Psychiatry's role in teaching medical students, psychiatric residents, and colleague physicians about human sexuality.

As psychiatrists, we seek to understand and foster mental health in relation to many aspects of life, including intimate life and the deeply personal domain of sexuality. In this special issue of Academic Psychiatry, we take a careful look at psychiatry’s role in teaching medical students, psychiatric residents, and colleague physicians about human sexuality and the sexual concerns that arise in clinical care. The authors in this issue discuss the ways in which medical professionals address sensitive sexual healthrelated topics with their patients and how the medical system at times fails patients by neglecting the important role of sexual health in human health and well-being. The work in this collection articulates critical implications for undergraduate medical curricula and psychiatric training programs. And, taken together, the collection makes the persuasive argument that assessment of sexual function and treatment of sexual concerns is certainly within the purview—and some would suggest the imperatives—of the field of psychiatry. Sexual concerns are common. Most people believe that healthy sexual function is an extremely important factor in one’s quality of life (1). Individuals rely on clinicians to answer questions about normal sexual functioning, safe sexual practices, contraception, family planning, and sexually transmitted illnesses. Clinicians, in turn, are better able to diagnose and treat medical conditions when their patients are honest with them about sexual practices that may be relevant to their medical concerns. Sexual function may be compromised by common medical conditions such as diabetes mellitus (2), or by the hormonal changes associated with normal aging (3). In some cases, sexual dysfunction may be related to psychological concerns such as paraphilias (4), anxiety, stress (5), or the direct result of psychopharmacologic treatments for mood disorders, anxiety, or psychosis (6). Patients do not bring sexual concerns to their physician’s attention. Despite the fact that healthy sexual function is important, patients report that they feel uncomfortable discussing such issues with their physician. Studies show that patients feel uncomfortable talking about sexual issues and believe that their clinician will be similarly ill at ease (7). More concerning are the beliefs that they will be judged as being “abnormal” and the fears that their concerns will not be validated or taken seriously. Patients also report that they do not ask their medical provider about sexual problems due to concerns that there will not be an effective intervention or treatment available to them (7). Lesbian, gay, bisexual, and transgender (LGBT) patients, in particular, are more likely not to seek medical care— and therefore neglect their personal health—due to barriers accessing the health care system such as systemic discrimination, ineligibility of extended health care coverage to same-sex partners, and a dearth of health data collection for LGBT populations (8). A surprising number of physicians do not feel comfortable discussing sexual issues. Fewer than 50% of U.S. and Canadian medical schools have formal curricula ( 2 hours) devoted to teaching human sexuality, and those that do have a very limited amount of time to cover the information in a way that leaves trainees feeling adequately prepared (9). The majority of graduates feel that they lack Received May 9, 2010; revised May 28, 2010; accepted June 1, 2010. Dr. Roberts is Chairman and Katharine Dexter McCormick and Stanley McCormick Memorial Professor, Department of Psychiatry and Behavioral Sciences, at Stanford University. Dr. Derenne is affiliated with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee. Address correspondence to Jennifer Derenne, M.D., Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, 8701 Watertown Plank Road, Milwaukee, WI 53226; [email protected] (e-mail). Copyright © 2010 Academic Psychiatry