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Gyan SE, Boafo IM. "When you use tramadol, the sperms will not come out. . .": Unconventional strategies for avoiding unintended pregnancy among adolescents in Ghana. SAGE Open Med 2024; 12:20503121231224660. [PMID: 38292416 PMCID: PMC10826370 DOI: 10.1177/20503121231224660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/05/2023] [Indexed: 02/01/2024] Open
Abstract
Background In spite of adolescents' high knowledge about modern contraceptives, usage is low especially in sub-Saharan Africa. Little is known about what adolescents use in place of modern contraceptive methods. Objective This paper discusses lay strategies that adolescents use in their quest to prevent unintended pregnancy. Methods A qualitative approach was used in the study reported in this paper. The paper draws on focus group data from a larger study looking at adolescent contraceptive needs in Ghana. A purposive sampling technique was used to select 79 adolescents who participated in a focus group discussion. Eight focus group discussions were held with both male and female adolescents aged 15-19. The data were analysed using the inductive thematic analysis method after transcribing the data. Results We found that after having sex without using condom, adolescent girls ejected sperms by using water, salt solution or ice cubes, while others engaged in pushing with pelvic floor muscles. In their bid to prevent pregnancy, for boys, engaging in masturbation and the intake of Tramadol before sex was observed. When these lay strategies fail, adolescents resorted to unsafe and illegal abortion. Conclusions Though adolescents girls engaged in unprotected sex, they still tried to avoid pregnancy, and consequently adopted lay strategies of pregnancy prevention that do not expose them to stigma. It is therefore recommended that the Ministry of Health through the Ghana Health Service consider establishing more adolescent-friendly health centres and expanding existing ones where adolescents could easily visit to have their sexual and reproductive health needs addressed in a very confidential and non-judgemental manner.
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Affiliation(s)
- Sylvia Esther Gyan
- Department of Sociology, College of Humanities, University of Ghana, Accra, Ghana
| | - Isaac Mensah Boafo
- Department of Sociology, College of Humanities, University of Ghana, Accra, Ghana
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Carvalho AOD, Andrade LBD, Ruano FFLO, Wigg CMD, Marinheiro LPF. Knowledge, practices and barriers to access sexual health of women in the menopausal stages: a cross-sectional study with Brazilian gynecologists. BMC Womens Health 2024; 24:52. [PMID: 38238746 PMCID: PMC10795360 DOI: 10.1186/s12905-024-02901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Sexual health access and care for women in the menopausal stages face significant barriers, presenting deficits in relation to diagnosis and treatment. Although epidemiological data indicate high prevalence of problems related to sexual health in this population, traditionally, the theme is not discussed in health care settings. This study aimed to analyze knowledge, practices and barriers to access sexual health of women in the menopausal stages in the context of women's health care in Brazil. METHODS With a cross-sectional design, a questionnaire was distributed electronically, encompassing variables related to knowledge; practices; and barriers to access sexual health of women in the menopausal stages. The data obtained were subjected to analysis using both descriptive and inferential statistics. Specifically, we employed multivariate analysis, employing multiple linear regression models, to discern potential factors associated with outcomes concerning the level of knowledge and the frequency of addressing the topic in professional practice. RESULTS The sample included 70 physicians with specialization in obstetrician/gynecologists who work in health care with women in the menopausal transition or postmenopausal women. A high level of self-reported knowledge about sexual health was identified. Regarding the practices, most of them reported directly proposing the subject and not using instruments. Although they reported frequently addressing the topic in general, topics related to vaginal lubrication, dyspareunia, and sexual dysfunction have been more present in the clinic compared to sexual orientation and women's relationship with themselves. The main barriers were time limitation and patient discomfort with the topic. The multivariate models indicated that female gynecologists and professionals with higher levels of knowledge on the subject had a higher frequency of addressing sexual health in clinical practice with women in menopausal stages. CONCLUSIONS Sexual health access and care for brazilian women in the menopausal stages presents discrepancies in the frequency of approach between the various topics, in addition to the predictive character of technical knowledge in the practices of professionals. To ensure universal access to sexual health services for this population, an active approach through specific instruments is important, as well as the reinforcement of strategies to improve the level of knowledge of professionals.
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Affiliation(s)
- Amanda Oliveira de Carvalho
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fundação Oswaldo Cruz (IFF/Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, CEP 22250-020, Brazil.
| | | | - Flávia Fairbanks L O Ruano
- Universidade de São Paulo, São Paulo, SP, Brasil
- Miller School of Medicine - University of Miami, Miami, FL, USA
| | | | - Lizanka Paola Figueiredo Marinheiro
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fundação Oswaldo Cruz (IFF/Fiocruz), Avenida Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, CEP 22250-020, Brazil
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3
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Novais C, Santos J, Alves C, Mendonça E, Salgado J, Lopes D, Cruz AM. Optimizing Contraceptive Prescription in Smoking Women: A Quality Improvement Study. Cureus 2023; 15:e45701. [PMID: 37868398 PMCID: PMC10590168 DOI: 10.7759/cureus.45701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Family planning is fundamental in primary care (PC), and informed counseling helps to guide contraceptive choices. Combined hormonal contraceptives (CHC) pose cardiovascular risks, particularly when combined with smoking. According to the World Health Organization, the recommended global clinical decision is to refrain from employing CHC in female smokers aged 35 or older. This study aimed to improve contraception prescription for female smokers aged 35-54 in PC. Methods This study was conducted in a Portuguese Family Health Unit (FHU) from October 2021 to August 2022, and it followed the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines and the Plan-Do-Study-Act approach. Female smokers aged 35-54 were included and evaluated in three moments: baseline evaluation (October 2021), intermediate evaluation (February 2022), and post-intervention evaluation (August 2022). Interventions involved educating medical staff, creating patient awareness campaigns, and evaluating contraceptive methods. The established quality-defining goal was to decrease the prevalence of female smokers aged 35 or above using CHC to ≤5%. Results CHC prevalence among smoking women aged 35-54 decreased from 16.4% to 8.5% after nine months of the initial intervention. There was an increase in progestogen-only methods usage over time, from 25.7% to 34.0%. Discussion Despite not fully achieving the predefined goal, interventions led to a substantial reduction of CHC use among smoking women aged 35-54. Collaborative efforts between healthcare professionals and patients played a pivotal role in optimizing care and reducing cardiovascular risk. This study underscores the importance of continuous quality improvement, collaborative interventions, and knowledge updates in Family Medicine practice. While conducted in a single FHU, the intervention's multidimensional approach holds the potential for broader applicability. Conclusion In the future, healthcare teams should continue to reflect on achieved results, maintain knowledge, and empower patients in contraceptive method choices. The study contributes to improved care quality and highlights the positive impact on medical practice and patient outcomes.
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Affiliation(s)
- Catarina Novais
- Family Medicine, USF Bom Porto - ACeS Porto Ocidental, Porto, PRT
| | - Joaquim Santos
- Family Medicine, USF Bom Porto - ACeS Porto Ocidental, Porto, PRT
| | - Claúdia Alves
- Family Medicine, USF Bom Porto - ACeS Porto Ocidental, Porto, PRT
| | - Ema Mendonça
- Family Medicine, USF Bom Porto - ACeS Porto Ocidental, Porto, PRT
| | - João Salgado
- Family Medicine, USF Bom Porto - ACeS Porto Ocidental, Porto, PRT
| | - Diogo Lopes
- Family Medicine, USF Bom Porto - ACeS Porto Ocidental, Porto, PRT
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Falsetta ML, Maddipati KR, Honn KV. Inflammation, lipids, and pain in vulvar disease. Pharmacol Ther 2023; 248:108467. [PMID: 37285943 PMCID: PMC10527276 DOI: 10.1016/j.pharmthera.2023.108467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
Localized provoked vulvodynia (LPV) affects ∼14 million people in the US (9% of women), destroying lives and relationships. LPV is characterized by chronic pain (>3 months) upon touch to the vulvar vestibule, which surrounds the vaginal opening. Many patients go months or years without a diagnosis. Once diagnosed, the treatments available only manage the symptoms of disease and do not correct the underlying problem. We have focused on elucidating the underlying mechanisms of chronic vulvar pain to speed diagnosis and improve intervention and management. We determined the inflammatory response to microorganisms, even members of the resident microflora, sets off a chain of events that culminates in chronic pain. This agrees with findings from several other groups, which show inflammation is altered in the painful vestibule. The vestibule of patients is acutely sensitive to inflammatory stimuli to the point of being deleterious. Rather than protect against vaginal infection, it causes heightened inflammation that does not resolve, which coincides with alterations in lipid metabolism that favor production of proinflammatory lipids and not pro-resolving lipids. Lipid dysbiosis in turn triggers pain signaling through the transient receptor potential vanilloid subtype 4 receptor (TRPV4). Treatment with specialized pro-resolving mediators (SPMs) that foster resolution reduces inflammation in fibroblasts and mice and vulvar sensitivity in mice. SPMs, specifically maresin 1, act on more than one part of the vulvodynia mechanism by limiting inflammation and acutely inhibiting TRPV4 signaling. Therefore, SPMs or other agents that target inflammation and/or TRPV4 signaling could prove effective as new vulvodynia therapies.
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Affiliation(s)
- Megan L Falsetta
- University of Rochester, OB/GYN Research Division, Rochester, NY, United States of America; University of Rochester, Pharmacology and Physiology Department, Rochester, NY, United States of America.
| | - Krishna Rao Maddipati
- Wayne State University, Pathology Department, Detroit, MI, United States of America; Wayne State University, Lipidomics Core Facility and Bioactive Lipids Research Program, Detroit, MI, United States of America
| | - Kenneth V Honn
- Wayne State University, Pathology Department, Detroit, MI, United States of America; Wayne State University, Lipidomics Core Facility and Bioactive Lipids Research Program, Detroit, MI, United States of America
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Lukumay GG, Mgopa LR, Mushy SE, Rosser BRS, Massae AF, Mkonyi E, Mohammed I, Mwakawanga DL, Trent M, Wadley J, Ross MW, Bonilla Z, Leshabari S. Community myths and misconceptions about sexual health in Tanzania: Stakeholders' views from a qualitative study in Dar es Salaam Tanzania. PLoS One 2023; 18:e0264706. [PMID: 36763616 PMCID: PMC9916544 DOI: 10.1371/journal.pone.0264706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/15/2022] [Indexed: 02/11/2023] Open
Abstract
INTRODUCTION Sexual and reproductive health problems are one of the top five risk factors for disability in the developing world. The rates of sexual health problems in most African countries are overwhelming, which is why HIV and other STIs are still such a challenge in sub-Saharan Africa. Talking about sex in most African countries is a taboo, leading to common myths and misconceptions that ultimately impact community sexual health. METHODS In this study, we conducted 11 key stakeholder individual interviews with community, religious, political, and health leaders (sexual health stakeholders) in Tanzania. Qualitative content analysis was used to analyze all the materials. RESULTS Two main categories merged from the analysis. The first category, "Ambiguities about sexual health" focused on societal and political misconceptions and identified ten myths or misconceptions common in Tanzania. Stakeholders highlighted the confusion that happens when different information about sexual health is presented from two different sources (e.g., community leaders/peers and political leaders), which leaves the community and community leaders unsure which one is reliable. The second category, "Practical dilemmas in serving clients", addressed a range of professional and religious dilemmas in addressing sexual health concerns. This included the inability of religious leaders and health care providers to provide appropriate sexual health care because of internal or external influences. CONCLUSION Myths and misconceptions surrounding sexual health can prevent communities from adequately addressing sexual health concerns, and make it more difficult for healthcare providers to comfortably provide sexual health care to patients and communities. Stakeholders affirmed a need to develop a sexual health curriculum for medical, nursing and midwifery students because of the lack of education in this area. Such a curriculum needs to address nine common myths which were identified through the interviews.
