“Homo sapiens is one of the few species on earth that care if they’re seen having sex. The impala is unconcerned. The dingo roundly flaunts it. A masturbating chimpanzee will stare straight at you. To any creature other than you and I and 6 billion other privacy-needing H. sapiens, sex is like peeling a mango or scratching your ear. It’s just something you do sometimes.”
– Mary Roach, Bonk: The Curious Coupling of Science and Sex
Mary Roach is one of my all-time favorite writers because she delves into topics that make the average person squeamish. I’ll admit, as I read Bonk: The Curious Coupling of Science and Sex, I found myself peering over the top of the pages at the pool, carefully checking that no one realized I was reading about sex. After finishing this text I wondered, why was I trying to hide? Why is our society so confined (in comparison to, for example, Europe) when it comes to our sexual well-being?
Even though many medical students will boast that very little makes them uncomfortable (they get excited to dissect cadavers or watch an open heart surgery), it is clear from the literature reviews that a large number of medical students are not comfortable, nor prepared to take accurate sexual histories from their patients. A study published in the Journal of Sexual Medicine reported that, “The majority of medical students (75.2%) feels that taking a sexual history will be an important part of their future careers, yet only 57.6% feel adequately trained to do so. Furthermore, 68.8% feel that addressing and treating sexual concerns will be an important part of their future careers, and only 37.6% feel adequately trained to do so.”1
This data is pretty alarming seeing that many Americans, young and old, struggle with sexual disorders and diseases. In my opinion, there is one main reason that underlies these statistics – lack of education (don’t scold me for saying this, I know our training is already quite lengthy, but, hey, we are lifelong learners).
In the 2008 article “Medical school sexual health curriculum and training in the United States,” researchers reported that a whopping 44% of US medical schools lacked formal sexual health curricula.2 Although a few years have gone by, it is clear that this percentage is way too high. Similar results were reflected in a study done in Malaysia by Arrifin et al.; researchers reported that only half of research participants (final-year medical students) reported feeling comfortable taking a sexual history and only 46% felt that they had received adequate training to take the sexual history.3 This level of inadequate training reflects in the demeanor of medical students when they are asked to take a sexual history.
Although I can’t speak for medical students at other institutions, many of my classmates, including myself, have expressed a certain level of unease when asked to question patients about their sexual history. What is the proper way to ask a person about his or her sexual identity and orientation? How can I make patients comfortable enough to tell me about the rash they are panicking about, but too embarrassed to bring up casually in conversation? What if the patient identifies as a transgender individual, how am I supposed to know what his or her needs are from me as a health care provider?
All medical students should know it’s okay to struggle through these questions and mess up, possibly offending a patient (future patients please be kind to the students who are still learning!). These are all questions that I don’t have the answer to, but I want to learn more so I can give my patients what they need from me. These are essential questions for medical students to ask and explore, but more importantly these discussions really require an individual with years of experience and education to be present. Although many US medical schools may be working towards providing a more solid education on sexual health, it is urgent that this be done swiftly and accurately, because our patients are the ones who are suffering as a result of our inadequate training on this aspect of health.
To the medical school officials, please answer our desire to learn more about these topics. To medical students and other health care providers, don’t be afraid to bring up sexual health with your patients. Our minds and the overthinking we do are the only things that hold us back.
- Wittenberg A, Gerber J. Recommendations for improving sexual health curricula in medical schools: results from a two-arm study collecting data from patients and medical students. J Sex Med. 2009 Feb;6(2):362-8.
- Malhotra S, Khurshid A, Hendricks KA, Mann JR. Medical school sexual health curriculum and training in the United States. J Natl Med Assoc. 2008 Sep;100(9): 1097-106.
- Ariffin et al. BMC Res Notes (2015) 8:248