Recommendations for teaching sexual health: how to ask and what to do with the answers.

What do physicians know about human sexuality? What do they know about healthy sexual functioning, psychosexual development, sexual disorders, sexual orientation, and the behaviors of those who commit sexual offenses? Are physicians appropriately educated to approach patients’ potential reluctance in discussing sexuality and sexual health? Should not medical educators ensure that physicians are adequately educated on all aspects of the topic, given its likelihood to present for almost every specialty? It is an obvious topic for obstetrics and gynecology, urology, and family medicine, but it is also clearly significant for psychiatry, emergency medicine, pediatrics, geriatrics, surgery, internal medicine, and every other specialty that has occasion to address sexual dysfunction or prescribe a medication with possible sexual side effects. This is not a new topic, nor is it new to address the content of instruction appropriate for medical curriculum. An editorial from a 1966 issue of the Annals of Internal Medicine (1) referenced a study comparing medical and law students and found that students entering each program were equal in their limited knowledge of sexual topics. The medical graduates scored better than the law school graduates but still scored below what was expected of physicians. The Liaison Committee on Medical Education (LCME) accreditation standards (2) require that “the curriculum must include behavioral and socioeconomic subjects, in addition to basic science disciplines.” The LCME standards do not clarify the meaning of “behavioral and socioeconomic subjects” beyond listing content that includes “human development/life cycle, human sexual/gender development and human sexuality/sexual functioning.” Although human sexuality is considered one topic that must be covered under this standard, no guidelines exist for implementation. Medical schools must independently institute curriculum that adddresses sexual health. This column describes one attempt using a multidisciplinary and multiple modality approach and serves as a starting point for dialog among medical educators.