate an inclusive sexual orientation
and gender identity history within this framework. A thorough
sexual history, however, also needs to include an assessment of
sexual wellness: a sixth P (plus) (Figure 1). The Summit on
Medical Education in Sexual Health recommends that the plus
should encompass an assessment of trauma, violence, sexual
satisfaction, sexual health concerns/problems, and support for
gender identity and sexual orientation (Table 2). Many of these
topics are overlooked in sexual history taking education, perhaps
because they may be considered more challenging to address.
Recently, the National Coalition for Sexual Health (NCSH)
developed a guide for primary care providers to address the sexual
health of their patients.
This guide is an excellent tool for
undergraduate medical education. It includes the 5 Ps, a list of
essential sexual health questions to ask at least once annually, and
questions relevant to adults vs adolescents. Essential questions to
ask regarding the sixth P (plus), listed in Table 2, are an
important extension of this NCSH guide.
First-year medical students rarely have experience discussing
sensitive issues, and thus time should be spent outlining the
setting for patient discussions about sex or sexuality. Students
should be explicitly taught verbal and non-verbal elements of
creating a positive sexual health discussion setting, outlined in
Table 3.
Additionally, time should be devoted to discussing
the use of open-ended vs closed-ended questions.
Transition and Timing
Students should be supplied with techniques for transitioning
to the discussion of sexual health, including ideal transition
statements that utilize asking patient permission to discuss sexual
health, normalizing sexual health questions, and validation of
patient concerns. The NCSH guide suggests the following
transition statement, Im going to ask you a few questions about
your sexual health. Since sexual health is very important to
overall health, I ask all my patients these questions. Before I
begin, do you have any questions or sexual concerns youd like to
Students should learn that the sexual history needs to
t logically into the ow of questions, following medical history,
social history, or urologic/gynecologic review of systems.
applicable to the patient, students may want to link sexual his-
tory questions to questions about menstrual cycles, birth control,
menopausal status, or urinary concerns. In learning about tran-
sition and timing, students will also begin to discover which
elements of a sexual history are most important for different
clinical encounters.
Varied teaching methods/formats will more effectively reach
students with different learning styles.
learning strategies for an entire sexual medicine curriculum are
outlined in Shindel et al
in 2016. The core elements and
teaching methods/formats of a rst-year curriculum in sexual
health communication skills are outlined in Table 4.
Student Self-Preparation
Directly prior to the initiation of the sexual health interview
curriculum, students should be referred to appropriate educa-
tional materials. Self-preparation is critical to student founda-
tional learning of not only the questions to ask, but the elements
of the setting as described in Table 2. In addition to receiving a
sexual history script, students should be assigned homework of
key articles introducing students to the fundamentals of taking a
sexual history. Standard Operating Procedure for Taking a
Sexual History,”“The Proactive Sexual History,and the CDC
A Guide to Taking a Sexual Historyare easily accessible in-
troductions, the last of which reviews the 5 Ps.
should also review a video demonstrating a sexual history role
play. Medical schools may wish to purchase a video for use or
create their own school-specic video. The Association of
American Medical Colleges (AAMC) and others have developed
Figure 1. US Centers for Disease Control and Prevention (CDC) 5 Ps and the sixth P (plus). Infographic showing the categories of sexual
history topics clinicians should cover during a sexual health interview. SOGI ¼sexual orientation/gender identity; STI ¼sexually transmitted
infections. Adapted with permission from the CDC.
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1417
a series of free online videos on sexual history taking
Although not as effective at teaching skills and promoting self-
reection as interactive modalities,
large group lectures remain
the dominant paradigm in medical school education.
In a
sexual health communication curriculum, lectures can be used to
introduce sexual health questions and effective communication
skills and to demonstrate an example of an effective, standardized
sexual history.
This should be made possible via
video or a live role-play demonstration, as observing an interview
has been found to improve interviewing skills.
An instructor
who has signicant experience in sexual health communication,
ideally within the eld of sexual medicine, should be identied
for this demonstration.
Although this demonstration should
utilize the standardized script, students may also benet from an
additional, more advanced demonstration. AAMC has developed
a free modiable sexual history taking lecture located online at
Role Play
Role play, that is, taking on scripted "parts" and practicing a
physician-patient encounter, has been found to be an effective
teaching modality for teaching sexual health communica-
This is the rst-year studentsopportunity to
practice their recitation of sexual history questions as well as the
body language critical to a comfortable encounter. Multiple
opportunities should be presented to rst-year students to
practice their sexual history taking skills. Initially students should
practice with peers, with peer and faculty feedback. Programs
should ensure that they provide adequately developed role-play
characters such that the students do not have to draw from
their own personal experience.
SP/Standardized Patients
It may be benecial for students to have at least 1 encounter
with a SP designed specically for the purpose of practicing
sexual history with immediate SP or faculty feedback.
education has been found to be effective in reducing student
anxiety and improving interview performance.
However, the
benets of utilizing a SP appear to be comparable to those of peer
role play.
Ultimately, the educational benetmaybe
determined more by the quality of feedback received, rather than
the individual giving that feedback.
Yet, unlike peer role play,
SP cases have the advantage of including a variety of ages, sexual
orientations, and gender identities, which enhances student
Table 3. Approach to creating a positive sexual health interview
setting for students
1. Reassure patient of privacy, and explain condentiality (including who
has access to personal information via electronic medical records)
2. Make efforts to ensure patient trust, comfort, and openness
3. Utilize empathy and build rapport
4. Use open body language and appropriate eye contact
5. Be aware of patients cultural background
6. Avoid assumptions about sexual orientation, gender identity,
monogamy, sexual activities, or age-related practices
7. Use simple, direct language within your comfort zone
8. Avoid unnecessary interruptions while utilizing gentle redirection
9. Disengage from electronic medical record, turn away from computer,
avoid typing
Table 2. "Plus"assessment of sexual wellness
Do you have a history of unwanted sexual experiences? [If patient is confused] Have you ever been forced or coerced to have sex/sexual activity against
your will, either as a child or as an adult?
o If yes, is there anything about that experience that impacts your current sexuality?
o If yes, is there anything about that experience that makes seeing a health care provider or having a physical examination (if applicable) difcult?
