Sexual health education of ob-gyn resident physicians: How are we doing?

Female sexual health education, while identified as a priority by many ob-gyn residency directors, remains a work in progress at many academic institutions throughout the United States.¹ Previous surveys have shown that recent medical school graduates and residents feel ill-equipped to manage patients with specific sexual health issues such as sexual dysfunction and arousal issues.²

To help address this deficiency, the Council on Resident Education in Obstetrics and Gynecology (CREOG) was formed in 2005 to create a set of specific learning objectives for residents focused on sexual health education. Specific areas of focus included education of the normal/abnormal sexual response, issues related to sexual dysfunction, key steps when taking a sexual history, and potential interventions in cases of identified sexual dysfunction. Ten years later, in 2015, CREOG established the Sexual Health Task Force to help create specific educational interventions tied to these learning objectives.

To gauge progress that had been made in the decade since the establishment of CREOG, more than 4,000 U.S.-based ob-gyn residents were sent a 32-item survey in June 2016 to gauge their comfort level in asking patients about their sexual history and providing counseling to patients of varying ages and ethnic/racial backgrounds. Brief case vignettes were used to pinpoint specific potential scenarios that would raise or lower respondents’ comfort levels.

For each of the 9 case vignettes, participants were asked to respond to 2 questions via a 5-point Likert scale (Very comfortable, somewhat comfortable, not very comfortable, not at all comfortable, I don’t know):

• How comfortable would you be in obtaining a sexual history from (this) patient?
• How comfortable would you be counseling (this) patient?

The case vignettes included the following patient descriptions:

1. 35-year-old presenting with vaginal discomfort that worsens with intercourse;
2. 28-year-old who has never had an orgasm and is incredibly nervous during the pelvic exam;
3. 16-year-old seeking contraception;
4. 26-year-old Somali refugee (interpreter is available as needed);
5. 57-year-old who complains of pain during intercourse and decreased libido;
6. 31-year-old who desires pregnancy and presents with her female partner;
7. 58-year-old transgender patient planning hormone therapy and surgery;
8. 17-year-old who discloses that she is a victim of sex trafficking;
9. 25-year-old who presents with vaginal discharge and discloses that she is a sex worker.

Results showed that at least 75% of respondents were comfortable taking a history and providing counseling for the majority of these patients, with the lone exceptions being patients 7 (transgender patient planning hormone therapy and surgery) and 8 (adolescent victim of sex trafficking). The highest level of comfort – topping 95% – came for patient 3 (teenager seeking contraception).

“I was pleasantly surprised by the wide-reaching interest in sexual health residents have,” Brett Worly, MD, MBA, an associate professor in the Department of Obstetrics and Gynecology at The Ohio State University Wexner Medical Center in Columbus, Ohio, and lead author of the study, told Contemporary OB/GYN®.

“They realize that sexual health education is an important component of their training in being prepared to take care of their patients,” he said. “I had hoped that the opportunities for more education would have been less pronounced, but areas like sex trafficking survivorship, cultural competency, and transgender care are real areas of opportunity for change.”

Overall, of the 968 respondents to the survey, 63.2% said that sexual health training was either “a priority” (53.5%) or a “top priority” (9.7%) during residency. However, the majority of respondents added that they didn’t have the ability to either describe disorders of sexual function (56.1%) or prepare a list of medications that affect sexual function (53.5%) following their residency program. Additionally, more than half of respondents said they were unaware that a comprehensive sexual history includes questions about masturbation and masturbation devices.

A final section of the survey asked about specific topics highlighted in the CREOG educational objectives that were or were not included in residents’ academic training. Correlating with the case vignette responses, only 16.8% of respondents said that they had received education focused on screening for human sex trafficking. Other areas of deficiency included sexual health for women with disabilities, cultural competence in sexual health, and therapies for sexual dysfunction.

Worly said that the COVID-19 pandemic has changed the way that education is broadly delivered, which may provide easier access to sexual health education resources for ob-gyn residents. This, he said, gives him hope that some of the deficiencies identified in this survey will be addressed in the future.

“COVID-19 has been horrible in every single way, but over the past 1.5 years, we have learned to be more accepting of virtual learning,” Worly said. “We no longer have to take several days out of our lives to travel across the country to give a 60-minute lecture on a subspecialized area of expertise. We can now use taped lectures, virtual platforms, and centralized access points to reach ob-gyn residents across the country and around the world. An important next step would be to create online learning experiences with subspecialized curriculum experts so that we can disseminate this information easily to residency programs who may not have an expert in a particular area. This will allow us to provide top notch education to our next generation of ob-gyn physicians.”

References

1. Worly B, Manriquez M, Stagg A, et al. Sexual health education in Ob/Gyn residencies – the program directors’ perspective. Int J Sex Health. 2019;30:390-397.
2. Pancholy AB, Goldenhar L, Fellner AN, et al. Resident education and training in female sexuality: Results of a nationwide survey. J Sex Med. 2011;8:361-366.
3. Worly B, Manriquez M, Stagg A, et al. Sexual health education in obstetrics and gynecology residencies – a resident physician survey. J Sex Med. 2021;Epub ahead of print.