Sexual Well-being Among Medical Residents at a Community-Based Academic Institution

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INTRODUCTION
Sexual well-being has generally been discussed in terms of
risks and dangers to overall health (e.g., sexually transmitted
infections, unintended pregnancy, sexual violence) [1]. In 2002,
the World Health Organization (WHO) expanded the deni-
tion of sexual health to include positive aspects of sexual health,
stating that it is not “merely the absence of disease, dysfunction
or inrmity” but a “positive and respectful approach to sexual-
ity and sexual relationships, as well as the possibility of having
pleasurable and safe sexual experiences, free of coercion, dis-
crimination and violence” [2]. Since 2002, several studies have
examined the interplay among sexual wellness and physical,
mental, and overall health [1]. e sexual experience has been
linked to changes in endocrine and cardiovascular function, and
the post-orgasmic release of prolactin has been associated with
decreased stress and anxiety [3].
Sexual wellness during medical residency training is largely
unexamined relative to the other domains of wellness. Medical
residency training is associated with higher rates of stress and
burnout [4]. Challenging work hours and excessive workloads
contribute to higher than average levels of depression, anxiety
and psychological distress [5] and signicant decreases in phys-
ical activity and sleeping hours [6]. Preliminary studies suggest
that medical trainees are prone to poor sexual wellness [7,8].
is study aims to further describe the state of sexual well-be-
ing among physicians in-training at a single community-based
academic institution.
JOURNAL OF WELLNESS
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©JWellness 2023 Vol 5, (2)
*Correspondence To: Fiore Casale
Email: ore.casale@ascension.org
Copyright: © 2023 The author(s). This is an open access article distributed under the terms of the
Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original author and source are credited.
Sexual Well-being Among Medical Residents at a Community-
Based Academic Institution
Fiore Casale, MD, MMS1*, Hinduja Nallamala, DO1, Todd Foster, PhD2, Christine Alicea, MD1,
Laurel Fick, MD1
Received Date: Mar 2, 2023
Accepted Date: June 22, 2023
Publication Date: Sept 28, 2023
JOURNAL OF WELLNESS BRIEF REPORT
DOI: 10.18297/jwellness/vol5/iss2/2
Website: https://ir.library.louisville.edu/jwellness/
Aliations: 1Department of Internal Medicine, Ascension St. Vincent Hospital and Medical Center,
2Department of Medical Education, Ascension St. Vincent Hospital and Medical Center
Recommended Citation: Casale, Fiore; Nallamala, Hinduja; Foster, Todd; Alicea, Christine; and Fick,
Laurel (2023) "Sexual Wellbeing Among Medical Residents at a Community-Based Academic Institu-
tion," Journal of Wellness: Vol. 5: Iss. 2, Article 2.
Introduction: Medical residency training is demanding, with challenging workloads, long hours, and excessive stress that impact residents’ phys-
ical, mental, and emotional health. Although the concept of health and wellness in residency has become more widespread across programs, few
studies have explored the sexual health of medical residents during training.
Methods: To better understand the current state of sexual health and well-being of resident physicians, physicians in training across Internal
Medicine, Pediatrics, Family Medicine, OB/GYN, Transitional Year, and General Surgery completed anonymous surveys that incorporated val-
idated questionnaires, including the International Index of Erectile Function (IIEF) and the Index of Premature Ejaculation (IPE) for males, and
the female Sexual Function Inventory (FSFI) for females.
Results: A total of 69 out of the potential 100 respondents completed the survey. Most respondents (63.8%) reported a negative impact of med-
ical residency training on their sexual wellness, with married respondents experiencing more dissatisfaction than single respondents (77.8%
versus 46.7%; p = 0.02). Higher satisfaction with frequency of intercourse was seen among residents who work less than 60 hours per week
(35.7% versus 12.5%; p = 0.02). Moreover, cis males endorsed a lesser impact of sexual wellness on relationship satisfaction compared to cis
females (6.9% versus 33.3%; p = 0.01). Compared to their heterosexual counterparts, non-heterosexual respondents reported a larger impact of
sexual well-being on relationship satisfaction (75.0% versus 15.5%; p = 0.001). Single respondents displayed greater dissatisfaction (30.0%) with
the number and/or type of sexual partners than their counterparts who were married (0.0%; p < 0.001) or in committed relationships (0.0%; p =
0.001). Sexually inactive respondents reported little impact of their sexual well-being on work performance (37.5% versus 0.0%; p = 0.004) com-
pared to their sexually active colleagues, but a higher level of dissatisfaction with the frequency of intercourse (75.0% versus 12.3%; p = 0.007).
Conclusion: Recent studies have demonstrated negative impacts of medical training on physical, emotional, and mental well-being. is study
demonstrates additional negative impacts on sexual well-being. Multi-institutional, large cohort studies are needed to further assess physician
in-training sexual wellness and develop appropriate interventions.
