What has happened to teaching human sexuality in psychiatric training programs?

A 1999 poll of 500 American adults ages 25 years or older (1) revealed that 71% of respondents were concerned that their doctor would dismiss discussions related to issues of sexual problems and would say that the problems were “just in their head.” In addition, 68% were concerned that their doctor would be uncomfortable talking about the problem because it was sexual in nature, and 76% felt that there were no medical treatments available to help them. Yet this survey also indicated that people felt that sexual health was important—91% of married men and 84% of married women ranked a satisfying sexual life as important, and 94% of those polled stated that sexual enjoyment added to the quality of life at any age. Interestingly, more than 90% of respondents also believed that sexual difficulties cause problems such as depression and emotional distress. In a recent study of 501 undergraduate and graduate students in Vermont (2), 45% of participants preferred most to receive sexual health information from a provider who initiates the conversation, 32% preferred most to receive sexual health information from a provider after they themselves initiate the conversation, and 19% preferred most to receive the information from their provider after first filling out a questionnaire addressing sexual concerns. The same participants least preferred to receive the information from the internet (25%), textbooks or pamphlets (22%), or friends or family members (13%). The majority of this sample also felt much less comfortable when their provider was uncomfortable or ignored their sexual concerns, while almost three-quarters felt much more comfortable when their provider was knowledgeable about sexual concerns. Over two-thirds of the respondents also felt much more comfortable when their provider seemed comfortable addressing sexual concerns. Interestingly, while 75% of 125 medical students in another part of this study perceived that taking a sexual history would be an important part of their future career, only 58% felt adequately trained to do so. In addition, only 38% of medical students in this arm of the study felt adequately trained in addressing and treating sexual concerns of their future patients. In spite of the obvious limitations of the poll (1) (e.g., date, small sample size) and the very selected population of participants in the study (2), the message seems to be fairly clear: our patients feel that sexuality is important to them and that sexual difficulties may be connected to other mental health issues; they would like to get sexual health information from educated providers. However, we physicians may be inadequately prepared to address the sexual concerns of their patients. These are interesting and sobering notions. We dare to say that these notions are especially interesting to the field of psychiatry. Many psychological theories are rooted in early sexual experiences and sexual development. Sexual therapy used to be part of residency training at least in some programs. The assessment of both interpersonal and sexual relationships used to be an integral part of a complete biopsychosocial evaluation of our patients. Although the aforementioned survey and study (1, 2) did not focus specifically on psychiatry, their results suggest this may not still be so. Psychiatrists conduct very little research in human sexuality. Major psychiatric journals rarely publish articles focused on human sexuality beyond sexual trauma or a rare discussion related to revising the DSM diagnostic criteria. Even the composition of the DSM-V committee addressing diagnostic issues in human sexuality illustrates the lack of interest in this field—only one committee member is a psychiatrist. The situation in teaching human sexuality may be similar. The Residency Review Committee for Psychiatry has no Received January 8, 2010; accepted January 22, 2010. The authors are affiliated with the Department of Psychiatry and Behavioral Neurosciences at Wayne State University School of Medicine in Detroit. Address correspondence to Richard Balon, M.D., UPC Jefferson, 2751 E. Jefferson, Ste. 200, Detroit, MI 48207; [email protected] (e-mail). Copyright © 2010 Academic Psychiatry