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Affiliation(s)
- Gift G. Lukumay
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Lucy R. Mgopa
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Stella E. Mushy
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - B. R. Simon Rosser
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Agnes F. Massae
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Inari Mohammed
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | | | - Maria Trent
- Johns Hopkins Medicine, Baltimore, MD, Washington, DC, United States of America
| | - James Wadley
- School of Adult and Continuing Education, Lincoln University, Baltimore Pike, PA, United States of America
| | - Michael W. Ross
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Zobeida Bonilla
- University of Minnesota, School of Public Health, Minneapolis, MN, United States of America
| | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
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Chathoth V, Mavillapalli VV, Puli SK. Lacunae in Addressing Sexual Problems in Postgraduate Psychiatry Training in India. JOURNAL OF PSYCHOSEXUAL HEALTH 2022. [DOI: 10.1177/26318318221143896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Vijay Chathoth
- JSS Medical College and Hospital, Mysore, Karnataka, India
| | | | - Sai Krishna Puli
- Prathima Institute of Medical Sciences, Karimnagar, Telangana, India
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Stumbar SE, Garba NA, de la Cruz M, Bhoite P, Uchiyama E. Integration of Sex and Gender Minority Standardized Patients into a Workshop on Gender-Inclusive Patient Care: Exploring Medical Student Perspectives. South Med J 2022; 115:722-726. [PMID: 36055662 DOI: 10.14423/smj.0000000000001435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Sexual and gender minority (SGM) communities experience significant health disparities. Although coverage of health issues specific to these communities has increased in the undergraduate medical curriculum, there is still opportunity for improved teaching about sexual diversity and inclusive care. The goal of this study was to assess students' perceptions of and satisfaction with a half-day workshop focused on sexual history taking and transgender health. METHODS The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a sexual history workshop that starts with a 1-hour lecture on sexual history taking. This is followed by a faculty-facilitated small group session during which students interview an SGM patient and debrief about this experience. In 2020, for the first time, the standardized patients were members of the SGM community, and the session was on Zoom. Students completed an optional, anonymous postsession survey assessing the workshop. RESULTS Students overwhelmingly believed that the integration of SGM standardized patients into the session helped improve their knowledge, attitudes, and skills related to providing care for this population. They noted that the standardized patient interaction and debriefing were the most beneficial parts of the session. CONCLUSIONS Given the positive feedback, future iterations of this session will continue to use the SGM community as standardized patients. In addition, student competency related to SGM patient care will be assessed through observed structured clinical examinations.
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Affiliation(s)
- Sarah E Stumbar
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, and the Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nana Aisha Garba
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, and the Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - MariaSyl de la Cruz
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, and the Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Prasad Bhoite
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, and the Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Emiri Uchiyama
- From the Herbert Wertheim College of Medicine, Florida International University, Miami, and the Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
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Bunting SR, Feinstein BA, Calabrese SK, Hazra A, Sheth NK, Chen AF, Garber SS. Assumptions about patients seeking PrEP: Exploring the effects of patient and sexual partner race and gender identity and the moderating role of implicit racism. PLoS One 2022; 17:e0270861. [PMID: 35776746 PMCID: PMC9249206 DOI: 10.1371/journal.pone.0270861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/09/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Daily pre-exposure prophylaxis (PrEP) for HIV-prevention is an essential component of national plans to end the HIV epidemic. Despite its well-documented safety and effectiveness, PrEP prescription has not met the public health need. Significant disparities between White and Black people exist with respect to PrEP prescription, as do disparities between men and women. One factor contributing to these disparities is clinicians’ assumptions about patients seeking PrEP. Methods The present study sought to investigate medical students’ assumptions about patients seeking PrEP (anticipated increased condomless sex, extra-relational sex, and adherence to PrEP), and assumed HIV risk when presenting with their sexual partner. We systematically varied the race (Black or White) and gender (man or woman) of a fictional patient and their sexual partner. All were in serodifferent relationships including men who have sex with men (MSM), women (MSW), and women who have sex with men (WSM). Participants also completed an implicit association test measuring implicit racism against Black people. We evaluated the moderation effects of patient and partner race on assumptions as well as the moderated moderation effects of implicit racism. Results A total of 1,472 students participated. For MSM patients, having a Black partner was associated with higher assumed patient non-adherence to PrEP compared to a White partner, however a White partner was associated with higher assumed HIV risk. For MSW patients, a White male patient was viewed as being more likely to engage in more extra-relational sex compared to a Black male patient. For WSM patients, White women were assumed to be more likely to have condomless and extra-relational sex, be nonadherent to PrEP, and were at higher HIV risk. Overall, implicit racism was not related to negative assumptions about Black patients as compared to White patients based on patient/partner race. Discussion Medical education about PrEP for HIV prevention must ensure future health professionals understand the full range of patients who are at risk for HIV, as well as how implicit racial biases may affect assumptions about patients in serodifferent couples seeking PrEP for HIV prevention. As gatekeepers for PrEP prescription, clinicians’ assumptions about patients seeking PrEP represent a barrier to access. Consistent with prior research, we identified minimal effects of race and implicit racism in an experimental setting.
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Affiliation(s)
- Samuel R. Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | - Brian A. Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University, North Chicago, Illinois, United States of America
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia, United States of America
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Neeral K. Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Alex F. Chen
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, United States of America
| | - Sarah S. Garber
- Department of Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University, North Chicago, Illinois, United States of America
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Kacperczyk-Bartnik J, Nowosielski K, Razumova Z, Bizzarri N, Pletnev A, Lindquist D, Lanner M, Nikolova T, Theofanakis C, Strojna AN, Bartnik P, Gómez-Hidalgo NR, Vlachos DE, Selcuk I, Zalewski K. Clinician attitude towards sexual counseling in women with gynecologic malignancies: European Network of Young Gynaecological Oncologists (ENYGO) survey. Int J Gynecol Cancer 2022; 32:ijgc-2021-003309. [PMID: 35568382 DOI: 10.1136/ijgc-2021-003309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Both the location of primary disease and treatment side effects may have an impact on sexual function in oncogynecological patients. The aim of this study was to examine the prevalence, strategies, difficulties, and ideas for improvement in sexual counseling among specialists managing patients with gynecologic malignancies. METHODS This was a cross-sectional survey study performed among healthcare professionals treating patients with gynecologic malignancies. A self-prepared questionnaire included 61 questions concerning general demographic information and different aspects of sexual counseling in the gynecologic oncology practice. Analysis included attitudes, behaviors, management strategies, difficulties, and ideas for possible systemic improvements. Statistical analysis involved descriptive statistics, two-sided chi-square test, and Fisher's exact test. RESULTS A total of 150 respondents from 46 countries answered the survey. The majority of survey participants stated that sexual counseling of oncological patients is very important (n=73, 49%) or important (n=46, 31%). One hundred and two (68%) respondents agreed that sexual counseling of gynecologic oncology patients should be routinely provided by the specialist managing the primary disease. However, collecting information concerning sexual function is performed often or always by only 21% of respondents and 19% discuss the topic rarely or never. The most frequently indicated barriers leading to difficulties in sexual counseling include lack of time (74%), lack of specialist knowledge (55%), and patient embarrassment (48%). One hundred and seven (71%) respondents expressed interest in participating in sexual counseling workshops organized by the European Society of Gynaecological Oncology (ESGO)/European Network of Young Gynaecological Oncologists (ENYGO), 74 (49%) would like to access webinars on the topic, and 120 (80%) would be interested in materials in the ESGO online educational resources. CONCLUSION One of the proposed solutions to insufficient access to sexual care for women with gynecologic malignancies is providing access to specialist educational programs for both patients and healthcare specialists.
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Affiliation(s)
| | - Krzysztof Nowosielski
- Department of Gynecology, Obstetrics and Gynecological Oncology, University Clinical Center, Medical University of Silesia, Katowice, Poland
| | - Zoia Razumova
- Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Andrei Pletnev
- Department of Gynecology and Obstetrics, University of Zielona Góra, Zielona Góra, Poland
| | - David Lindquist
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - Maximilian Lanner
- Department of Obstetrics and Gynaecology, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
| | - Tanja Nikolova
- Department of Gynecologic Oncology, Klinikum Mittelbaden, Academic Teaching Hospital of Heidelberg University, Baden-Baden, Germany
| | - Charlampos Theofanakis
- Department of Gynaecological Oncology, General Hospital of Athens Alexandra, Athens, Greece
| | | | - Paweł Bartnik
- II Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | | | - Dimitrios-Efthymios Vlachos
- First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilker Selcuk
- Department of Gynecologic Oncology, Zekai Tahir Burak Kadin Sagligi EAH, Ankara, Turkey
| | - Kamil Zalewski
- Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland
- Department of Gynaecology, Royal Marsden Hospital NHS Trust, London, UK
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Garrett CC, Vaisey A. 'Most women really actually do just appreciate being asked': clinicians' views on integrating sexual wellbeing into contraceptive care. CULTURE, HEALTH & SEXUALITY 2022; 24:315-329. [PMID: 33170110 DOI: 10.1080/13691058.2020.1840630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
A growing body of literature suggests that contraceptives' impact on sexual experiences influences willingness to initiate and continue with a method. Little is known, however, about how clinicians engage with clients on this topic during contraceptive consultations. Fifteen clinicians in South Eastern Australia participated in semi-structured interviews between April and June 2019. Interviews were analysed using inductive, semantic thematic analysis. Participants varied in their evaluation and management of contraceptives' sexual side effects and the legitimacy given to women's bodily experience versus their own understanding of the evidence in the medical literature. We identified two distinct groups of clinicians: those who prioritised sexual wellbeing as a primary issue in contraceptive consultations and those who perceived sexual wellbeing as a secondary concern. The difference in practices was influenced by whether participants considered sexual wellbeing to be part of holistic care provision and their views on the clinician's role in raising the topic. Strategies to equip clinicians to integrate sexual wellbeing into contraceptive consultations include interactive clinical training and incorporating information about sexual side effects into contraceptive guidelines and client resources. Benefits gained from normalising sexual wellbeing could extend beyond contraceptive care to help clinicians address clients' sexual wellbeing in other contexts.
