Sexual health

The political events of the past few weeks, when three British cabinet ministers were either forced to admit their homosexuality or had it exposed by others, illustrates how difficult individuals, the press, and society find it to deal with sexual matters and sexual identity. Like any other members of the public, doctors will at times grapple with their own sexual orientation and problems and have varying views and value systems about sexual matters and morality. But they also have a responsibility to be well informed about sexual health so that they can educate and help patients at the same time as adopting a neutral and non-censorious position. It is bad manners and bad medicine to force one’s own personal moral attitudes and beliefs about sexual matters on patients.

Are members of the medical profession knowledgeable and comfortable enough about sexual health to be able to help their patients? Probably not. If undergraduate education is anything to go by, the omens are poor. A survey of undergraduate teaching of genitourinary medicine in Britain reported that only a third of teachers felt that most students (over 80%) from their medical schools would be able to take a sexual history or perform a genital examination on qualifying as doctors.¹ This survey also showed that the amount of time available for undergraduate teaching of genitourinary medicine had decreased during the decade before the survey. A further survey showed that a substantial proportion of Cambridge medical students thought that patients with HIV infection were to blame for their condition, that some did not deserve treatment, and that homosexuality could not be seen as part of an acceptable lifestyle.² Some hope came from the fact that London undergraduate students were more accepting of people with HIV; this might be because greater experience of dealing with patients has helped to create a more tolerant attitude.

The Medical Society for the Study of Venereal Diseases has now developed its own national consensus document on the essential topics in genitourinary medicine that should be included in the undergraduate core curriculum of all medical schools. It emphasises the fact that no other specialty deals so specifically with sexuality and that students should be encouraged to develop non-judgmental approaches towards patients with sexually transmitted diseases and sexual health problems.

This lack of training in sexual health at an undergraduate level must mean that doctors are ill prepared for this branch of medicine. The ABC of Sexual Health launched in this week’s issue is, therefore, to be warmly welcomed (p 1509). The two current ABCs, on AIDS and Sexually Transmitted Diseases (the second out in a new edition also this week), have dealt primarily with the clinical aspects of these diseases.³,⁴ The new ABC is a much more detailed examination of sexual problems and variations. This makes sense only if done in an open and explicit fashion, covering a wide variety of sexual habits and practices. Some readers may find the series too explicit for them, but ultimately it will help them to understand a variety of problems and behaviours so as to be able to deal with everyday issues presented by their patients. The new series will put the profession in touch with the real people with real problems and fill a large gap in our knowledge.

ABC p 1509