Medicine Without Sexual Medicine Is Not Medicine: An MJCSM and ESSM Petition on Sexual Health to the Political and University Authorities
An editorial commentory in the Journal of Sexual Medicine (2019; Volume 16, Issue 6), by Emmanuele Jannini, MD and Yacov Reisman, MD, PhD, FECSM, ECPS
Quo usque tandem abutere, Catilina, patientia nostra? Quam diu etiam furor iste tuus nos eludet? (When, O Catiline, do you mean to cease abusing our patience? How long is that madness of yours still to mock us?).
Adapting the Incipit’s famous harangue of the most famous lawyer in history, we may ask when do we cease abusing our patients’ patience? How long until a modern medical student cannot earn the degree of physician without formal education in the basics and fundamentals of both biology and behavior—that is, sexuality?
Sexual medicine (SM) is a relatively young science, multidisciplinary in nature, encompassing all aspects of sexual health from the biopsychosocial perspective of systems medicine, a new interdisciplinary ﬁeld of study in which the individual’s or couple’s sexual health is considered in the context of interactions among genetic, biochemical, physiological, psychological, socioeconomic, political, and environmental variables.
Although the World Health Organization includes sexual health in the deﬁnition of overall health, well-being, and quality of life, SM and sexology are still not adequately recognized by the large majority of the European medical schools. However, numerous studies have shown not only a high prevalence of sexual dysfunction and its impact on intrapsychic, relational, and general health, but also the exquisite ability of sexual dysfunction itself to predict, or to be comorbid with, a number of noncommunicable chronic diseases.
Finally, the traditional belief that sexology is grounded more on opinions than on evidence is no longer tenable, considering the rapid accumulation of scientiﬁc evidence regarding SM and sexology over the last 20 years, with this area now well-recognized, ﬂourishing part of mainstream science.
Therefore, considering (i) the development of sophisticated diagnostic techniques in SM and psychometry; (ii) the growing availability of a number of speciﬁc psychological, pharmacologic, and surgical therapies for sexual dysfunction; (iii) the importance of sexual counseling for general health throughout the lifespan and in the large majority of diseases; (iv) the widespread interest in sexual health; and (v) the need for patients to get professional care and help for their sexual concerns, problems, and dysfunctions, students of medicine and healthcare professions within various specialties must be academically prepared to deal with medical and psychosocial aspects related to sexual health.
The Multidisciplinary Joint Committee of Sexual Medicine (MJCSM) is a body of the European Union of Medical Specialists (UEMS), the oldest continental medical organization with a current membership from 40 countries of the National Associations of Medical Specialists in the European Union and its associated countries, supporting excellence in SM and diffusion of good sexology practices by setting and deﬁning educational standards and accrediting training institutions, identifying minimal requirements for training, and developing an assessment framework. For all these reasons, the MJCSM recognizes the need to improve the impact of SM on academic and health institutions starting at the European level. This initiative has been jointly and strongly supported by the European Society of Sexual Medicine (ESSM), which was the founder of the MJCSM alongside the representatives of the UEMS Boards of Dermatology and Venereology, Endocrinology, Obstetrics and Gynecology, Psychiatry, and Urology. These boards are currently examining the issue in order to obtain the endorsement of the entire UEMS, and then the approval of the European Parliament.
The lack of academic education in sexology is not just a problem of the European Community, nor it is limited to the medical schools. SM is not taught in almost all faculties of medicine worldwide, and, surprisingly even many schools of psychology do not include sexology and psychosexology in their core curriculum. Thus, this MJCSM initiative garnered immediate support from the International Society of Sexual Medicine (ISSM) and the International Society for the Study of Women’s Sexual Health (ISSWSH), as well as such psychosexology associations as the European Federation of Sexology (EFS) and the World Association for Sexual health (WAS). Today, all experts in SM and in psychosexology, as well as all persons worldwide concerned with sexual health, are more than welcome to sign the MJCSM-ESSM petition, available at http://chng.it/nKynPF75.