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Affiliation(s)
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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11
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Pretorius D, Couper ID, Mlambo MG. Sexual history taking: Doctors' clinical decision-making in primary care in the North West province, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e9. [PMID: 34636612 PMCID: PMC8517797 DOI: 10.4102/phcfm.v13i1.2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Clinical reasoning is an important aspect of making a diagnosis for providing patient care. Sexual dysfunction can be as a result of cardiovascular or neurological complications of patients with chronic illness, and if a patient does not raise a sexual challenge, then the doctor should know that there is a possibility that one exists and enquire. AIM The aim of this research study was to assess doctors' clinical decision-making process with regards to the risk of sexual dysfunction and management of patients with chronic illness in primary care facilities of the North West province based on two hypothetical patient scenarios. SETTING This research study was carried out in 10 primary care facilities in Dr Kenneth Kaunda health district, North West province, a rural health district. METHODS This vignette study using two hypothetical patient scenarios formed part of a broader grounded theory study to determine whether sexual dysfunction as comorbidity formed part of the doctors' clinical reasoning and decision-making. After coding the answers, quantitative content analysis was performed. The questions and answers were then compared with standard answers of a reference group. RESULTS One of the doctors (5%) considered sexual dysfunction, but failed to follow through without considering further exploration, investigations or management. For the scenario of a female patient with diabetes, the reference group considered cervical health questions (p = 0.001) and compliance questions (p = 0.004) as standard enquiries, which the doctors from the North West province failed to consider. For the scenario of a male patient with hypertension and an ex-smoker, the reference group differed significantly by expecting screening for mental health and vision (both p = 0.001), as well as for HIV (p 0.001). The participating doctors did not meet the expectations of the reference group. CONCLUSION Good clinical reasoning and decision-making are not only based on knowledge, intuition and experience but also based on an awareness of human well-being as complex and multidimensional, to include sexual well-being.
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Affiliation(s)
- Deidré Pretorius
- Division of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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Ford JV, El Kak F, Herbenick D, Purdy C, Tellone S, Wasserman M, Coleman E. Sexual Pleasure and Healthcare Settings: Focusing on Pleasure to Improve Healthcare Delivery and Utilization. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:572-586. [PMID: 38595777 PMCID: PMC10903612 DOI: 10.1080/19317611.2021.1955802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/24/2021] [Accepted: 06/25/2021] [Indexed: 04/11/2024]
Abstract
Sexual pleasure is best attained through facilitating access to the highest standard of health. Today global data show a persistent high burden of sexual health issues. Yet, pleasure remains a sensitive, stigmatized, and unspoken topic in healthcare services. This article examines how to incorporate a value for pleasure into healthcare services, grounded in the assumption that pleasure is a fundamental reason why people have sex and that acknowledging this can support people in creating safer, more pleasurable sexual experiences. Drawing upon examples from the literature and field experience, this article explores how to better address pleasure in healthcare settings.
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Affiliation(s)
- Jessie V. Ford
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Faysal El Kak
- Women Integrated Sexual Health Program, Department of Obstetrics and Gynecology, Medical Center, American University of Beirut, Beirut, Lebanon
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | | | - Stephen Tellone
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Eli Coleman
- Institute for Sexual and Gender Heath, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
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Mushy SE, Rosser BRS, Ross MW, Lukumay GG, Mgopa LR, Bonilla Z, Massae AF, Mkonyi E, Mwakawanga DL, Mohammed I, Trent M, Wadley J, Leshabari S. The Management of Masturbation as a Sexual Health Issue in Dar es Salaam, Tanzania: A Qualitative Study of Health Professionals' and Medical Students' Perspectives. J Sex Med 2021; 18:1690-1697. [PMID: 37057493 DOI: 10.1016/j.jsxm.2021.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Across Africa, there are strong cultural taboos against masturbation. AIM As part of a broader study investigating sexual health training needs of the health providers, researchers conducted a study to investigate how masturbation is addressed as a clinical issue in clinics in Dar es Salaam, Tanzania. METHODS An exploratory qualitative study design conducted in June 2019 involving 18 focus groups among health care providers and students in the health professions (midwives, nurses, medical doctors). A total of 61 health care students and 58 health providers were interviewed. The study participants were purposively selected and the design was purposively stratified to examine findings across the 3 main health care providers and by experience (clinicians vs students). A semistructured interview guide in Kiswahili language was used. The study participants were presented a case scenario of a 14-year-old boy who was found masturbating in his room by his father, and asked how this case would be handled in a clinical setting. Data were transcribed in Kiswahili and Translated to English. OUTCOMES Inductive-deductive thematic analysis was performed. Major themes and subthemes were identified. RESULTS Two main themes emerged: (i) knowledge about the management of masturbation and (ii) views about the effects of masturbation. Clinical interventions providers would try to include normalization of masturbation as a pubescent behavior combined with advice to stop the adolescent from masturbating, a recommendation to watch for negative effects immediately postmasturbation, and referral to a psychologist for treatment. Across providers and students, masturbation in adolescence was seen as clinically problematic, potentially leading to multiple issues in adulthood including sexual dissatisfaction with a spouse, psychological dependency, and erectile dysfunction, loss of sexual sensitivity in intercourse, premature ejaculation, and penis size reduction. Several participants mentioned they received no training about masturbation to guide their clinical practice. CLINICAL IMPLICATIONS These findings affirm the need for comprehensive sexual health training in Tanzanian universities. STRENGTHS AND LIMITATIONS Use of stratified design by profession and experience allowed to explore if there appear to be differences between students and experienced providers. The findings cannot be generalizable to all health professional students and providers across Tanzania. CONCLUSION When designing sexual health curricula for Tanzania, it is important to include accurate information about masturbation as a normal and healthy sexual practice to address widely held myths about its effects on health, and to train providers in how to counsel when concerns and inaccurate information are brought to the clinical encounter. Mushy SE, Rosser BRS, Ross MW, et al. The Management of Masturbation as a Sexual Health Issue in Dar es Salaam, Tanzania: A Qualitative Study of Health Professionals' and Medical Students' Perspectives. J Sex Med 2021;18:1690-1697.
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Affiliation(s)
- Stella E Mushy
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | | | - Lucy R Mgopa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Agnes F Massae
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ever Mkonyi
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - Maria Trent
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Sebalda Leshabari
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Ross MW, Bayer CR, Shindel A, Coleman E. Evaluating the impact of a medical school cohort sexual health course on knowledge, counseling skills and sexual attitude change. BMC MEDICAL EDUCATION 2021; 21:37. [PMID: 33419437 PMCID: PMC7791146 DOI: 10.1186/s12909-020-02482-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sexual health is generally considered an integral part of medical and allied healthcare professional training. However, many medical schools do not offer this as a mandatory curriculum, or minimize it. Sexual health as an academic area was introduced in the 1970s, but there have been few cohort evaluations of its impact. This was limited by the availability of few psychometric scales for evaluation. We evaluated the full, mandatory, sexual health course in year 1 medicine at a large state university in the Midwest US, including the course with lectures; panels and tutorials; a video app to give students feedback on their sexual history taking skills; and a 3-station sexual history OSCE at the end of the course. RESULTS Seventy-four medical students (43% of the course cohort) volunteered, for an incentive, to complete evaluation materials pre- and post-course. We used the Sexual Health Education for Professionals Scale (SHEPS), designed and with appropriate psychometric standardization for such evaluation. The SHEPS data covers 7-point Likert scale ratings of 37 patient situations, asking first how well the student could communicate with such a patient, and on the second part how much knowledge they have to care for such a patient. The third subscale examines personal sexual attitudes and beliefs. Data indicated that the matched pretest-posttest ratings for skills and knowledge were all statistically significant and with very large effect sizes. Few of the attitude subscale items were significant and if so, had small effect sizes. Sexual attitudes and beliefs may be well-formed before entry into medical school, and sexual health teaching and learning has minimal effect on sexual attitudes in this US sample. However, using the 3 sexuality OSCE cases scores as outcomes, two of the 26 attitude-belief items predicted > 24% of the variance. CONCLUSIONS The sexual health course produced major changes in Communications with patients sexual health skills and Knowledge of sexual health, but little change in personal Attitudes about sexuality. These data suggest that personal attitude change is not essential for teaching US medical students to learn about sexual health and sexual function and dysfunction, and comfortably take a comprehensive sexual history.
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Affiliation(s)
- Michael W Ross
- Program in Human Sexuality, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Carey Roth Bayer
- Departments of Community Health and Preventive Medicine/Medical Education, Morehouse School of Medicine, Atlanta, GA, USA
| | - Alan Shindel
- Department of Urology, School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Eli Coleman
- Program in Human Sexuality, University of Minnesota Medical School, Minneapolis, MN, USA
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Voegeli C, Fraze J, Wendel K, Burnside H, Rietmeijer CA, Finkenbinder A, Taylor K, Devine S. Predicting Clinical Practice Change: An Evaluation of Trainings on Sexually Transmitted Disease Knowledge, Diagnosis, and Treatment. Sex Transm Dis 2021; 48:19-24. [PMID: 33315783 PMCID: PMC7737854 DOI: 10.1097/olq.0000000000001282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexually transmitted disease clinical training for working professionals requires substantial time and resources. Understanding the predictors of change in worksite practices and barriers to change will allow educators, learners, and clinical leadership to aid in ensuring learned practices are implemented and barriers are addressed. METHODS Data for this analysis come from the first standardized national evaluation of a Centers for Disease Control and Prevention-funded clinical prevention training network, including precourse registration and responses to immediate postcourse (1-3 days) and 90-day postcourse evaluations from 187 courses. Univariate statistics describe the trainees and their workplace. Bivariate statistics describe their intention to change and actual change stratified by functional role and employment setting. Logistic regression identified predictors of self-reported changes in practice. RESULTS The strongest predictors for practice change included an intention to change and attendance at a training lasting 4 hours or more. Functional role was a weaker predictor of change in practice; employment setting did not predict change. More than half of the trainees (65.9%; n = 912) stated their intention to make a change in their practice immediately after training. At 90 days after a course, 62.4% (n = 863) reported making a practice change. Trainees that took courses lasting 4 hours or more reported making a change more often (70%) compared with trainees from shorter courses (53%). We also report on trainees' barriers to practice change. CONCLUSIONS Results suggest that longer trainings may result in more practice change than shorter trainings, recruitment of trainees should focus on those more likely to make a change in their practice, and future trainings should focus on organizational capacity building and assessing change at the organizational level.