If so, Id like to hear about this so we can work together more easily.
Support for sexual orientation/gender identity
Do you feel you are getting support and acceptance of your sexual orientation/gender identity from your family and friends?
Are you experiencing any harassment or violenceat home, at work, or in your communitydue to your sexual orientation or gender identity?
Sexual concerns/problems
Are you having any concerns with your sexual functioning or your interest in sexual activity?
Do you have decreased or increased interest in sex?
Do you have difculty becoming sexually aroused? Becoming lubricated/developing an erection?
What about maintaining lubrication or arousal/maintaining an erection?
Do you have difculty having an orgasm, orgasming too soon, or not soon enough?
Is sexual activity painful?
o If yes, what type of sexual activity is painful? Where is the pain
Are you having any sexual relationship difculties? Such as discrepancy between your and your partners interest in sex, or your partner is having sex
Sexual distress/satisfaction
On a scale from 1e10, with 10 being the greatest impact, how much impact has this problem had on your life? How distressing are these symptoms to
On a scale from 1e10, with 10 being the greatest satisfaction, how satised are you with your sexual health? Sexual relationship?
J Sex Med 2018;15:1414e1425
1418 Rubin et al
comfort in discussing sexual health with diverse patients.
to the logistical and nancial expense of securing SPs, some
programs may need to include sexual history taking SP en-
counters within other pre-existing SP experiences. All programs
should strive to provide at least 1 opportunity for students to
practice incorporating a sexual history into a complete patient
history with a SP.
Discussion Group and Self-Reection
Many students have discomfort when discussing sexual health
or taking sexual histories,
and it is important to normalize
these feelings.
This discomfort is multifactorial and in-
cludes embarrassment, cultural differences, inadequate knowl-
edge base, anxiety around personal sexual experience, and
concerns about perception or development of sexual feelings
toward a patient.
While some programs might choose to
isolate this topic for discussion, others may choose to incorporate
it as part of a larger discussion group on a potpourri of sensitive
issues. Small group settings have been found to be effective in
improving communication skills in medical students.
can provide each other with peer-to-peer strategies while high-
lighting the importance of working through the discomfort to
optimize patient care. Ideally this discussion group should be
facilitated by trained and experienced leaders.
This may also be
an avenue to explicitly discuss the hidden curriculum: while
students may not see their preceptors taking sexual histories, this
should not imply that they themselves should not.
First-year student evaluations should be formative rather than
summative based on faculty-observed SP encounters or video
Given the wide prevalence of smartphones, tablets,
and laptop computers with video capabilities, video review is
now a logistically and nancially viable evaluation method.
Students should have an opportunity to lm themselves taking a
sexual history with a peer or SP, either in isolation or in
conjunction with a complete patient history, for self- or faculty
review. Review can take the form of a written self-reection,
written feedback from a faculty member, or in-person self-
reection, and feedback with a faculty member.
Many existing clinical interview courses include a year-end
objective structured clinical examination (OSCE) on history
taking. Sexual history should be a part of this clinical inter-
viewing OSCE. Failure to include sexual history implies that the
sexual history is not as important as other elements of the clinical
interview and misses a valuable opportunity for evaluation.
Recommended student evaluation methods are outlined in
Table 4.
Second-year students should review and expand upon the
basics of sexual health communication by learning to incorporate
advanced interviewing skills and clinical decision making. In a
traditional curriculum with distinct rst and second years, edu-
cation on sexual health communication may be separated by over
12 months. In that setting, programs should review the basics of
sexual history taking in year 2. This should be rapidly paced and
include student self-review of the sexual history example video
and a provided sexual history script. Core elements and teaching
methods for a second-year curriculum are outlined in Table 5.
The sections that follow more specically discuss the advanced
sexual health communication skills that should be addressed in
pre-clinical education. These skills represent the consensus of the
authors and are based on expert opinion.
These advanced
interviewing skills include clinical reasoning and purpose-driven
questioning, questions for specic populations/diversity of
practices, sexual problem-based history, sexual health counseling,
and illness-related sexual health interviewing.
Table 5. Core elements and teaching methods for a second-year
Self-preparation: Review of rst-year material (video and script)
Self-preparation: Video demonstrations of advanced sexual history role
Didactics: Advanced sexual communication skills
Didactics: Advanced sexual history with counseling role play
Didactics: Inclusion of sexual history items in existing didactics
Role play: Advanced sexual history taking with feedback from faculty; a
scenario with a LGBTQ patient with a sexual problem or illness-related
sexual concern
Role play: Sexual history taking during focused history in general
simulated patient scenarios
Role play: Sexual history taking during complete history in general
simulated patient scenarios
Summative evaluation: Inclusion of sexual history in midterm and year
end objective structured clinical exam or group objective structured
clinical exam
LGBTQ ¼lesbian, gay, bisexual, transgender, and queer.
Table 4. Core elements and teaching methods for a rst-year
Self-preparation: Video demonstration of sexual history role play
Self-preparation: Recommended reading on the sexual history
Self-preparation: Sexual history script
Didactic: Principles of sexual history taking (see First-Year Content)
Didactic: Sexual history role-play demonstration with simulated patient
Role play: Sexual history taking with peers with feedback
Role play: Sexual history taking in simulated patient scenario
Role play: Sexual history taking in context of larger patient encounter
(eg, complete history) in simulated patient scenario
Discussion group: Sexual health communication strategies and comfort
Formative evaluation: Video self-review of 1 of the above role plays
Formative evaluation: Objective structured clinical exam or group
objective structured clinical exam
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1419
Clinical Reasoning/Purpose-Driven Questions
Second-year students should be encouraged to ask questions
more specically related to a chief symptom. They may, for
example, ask questions about pain during vaginal penetration for
a suspected diagnosis of endometriosis or questions about history
of chronic infections and allergic reactions for a suspected diag-
nosis of inammatory vestibulodynia. The subtleties of identi-
fying the truly critical elements for evaluation in a particular
patient encounter compared with what should be deferred should
also be addressed, along with directing the conversation and
working within time constraints. Students at the second-year
level should be able to utilize their clinical knowledge to this end.