ABSTRACT

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©JWellness 2023 Vol 5, (2)
METHODS
A Likert-scale survey was distributed to medical residents
across all medical specialties at a single community-based aca-
demic institution, which included Internal Medicine, Pediatrics,
Family Medicine, Obstetrics/Gynecology, Transitional Year,
and General Surgery. Participation was voluntary and facili-
tated through the online survey tool, Survey Monkey® [9]. To
ensure anonymity of respondents, IP addresses were not record-
ed. e survey (Supplemental Appendix 1) was distributed via
an email listserv consisting of all one-hundred medical residents
at a single institution. ere were no incentives to participate in
the survey. No medical specialties were excluded, however, any
healthcare professionals who were not medical residents were
excluded. e survey was composed primarily of demographic
characterizations and borrowed from pre-existing validat-
ed questionnaires, such as the International Index of Erectile
Function [10], the Index of Premature Ejaculation [11], and
the Female Sexual Function Inventory [12], for assistance with
phrasing and appropriate word-choice to assess sexual health.
Moreover, gender-neutral phrasing was incorporated to cap-
ture accurate responses from sexual and gender minorities. In
an eort to capture as many responses as possible in a small
study population with known time-constraints, the survey was
not piloted prior to implementation.
e Institutional Review Board deemed the study exempt.
Utilizing SPSS 24.0, ordinal data was analyzed using Wilcoxon
Signed Rank-Sum tests, nominal data with Fisher exact tests,
and Kruskal-Wallis tests for three or more groups. For respons-
es of “not applicable,” z - tests and Pearson Chi-Square tests
were performed to assess for signicant dierences between the
excluded responses. Univariate analyses were used to compare
responses among groups reecting resident physician charac-
teristics. A lower p-value threshold was considered (p < 0.01)
in these within group comparisons since post-hoc tests were
completed.
RESULTS
A total of 69 out of 100 physicians-in-training completed
the survey (response rate = 69%). Respondent characteristics
can be seen in Table 1. Overall, 84.0% stated that their overall
sexual well-being was acceptable or better. 88.3% of respondents
stated that their sexual wellness impacts their overall well-being,
34.3% stated that it impacts their work performance, and 92.5%
stated it impacts their relationship satisfaction. Most reported
adequate or better levels of libido (79.4%), physio-
logical ability (erection, lubrication, etc.) (93.2%),
and ability to achieve orgasm (91.5%). However,
36.8% expressed dissatisfaction with the frequen-
cy of intercourse. Moreover, 63.8% reported a
negative impact of medical residency training on
their sexual wellness, with the remaining 36.2%
reporting neither negative nor positive impact. As
seen in Table 2, married respondents experienced
more dissatisfaction than single respondents
(77.8% versus 46.7%; W = -2.35; p = 0.02).
Several signicant relationships were elic-
ited, which can be seen in greater detail in
Supplemental Appendix 2. When analyzed by gender, cis males
endorsed a lesser impact of sexual wellness on relationship sat-
isfaction (6.9% versus 33.3%; W = 780.5, p = 0.01), a greater
ability to achieve orgasm (42.9% versus 24.1%; W = 703.0, p
= 0.02), and greater satisfaction with masturbation frequen-
cy (45.8% versus 22.2%; W = 593.0, p = 0.03). When stratied
by sexual orientation, non-heterosexual respondents reported
greater impact of sexual well-being on relationship satisfac-
tion (75.0% versus 15.5%; W = 1789.0, p = 0.001). Additionally,
individuals greater than 30-years-old reported greater impact
of sexual wellness on relationship satisfaction (42.1% versus
16.7%; W = 1474.0, p = 0.02), higher levels of physiologic abil-
ity (61.1% versus 24.4%; W = 1091.0, p = 0.02), and greater
ability to achieve orgasm (53.3% versus 29.5%; W = 1185.5, p
= 0.01). Higher satisfaction with frequency of intercourse was
seen among residents who work fewer than 60 hours per week
(35.7% versus 12.5%; W = 1379.0, p = 0.02).