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Affiliation(s)
- Christopher Voegeli
- From the Denver Prevention Training Center, Denver Public Health, Denver, CO
| | - Jami Fraze
- Research and Evaluation Group, Atlanta, GA
| | - Karen Wendel
- From the Denver Prevention Training Center, Denver Public Health, Denver, CO
| | - Helen Burnside
- From the Denver Prevention Training Center, Denver Public Health, Denver, CO
| | | | | | - Kimberly Taylor
- From the Denver Prevention Training Center, Denver Public Health, Denver, CO
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Ross MW, Newstrom N, Coleman E. Teaching Sexual History Taking in Health Care Using Online Technology: A PLISSIT-Plus Zoom Approach During the Coronavirus Disease 2019 Shutdown. Sex Med 2020; 9:100290. [PMID: 33445044 PMCID: PMC7930878 DOI: 10.1016/j.esxm.2020.100290] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/03/2022] Open
Abstract
Aim Cancellation of university classes during the coronavirus disease 2019 pandemic challenges teaching inperson sexual history–taking skills to medical, physician assistant, and nursing students. We used commercial online electronic services for medical students to learn sexual history–taking skills. Methods A total of 174 medical students viewed a lecture on sexual history taking and the PLISSIT model (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and were then randomized into dyads. They arranged a time to meet online on Zoom with their partner, chose a simple sexual history case-history (male or female) from a small selection, and recorded the 5- to 6-minute sexual history within a 1-week time frame. Each student played a “provider” or “patient” and then switched roles with a new case. One of the course tutors, all sexual health practitioners, downloaded 10 videos randomly assigned to them asynchronously and viewed and commented on the interaction of each “provider” along with comments on what to improve in the sexual history. 2 weeks later after the remainder of the lectures in the course, a second, more complex set of 8 cases were provided, so students could move at their comfort pace and choose 1. Main Outcome Measure Students were required to make 1 online post and 1 comment on another student's post for each case, on the experience, and associated issues arising, positive or negative. All comments were downloaded and analyzed by theme. Results Major themes included developing comfort in using sexual language, using simpler sexual terms suitable for patients, feeling confidence and mastery, excitement using technology developing clinical skills, surprise watching their performances and body language, observation of how they appeared to the “patient,” organizing sexual histories and incorporating PLISSIT model, ability to ask about context and relationships, and seeing the exercise as building on existing clinical skills training. Some expressed anxiety and nervousness, which by the second case had largely or completely dissipated. Conclusion A readily replicable, secure, cheap cloud-based model to integrate sexual history training asynchronously was provided, with tutors’ comments, and student skills development, and performance evaluated. Ross MW, Newstrom N, Coleman E. Teaching Sexual History Taking in Health Care Using Online Technology: A PLISSIT-Plus Zoom Approach During the Coronavirus Disease 2019 Shutdown. Sex Med 2021;9:100290
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Affiliation(s)
- Michael W Ross
- Program in Human Sexuality, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Nicholas Newstrom
- Program in Human Sexuality, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eli Coleman
- Program in Human Sexuality, University of Minnesota Medical School, Minneapolis, MN, USA
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Drozdowicz L, Gordon E, Shapiro D, Jacobson S, Zalpuri I, Stewart C, Lewis AL, Robinson L, Myint MT, Daniolos P, Williamson ED, Pleak R, Graeff Martins AS, Gleason MM, Galanter CA, Miller S, Stubbe D, Martin A. Sexual Health in Child and Adolescent Psychiatry: Multi-Site Implementation Through Synchronized Videoconferencing of an Educational Resource Using Standardized Patients. Front Psychiatry 2020; 11:593101. [PMID: 33329142 PMCID: PMC7716796 DOI: 10.3389/fpsyt.2020.593101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs). Methods: We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country. Results: We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with "awkward" and "uncomfortable" the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge (p = 0.004) and in attitudes (p < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients (p < 0.001 for each). Conclusions: A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.
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Affiliation(s)
- Linda Drozdowicz
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | | | - Desiree Shapiro
- University of California, San Diego, San Diego, CA, United States
| | | | | | - Colin Stewart
- Georgetown University, Washington, DC, United States
| | - A. Lee Lewis
- Medical University of South Carolina, Charleston, SC, United States
| | - Lee Robinson
- Cambridge Health Alliance, Cambridge, MA, United States
| | | | | | | | - Richard Pleak
- Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | | | | | - Cathryn A. Galanter
- SUNY Downstate Medical Center, Brooklyn, NY, United States
- Kings County Hospital Center, Brooklyn, NY, United States
| | - Sarah Miller
- Temple University, Philadelphia, PA, United States
| | - Dorothy Stubbe
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, United States
- Private Practice, New York, NY, United States
- Standardized Patient Program, Teaching and Learning Center, Yale School of Medicine, New Haven, CT, United States
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Seitz T, Ucsnik L, Kottmel A, Bitzer J, Teleky B, Löffler-Stastka H. Let us integrate sexual health-do psychiatrists integrate sexual health in patient management? Arch Womens Ment Health 2020; 23:527-534. [PMID: 31897606 PMCID: PMC7368870 DOI: 10.1007/s00737-019-01016-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023]
Abstract
The high prevalence of sexual dysfunction and the importance of sexual health issues in general stress the need for a physician to integrate sexual health issues in patient management. In this study, we evaluate the frequency of psychiatrists addressing sexual health issues as well as their attitude towards sexual health. Plus, we want to evaluate the multi-professional network for patient treatment that is needed by physicians for collaboration with other medical specialists and health care professionals. At total 100 psychiatrists (age range 30-60 years), participating at the annual meeting of the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics, were invited to self-assess their caring for patients' sexual health issues and answer a self-report questionnaire. The return rate was 74%. A third of the participating psychiatrists and psychotherapists stated to address sexual health in patients in daily routine. Twenty-five percent of the physicians suspected sexual health problems in 60-100% of their patients but did not ask the patients about this topic. Mentioned reasons why patients would not actively address sexual problems were rated by the survey participants "a different problem was more important", "lack of time", and "embarrassment". Only few of the participating psychiatrists stated to offer a consultation in sexual health to the patients, none to offer sexual therapy. A mentioned reason was "lack of competence regarding sexual health". Twelve percent referred the patients with sexual issues to a physician with another medical specialization, especially to experts in gynaecology and obstetrics, to experts in urology, or to andrologists. However, a need for a network in the field of sexual medicine was stated and an unawareness of a sexual health care network: where to refer the patients in need. Our data showed an increased need in the routine treatment and management of sexual health care in psychiatrists and psychotherapists. Plus, the data stresses the need for professional sexual medicine qualification and for extended cooperation between different medical fields and health care professionals in order to integrate sexual health topics professionally in daily routine.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, SMZ SÜD, Vienna, Austria
| | - Lucia Ucsnik
- Department of Visceral Surgery, University Clinic of Surgery, Medical University Vienna, Vienna, Austria
| | - Andrea Kottmel
- Private Practice for Gynecology and Sexual Medicine, Vienna, Austria
| | | | - Bela Teleky
- Department of Visceral Surgery, University Clinic of Surgery, Medical University Vienna, Vienna, Austria
| | - Henriette Löffler-Stastka
- University Clinic of Psychoanalysis and Psychotherapy, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Austrian Society of Psychiatry, Psychotherapy and Psychosomatics, Section Psychotherapy, Vienna, Austria.
- Postgraduate Unit, Teaching Center, Medical University Vienna, Vienna, Austria.
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Baati I, Ellouze S, Jedidi J, Sellami R, Trigui D, Damak J, Feki I, Masmoudi J. Connaissances, attitudes et pratiques des étudiants en médecine en matière de sexualité. Pan Afr Med J 2020; 35:141. [PMID: 32655755 PMCID: PMC7335256 DOI: 10.11604/pamj.2020.35.141.12910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/16/2017] [Indexed: 12/01/2022] Open
Abstract
La sexualité est un aspect central de la personne humaine qui, devant des problèmes sexuels, va fréquemment se tourner vers une source qu'elle considère compétente et bien informée, son médecin. Les objectifs de notre étude étaient d’évaluer les connaissances, les attitudes et les pratiques des étudiants en médecine en termes de sexualité et d’identifier les principaux déterminants du manque de connaissances basiques à ce sujet. Notre étude était descriptive et analytique, menée auprès des étudiants à la faculté de médecine de Sfax (Tunisie). Le questionnaire, rempli individuellement et de manière anonyme par chaque étudiant, recueillait les données sociodémographiques, les connaissances en matière de sexualité ainsi que leurs sources, les attitudes adoptées par les étudiants vis-à-vis de la sexualité et les pratiques sexuelles. La note totale moyenne relative aux questions de sexologie était de 11,05/20. Les facteurs corrélés à un score moyen élevé aux questions de sexologie étaient le sexe masculin (p=0,003), le statut de marié (p=0,012), le niveau socio-économique élevé (p=0,02), les livres comme source d’informations (p=0,041) et la présence de pratiques sexuelles (p<0,001). Ces pratiques étaient toutes significativement plus fréquentes chez les étudiants de sexe masculin (p<0,001). Des lacunes dans les connaissances en matière de sexualité existent chez les étudiants en médecine, du moins dans certains de ses aspects. Un programme d'enseignement complet et uniforme sur la sexualité humaine, surtout dans ses aspects physiologiques, peut sensiblement améliorer la capacité des futurs médecins à fournir des soins optimaux à leurs patients.
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Affiliation(s)
- Imen Baati
- Service de psychiatrie «A», CHU Hédi Chaker Sfax, Université de Sfax, Tunisie
| | - Sahar Ellouze
- Service de psychiatrie «A», CHU Hédi Chaker Sfax, Université de Sfax, Tunisie
| | - Jihen Jedidi
- Service de médecine communautaire et d'épidémiologie, CHU Hédi Chaker Sfax, Université de Sfax, Tunisie
| | - Rim Sellami
- Service de psychiatrie «A», CHU Hédi Chaker Sfax, Université de Sfax, Tunisie
| | - Dorsaf Trigui
- Service de psychiatrie «A», CHU Hédi Chaker Sfax, Université de Sfax, Tunisie
| | - Jamel Damak
- Service de médecine communautaire et d'épidémiologie, CHU Hédi Chaker Sfax, Université de Sfax, Tunisie
| | - Ines Feki
- Service de psychiatrie «A», CHU Hédi Chaker Sfax, Université de Sfax, Tunisie
| | - Jawaher Masmoudi
- Service de psychiatrie «A», CHU Hédi Chaker Sfax, Université de Sfax, Tunisie
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20
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Olímpio LM, Spessoto LCF, Fácio FN. Sexual health education among undergraduate students of medicine. Transl Androl Urol 2020; 9:510-515. [PMID: 32420157 PMCID: PMC7215031 DOI: 10.21037/tau.2020.02.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Sexuality occupies a fundamental position in the lives of individuals and is related to general health. However, undergraduate curricula in medical courses address this topic in an incomplete manner. The aim of this study is to investigate sexual health education among undergraduate medical students. Methods A descriptive, cross-sectional study was conducted with students 18 years of age and older in the fifth and sixth years of the undergraduate course in medicine in 2018. Data were collected using a self-administered questionnaire addressing the teaching of sexual health in the first four years of the course and how knowledge on this topic affected their relationships with patients. Results A total of 125 students answered the questionnaire. Although the majority reported the teaching of sexual medicine during the undergraduate course, the classes were focused on reproduction (70%) and organic diseases (70%). A total of 52% of the respondents reported that the classes did not enhance their knowledge or confidence with regards to discussing the subject with patients. During routine care, the main difficulties the students faced in addressing the sexual health of patients were fear of offending the patient (53.8%) and insufficient knowledge on the subject (33.4%). Conclusions The present findings demonstrate that knowledge of students regarding sexual health in undergraduate courses is insufficient, as evidenced by deficiencies in teaching and difficulties in addressing the subject with patients.