Questions for Specic Populations/Diversity of
Second-year students will benet from in-depth discussion
about diversity in sexual practices and higher-level case exam-
This includes exposing students to questions relevant to
the needs of specic populations.
Though the spectrum of
sexual orientation has become more widely embraced throughout
the United States, a recent study suggests medical students,
residents, and fellows remain uncomfortable obtaining sexual
history from lesbian, gay, bisexual, transgender, and queer
(LGBTQ) individuals.
Medical students also lack knowledge of
the range of sexual practices engaged in by many same-sex
Students should have learned to include LGBTQ
patients in their questions during their rst year (outlined in
Table 2); however, many will need additional education for more
in-depth counseling. Additionally, students should learn perti-
nent questions for sex workers; victims of sexual trauma; sexual
enhancement device use; and those who engage in diverse sexual
activities including group sexual activity, bondage, dominance,
sadism, masochism, and paraphilias.
Although diagnosis,
treatment, and management are outside the scope of this article,
students may need background knowledge lectures in order to
better direct patient interviews.
Sexual Problem-Based History
Second-year students should advance beyond screening for
sexual problems (Table 2) and should learn the basics of con-
ducting a sexual problem-based history. This begins by learning
to contextualize patient problems and establish intent to help.
Students should then learn to appropriately inquire about the
problems impact on relationships, partner response to the
patients problem, and patient motivation for improving
Second-year students should begin training in sexual health
counseling. This includes explaining a diagnosis, soliciting and
addressing questions, and utilizing motivational interviewing
techniques to address barriers to change. Some programs may
already have established coursework in motivational interviewing
and can explain how these skills can be generalized to sexual
health discussions. For example, students may benet learning to
elicit a medication side effect from a contraceptive method and
how to counsel toward a different method. As students complete
coursework in contraception, sexual problems, and STIs, they
will be better equipped to respond to patient concerns, questions,
and misconceptions.
Illness-Related Sexual Health Interview
Second-year students should be exposed to the impact of
illness on sexual function and the illness-related sexual health
interview. Programs can teach the BETTER model for assisting
students in bringing up sex and sexuality while caring for patients
with chronic illnesses, such as cancer.
The BETTER mne-
monic, developed specically for cancer patients, stands for:
Bringing up the topic of sexuality; Explaining to the patient or
partner that sexuality is a part of quality of life; Telling the
patient about resources available to them (as well as gauging the
trainees ability and willingness to assist in addressing questions
and concerns); Timing the discussion to when the patient would
prefer, not only when it is convenient for the interviewer; and
Recording that the conversation took place and any follow-up
plans to further address patient concerns or questions.
A full
illness-related sexual interview is beyond the scope of a pre-
clinical education, but students may benet from learning the
goals of an illness-related sexual health interview. Table 6 out-
lines a medical student-level illness-related sexual health
Teaching modalities for second-year students are similar to
those of rst-year students: self-preparation, didactics, role play,
standardized patients/SPs, and discussion groups. Didactic ses-
sions and SP encounters should be specically tailored to
acquisition of more advanced content.
Second-year clinical interviewing or physical examination
course didactics should emphasize the sexual history as a neces-
sary component of conducting a focused history. Students should
receive didactics specically on taking a complex sexual history
and discussion of sexual problems, keeping in mind the content
areas described above, including a demonstration of a counseling
Table 6. Goals of illness-related sexual health interview for
medical students
Screening and identication of sexual concerns or diagnosis of
Clinical assessment of sexual dysfunction, origin, and impact on pa-
tients life
Empathy and counseling utilizing normalization and support
Referrals for counseling, physical therapy, and/or a medical specialist as
J Sex Med 2018;15:1414e1425
1420 Rubin et al
visit. Programs may wish to incorporate this into didactics on
caring for specic populations. When possible, focused sexual
history items should be included in existing didactic descriptions
of clinical presentations. Instructors should include scenarios in
which patients have sexual health problems to normalize and
emphasize the importance of these clinical discussions. If dedi-
cated class time is not possible, programs should seek out videos
of advanced sexual history taking for students to view. AAMC
has developed a series of online videos that can be used for this
Role Play
For teaching the advanced skills outlined above, programs may
need to reach outside their normal sphere of hired SPs. Some
programs may nd senior medical students or members of
community organizations such as LGBTQ community groups or
cancer survivorship groups willing to volunteer for these role
Role play is particularly important in teaching inter-
viewing skills pertinent to discussing sex and sexuality with
LGBTQ individuals.
The AAMC has developed a series of
online videos specically for sexual history taking with LGBTQ
Should programs wish to incorporate sexual history
taking for transgender patients into their role plays, it is
important to have transgender actors/volunteers playing such
patients as to avoid inadvertently offensive portrayals.
SP/Standardized Patients
Comfort with increasingly complex SP encounters is an
important skill second-year students must master in advance of
their clinical rotations and for passing the Step 2 Clinical Skills
U.S. Medical Licensing Exam.
While peer-to-peer role play
with large group feedback may not be time-efcient or high
stakes enough for second-year students, students should be given
time to practice their skills with a SP or faculty member with
Sexual history should regularly be included in SP
encounters designed to represent general or all-encompassing
clinical scenarios. Excluding this portion of the history re-
inforces it as unimportant. SP encounters may be important for
second-year students in the form of evaluation, described below.
