Female sexual medicine: What are students learning in undergraduate medical education?

Abstract

ABSTRACT Introduction In the United States, medical education on sexual medicine varies throughout the country and between institutions. With limited standardization, medical students and subsequent trainees have little to no training in how to approach a patient with concerns surrounding their sexual health. In 2018, half of the medical institutions in the United States required formal instruction in sexual medicine. Of those institutions that do include didactic material on sexual medicine, most of the material is dedicated to anatomy, physiology, and sexually transmitted infections, with limited or no information on sexual dysfunction and sexual history taking. Therefore, we identified a need to determine which components of sexual medicine, particularly female sexual medicine, are currently being covered in undergraduate medical education with the goal of proposing and developing standardized curriculum materials to be utilized by medical students during their preclinical education. Objective The aim of this study is to examine current preclinical curricula at all seven medical schools, including six allopathic and one osteopathic institution, in the Chicago, Illinois area to investigate which aspects of female sexual anatomy, physiology, pathology and pharmacology are being taught to medical students. Methods Curriculum materials on female sexual anatomy, physiology and pathology were collected from all seven medical schools in Chicago, Illinois. Courses covering topics on female sexual medicine varied between institutions due to differences in preclinical curriculum and coursework. To standardize our needs assessment, we utilized previous literature to identify specific components of anatomy, physiology, pathology, pharmacology, social sciences, and history and physical exam skills. Upon reviewing each institution's preclinical educational materials, we assessed curriculum content for saturation of specific concepts within each of the above areas. Results Curriculum materials were collected from seven (n=7) total medical schools in the surrounding Chicago, Illinois area. Out of the 7 institutions, 4/7 discussed clitoral anatomy, with 6/7 mentioning the glans, 1/7 mentioning the corona, 2/7 mentioning the clitoral hood, 6/7 mentioning the corpora cavernosa, 4/7 mentioning the corpus spongiosum, 6/7 mentioning the crus, 6/7 mentioning the bulb and 5/7 detailing the clitoral neurovasculature. In addition to the anatomy, 4/7 discussed the physiology of the female orgasm, 3/7 highlighted the rate and epidemiology of female sexual dysfunction (FSD), 3/7 included information on treatment for FSD, 1/7 taught a genitourinary physical exam specific to assessing FSD (external exam, internal exam, pelvic floor assessment), and 6/7 institutions included information on how to take a sexual history asking about sexual function, pleasure, and satisfaction. Conclusion Overall, our focused needs assessment of both allopathic and osteopathic medical schools in the Chicago, Illinois area highlights the need for restructuring of curriculum as it pertains to female sexual medicine and FSD in undergraduate medical education. Next steps include proposing individual curricular recommendations to institutions, due to the variation in current curriculum design, as to how they can better teach on areas surrounding FSD, while also aiming to standardize what medical students are learning during their preclinical years. Disclosure Work supported by industry: no.