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Affiliation(s)
- Larissa Martins Olímpio
- Undergraduate Student, São José Rio Preto School of Medicine (FAMERP/FUNFARME), São José do Rio Preto, SP, Brazil
| | - Luís Cesar Fava Spessoto
- Department of Urology, São José Rio Preto School of Medicine (FAMERP/FUNFARME), São José do Rio Preto, SP, Brazil
| | - Fernando Nestor Fácio
- Department of Urology, São José Rio Preto School of Medicine (FAMERP/FUNFARME), São José do Rio Preto, SP, Brazil
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Gruskin S, Yadav V, Castellanos-Usigli A, Khizanishvili G, Kismödi E. Sexual health, sexual rights and sexual pleasure: meaningfully engaging the perfect triangle. Sex Reprod Health Matters 2019; 27:1593787. [PMID: 31533569 PMCID: PMC7887957 DOI: 10.1080/26410397.2019.1593787] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To improve sexual health, even in this charged political moment, necessitates going beyond biomedical approaches, and requires meaningfully addressing sexual rights and sexual pleasure. A world where positive intersections between sexual health, sexual rights and sexual pleasure are reinforced in law, in programming and in advocacy, can strengthen health, wellbeing and the lived experience of people everywhere. This requires a clear understanding of what interconnection of these concepts means in practice, as well as conceptual, personal and systemic approaches that fully recognise and address the harms inflicted on people's lives when these interactions are not fully taken into account. Bridging the conceptual and the pragmatic, this paper reviews current definitions, the influences and intersections of these concepts, and suggests where comprehensive attention can lead to stronger policy and programming through informed training and advocacy.
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Affiliation(s)
- Sofia Gruskin
- Chair of the Global Advisory Board for Sexual Health & Wellbeing; Director of the Institute on Inequalities in Global Health, Program on Global Health and Human Rights, University of Southern California, Los Angeles, CA, USA
| | - Vithika Yadav
- Member of the Global Advisory Board for Sexual Health & Wellbeing; Head of Love Matters India, Delhi, India
| | - Antón Castellanos-Usigli
- Member of the Global Advisory Board for Sexual Health & Wellbeing; Director of Prevention Programs at Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Gvantsa Khizanishvili
- Member of the Global Advisory Board for Sexual Health & Wellbeing; World Contraception Day Ambassador for Eastern Europe and Central Asia, Tbilisi, Georgia
| | - Eszter Kismödi
- Member of the Global Advisory Board for Sexual Health & Wellbeing; Chief Executive, Sexual and Reproductive Health Matters, Geneva, Switzerland
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Komlenac N, Siller H, Hochleitner M. Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University. Sex Med 2019; 7:318-325. [PMID: 31153879 PMCID: PMC6728799 DOI: 10.1016/j.esxm.2019.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/04/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The quantity and quality of education in the field of human sexuality vary greatly in medical education programs in the United States and Europe. AIM The current state of medical school education with regard to human sexuality was assessed at an Austrian medical university. METHODS Self-constructed questionnaires and the Beliefs About Sexual Functioning Scale were filled out by 391 medical students (mean age = 24.0, SD = 2.5; 52.4% women, 47.6% men). Descriptive statistics are reported for summarizing students' responses, and structural equation models were calculated to reveal associations between variables of interest. MAIN OUTCOME MEASURES The outcome variable in the structural equation models was students' confidence in addressing sexual health concerns of patients. RESULTS Most students were not instructed in sexual history taking (96.9%), sexual behavior (94.3%), love (97.4%) or sexuality in elderly persons (95.1%), and they reported having poor knowledge of these topics. Most students (72.5%) reported having little or no confidence in addressing patients' sexual health concerns. The number of addressed topics was positively associated with male (β = 0.47, P < .001) and female students' (β = 0.52, P < .001) knowledge. Knowledge was positively associated with male (β = .49, P < 0.001) and female students' (β = 0.33, P < .001) confidence in addressing sexual health concerns and was negatively associated with stereotypical sexual functioning beliefs in the male subsample (β = -0.26, P = .009). CONCLUSIONS Most medical students revealed that the teaching of important sexual health content (eg, sexual history taking) was deficient at this medical university. Education in sexual health issues needs to be increased to positively influence students' knowledge of and consequently their confidence regarding dealing with patients' sexual health concerns. Komlenac N, Siller H, Hochleitner M. Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University. Sex Med 2019;7:318-325.
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Affiliation(s)
- Nikola Komlenac
- Gender Medicine Unit, Medical University of Innsbruck, Innsbruck, Austria.
| | - Heidi Siller
- Gender Medicine Unit, Medical University of Innsbruck, Innsbruck, Austria
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Frasca K, Castillo-Mancilla J, McNulty MC, Connors S, Sweitzer E, Zimmer S, Madinger N. A Mixed Methods Evaluation of an Inclusive Sexual History Taking and HIV Prevention Curriculum for Trainees. J Gen Intern Med 2019; 34:1279-1288. [PMID: 31037543 PMCID: PMC6614307 DOI: 10.1007/s11606-019-04958-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/30/2018] [Accepted: 02/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Health disparities exist in HIV risk in the USA among the lesbian-gay-bisexual-transgender-queer (LGBTQ) community. There is also scarce literature on curricula for HIV prevention and pre-exposure prophylaxis (PrEP) for trainees. AIM To create a curriculum to train residents to perform inclusive sexual history taking and HIV prevention care. The curriculum covers sexual history, LGBTQ health, sexually transmitted infections, and HIV risk assessment and risk reduction counseling including use of PrEP. SETTING A dedicated PrEP Clinic was created within an Academic Medical Center Outpatient HIV Clinic. Patients were primarily LGBTQ identified, but also included HIV sero-discordant couples, cisgender individuals, heterosexual invididuals, and those with experience of homelessness, sex work, and substance abuse. PARTICIPANTS Thirty-four internal medicine residents completed the course between November 2017 and May 2018. PROGRAM DESCRIPTION The curriculum was delivered as Just in Time Teaching (JiTT) via online virtual patient cases followed by directly observed clinical care at a large urban PrEP clinic. PROGRAM EVALUATION AND RESULTS The effectiveness of the curriculum was assessed through paired pre/post-self-assessment surveys (n = 19), additional post-surveys on the online modules (n = 22), and interviews (n = 9). Many respondents reported no prior training or inadequate prior training in the course content. As a result of the course, participants reported statistically significant increased confidence and comfort in all seven HIV prevention topic areas, with the greatest gains in safe sex counseling for LGBTQ patients and in discussing PrEP (mean changes of 1.21, 1.58 on 5-point Likert scale, respectively, p < 0.0001). Six of nine interviewees post-course had applied what they learned to patient care; five indicated their learning would benefit patients. DISCUSSION An HIV prevention curriculum focused on cultural humility in care can improve trainee's skills in HIV risk reduction counseling, including PrEP, among all patients including those identifying as LGBTQ.
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Affiliation(s)
- Katherine Frasca
- Division of Infectious Diseases, University of Colorado, Aurora, CO, USA.
| | | | | | - Susan Connors
- School of Education and Human Development, University of Colorado Denver, Aurora, CO, USA
| | - Elizabeth Sweitzer
- School of Education and Human Development, University of Colorado Denver, Aurora, CO, USA
| | - Shanta Zimmer
- Division of Infectious Diseases, University of Colorado, Aurora, CO, USA
- School of Medicine, University of Colorado, Aurora, CO, USA
| | - Nancy Madinger
- Division of Infectious Diseases, University of Colorado, Aurora, CO, USA
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Palmer BA, Lee JH, Somers KJ, Swintak CC, Rullo J, Bright RP, Michael Bostwick J, Frye MA, Sperry JA. Effect of In-Class vs Online Education on Sexual Health Communication Skills in First-Year Medical Students: a Pilot Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2019; 43:175-179. [PMID: 29949052 DOI: 10.1007/s40596-018-0949-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Online education is effective for knowledge acquisition, but its effect on clinical skill development is not well characterized. We aimed to compare communication skills of 50 first-year medical students who learned to assess and treat patients through an online learning module vs an in-class lecture. METHODS Twenty-six students were randomized to learn about antidepressant-induced sexual dysfunction in class and 24 learned the same content through an online module. Students were individually observed conducting an interview with a standardized patient with antidepressant-induced sexual dysfunction. Students were assessed by faculty raters blinded to the student's learning mode. Standardized patients were asked about their willingness to have the student as their physician. RESULTS More students who learned in class vs online demonstrated appropriate verbal empathy (18 [69%] vs 8 [33%]; P = 0.01), defined as completing each task in the "verbal empathy" assessment domain, as measured by a faculty rater. Other assessed variables were not significantly different. Standardized patients' willingness (vs unwillingness; P = 0.01) to have the student as their physician was associated with the demonstration (by faculty appraisal) of a number of basic skills: using open-ended questions, asking one question at a time, using gender-neutral terminology when asking about the patient's relationship, and using appropriate sexual-health terminology. CONCLUSIONS This study, although limited by a single-site design and the small number of participants, offers preliminary evidence that, if confirmed, may suggest that in-class learning from a psychiatrist (vs from an online module) is associated with greater verbal empathy in the assessment of SSRI-related sexual dysfunction.
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Affiliation(s)
| | - James H Lee
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Feuz C, Tse K, Kwan M, Hill C, Rakaric P, Tan K, Rosewall T. Implementing Workshops to Improve Radiation Therapists' Knowledge and Attitudes about Sexual Health Issues in Cancer Patients. J Med Imaging Radiat Sci 2018; 50:98-105. [PMID: 30777255 DOI: 10.1016/j.jmir.2018.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Although it is widely acknowledged that radiotherapy treatments can have a negative impact on a patient's sexual health, this aspect of side effect management is not commonly addressed by radiation therapists or by other cancer specialists. It is important for radiation therapists to recognize and address possible sexual health issues to provide a holistic approach to care. This quality-improvement project was designed to help radiation therapists discuss the sexual health needs of patients undergoing radiotherapy by improving their clinical knowledge, skills, and comfort level about the topic. METHODS This study used a cross-sectional descriptive prequestionnaire/postquestionnaire design, in which data were collected from a nonrandom sample of radiation therapists at a single urban radiation therapy center. Participants attended two 90-minute sexual health education workshops specifically designed for radiation therapists and completed online preworkshop/postworkshop questionnaires. All questions were quantitative in nature. The survey consisted of multiple-choice, multiple-select, and five-point Likert-scale questions. Descriptive analysis was used for data analysis. RESULTS The results of this improvement project indicated that participants had introductory-level knowledge about how cancer treatments can impact patients' sexual health. Although there is potential for some changes in the general knowledge levels of the participants after the initiative, two general workshops about the topic are not enough to have radiation therapists feel comfortable enough with the topic to change their clinical practice. CONCLUSION This project identified that although radiation therapists acknowledge the importance of discussing sexual health concerns as part of delivering holistic health care, lack of knowledge and expertise with the topic is a main barrier to initiating conversations. To help prepare radiation therapists, education and training initiatives, which build on knowledge and offer opportunities to develop and apply practical skills in both simulated and real-life situations, should be created. This can help to increase confidence in the sexual health counseling provided, which may result in more radiation therapists frequently engaging in these important sexual health conversations.