Second-year evaluations should be summative as students
should have advanced beyond needing targeted sexual history-
specic evaluations. Instead, sexual history taking should be
incorporated into pre-existing OSCE or group OSCE that
evaluate overall communication or interviewing skills. Students
should be required to ask relevant sexual history questions in
order to pass mid-year clinical exams that evaluate complete
history taking, focused history taking, or time management.
Finally, sexual history should be included in the history taking
components of a summative year-end OSCE.
The rst-year curriculum weve described is focused on
acquiring satisfactory basic sexual history taking skills, including
both sexual risk (ie, the 5 Ps)
as well as the sixth P (plus),
which encompasses the assessment of trauma, violence, support
for gender identity and sexual orientation, sexual satisfaction, and
sexual health concerns/problems. The second-year curriculum is
focused on incorporating improved clinical reasoning, empha-
sizing sexual history taking of diverse populations and practices,
and including the impact of illness on sexual health. For more
effective learning, teaching methods must include varied formats
including student self-reection, didactics, video demonstrations,
SP encounters with immediate feedback, and role play. Evalua-
tion may be best as a formative OSCE in the rst year and
summative OSCE in the second year.
Several barriers exist regarding the incorporation of a compre-
hensive education in sexual health communication into an existing
undergraduate medical school curriculum.
First, pre-clinical
curricula are becoming increasingly condensed; and the majority
of lecture time is often devoted to only those topics tested on the
U.S. Medical Licensing Exam. In an effort to address monetary
and temporal constraints, lectures, role plays, and discussion
groups must be organized and efcient. Whenever possible, sexual
history taking should be included into existing courses on clinical
interviewing or human reproduction. Students should be advised
that their skills must be practiced outside of class time.
Additionally, faculty endorsement can be difcult to obtain, as
faculty themselves may be uncomfortable discussing sexual health,
may lack experience in sexual medicine, or may not take sexual
histories in their own practices. This in turn can shape the "hidden
curriculum," ie, the practices learned by observing faculty mem-
bersattitudes or behavior. Utilizing faculty sexual health cham-
pions to rally for curriculum committee support can mitigate issues
surrounding faculty buy-in. Clinical faculty will need professional
development around discussing sexual health.
Content for faculty
is similar to that for students and should include a script, current
standard operating procedures or best practices in sexual history
taking, and webinars or video modules. Materials are frequently
available fully formed and free of cost. For example, the National
LGBT Health Education Center, a program of the Fenway Insti-
tute, has developed a free, modiable, all-staff sexual history
training presentation that is available online.
Similarly, MedEd-
has a number of well-developed sexual history taking
curriculum materials that can be used for faculty development.
Due to the nature of expert consensus, our proposed curric-
ulum is limited in that it is not yet validated. Ideally, validation
would comprise student appraisal of the individual curricular
components, including an assessment of which elements students
perceive to be most useful. Optimal validation needs to
also incorporate faculty input regarding the quality of the
implementation of curricular components and ideally patient
feedback regarding evidence of acquisition of skills. Assessment is
J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1421
needed regarding the effectiveness of this curriculum in teaching
sexual history taking across the spectrum of sexuality and illness
(eg, sexual orientation, gender identity, disability). To ensure the
appropriate skills are being acquired, validation may also occur
using assessments before and after curricular intervention via
OSCEs and/or observed patient encounters.
Our proposed curriculum represents expert consensus on the
ideal curriculum that will be attainable for some programs. This
curriculum is aspirational, and many programs will only be able to
incorporate those aspects that align with their current curriculum.
Programs may nd they need to incorporate some of this material
into the clinical years. Indeed, next steps in this eld would be
creating sexual health communication skills curricula in relevant
clerkships including obstetrics and gynecology, internal medicine,
family medicine, pediatrics, ambulatory care, psychiatry, and
urology. At present, it is of the utmost importance that medical
schools use the dedicated pre-clinical time to create the foundation
for excellent clinical sexual health communications skills.
This article is a summary of the consensus from 2012, 2014,
and 2016 Summits on Medical Education in Sexual Health on
best practices in medical education in sexual history taking and
serves as a blueprint for sexual health communication curricula in
pre-clinical undergraduate medical education in North America.
The ideal model for developing these skills includes a spiral
curriculum utilizing multiple educational modalities that weaves
the core concepts of sexual history taking into the advanced skills
required for medical students in the clinical setting.
The authors of this article would like to acknowledge the
Program in Human Sexuality in the Department of Family
Medicine and Community Health at University of Minnesota
Medical School as well as additional members of the Subcom-
mittee on Sexual History Taking Education: Alyson Kristensen
and Daniel E. Rohe, PhD.
Corresponding Author: Elizabeth S. Rubin, MD, Department
of Obstetrics and Gynecology, Hospital of the University of
Pennsylvania, 3400 Spruce Street, Fifth Floor Dulles Building,
Philadelphia, PA 19104, USA. Tel: 215-662-2459; Fax: 215-
349-5893; E-mail:
Conict of Interest: The authors report no conicts of interest.
Funding: None.
Category 1
(a) Conception and Design
Elizabeth S. Rubin; Jordan Rullo; Joycelyn Elders; Sharon J.
(b) Acquisition of Data
Elizabeth S. Rubin; Jordan Rullo; Sharon J. Parish
(c) Analysis and Interpretation of Data
Elizabeth S. Rubin; Jordan Rullo; Sharon J. Parish
Category 2
(a) Drafting the Article
Elizabeth S. Rubin; Jordan Rullo; Sharon J. Parish
(b) Revising It for Intellectual Content
Elizabeth S. Rubin; Jordan Rullo; Perry Tsai; Shannon Criniti;
Joycelyn Elders; Jacqueline M. Thielen; Sharon J. Parish
Category 3
(a) Final Approval of the Completed Article
Elizabeth S. Rubin; Jordan Rullo; Perry Tsai; Shannon Criniti;
Joycelyn Elders; Jacqueline M. Thielen; Sharon J. Parish
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J Sex Med 2018;15:1414e1425
Medical Education in Sexual History Taking 1425
... Students are unlikely to ask about sexual health at the extremes of age, are unlikely to screen men who have oral sex with men for STIs, and only 75% would screen asymptomatic sexually active females for STIs 6 . Additionally, studies show that providers are more likely to perform sexual health histories, are more comfortable with sexual health topics, more comfortable with special populations and are more likely to prescribe risk modifying therapies such as PrEP when they have prior exposure to training on sexual health or PrEP guidelines (13)(14)(15). ...
