Sexual dysfunction: a study on learning experience of Australian medical students

Introduction

Sexual dysfunction (SD) refers to the difficulties that occur during any or all phases of sexual response that prevents an individual from experiencing satisfying sexual activity, and it is (i.e. SD) sometimes referred to as sexual ‘problems’, ‘concerns’ or ‘difficulties’. SD is common in the Australian population, with the second Australian Study of Health and Relationships reporting over half the participants having at least one SD.¹ A patient’s sexual health and wellbeing is closely related to their physical and psychosocial wellbeing.^2,3 As such, SD can lead to sexual dissatisfaction, distress and a poorer quality of life.⁴ Despite this, research has shown that clinicians feel uncomfortable managing SD.^5–7 In a systematic review, a common theme between clinicians was the belief that they do not have the knowledge and skills to deal with SD of patients.⁷ Regardless of specialty, all physicians will encounter patients with SD and must have the adequate knowledge and skills to provide optimal sexual health care, including SD.⁵

There could be many reasons contributing to a clinician’s lack of comfort in discussing SD, including limited exposure to the content as a medical student.^6–8 A primary aim of medical education is to prepare future medical doctors with a sense of confidence to begin their work safely upon graduation.⁹ Studies have shown that medical students lack the confidence in addressing SD of patients, as they feel ill-equipped to do so.^10–12 Despite this, medical students do recognise the usefulness of learning about SD for their future clinical practice.^13,14 There is consensus within existing research that there is limited education and great variability in areas of SD in medical schools globally.^13–15 SD is usually taught in the sexual health curriculum alongside fertility, contraception, and sexual infections but comparatively receives less attention.^16,17 Potential reasons for this include competition for space within the curriculum, lack of expertise in teaching staff, and a failure to appreciate the importance of SD in clinical practice.¹⁸ There is currently little research detailing the gaps in medical curricula and the learning needs of medical students in Australia on topics of SD. One 2011 study of Australian and New Zealand medical schools found the topics of SD to be missing from the medical curricula.¹⁹

This study explores the nature and extent of SD-specific training that postgraduate medical students receive in one Australian university. The study aims to explore the students’ learning experience, the learning opportunities they are exposed to, and their level of comfort discussing SD.

Methods

Inclusion criteria for this study was final-year medical students attending The University of Sydney (Class of 2023). The total number of students was 252. An anonymous 10-item online questionnaire was developed. The survey questions were developed by the authors by considering the study’s aims. REDCap was used for survey development, distribution, and data collection. The questionnaire collected data regarding participant demographics, ratings of training experience, learning opportunities, and preparedness in managing a range of SD topics. A free text field allowed students to comment on the gaps in the curricula and training needs in SD. An inductive thematic analysis, using Braun and Clarke’s six steps guide, was used to identify the themes.²⁰ The survey was distributed during June–July 2023 via the learning management system, a closed cohort Facebook page, student email distribution, and flyers in each clinical schools’ communal space. Data were entered and statistically analysed in IBM SPSS ver. 29,²¹ and institutional ethics approval (HREC 2023/166) was obtained. Descriptive statistics were used to report most findings. A Chi-squared test was used to analyse students’ preparedness to manage ‘medication/substance-induced sexual dysfunction’ (MSISD) based on their learning experience in this topic. The reason for selecting MSISD for this analysis is because it is a topic that the majority of students had some training in; it is a medically focused topic that is not gender specific.

Results

Discussion

A study of medical schools in Australia and New Zealand found that ‘inadequate clinical placement opportunities’ was a weakness of the current sexual health curricula.¹⁹ Our data aligns with this finding, as it revealed students had limited opportunities to learn from patients presenting with SD as their primary complaint or as part of other co-morbidities.

Our study revealed that students were most likely to see patients presenting with SD in a community setting, rather than a hospital setting, and it aligns with the evidence that general practitioners act as the first point of contact for patients with sexual health concerns.^22,23

Consistent with previous studies, students reported an overall feeling unpreparedness to manage patients with SD.^10,11 We found that training improved self-perceived preparedness. This finding differs from a previous Australian study, which found students who had one or two learning experience opportunities reported no greater preparedness for clinical management than those reporting no experience.⁹ When analysing the nature of the training the students received, it was predominantly ‘semi-formal’ teaching (e.g. mentioning as part of broader case discussion). Our qualitative findings indicate that students are keen to have more education that provides both the knowledge and skills required to become confident in managing SD. Case-based discussions and role plays could be used to develop skills in initiating sensitive discussions.

Our study found that the most commonly taught SD topics were those with biomedical rather than psychosocial pathology, and this mirrors findings in previous research.^3,19 This may be because the psychotherapeutic techniques required for the management of SD originating from psychosocial causes are not usually taught in detail in an undergraduate curriculum. Only one in two students were comfortable initiating discussions on SD with patients, which is consistent with prior research into medical students’ low self-reported confidence.^11,13

This is a study for exploring the current training and attitudes of student towards SD in one medical school, which limits the generalisability of the findings to all medical schools in Australia. The intention of this study was not to be conclusive but to open a discussion on training needs in SD, and to pave a way for further research into medical students in Australia. Our study not only suggests that the current medical curriculum in the University of Sydney does offer some training and opportunity for medical students but also highlights the need for additional training to manage SD confidently and comfortably in real-world clinical settings. Considerations should be made in the curriculum to facilitate a broader recognition and understanding of SD and to prepare future clinicians to adequately address and manage these topics.