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Affiliation(s)
- Carina Feuz
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada.
| | - Karen Tse
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Maisie Kwan
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christine Hill
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Peter Rakaric
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Kieng Tan
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Tara Rosewall
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; University of Toronto, Department of Radiation Oncology, Toronto, Ontario, Canada
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Vieira TCSB, Nakamura MU, da Silva I, Torloni MR, Ribeiro MC, Scanavino MDT, de Souza E. Experience of an online course on sexuality during pregnancy for residents. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 12:76-81. [PMID: 28477936 DOI: 10.1016/j.srhc.2017.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/01/2017] [Accepted: 03/08/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Many obstetrics and gynecology (Ob/Gyn) residents report insufficient knowledge about female sexuality and this has a negative impact on their capacity to manage their patients. The aim of this study was to describe an online course about sexuality during pregnancy for Brazilian Ob/Gyn residents and evaluate their knowledge acquisition. METHODS This longitudinal educational intervention study involved 219 Brazilian Ob/Gyn residents. The online course lasted 24h (10 video lectures and discussion chats). Upon enrollment, the participants answered a questionnaire in regard to their training, attitudes and practices about sexuality during pregnancy. Participants' knowledge acquisition was assessed using a pre- and post-course test about sexuality during pregnancy. At the end of the course, participants were asked to evaluate their educational experience. Student's t and chi-square tests were used to analyze the pre- and post-course test scores. P values<0.05 were considered statistically significant. RESULTS A total of 143 Ob/Gyns (65.3% of those enrolled) completed the course. At baseline, most participants reported that they did not have any sexology classes as undergraduates (62.5%) or in their residency (52.1%), and that they lacked specific knowledge in this area to manage their patients. Mean test scores increased significantly at the end of the course: 4.4 (±1.6) versus 6.0 (±1.3) (out of a maximum score of 10), before and after the course, respectively (p<0.0001). Most of the residents rated the overall quality of the course as "higher than expected". CONCLUSION An online course for Ob/Gyn residents was associated with a significant increase in knowledge about sexuality during pregnancy.
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Affiliation(s)
- Teresa Cristina Souza Barroso Vieira
- Department of Obstetrics, São Paulo Federal University (UNIFESP), Rua Napoleão de Barros, 875, Vila Clamentino, CEP 04124-002 São Paulo, São Paulo, Brazil
| | - Mary Uchiyama Nakamura
- Department of Obstetrics, São Paulo Federal University (UNIFESP), Rua Napoleão de Barros, 875, Vila Clamentino, CEP 04124-002 São Paulo, São Paulo, Brazil
| | - Ivaldo da Silva
- Department of Gynecology, São Paulo Federal University (UNIFESP), São Paulo, Brazil
| | - Maria Regina Torloni
- Department of Obstetrics, São Paulo Federal University (UNIFESP), Rua Napoleão de Barros, 875, Vila Clamentino, CEP 04124-002 São Paulo, São Paulo, Brazil; Department of Internal Medicine, São Paulo Federal University (UNIFESP), São Paulo, Brazil.
| | - Meireluci Costa Ribeiro
- Department of Obstetrics, São Paulo Federal University (UNIFESP), Rua Napoleão de Barros, 875, Vila Clamentino, CEP 04124-002 São Paulo, São Paulo, Brazil
| | - Marco de Tubino Scanavino
- Department and Institute of Psychiatry, São Paulo State University Medical School (FMUSP), São Paulo, Brazil
| | - Eduardo de Souza
- Department of Obstetrics, São Paulo Federal University (UNIFESP), Rua Napoleão de Barros, 875, Vila Clamentino, CEP 04124-002 São Paulo, São Paulo, Brazil
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Bos-Bonnie LHA, van Bergen JEAM, te Pas E, Kijser MA, van Dijk N. Effectiveness of an individual, online e-learning program about sexually transmitted infections: a prospective cohort study. BMC FAMILY PRACTICE 2017; 18:57. [PMID: 28438124 PMCID: PMC5402660 DOI: 10.1186/s12875-017-0625-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/30/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Primary health-care professionals play an important role in the treatment and prevention of Sexually Transmitted Infections (STI). Continuing Medical Education (CME)-courses can influence the knowledge and behavior of health-care professionals concerning STI. We performed a prospective cohort study to evaluate if the individual and online e-learning program "The STI-consultation", which uses the Commitment-to-Change (CtC)-method, is able to improve the knowledge, attitude and behavior of Dutch General Practitioners (GPs), concerning the STI-consultation. This e-learning program is an individual, accredited, online CME-program, which is freely available for all GPs and GP-trainees in the Netherlands. METHODS In total 2192 participants completed the questionnaire before completing the e-learning program and 249 participants completed the follow-up questionnaire after completing the e-learning program. The effect of the program on their knowledge, attitude and behavior concerning the STI-consultation was evaluated. RESULTS In total 193 participants formulated 601 learning points that matched the learning objectives of the program. The knowledge and attitude of the participants improved, which persisted up to two years after completing the program. Another 179 participants formulated a total of 261 intended changes concerning the sexual history taking, additional investigation and treatment of STI, 97.2% of these changes was partially or fully implemented in daily practice. Also, 114 participants formulated a total of 180 "unintended" changes in daily practice. These changes concerned the attitude of participants towards STI and the working conditions concerning the STI-consultation. CONCLUSION The individual, online e-learning program "The STI-consultation", which uses the CtC-method, has a small but lasting, positive effect on the knowledge, attitude, and behavior of GPs concerning the STI-consultation.
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Affiliation(s)
- Linda H. A. Bos-Bonnie
- Department of General Practice, Academic Medical Centre-University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
| | - Jan E. A. M. van Bergen
- Department of General Practice, Academic Medical Centre-University of Amsterdam, STI Aids Netherlands (Soa Aids Nederland), Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
| | - Ellen te Pas
- Department of Educational Support, Academic Medical Centre-University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
| | - Michael A. Kijser
- Dutch College of General Practitioners (Nederlands Huisartsen Genootschap, NHG), Mercatorlaan 1200, Utrecht, 3528 BL The Netherlands
| | - Nynke van Dijk
- Department of General Practice, Academic Medical Centre-University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ The Netherlands
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Sexuality education in Japanese medical schools. Int J Impot Res 2017; 29:160-163. [PMID: 28424503 DOI: 10.1038/ijir.2017.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/31/2017] [Accepted: 03/01/2017] [Indexed: 11/08/2022]
Abstract
The present study aimed to investigate current sexuality education in Japanese medical schools and the impact of position title in the Japanese Society for Sexual Medicine (JSSM). Questionnaires were mailed to urology departments in all Japanese medical schools. The responses were evaluated according to four factors: the number of lecture components, curriculum hours, degree of satisfaction with the components and degree of satisfaction with the curriculum hours. We also investigated differences in these four factors among three groups: Directors, Council members and non-members of the JSSM. The medians of curriculum hours and the number of the lecture components were 90.0 min and 7.0, respectively. The curriculum hours of the Directors (140.0 min) were significantly longer than those of the non-members (90.0 min; P<0.05). The number of lecture components taught by Directors (9.5) was significantly higher than that of the Council (4.0; P<0.01) and non-members (7.0; P<0.05). More than half of the faculties were not satisfied with the lecture components and curriculum hours. This is the first study on sexuality education in Japanese medical schools. It showed the inadequacy of both curriculum hours and lecture components, and that the position title of department chair affects sexuality education in medical schools.
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Toskin I, Cooper B, Troussier T, Klugman B, Kulier R, Chandra-Mouli V, Temmerman M. WHO guideline for brief sexuality-related communication: implications for STI/HIV policy and practice. REPRODUCTIVE HEALTH MATTERS 2017; 23:177-84. [PMID: 26719009 DOI: 10.1016/j.rhm.2015.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 11/06/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
Abstract
Brief sexuality-related communication (BSC) aims to identify current and potential sexual concerns and motivate those at risk to change their sexual behaviour or maintain safe sexual behaviour. BSC in primary health care can range from 5 to 60 minutes and takes into account biological, psychological and social dimensions of sexual health and wellbeing. It focuses on opportunistic rather than systematic or continuous communication and can be used in conjunction with already established prevention programs. The informational and motivational techniques of BSC enable health care providers to communicate more effectively with their patients, encouraging them to take steps to avoid HIV and sexually transmitted infections. The WHO Department of Reproductive Health and Research, following a review and assessment of existing evidence with regards to BSC, has recently published the guideline on Brief Sexuality-Related Communication: Recommendations for a Public Health Approach.
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Affiliation(s)
- Igor Toskin
- Scientist, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Bergen Cooper
- Consultant, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Barbara Klugman
- Visiting Professor, School of Public Health, Faculty of Health Sciences, University of the Witwatersrandd
| | | | | | - Marleen Temmerman
- Director, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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A black and white issue? Learning to see the intersectional and racialized dimensions of gynecological pain. SOCIAL THEORY & HEALTH 2017. [DOI: 10.1057/s41285-017-0027-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Schloegl I, Köhn FM, Dinkel A, Schulwitz H, Gschwend JE, Bosinski HAG, Herkommer K. Education in sexual medicine - a nationwide study among German urologists/andrologists and urology residents. Andrologia 2016; 49. [DOI: 10.1111/and.12611] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- I. Schloegl
- Department of Urology; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | | | - A. Dinkel
- Department of Psychosomatic Medicine and Psychotherapy; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | - H. Schulwitz
- Department of Urology; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | - J. E. Gschwend
- Department of Urology; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
| | | | - K. Herkommer
- Department of Urology; Klinikum rechts der Isar; Technical University of Munich; Munich Germany
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van Ek GF, Krouwel EM, Nicolai MP, Bouwsma H, Ringers J, Putter H, Pelger RCM, Elzevier HW. Discussing Sexual Dysfunction with Chronic Kidney Disease Patients: Practice Patterns in the Office of the Nephrologist. J Sex Med 2015; 12:2350-63. [PMID: 26633081 DOI: 10.1111/jsm.13062] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Sexual dysfunction (SD) is a common problem in patients suffering from chronic kidney disease (CKD). Sexual health remains a difficult subject to detect and discuss. Although many studies have been performed on the incidence of SD, little is known about practice patterns when it concerns quality of life (QoL)-related questions such as SD in the nephrologists' practice. AIM The aim of this study was to determine to which extent nephrologists, important renal care providers, discuss SD with their patients and their possible barriers toward discussing this subject. METHODS A 50-item questionnaire was sent to all Dutch nephrologists (n = 312). MAIN OUTCOME MEASURES The survey results. RESULTS The response rate of the survey was 34.5%. Almost all responders (96.4%) stated to address SD in less than half of their new patients. The most important barrier not to discuss SD was patients not expressing their concern regarding SD spontaneously (70.8%). Other important barriers were: "the lack of a suitable moment to discuss" (61.9%) and "insufficient time" (46.9%). Eighty-five percent of the nephrologists stated that insufficient attention was paid to SD and treatment options during their training. Sixty-five percent of the respondents stated to be in need of extending their knowledge on the discussing of SD. CONCLUSIONS Dutch nephrologists do not discuss problems with sexual function routinely. The lack of knowledge, suitable education, and insufficient time are factors causing undervaluation of SD in CKD patients. Implementation of competent sexual education and raising awareness among nephrologists on the importance of paying attention to SD could improve care and QoL for patients with CKD. More research should be performed among patients and other renal care providers to develop an adequate method to enhance our current system.