... While much research describes the lack of a speci c sexual health curriculum in graduate medical education and calls for more standardized methods of teaching sexual health (6) , (7), (13) , there has yet to be a uni ed strategy for sexual health education in US medical schools. The aim of our study is to demonstrate that medical student exposure to sexual health topics in a free student-run PrEP clinic, which serves a mainly LGBTQIA + patient population, improves attitudes around sexual health screening, increases comfort in medical trainees with sensitive topics such as sexual and LGBTQIA + health and increases awareness for LGBTQIA + health issues. ...
Full-text available
Background: Pre-exposure prophylaxis (PrEP) is an established preventative measure for HIV transmission, however not enough providers are prescribing PrEP for their patients. Reasons for inadequate PrEP coverage include discomfort among providers addressing sexual health and lack of adequate sexual health training among medical trainees. Objective: Our aim was to determine if volunteer experience in a free PrEP clinic improved medical student knowledge and comfort level addressing sexual health and PrEP with patients. Methods: An online survey was conducted to determine knowledge and comfort of PrEP, general sexual and LGBTQIA+ health knowledge among medical students who had and had not volunteered at our free PrEP clinic. Results: 269 students across all four years of medical school were surveyed. Demographics among the two groups were similar. Across the 10 primary survey questions assessing comfort with sexual health and PrEP, those who had volunteered reported significantly more comfort than students who had not. Responses between the two groups differed in the proportion of respondents who reported “extremely” or “very” comfortable with these sexual health topics. There were several affirming narratives provided by students regarding the importance of the PrEP clinic in their medical education. There was no difference between the groups in terms of general sexual health knowledge. Conclusions: This study demonstrates that volunteering at a PrEP clinic correlated with higher reported comfort with sexual health, including discussions surrounding PrEP. Given the importance of addressing sexual health topic with patients, we conclude that medical students would benefit from more in-person opportunities to learn about sexual health. This study illustrates the importance of exposure in generating comfort for trainees on sensitive topics which could lead to better sexual health care for patients.
... In medical school, sexual education has focused more on contraception counseling and prevention of sexually transmitted diseases rather than sexual dysfunction [45,46]. There has been growing curricula to standardize how to obtain comprehensive sexual histories including sexual wellness [47,48]. Medical students and physicians who perceived they had adequate training in sexual health during medical school was associated with feeling comfortable addressing patients' sexuality across the lifespan [46,48]. ...
Full-text available
Background Breast cancer is the most common non-skin cancer in women and an increasing number of people are living as breast cancer survivors. While the prognosis of breast cancer continues to improve, the rates of sexual dysfunction and the risk related to cancer treatments have not been well characterized in a population-based study. Methods We identified a cohort of 19,709 breast cancer survivors diagnosed between 1997 and 2017 from the Utah Cancer Registry, and 93,389 cancer-free women who were matched by age and birth state from the Utah Population Database. Sexual dysfunction diagnoses were identified through ICD-9 and ICD-10 codes from electronic medical records and statewide healthcare facilities data. Cox proportional hazard models were used to estimate hazard ratios for risk of sexual dysfunction. Results Breast cancer survivors were at higher risk of sexual dysfunction diagnosis (9.1% versus 6.9%, HR 1.60, 95% CI 1.51–1.70) compared to the general population. This risk increased 2.05-fold within 1 to 5 years after cancer diagnosis (95% CI 1.89–2.22) and 3.05-fold in individuals diagnosed with cancer at < 50 years of age (95% CI 2.65–3.51). Cancer treatments including endocrine therapy, chemotherapy and radiation therapy were associated with an increased risk of sexual dysfunction among breast cancer survivors. Conclusions Risk of sexual dysfunction in breast cancer survivors is higher than in the general population, but may be underdiagnosed in the clinical setting. Health care professionals should be encouraged to address the topic of sexual health early on in the treatment of breast cancer, and routinely screen patients for symptoms of sexual dysfunction.
... The profession should also seek to develop and optimize curricula for teaching sexual and reproductive history-taking to prevent unwanted pregnancies, especially among vulnerable groups. Consensus guidelines for doing so exist [44], although there are few high-quality studies to guide curriculum development and essentially none in psychiatry [45]. Indeed, research suggests that psychiatrists and other mental health workers may not be adept at routinely identifying patients' family planning needs [46][47][48]. ...
... At present, the lack of sex education courses in China reflects in most medical schools that do not offer independent sex education courses. Found in the interview, due to the lack of school sex education as well as continuing education, most of the Evidence-Based Complementary and Alternative Medicine obstetric staff in Guangdong Province facing pregnant women and their families' sex consultation show anxiety, overwhelmed intentionally or unintentionally avoiding patients, without knowing how to communicate and process. is is similar to other research conclusions [23]. e implementation of sex education is an urgent need for the development of medical disciplines and social sciences, a prerequisite for the implementation of safe management of pregnancy, and a basis for maternal and child health. ...
