by Rebekah Rollston
As a primary care physician, people come to me with all sorts of questions about their sexual health: they want to know if their bodies are “normal,” how to keep themselves and their partners safe, what to do if they no longer desire sex. While they may have a hard time raising these questions, when asked directly, they are often grateful that I can listen and address their concerns without judgment.
Many people assume that their physicians have received significant training in sexual health, but unfortunately, the vast majority haven’t. The average medical school student, over the course of 4 years, receives just 3-10 hours of sexual health education.
Though my medical school offered more training than most schools, I felt the need to supplement this education. I attended the Sexual Health Leadership Course run by the American Medical Student Association, which was launched in 2009.
The course educates medical students on a range of topics related to sexuality, including body image, sexual self-esteem, transgender health concerns, sexual health counseling, the spectrum of sex practices, and the intersection of sexuality with culture and religion. It was during this course that I came to fully understand the enormity of the gender spectrum. During a small group session was dedicated to sexual health counseling for transgender health concerns, I struggled with how to address a patient during role play. It was then that the session leader noted, “Do not attempt to categorize people as male or female but instead, as a person with a uterus, or a person who has a penis.” This set me down the path of educating providers and advocating for patients who identify anywhere along the gender spectrum.
The year after I completed the Sexual Health Leadership Course, I was selected to be the co-director for the following two years. I had the opportunity to learn extensively about sexual health and ultimately, introduce some of these topics into the curriculum of my medical school.
In addition to training doctors to better understand and answer their patients’ questions, I believe we need more and better public health research into specific aspects of sexual health. During medical school, I participated in research looking at the correlation between self-esteem and the age of first sexual intercourse among high school students, the comfort level of primary care physicians when addressing patients’ sexual health concerns, and barriers to cervical cancer screening among transgender men.
I was met with much support for these projects, but also inevitably faced some obstacles. In my home state of Tennessee, where abstinence-based education remains the legal standard, school administrators balked at including survey questions that asked about types of sexual practices students engage in. I’ve had multiple teachers interrupt me during contraceptive education lectures with public high school students to note that abstinence until marriage is the expectation. During my third year of medical school, an attending physician pushed back against my research to measure comfort level of clinicians in addressing sexual health concerns because this research topic would make the other providers in his clinic feel uncomfortable. When I discussed my public health research regarding barriers to cervical cancer screening among transgender men with my physician colleagues, many providers noted they’ve never thought to perform pap smears for transgender men.
I’m fortunate to be in a primary care residency program where full-spectrum women’s health, including contraceptive and abortion care, is the norm. Sexual and reproductive health education of health care providers must be the way of the future. It is absolutely vital that we promote positive body image, healthy relationships, sexual self-esteem, consensual sex, reduction of sexual violence, movement from gender binary attitudes to embracing the full gender spectrum, and much more. The healthcare field has the opportunity to be on the frontlines of shaping healthier sexualities in our society — but first, medical educators and residency training programs must embrace the importance of their roles in the sexual health revolution.