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Affiliation(s)
- Gaby F van Ek
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Esmée M Krouwel
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Melianthe P Nicolai
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hanneke Bouwsma
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Ringers
- Department of Transplant Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hein Putter
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Henk W Elzevier
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
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Collecting and registering sexual health information in the context of HIV risk in the electronic medical record of general practitioners: a qualitative exploration of the preference of general practitioners in urban communities in Flanders (Belgium). Prim Health Care Res Dev 2015; 17:333-50. [PMID: 26486073 DOI: 10.1017/s1463423615000456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
UNLABELLED Background and aim Current health-care delivery requires increasingly proactive and inter-professional work. Therefore, collecting patient information and knowledge management is of paramount importance. General practitioners (GPs) are well placed to lead these evolving models of care delivery. However, it is unclear how they are handling these changes. To gain an insight into this matter, the HIV epidemic was chosen as a test case. METHODS Data were collected and analysed from 13 semi-structured interviews with GPs, working in urban communities in Flanders. Findings GPs use various types of patient information to estimate patients' risk of HIV. The way in which sexual health information is collected and registered, depends on the type of information under discussion. General patient information and medical history data are often automatically collected and registered. Proactively collecting sexual health information is uncommon. Moreover, the registration of the latter is not obvious, mostly owing to insufficient space in the electronic medical record (EMR). CONCLUSIONS GPs seem willing to systematically collect and register sexual health information, in particular about HIV-risk factors. They expressed a need for guidance together with practical adjustments of the EMR to adequately capture and share this information.
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Ariffin F, Chin KL, Ng C, Miskan M, Lee VK, Isa MR. Are medical students confident in taking a sexual history? An assessment on attitude and skills from an upper middle income country. BMC Res Notes 2015; 8:248. [PMID: 26082003 PMCID: PMC4470357 DOI: 10.1186/s13104-015-1220-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 06/02/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Sexual history training during undergraduate education is essential for preparing future doctors to handle patients' sexual health concerns. The purpose of this study was to assess the attitudes and perceptions of final-year medical students in Malaysia toward sexual history taking and the training they receive from their medical schools. METHODS The study used a cross-sectional survey of 379 final-year medical students from three medical schools in Malaysia. Students were asked to rate their attitudes and perceptions regarding training on taking sexual histories using a newly developed questionnaire with good internal consistency (Cronbach's alpha = 0.73). Ethics approval was obtained from the relevant medical schools, and the statistical analysis was conducted using SPSS, Version 20.0. RESULTS The mean age of participants was 23.58 ± 0.65 SD. Participants reported high interest in sexual health and felt it was important for doctors to know how to take a sexual history (95%). Among the participants, only half felt comfortable in taking sexual histories from patients. The participants identified cultural and religious differences between the doctor and the patient as a potential barrier for discussing sexual health. Participants were aware of their own practice and ability, as well as their limitations, in taking sexual histories. Less than half (46%) felt that the training they received adequately prepared them to take sexual histories. CONCLUSIONS This study identified gaps in sexual health training among medical schools in Malaysia. The delivery of sexual health education program should incorporate confidence building and to make students feel comfortable to take sexual histories from patients. The barrier caused by differences in culture or religion between a doctor and a patient may be overcome through cross cultural and cultural competency training. This is important for multi-faith, multi cultural societies such as Malaysia and other similar countries.
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Affiliation(s)
- Farnaza Ariffin
- Department of Family Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
| | - Ken Lee Chin
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Shah Alam, Malaysia.
| | - ChirkJenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Maizatullifah Miskan
- Department of Family Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia.
| | - Verna KarMun Lee
- Department of Family Medicine, Faculty of Medicine, International Medical University, Bukit Jalil, Malaysia.
| | - Mohammad Rodi Isa
- Department of Community Medicine, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia.
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Bayer CR, Satcher D. Moving Medical Education and Sexuality Education Forward. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-015-0050-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vieira TCSB, de Souza E, da Silva I, Torloni MR, Ribeiro MC, Nakamura MU. Dealing with female sexuality: training, attitude, and practice of obstetrics and gynecology residents from a developing country. J Sex Med 2015; 12:1154-7. [PMID: 25855896 DOI: 10.1111/jsm.12875] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is little research on how obstetrics and gynecology (Ob/Gyn) residents deal with female sexuality, especially during pregnancy. AIM The aim of this study was to assess the training, attitude, and practice of Ob/Gyn residents about sexuality. METHODS A cross-sectional survey of Brazilian Ob/Gyn residents enrolling in an online sexology course was conducted. A questionnaire assessed their training in sexuality during medical school and residency and their attitude and practice on sexual issues during pregnancy. MAIN OUTCOME MEASURES Training, attitude, and practice of Ob/Gyn residents regarding sexuality were the main outcome measures. RESULTS A total of 197 residents, from 21 different programs, answered the online questionnaire. Mean age was 27.9 ± 2.2, most were female (87%), single (79%), and had graduated in the last 5 years (91%). Almost two-thirds (63%) stated that they did not receive any training at all and 28% reported having only up to 6 hours of training about sexuality in medical school. Approximately half of the respondents (49%) stated that they had received no formal training about sexuality during their residency up to that moment and 29% had received ≤6 hours of training. Over half (56%) never or rarely took a sexual history, 51% stated that they did not feel competent or confident to answer their pregnant patients' questions about sexuality, and 84% attributed their difficulties in dealing with sexual complaints to their lack of specific knowledge on the topic. CONCLUSION The vast majority of Brazilian Ob/Gyn residents enrolling in a sexuality course had little previous formal training on this topic in medical school and during their residency programs. Most residents do not take sexual histories of pregnant patients, do not feel confident in answering questions about sexuality in pregnancy, and attribute these difficulties to lack of knowledge. These findings point to a clear need for additional training in sexuality among Brazilian Ob/Gyn residents.
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Affiliation(s)
| | - Eduardo de Souza
- Department of Obstetrics, São Paulo Federal University (UNIFESP), São Paulo, Brazil
| | - Ivaldo da Silva
- Department of Gynecology, São Paulo Federal University (UNIFESP), São Paulo, Brazil
| | - Maria Regina Torloni
- Department of Obstetrics, São Paulo Federal University (UNIFESP), São Paulo, Brazil.,Internal Medicine Department, São Paulo Federal University (UNIFESP), São Paulo, Brazil
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Bronner G, Aharon-Peretz J, Hassin-Baer S. Sexuality in patients with Parkinson's disease, Alzheimer's disease, and other dementias. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:297-323. [PMID: 26003251 DOI: 10.1016/b978-0-444-63247-0.00017-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sexual dysfunction (SD) is common among patients with Parkinson's disease (PD), Alzheimer's disease (AD), and other dementias. Sexual functioning and well-being of patients with PD and their partners are affected by many factors, including motor disabilities, non-motor symptoms (e.g., autonomic dysfunction, sleep disturbances, mood disorders, cognitive abnormalities, pain, and sensory disorders), medication effects, and relationship issues. The common sexual problems are decreased desire, erectile dysfunction, difficulties in reaching orgasm, and sexual dissatisfaction. Hypersexuality is one of a broad range of impulse control disorders reported in PD, attributed to antiparkinsonian therapy, mainly dopamine agonists. Involvement of a multidisciplinary team may enable a significant management of hypersexuality. Data on SD in demented patients are scarce, mainly reporting reduced frequency of sex and erectile dysfunction. Treatment of SD is advised at an early stage. Behavioral problems, including inappropriate sexual behavior (ISB), are distressing for patients and their caregivers and may reflect the prevailing behavior accompanying dementia (disinhibition or apathy associated with hyposexuality). The neurobiologic basis of ISB is still only vaguely understood but assessment and intervention are recommended as soon as ISB is suspected. Management of ISB in dementia demands a thorough evaluation and understanding of the behavior, and can be treated by non-pharmacologic and pharmacologic interventions.
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Affiliation(s)
- Gila Bronner
- Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel.
| | | | - Sharon Hassin-Baer
- Parkinson's Disease and Movement Disorders Clinic, Sagol Neuroscience Center, Department of Neurology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Lowenstein L, Reisman Y, Tripodi F, Dean J, Shechter A, Porst H. Oxford School of Sexual Medicine: how are we doing? J Sex Med 2014; 12:59-65. [PMID: 25329856 DOI: 10.1111/jsm.12719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Since 2007, the European Society of Sexual Medicine has held an annual 2-week educational residential program at Oxford. The Oxford School of Sexual Medicine provides knowledge and skills learning opportunities for healthcare professionals. AIM The aim of the current study was to evaluate the impact of Oxford School courses on the daily practice and medical careers of fellows from different countries. METHODS All participants in the Oxford School programs were invited to anonymously complete a self-administered questionnaire. MAIN OUTCOME MEASURES The questionnaire comprised three sections: socio-demographic characteristics of the respondents; four Likert-scale score items inquiring about professional background; and 17 closed and two open questions to evaluate the impact of Oxford School on the respondents' practices. Differences in proportions of categorical variables between respondent subgroups were assessed using Pearson χ(2) test. RESULTS The mean age of the 54 fellows who participated in the study was 44 years (range 28-63 years), 71% were men and 29% were women. Fifty (92%) were physicians, two (4%) psychologists, and two (4%) were sex therapists. Following participation in the Oxford School course, significantly more participants reported spending 50% or more of their clinical time practicing sexual medicine than prior to the course (59% [32] vs. 27% [15], P < 0.001, Figure 1); and significantly more reported spending 50% or more of their working time in clinical research (54% [29] vs. 33% [18], P < 0.001, Figure 2). Forty-six fellows (85%) reported current participation in teaching activities, compared with only 29 (54%) prior to participating in the Oxford School course. CONCLUSION Educational activities in sexual medicine, such as the Oxford School, may contribute to the advancement of clinical practice, teaching activities, and clinical research of healthcare providers who are interested in sexual medicine.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel
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Tales of a Reluctant Sex Radical: Barriers to Teaching the Importance of Pleasure for Wellbeing. SEXUALITY AND DISABILITY 2014. [DOI: 10.1007/s11195-014-9381-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schover LR, van der Kaaij M, van Dorst E, Creutzberg C, Huyghe E, Kiserud CE. Sexual dysfunction and infertility as late effects of cancer treatment. EJC Suppl 2014; 12:41-53. [PMID: 26217165 PMCID: PMC4250536 DOI: 10.1016/j.ejcsup.2014.03.004] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 01/08/2023] Open
Abstract
Sexual dysfunction is a common consequence of cancer treatment, affecting at least half of men and women treated for pelvic malignancies and over a quarter of people with other types of cancer. Problems are usually linked to damage to nerves, blood vessels, and hormones that underlie normal sexual function. Sexual dysfunction also may be associated with depression, anxiety, relationship conflict, and loss of self-esteem. Innovations in cancer treatment such as robotic surgery or more targeted radiation therapy have not had the anticipated result of reducing sexual dysfunction. Some new and effective cancer treatments, including aromatase inhibitors for breast cancer or chemoradiation for anal cancer also have very severe sexual morbidity. Cancer-related infertility is an issue for younger patients, who comprise a much smaller percentage of total cancer survivors. However, the long-term emotional impact of being unable to have a child after cancer can be extremely distressing. Advances in knowledge about how cancer treatments may damage fertility, as well as newer techniques to preserve fertility, offer hope to patients who have not completed their childbearing at cancer diagnosis. Unfortunately, surveys in industrialised nations confirm that many cancer patients are still not informed about potential changes to their sexual function or fertility, and all modalities of fertility preservation remain underutilised. After cancer treatment, many patients continue to have unmet needs for information about restoring sexual function or becoming a parent. Although more research is needed on optimal clinical practice, current studies suggest a multidisciplinary approach, including both medical and psychosocial treatment options.