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Objective: The purpose of this study was to understand the current status and existing responses of obstetricians and obstetric nurses in Guangdong Province regarding sex education during pregnancy and to understand their acceptance of sex education during pregnancy and the knowledge and information they would like to obtain in sex education courses. Methods: A phenomenological research method was used to conduct in-depth interviews with 12 obstetricians and obstetric nurses in a tertiary hospital in Guangdong Province to understand their perceptions and attitudes toward providing sex education to pregnant women. A self-designed questionnaire was used to survey 462 obstetricians and obstetric nurses in Guangdong Province to understand their needs for sex education. Results: Three themes were summarized: insufficient awareness of sex education during pregnancy; negative attitudes of obstetricians and obstetric nurses toward sex education during pregnancy; and the need for a long-term process for the development and popularization of sex education during pregnancy. We obtained the required scores of obstetricians and obstetric nurses on 11 aspects of sex education during pregnancy with a coefficient of variation ≤25%. Conclusion: There is an urgent need to improve the awareness and related competencies of obstetricians and obstetric nurses about sex education during pregnancy, and the purpose and content of sex education courses should be in line with the clinical reality.
... Medical students are taught the components of sexual risk for infection when learning how to take a sexual history. 28 Understanding these risk factors, the epidemiology of HIV infection in local and national populations, and the components of HIV preventative care services may provide context to help healthcare providers understand HIV preventative care services needs and how these services are implemented. However, there may be a gap between learning these skills and implementing them in clinical care. ...
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Background: HIV-stigma can influence engagement in care and viral suppression rates among persons living with HIV (PLWH). Understanding HIV-provider level stigma and its associated factors may aid in development of interventions to improve engagement in care. Methods: We assessed HIV-related stigma, provider knowledge, and practices and beliefs among healthcare providers using an online survey tool. Generalized linear modeling was used to determine factors associated with HIV-stigma score. Results: Among 436 participants, the mean age was 42.3 (SD 12.3), 70% female, 62% white, 65% physicians, and 44% worked at an academic center. The mean HIV Health Care Provider Stigma Scale (HPASS) score was 150.5 (SD 18.9, total = 180 [higher score = less stigma]) with factor subscale scores of 67.1 (SD 8.2, total = 78) prejudice, 51.3 (SD 9.7, total = 66) stereotyping, and 32.1 (SD 5, total = 36) discrimination. Female sex and comfort with talking about sex and drug use had 4.97 (95% CI 0.61, 9.32) and 1.99 (95% CI 0.88, 3.10) estimated higher HPASS scores. Disagreement/strong disagreement versus strong agreement with the statement that PLWH should be allowed to have babies and feeling responsible for talking about HIV prevention associated with −17.05 (95% CI −25.96, −8.15) and −2.16 (95% CI −3.43, −0.88) estimated lower HPASS scores. Conclusions: The modifiable factors we identified as associated with higher HIV related stigma may provide opportunities for education that may ameliorate these negative associations.
... Medical SHE originally incorporated some biopsychosocial focus on sexuality as well as instruction in reproductive physiology with a dual purpose of providing the basics of the education and shifting undergraduate medical students' personal attitudes towards sexuality. Now medical SHE often emphasizes sexual engagement risk reduction, and the biological and physiological elements of reproductive biology and sexual engagement rather than a comprehensive biopsychosocial focus incorporating sexual medicine [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Unfortunately, since the 1980s, the amount of medical SHE has been decreased [5-9, 11, 15]. ...
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Purpose of Review The purpose of this paper is to open a discussion of the ethics of medical sexual health education (SHE) and its provision in medical education. The paper utilizes a qualitative analysis of currently available literature on medical SHE and a medical ethics framework of the four prima facie principles of (1) respect for autonomy, (2) beneficence, (3) non-maleficence, and (4) justice, together with expert opinion. The result is a review of the ethics of medical SHE as well as the ethics of the decision to provide, or not to provide, comprehensive SHE. Recent Findings Recent literature has underscored the many ways in which comprehensive medical SHE supports trainees’ ability to provide sexual health care and improve their delivery of general health care, as well as the many ways sexual health is correlated with systemic health. The literature also provides evidence that the provision of comprehensive SHE is limited in undergraduate and graduate medical education. There is a dearth of literature specifically examining the ethics of medical SHE provision. Summary This analysis demonstrates the ways in which comprehensive medical SHE and its provision conforms with the principles of the ethical practice of medicine. The analysis also supports that a lack of inclusion of SHE in medical education programs may be a violation of these principles and increases the risk of future unethical practice by medical professionals. MESH Headings: Ethics, Medical, Social justice, Sexual health, Sexuality, Human, Education, Medical, Undergraduate, Education, Medical, Graduate
Localized provoked vulvodynia (LPV) affects ~14 million people in the US (9% of women), destroying lives and relationships. LPV is characterized by chronic pain (> 3 months) upon touch to the vulvar vestibule, which surrounds the vaginal opening. Many patients go months or years without a diagnosis. Once diagnosed, the treatments available only manage the symptoms of disease and do not correct the underlying problem. We have focused on elucidating the underlying mechanisms of chronic vulvar pain to speed diagnosis and improve intervention and management. We determined the inflammatory response to microorganisms, even members of the resident microflora, sets off a chain of events that culminates in chronic pain. This agrees with findings from several other groups, which show inflammation is altered in the painful vestibule. The vestibule of patients is acutely sensitive to inflammatory stimuli to the point of being deleterious. Rather than protect against vaginal infection, it causes heightened inflammation that does not resolve, which coincides with alterations in lipid metabolism that favor production of proinflammatory lipids and not pro-resolving lipids. Lipid dysbiosis in turn triggers pain signaling through the transient receptor potential vanilloid subtype 4 receptor (TRPV4). Treatment with specialized pro-resolving mediators (SPMs) that foster resolution reduces inflammation in fibroblasts and mice and vulvar sensitivity in mice. SPMs, specifically maresin 1, act on more than one part of the vulvodynia mechanism by limiting inflammation and acutely inhibiting TRPV4 signaling. Therefore, SPMs or other agents that target inflammation and/or TRPV4 signaling could prove effective as new vulvodynia therapies.