Respondents in a relationship reported greater satisfaction
with the number and/type of sexual partners compared to single
respondents (82.9% versus 10.0%; W = 110.0, p < 0.001). When
Characteristic n Percentage, (%)
Age, years
26 – 30
48
69.6%
≥ 31
21
30.4%
Gender
Cis Male
29
42.6%
Cis Female
38
55.9%
Nonbinary
1
1.5%
Sexuality
Heterosexual
60
88.2%
Not-Heterosexual
8
11.8%
Relationship Status
Single or Casually Dating
15
21.7%
In a Committed Relationship
18
26.1%
Married
36
52.2%
Sexual Activity
Sexually Active
59
86.8%
Sexually Inactive
9
13.2%
PGY*
PGY-1
30
45.5%
PGY-2
13
19.7%
≥ PGY-3
23
34.8%
Hours Worked Per Week, Average
40 – 60
18
26.1%
≥ 61
51
73.9%
Prior Sexual Trauma
Yes
8
11.8%
No
60
88.2%
* PGY = Post-Graduate Year
Table 1: Characteristics of physicians in-training who completed the
survey
Large Negative Impact Some Negative Impact Neither Negative nor
Positive Impact
Single
n
1*
6
8*
%
6.7%
40.0%
53.3%
Married
n
10*
18
8*
% 27.8% 50.0% 22.2%
In a Committed
Relationship
n
3
6
9
% 16.7% 33.3% 50.0%
* Statistically significant diff erence between single respondents and married res pondents
(Wilcoxon Signed Rank-Sum = -2.35, p-value = 0.02).
Table 2: Impact of medical residency training on sexual well-being, stratied
by relationship status (Kruskal Wallis X2 = 6.79, p = 0.03).

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©JWellness 2023 Vol 5, (2)
considering marital status, single respondents displayed greater
dissatisfaction (30.0%) with the number and/or type of sexual
partners than their counterparts who were married (0.0%; W =
91, p < 0.001) or in committed relationships (0.0%; W = 74, p
= 0.001). No single individuals and no subjects in committed
relationships had children in the home, compared to 60% of
married subjects (X2 = 16.62, p = 0.03).
When stratied by level of sexual activity, sexually inactive
respondents reported little impact of their sexual well-being on
work performance (37.5% versus 0.0%; W = 168.5, p = 0.004)
compared to their sexually active colleagues. Sexually inactive
individuals reported higher dissatisfaction with the frequency
of intercourse (75.0% versus 12.3%; W = 34.0; p = 0.007), the
number and/or type of sexual partners (75.0% versus 0.0%; W
= 19.5; p < 0.001), and the variety and types of sexual experienc-
es (50.0% versus 5.3%; W = 28.5; p = 0.003).
DISCUSSION
is single site cross-sectional study demonstrates an appar-
ent eect of medical training on sexual well-being. Alarmingly,
63.8% of physicians-in-training felt that medical residency has
negatively impacted their sexual wellness, particularly those
who are married. Confounding this impact is the fact that mar-
ried individuals had children in the home, which is also linked
to negative impacts on sexual wellness [13]. However, working
greater than 60 hours per week was associated with lower sat-
isfaction with intercourse frequency; this is comparable to the
impact excessive working hours has on the physical and mental
well-being [4, 6].
Recent studies suggest that sexual satisfaction and relation-
ship satisfaction are intimately intertwined, and that sexual
dysfunction early in a marriage has negative long-term eects
[14]. Medical residents, who are oen early in their marriages
[15], are at risk for sexual distress; in the current study, respon-
dents younger than 31-years-old exhibited relatively worse
physiological ability and ability to achieve orgasm compared
to those 31-years and older. Strategies to reduce sexual distress
during medical training should be explored because reduced
sexual distress is associated with greater marriage satisfaction
and longevity [15].
ese data suggest that single and sexually inactive physi-
cians in-training have decreased satisfaction with their sexual
well-being. Single and sexually inactive respondents expressed
dissatisfaction across several categories of sexual wellness,
including number and/or type of sexual partners and variety
and type of sexual experiences. A recent study found that sexual
inactivity and single status was associated with and obesity, indi-
cators of poor health, and physical inactivity [16]. However, this
is not unique to physicians in-training; some associations align
with those in the general population, such as cis males having a
greater ability to achieve orgasm and higher masturbation fre-
quency [17, 18].
Limitations
Limitations of this study include small sample size, lack
of stratication by medical specialty, multiple univariate
group comparisons, and data from a single community-based
academic residency institution. Further limitations include a
small body of existing data regarding sexual well-being among
medical residents, and scant literature exploring specic under-
represented populations, such as sexual and gender minorities.
Future directions could include larger cohorts allowing for
ordinal or multinominal logistic regression models and studies
across multiple community and academic institutions to char-
acterize dierences in sexual well-being by medical specialty.
New studies could also assess the impact of the pandemic on
medical resident sexual well-being.
CONCLUSION
Resident physicians report that medical training negative-
ly impacts sexual wellness, particularly for married physicians
in-training, who had signicantly more dissatisfaction with how
residency has impacted their sexual well-being. is prelimi-
nary study provides justication for further assessment of sexual
wellness among physicians in-training. is could lead to devel-
opment of interventions to address decits and enhance sexual
well-being, similarly to those designed for physical, emotional
and mental well-being.
Funding Source: e author(s) received no specic funding for
this work.
Conicts of Interest: e author(s) have no conict of interest
to declare for this work.
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