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Affiliation(s)
- Leslie R. Schover
- Department of Behavioral Science, Unit 1330, University of Texas MD Anderson Cancer Center, PO Box 301439, Houston, TX 77230-1439, USA
| | - Marleen van der Kaaij
- Department of Internal Medicine, ZH 4A 35, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Eleonora van Dorst
- Department of Reproductive Medicine and Gynaecological Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Carien Creutzberg
- Department of Clinical Oncology, Leiden University Medical Center, K1-P, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Eric Huyghe
- Service d’Urologie et d’Andrologie, Hopital Rangueil, 1, avenue Jean Poulhes, TSA 50032, 31059 Toulouse Cedex 9, France
| | - Cecilie E. Kiserud
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
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Penwell-Waines L, Wilson CK, Macapagal KR, Valvano AK, Waller JL, West LM, Stepleman LM. Student perspectives on sexual health: implications for interprofessional education. J Interprof Care 2014; 28:317-22. [PMID: 24547937 DOI: 10.3109/13561820.2014.884553] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interprofessional collaboration requires that health professionals think holistically about presenting concerns, particularly for multimodal problems like sexual dysfunction. However, health professions students appear to receive relatively little sexual health education, and generally none is offered on an interprofessional basis. To assess current degree of interprofessional thinking in sexual health care, 472 health professions students in Georgia, United States, were presented with a sexual dysfunction vignette and asked to rate the relevance of, and their familiarity with, interventions offered by several professionals. They also were asked to identify the most likely cause of the sexual dysfunction. Students rated relevance and familiarity with interventions as highest for physicians and lowest for dentists, with higher ratings of nurses by nursing students. More advanced students reported greater familiarity with mental health, physician, and physical therapy interventions. Finally, nursing students were less likely to attribute the dysfunction to a physical cause. These findings indicate that students may prioritize biomedical approaches in their initial assessment and may need additional supports to consider the spectrum of biopsychosocial factors contributing to sexual functioning. To encourage interprofessional critical thinking and prepare students for interprofessional care, sexual health curricula may be improved with the inclusion of interprofessional training. Specific recommendations for curriculum development are offered.
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Affiliation(s)
- Lauren Penwell-Waines
- Department of Psychiatry and Health Behavior, Georgia Regents University Medical College of Georgia , Augusta, GA , USA
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Ribeiro S, Alarcão V, Simões R, Miranda FL, Carreira M, Galvão‐Teles A. General Practitioners' Procedures for Sexual History Taking and Treating Sexual Dysfunction in Primary Care. J Sex Med 2014; 11:386-93. [DOI: 10.1111/jsm.12395] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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MESH Headings
- Education, Medical, Graduate/standards
- Female
- Humans
- Male
- Quality of Health Care/standards
- Reproductive Health
- Reproductive Medicine/education
- Reproductive Medicine/standards
- Sexual Behavior
- Sexual Dysfunction, Physiological/diagnosis
- Sexual Dysfunction, Physiological/physiopathology
- Sexual Dysfunction, Physiological/psychology
- Sexual Dysfunction, Physiological/therapy
- Sexual Dysfunctions, Psychological/diagnosis
- Sexual Dysfunctions, Psychological/physiopathology
- Sexual Dysfunctions, Psychological/psychology
- Sexual Dysfunctions, Psychological/therapy
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Sidi H, Loh SF, Mahadevan R, Puteh SEW, Musa R, Wong CY, Hadi AAA, Sa'aid SH, Amali Z, Abidin M, Das S, Saharom MH, Zakaria H. Knowledge and attitude on sex among medical students of a Malaysian university: a comparison study. Asia Pac Psychiatry 2013; 5 Suppl 1:103-9. [PMID: 23857845 DOI: 10.1111/appy.12053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this study was to determine the relationship between clinical/socio-demographic factors with knowledge and attitude on sex among medical students of the National University of Malaysia (UKM). METHODS A cross-sectional study assessing 452 students using a self-administered questionnaire of knowledge and attitude was performed and had a response rate of 80%. RESULTS The majority of respondents were Malays (56%), females (57.5%), lived in urban areas (66.4%), had a median family income of RM3000 and perceived themselves as moderately religious (60%). The overall score on knowledge about sex was 21.7 of 35 (a higher score indicates better knowledge about sex). It was noted that 73.2% of students felt that they did not receive adequate training in medical school to deal with patients' sexuality and sexual problems, while 51.5% felt uncomfortable talking to patients about these issues. Students in the clinical year were more knowledgeable than those in pre-clinical years (22.67 versus 20.71, P < 0.001). No significant differences were found in terms of their backgrounds, such as being from urban or rural areas (P = 0.349) and between genders (P = 0.286). Only 54.9% of students had a satisfactory level of knowledge on sex (>22 marks [median score]). DISCUSSION The students' attitude on sex was considered conservative as the majority of them disagreed on premarital sex, masturbation, abortion, homosexuality and oral sex. Gender and religiosity have a large influence on attitudes on controversial sexual issues, whereas clinical status plays a small role. Knowledge on sex among UKM medical students is inadequate and their attitudes on sex are considered conservative. Integration of sexual medicine and health modules in the medical curriculum is crucial for students to more effectively address patients' sexual problems and promote non-judgmental attitudes towards patients.
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Affiliation(s)
- Hatta Sidi
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Tsai LY, Huang CY, Liao WC, Tseng TH, Lai TJ. Assessing student nurses' learning needs for addressing patients' sexual health concerns in Taiwan. NURSE EDUCATION TODAY 2013; 33:152-159. [PMID: 22683255 DOI: 10.1016/j.nedt.2012.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 04/27/2012] [Accepted: 05/14/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Patients' health status may involve sexual issues and nursing education must prepare nurses to address patients' sexual health concerns. In Taiwan, nursing school curricula rarely include programs related to patients' sexuality or sexual health issues, and reflect conservative Asian attitudes toward sexuality. OBJECTIVES Our aims were to determine Taiwanese student nurses' learning needs relative to addressing patients' sexual health concerns, and to gather information for curriculum development in sexual health education. DESIGN Descriptive, correlational study. SETTING Nursing school at a medical university in central Taiwan. PARTICIPANTS 140 senior student nurses. METHODS A 24-item instrument entitled "Learning Needs for Addressing Patients' Sexual Health Concerns" (LNAPSHC) was developed through 15 semi-structured interviews of senior nursing students, expert review, and comparative analysis of text and field notes. Content validity and reliability were evaluated using exploratory factor analysis to measure construct validity and Cronbach's alpha to measure internal consistency. Univariate and multivariate linear models were developed. RESULTS Age, gender, and religion were not significant influences. Expressed learning needs included sexuality in health and illness, communication about patients' intimate relationships, and approaches to sexual health care. "Obtaining a comprehensive sexual health history" was the highest learning need. "Having sexual consultations with patients without embarrassment" was lower. Most participants recognized their role in sexuality-related health care, but their preparation and willingness to address it were limited. CONCLUSIONS Our results indicated a gap between student nurses' positive perspectives on the role of nursing in sexual health care and their limited intention to provide it. Reported learning needs indicated that student nurses needed an effective curriculum to increase their ability and willingness to address patients' sexual health. Our results may help nursing educators develop curricula and clinical training to increase student nurses' competence in addressing patients' sexual health concerns.
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Affiliation(s)
- Li-Ya Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Oliver V, van der Meulen E, June L, Flicker S. If you teach them, they will come: providers' reactions to incorporating pleasure into youth sexual education. Canadian Journal of Public Health 2013. [PMID: 23618207 DOI: 10.1007/bf03405678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Sexual pleasure and satisfaction are integral components of the human sexual experience, yet these crucial aspects of sexuality are rarely placed on sexual education agendas. The objective of this paper is to explore the ways in which various groups of Service Providers (SPs) participating in the Toronto Teen Survey (TTS) understand the role of pleasure in sexual education for youth, highlighting the challenges and benefits of teaching pleasure in diverse settings. METHODS The TTS employed a community-based research (CBR) methodology. Between December 2006 and August 2007, 1,216 surveys were collected from youth in over 90 different community-based settings across Toronto by youth peer researchers. In 2008, 13 follow-up focus groups were conducted with 80 service providers from 55 different agencies around the Greater Toronto Area. All transcripts were input into qualitative data management software, NVIVO. Coding and analysis of data employed the constant comparative method. RESULTS SPs had a number of competing opinions about the inclusion of pleasure in sexual health education and programming. These concerns can be divided into three major areas: placing pleasure on the agenda; the role of gender in pleasure education; and the appropriate spaces and professionals to execute a pleasure-informed curriculum. CONCLUSION Access to resources, training and personal background determine SPs' willingness and ability to engage in the pedagogy of sexual pleasure. Medically trained clinicians were less likely to see themselves as candidates for instructing youth on issues of pleasure, believing that public health and health promotion professionals were more adequately trained and organizationally situated to deliver those services.
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Affiliation(s)
- Vanessa Oliver
- Department of Sociology, Mount Allison University, Sackville, NB.
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Shindel AW, Parish SJ. CME Information:Sexuality Education in North American Medical Schools: Current Status and Future Directions (CME). J Sex Med 2013; 10:3-17; quiz 18. [DOI: 10.1111/j.1743-6109.2012.02987.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Althof SE, Rosen RC, Perelman MA, Rubio-Aurioles E. Standard Operating Procedures for Taking a Sexual History. J Sex Med 2013; 10:26-35. [DOI: 10.1111/j.1743-6109.2012.02823.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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