Sexually transmitted infections (STIs) have been increasing in older adults. Sexual health remains an important part of overall health care at any age. There are several barriers and facilitators to addressing sexual health in this population. Changes attributable to normal physiologic aging as well as sexual dysfunction can affect sexuality in older adults. When it comes to preventing STIs, combination prevention strategies remain applicable in older adults. Addressing sexual health using a tailored approach is critical to stem the tide of increasing STIs rates in older adults.
Sexual side effects of cancer treatment are common and, unfortunately, often not discussed with patients and their partner. This may be due to personal factors of the health care provider, fear of offending the patient or lack of knowledge, time constraints, and perception of the importance to the patient based on age and severity of the cancer. Despite the barriers to communication about a sensitive topic, oncology care providers are well situated to initiate the conversation. This article will identify key issues related to communication about sexuality by oncology care providers with individuals with the most common kinds of cancer. Models for assessing sexuality in these patients are presented to facilitate communication about this important aspect of quality of life that is impacted by cancer treatment.
Objectives: Sexual and gender minority (SGM) communities experience significant health disparities. Although coverage of health issues specific to these communities has increased in the undergraduate medical curriculum, there is still opportunity for improved teaching about sexual diversity and inclusive care. The goal of this study was to assess students' perceptions of and satisfaction with a half-day workshop focused on sexual history taking and transgender health. Methods: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a sexual history workshop that starts with a 1-hour lecture on sexual history taking. This is followed by a faculty-facilitated small group session during which students interview an SGM patient and debrief about this experience. In 2020, for the first time, the standardized patients were members of the SGM community, and the session was on Zoom. Students completed an optional, anonymous postsession survey assessing the workshop. Results: Students overwhelmingly believed that the integration of SGM standardized patients into the session helped improve their knowledge, attitudes, and skills related to providing care for this population. They noted that the standardized patient interaction and debriefing were the most beneficial parts of the session. Conclusions: Given the positive feedback, future iterations of this session will continue to use the SGM community as standardized patients. In addition, student competency related to SGM patient care will be assessed through observed structured clinical examinations.
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Introduction: The number of hours spent teaching sexual health content and skills in medical education continues to decrease despite the increase in sexual health issues faced by patients across the lifespan. In 2012 and 2014, experts across sexuality disciplines convened for the Summits on Medical School Education and Sexual Health to strategize and recommend approaches to improve sexual health education in medical education systems and practice settings. One of the summit recommendations was to develop sexual health competencies that could be implemented in undergraduate medical education curricula. Aim: To discuss the process of developing sexual health competencies for undergraduate medical education in North America and present the resulting competencies. Methods: From 2014 to 2016, a summit multidisciplinary subcommittee met through face-to-face, phone conference, and email meetings to review prior competency-based guidelines and then draft and vet general sexual health competencies for integration into undergraduate medical school curricula. The process built off the Association of American Medical Colleges' competency development process for training medical students to care for lesbian, gay, bisexual, transgender, and gender non-conforming patients and individuals born with differences of sex development. Main outcome measures: This report presents the final 20 sexual health competencies and 34 qualifiers aligned with the 8 overall domains of competence. Results: Development of a comprehensive set of sexual health competencies is a necessary first step in standardizing learning expectations for medical students upon completion of undergraduate training. Conclusions: It is hoped that these competencies will guide the development of sexual health curricula and assessment tools that can be shared across medical schools to ensure that all medical school graduates will be adequately trained and comfortable addressing the different sexual health concerns presented by patients across the lifespan. Bayer CR, Eckstrand KL, Knudson G, et al. Sexual Health Competencies for Undergraduate Medical Education in North America. J Sex Med 2017;14:535-540.
Introduction: This review was designed to make recommendations on future educational needs, principles of curricular development, and how the International Society for Sexual Medicine (ISSM) should address the need to enhance and promote human sexuality education around the world. Aim: To explore the ways in which graduate and postgraduate medical education in human sexuality has evolved and is currently delivered. Methods: We reviewed existing literature concerning sexuality education, curriculum development, learning strategies, educational formats, evaluation of programs, evaluation of students, and faculty development. We reviewed literature relating to four main areas: (i) the current status of the international regulation of training in sexual medicine; (ii) the current delivery of education and training in sexual medicine; (iii) resident and postgraduate education in sexual medicine surgery; and (iv) education and training for allied health professionals. Results: The main findings in these four areas are as follows. Sexual medicine has grown considerably as a specialty during the past 20 years, with many drivers being identified. However, the regulatory aspects of training, assessment, and certification are currently in the early stages of development and are in many ways lagging behind the scientific and clinical knowledge in the field. However, there are examples of the development of curricula with accompanying assessments that have attempted to set standards of education and training that might underlie the delivery of high-quality care to patients in sexual medicine. The development of competence assessment has been applied to surgical training in sexual medicine, and there is increasing interest in simulation as a means of enhancing technical skills training. Although the focus of curriculum development has largely been the medical profession, there is early interest in the development of standards for training and education of allied health professionals. Conclusion: Organizations of professionals in sexual health, such as the ISSM, have an opportunity, and indeed a responsibility, to provide and disseminate learning opportunities, curricula, and standards of training for doctors and allied health professionals in sexual medicine. Eardley I, Reisman Y, Goldstein S, et al. Existing and Future Educational Needs in Graduate and Postgraduate Education. J Sex Med 2017;14:475-485.
87 Background: Following radiation therapy (RT), gynecologic oncology patients report high rates of sexual dysfunction. However, little is known regarding communication of sexual health among these patients and their healthcare providers. The aim of this study was to assess the beliefs/attitudes of patients regarding sexual history taking. Methods: Survey results were obtained from 75 women who presented for follow up care for gynecologic cancers in the radiation oncology department. The surveys assessed patient beliefs about sexual health and its impact on overall quality of life, the role practitioners should play in obtaining an accurate sexual history, and preferences and level of embarrassment regarding sexual history collection. Overall level of sexual functioning was assessed using the Female Sexual Function Index (FSFI). Chi-squared tests were used to analyze categorical variables and logistic regression modeling was used to predict agreement with survey statements. Results: Most subjects were whi...
