Thinking Research: Educating Providers About Sexuality

By Gina Lepore, MEd / June 20, 2014

Few people realize how little education doctors and other health care providers typically receive about sexual and reproductive health. Because such training is spotty at best, there’s enormous variety in health care providers’ comfort with and knowledge of sexual health and sexual practices. Unfortunately, patients often suffer when provider knowledge and comfort concerning human sexuality are poor.

It’s true that women who see an OB-GYN are likely to find their health care provider possesses an in-depth understanding of the reproductive system. Similarly, urologists generally have a broader knowledge of the male reproductive system—it is, after all, intertwined with the urinary system. However, we can’t assume these health care providers know how to discuss sexual behaviors, satisfaction or dysfunction. It’s possible that none of their training or coursework has asked them to examine their own sexual values and assumptions, or consider how these might influence their ability to serve their patients.

In my current work as a Gynecological Teaching Associate (GTA) with Project Prepare, I conduct educational sessions with medical students at Stanford University, University of California San Francisco and Touro University. GTAs, along with Male Urological Teaching Assistants, or MUTAs, teach medical students how to perform comfortable and respectful gynecological and uro-genital exams. We also provide students an opportunity to practice how to talk with patients about sexual health in a sex-positive manner.

What They Don't Learn in Medical School

In my sessions with medical students, I incorporate insights gained from a range of professional experiences. In addition to my work with Project Prepare, I’ve worked at ETR, Planned Parenthood and a local adult store called Pure Pleasure. I’ve recently completed a master’s degree in human sexuality education. All of these experiences combine to help me present students with information and insights they don’t receive in medical school. Our sessions help raise students’ awareness about their personal assumptions concerning sexuality, and identify areas where their knowledge about sexual practices may be limited.

Understanding human sexuality—behaviors, drives, satisfaction, function and dysfunction—is crucial for practitioners who wish to offer quality care. Although sexuality educators and therapists can help people address sexual health issues, many people first take such issues to their health care providers. If these issues are met with discomfort, judgment or misinformation, the patient will be less likely to seek further support. To see how quickly biases or limited understanding can alienate patients and decrease the chance that they’ll return for future services, read the first few paragraphs of this article by Stephen S. Mills. The judgmental quality of his physician’s comments and queries tainted this man’s entire encounter.

Some providers avoid starting conversations about sexual health altogether, either consciously or unconsciously. Check Kris Freiwald’s recent column about the lack of condom use among middle-aged single and divorced males. I find myself wondering how often health care practitioners actually start conversations with heterosexual males about taking responsibility for their sexual health. Do they talk about using condoms, getting tested, being informed, and starting safer sex conversations with their partners?

Starting the Conversation

Earlier, I mentioned my work at Pure Pleasure. This is a “clean, well-lighted place” offering products for adult pleasure in a non-judgmental and supportive atmosphere. It’s owned and operated by a mother-daughter business team (“locally owned, certified green business”). They are committed to supporting positive sexuality, diversity and well-being.

People who aren’t familiar with businesses such as Pure Pleasure sometimes hold negative stereotypes about people who patronize such establishments. In fact, our customers are pretty much like anyone else you might meet at work, in your neighborhood or around your town. They’re regular folks of all ages who have questions about or an interest in sexual pleasure. Working at Pure Pleasure affords me the opportunity to have many conversations about sexual health and pleasure, as well as issues related to dysfunction.

One recent Sunday afternoon, an elderly man entered the store. He asked if we had a selection of items for men. As I directed him to that section of the store, he shared with me that since having prostate cancer surgery two years ago, he had experienced changes in his sexual response and ability to maintain an erection. He was frustrated that his doctor had not informed him of these potential side effects prior to his surgery, nor inquired about his sexual health since.

He likened his situation to receiving a sexual “death sentence”—one that affected his overall feeling of well-being and zest for life. This was especially disturbing because with a little education from his health care providers, he could have been prepared for changes in sexual function and given support to identify appropriate responses. There are an abundance of paths to regaining function and satisfaction.

Let's Learn From These Stories

These stories are telling us something important. Sexually responsible individuals such as author Stephen Mills find themselves chastised by ill-informed health workers. The physicians of middle-aged heterosexual men are missing opportunities to discuss safer sex practices. People who undergo surgeries receive inadequate education about how to prevent or mitigate side effects that affect their sexual well-being. Sexual health intersects with health care, and these stories underscore an important message: There is a clear and present need for increased sexual health education for medical practitioners.

In honor of men's health month (celebrated every June), I've shared stories that bring attention to some of the particular issues concerning men, their sexual health and their doctors. Let me hasten to add that women also face challenges getting support from health care providers about matters of sexual health. I could easily include tales of women being discouraged, discounted or misunderstood by health care providers on the matter of healthy sexuality. Any one of us, our friends and family, our clients and patients, might experience negative interactions with a poorly informed provider.

Here at ETR, we are expanding our focus on sexual and reproductive health. I have every intention of starting and sustaining conversations about this need for provider education and what we, as an organization, can do about it.

What Can You Do?

What can you do? Here are a few ideas:

1. If your doctor brings up the matter of sexual health and satisfaction, express your appreciation.
2. If your doctor doesn’t, consider starting the conversation yourself. “I have some questions about my sexual health I’d like to discuss.”
3. If your organization works with health generally or sexual and reproductive health specifically, get conversations going about supporting provider education on sexuality.
4. If you work directly with patients or clients, consider where there may be room for growth in your conversations about sexual health.
5. Talk this up with your friends. Let them know they have a right to respectful conversations about sexuality with their providers.

When and where are you starting these conversations? Please let me know. I’d love to hear more about it!

Gina Lepore, MEd, is a human sexuality educator and a Research Associate at ETR. You can reach her at ginal@etr.org or find her at LinkedIn.