The MJCSM, with the support of the UEMS and its afore mentioned boards involved in SM, and with the endorsement of the ESSM, ISSM, ISSWSH, EFS, WAS, and other continental and national scientiﬁc societies dealing with sexual health from different perspectives, proposes to the political authorities and the national university authorities and Ministry of Education in Europe and outside the continent the following central 4 points of essential need:
- Deﬁning SM as a part of medicine dealing with human sexuality and its disorders, to improve sexual health through the prevention, diagnosis, treatment, and rehabilitation of conditions or diseases that involve gender identity, sexual function, sexual and/or partnership experience and behavior, and sexual trauma and its consequences
- Establishing SM as an integral and obligatory part of the core curriculum for students in all medical schools
- Establishing SM in the core curriculum of medical specialties directly involved in the ﬁeld of SM (eg, dermatology and venereology, endocrinology, internal medicine, obstetrics and gynecology, oncology, psychiatry, rehabilitation, urology) necessary for the medical management of sexual dysfunctions at the specialist level
- Deﬁning standards of qualiﬁcation for academic teachers in the ﬁeld of SM.
To achieve a more elevated standard of complete medical education, medical schools should meet the following criteria:
- Developing students’ knowledge and understanding about sexual function, gender identity, sexual orientation, and the diversity of human sexual expression and behavior
- Teaching diagnosis and integrated therapies of the major sexual dysfunctions from early age to old age
- Recognizing the role of sexual dysfunction as a precocious biomarker in identifying noncommunicable chronic diseases
- Promoting the role of medical professionals in SM and prevention of sexual dysfunction
- Improving students’ ability to communicate about sexuality and sexual health and about mutual respect of genders and sexual orientations.
In summary, the MJCSM-ESSM petition advocates the need for all students of the medical schools to receive speciﬁc education and formal academic learning in SM grounded on a formal, 1-credit (minimum) course of the University Credit System for year IV or V medical students, using the following curriculum (modiﬁed from Pryor and Eardley et al):
- Gender and sexual development: sexual differentiation, imprinting, and development, including abnormalities male and female genital and reproductive systems, social and cultural factors, psychosexual development (including gender identity and sexual orientation), incorporating sexuality into relationships, mating strategies and patterns of sexual behavior
- Psychology and physiology of sexual desire, arousal, and sexual response: central nervous mechanisms, role of hormones, genital responses, orgasm, emission, and ejaculation
- Sexuality throughout the lifespan: sexual imprinting, childhood, puberty, reproductive life, climaterium, aging
- Sexual dysfunctions: deﬁnitions and classiﬁcations, epidemiology, pathophysiology, risk factors, psychometric assessment, diagnosis, medical and surgical treatment of sexual dysfunctions,
such as desire, arousal, ejaculatory, and orgasmic diorders; genital pain and pelvic ﬂoor disorders; sexual symptoms in other diseases; sexuality in the presence of a handicap
- Diversity of sexual behaviors (including paraphilias, sexual offences, high risk, compulsive and/or addictive sexual behavior) and gender variance
- Prevention in SM (eg, sexual risk behaviors, sexually transmitted infections, lifestyles, drugs)
- Promotion and understanding of sexual rights and ethical and cultural aspects of sexuality.
Another petition from the EFS, once again with the support of ESSM, not having an organization such as the UEMS, will go directly to the same authorities using the described petition as a
template, with slight changes to adapt the curriculum to the psychological milieu. Everyone is also welcome to sign the ESSM-EFS petition, available at http://chng.it/x5MFwvQJJm.
The shared approach of both cultures, once separated but now encompassed by the same systems sexology, following but also enlarging and expanding the biopsychosocial model, is surely the
best way to ensure a bright present and shining future not only for our ﬁeld, but also for medicine and psychology themselves, and of course, for the patients deserving professional care to
preserve the ﬁrst (at least chronologically) health: the sexual one.
Read the full article here: https://www.jsm.jsexmed.org/article/S1743-6095(19)31087-2/pdf