Introduction: This exploratory study evaluated student perceptions of their ability to self- and peer assess (i) interpersonal communication skills and (ii) clinical procedures (a head and neck examination) during standardised patient (SP) interactions recorded by Google Glass compared to a static camera. Methods: Students compared the Google Glass and static camera recordings using an instrument consisting of 20 Likert-type items and four open- and closed-text items. The Likert-type items asked students to rate how effectively they could assess specific aspects of interpersonal communication and a head and neck examination in these two different types of recordings. The interpersonal communication items included verbal, paraverbal and non-verbal subscales. The open- and closed-text items asked students to report on more globally the differences between the two types of recordings. Descriptive and inferential statistical analyses were conducted for all survey items. An inductive thematic analysis was conducted to determine qualitative emergent themes from the open-text questions. Results: Students found the Glass videos more effective for assessing verbal (t22 = 2.091, P = 0.048) and paraverbal communication skills (t22 = 3.304, P = 0.003), whilst they reported that the static camera video was more effective for assessing non-verbal communication skills (t22 = -2.132, P = 0.044). Four principle themes emerged from the students' open-text responses comparing Glass to static camera recordings for self- and peer assessment: (1) first-person perspective, (2) assessment of non-verbal communication, (3) audiovisual experience and (4) student operation of Glass. Discussion and conclusion: Our findings suggest that students perceive that Google Glass is a valuable tool for facilitating self- and peer assessment of SP examinations because of students' perceived ability to emphasise and illustrate communicative and clinical activities from a first-person perspective.
This article explores the evolution and current delivery of undergraduate medical education in human sexuality. To make recommendations regarding future educational needs, principles of curricular development, and how the International Society for Sexual Medicine (ISSM) should address the need to enhance and promote human sexuality education around the world. The existing literature was reviewed for sexuality education, curriculum development, learning strategies, educational formats, evaluation of programs, evaluation of students, and faculty development. The prevailing theme of most publications in this vein is that sexuality education in undergraduate medical education is currently not adequate to prepare students for future practice. We identified components of the principles of attitudes, knowledge, and skills that should be contained in a comprehensive curriculum for undergraduate medical education in human sexuality. Management of sexual dysfunction; lesbian, gay, bisexual, and transgender health care; sexuality across genders and lifespan; understanding of non-normative sexual practices; sexually transmitted infections and HIV, contraception; abortion; sexual coercion and violence; and legal aspects were identified as topics meriting particular attention. Curricula should be integrated throughout medical school and based on principles of adult learning. Methods of teaching should be multimodal and evaluations of student performance are critical. To realize much of what needs to be done, faculty development is critical. Thus, the ISSM can play a key role in the provision and dissemination of learning opportunities and materials, it can promote educational programs around the world, and it can articulate a universal curriculum with modules that can be adopted. The ISSM can create chapters, review documents, slide decks, small group and roleplay topics, and video-recorded materials and make all this material easily available. An expert consensus conference would be needed to realize these recommendations and fulfill them.
An inaccurate definition of what constitutes sex can negatively impact the sexual health and wellbeing of patients. This study aimed to determine which behaviors medical students consider to be sex. Survey questions about various sexual behaviors were administered to medical students. All participants agreed that penile-vaginal penetration is sex. More than 25% of participants did not consider genital-genital contact without penetration, oral-genital contact, foreign object in rectum, and forced vaginal/rectal penetration as sex. Nonheterosexuals were more likely to consider genital-genital contact without penetration sex. We determined there was less than complete consensus among future physicians on what activities are considered sex.
Unlabelled: Background Female sexual dysfunction is highly prevalent and it has a major effect on quality of life. However, responding to this healthcare need is challenging for physicians due to limited time, insecurities about how and what to ask, and lack of knowledge of therapy options. In Germany, additional barriers such as poor training during residency, lack of sexual therapists, and limited options for continuing education result in an under-diagnosis and under-treatment of female sexual dysfunction. This study aims to better understand the perspectives of German obstetricians and gynaecologists (OB/GYNs) in terms of diagnosing and treating patients with female sexual dysfunction. Methods: In November 2014 all Bavarian-based OB/GYNs working in outpatient care were sent a 23-item questionnaire by mail. A reminder was sent 4 weeks later. A non-response survey was also performed. Results: Out of 1291 distributed questionnaires, 235 were completed and returned (18%). The greatest challenges to OB/GYNs caring for women with sexual dysfunction were: (1) long waiting times for referrals; (2) too little time with patients; and (3) insufficient training during residency. Only one out of five OB/GYNs brought up the topic of sexual function routinely; initiating a conversation about sexual function was significantly associated with perceived communication skills (P=0.001) and perceived medical competence (P=0.008). Conclusions: There are several barriers to diagnosing and treating female sexual dysfunction in a German outpatient setting. Further surveys of patients, psychologists, therapists and health insurance providers are needed to provide more perspectives on this particular health issue.
Background: General practitioners (GPs) are well placed to identify patients who are at risk of human immunodeficiency virus (HIV) infection, including men who have sex with men (MSM). Hence, GPs play a vital role in facilitating MSM with HIV to gain early access to HIV treatment, which will also help to reduce HIV transmission rate. Objective: This article provides a summary of current management issues when providing primary care for MSM, such as HIV testing and treatment, biomedical HIV prevention strategies, and current trends in other sexually transmissible infections (STIs). Discussion: In order for MSM to receive optimal care in general practice, questions about sexual history need to be a routine part of clinical care. Those individuals who are found to be at risk of HIV infection should be offered regular HIV testing and access to risk-reduction strategies such as pre- and post-exposure prophylaxis. Patients who are diagnosed with HIV should be offered early access to HIV treatment, and regular screening for STIs and hepatitis C.