Sexual Health Curriculum Focuses on Varieties of Sexual Experience

Norra MacReady

March 26, 2010

March 26, 2010 (Anaheim, California) — Are whips and chains dangerous for women with osteoporosis? Can a man with a history of abdominal aortic aneurysm use electrical sex toys? Physicians who treat practitioners of bondage, discipline, sadism, and masochism (BDSM) must learn to take questions like these in stride, attendees were reminded here at the American Medical Student Association 60th Annual Convention.

It has been estimated that 10% of the general population participates in BDSM, and more than 40% of people fantasize about it, according to an abstract presented here. "Thus, it is inevitable that physicians will treat many BDSM practitioners over the course of their career, whether or not they are ever aware of these patients' activities," said the abstract's author, Sara Thorp, a second-year student at Ohio University College of Osteopathic Medicine in Northfield. All too often, these patients hesitate to seek medical care because of fears of being marginalized or stigmatized. When they do go for a checkup, often they will not reveal their predilections. "I was surprised at the depth of fear and anxiety that people have about presenting these issues to their doctors," said Ms. Thorp.

In some instances these fears are justified, Ms. Thorp told Medscape Med Students. She related one case in which a woman with breast cancer had her insurance policy cancelled retroactively after the company learned she engaged in BDSM. The insurer claimed that such activities were dangerous and accused the patient of withholding the information. In other cases, BDSM aficionados have been referred to local child protective services, despite no evidence that their children were ever in danger or had been mistreated in any way.

Misconceptions aside, the little research that exists shows that people who practice BDSM "are as psychologically healthy as the general population," Ms. Thorp wrote in her abstract. Clinicians who remain tolerant and nonjudgmental can help their patients pursue these activities as safely as possible, for example by advising them on how to sterilize needles adequately, how to avoid piercing major nerves, and how to determine when something crosses the line from consensual to abusive. "Being familiar with these practices helps me tailor what I need to know to meet the needs of the patient," she explained.

At least one independent expert agrees that clinicians should reserve judgment until they know how the behavior affects the patient's life and health. "A particular kind of sexual behavior shouldn't be seen as reflective of a disorder if it's just a pleasurable variant for folks," said Fred S. Berlin, MD, associate professor of psychiatry, Johns Hopkins University School of Medicine, and director of the university's Sexual Behavior Consultation Unit, in Baltimore, Maryland. "On the other hand, we shouldn't assume it's just a pleasurable variant if it is causing significant problems in the patient's life."

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), defines a paraphilic disorder as unusual sexual behavior that distresses the patient or impairs his or her ability to function, said Dr. Berlin. "If people are just having fun through play acting, and nobody's in serious danger, fine. On the other hand, let's not assume that all of this is benign, when we know that some people get into very serious difficulties when they engage in these behaviors."

The abstract arose from Ms. Thorp's participation in the Sexual Health Scholars Program (SHSP), a distance-learning course aimed at improving students' knowledge, attitudes, and clinical skills about various sexual health topics. Developed by Rebecca Bak and Shannon O'Hern as an adaptation of the Morehouse Center for Excellence in Sexual Health curriculum for healthcare professionals, the SHSP ran its first online course from October 2009 to March 2010. Of 77 applicants to the program, 15 were accepted.

The SHSP was started to help compensate for "the very limited information with respect to sexual health" that medical students usually receive, said Ms. Bak, a fourth-year medical student at Mount Sinai School of Medicine in New York City. When sexual medicine is taught, "normally what is presented are the negative consequences of sex, such as sexually transmitted diseases."

"The level of interest was a big surprise to me," said Ms. O'Hern, a third-year student at the University of Medicine and Dentistry of New Jersey in New Brunswick. "We were hoping for 30 applicants, and we got more than 75."

"Sexual wellness is a perspective that isn't taught very often in medical school," Ms. O'Hern added. "The students are ready to learn it."

American Medical Student Association (AMSA) 60th Annual Convention: Abstracts 59 and 62. Presented March 11, 2010.

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