On June 2-3, 1970, the first Sexual Attitude Reassessment (SAR) seminar was held at the University of Minnesota, and the Program in Human Sexuality was born. This June, forty years later, the PHS faculty just completed our course in human sexuality required for all first-year medical students, which included a SAR seminar. One could barely recognize the format from the earlier years. We sit on chairs rather than pillows, and we listen to panels of people describing their sexual lives rather than being bombarded with sexually explicit media. However, the goals of the seminar remain: to explore sexual attitudes and behavior, to become "askable" physicians, to separate one's personal values from professional sexual health care, to help physicians become more comfortable in bringing up the topic, and ultimately to provide compassionate, non-judgmental, science-based sexual health care.
The SAR seminar formed the basis of the sexual health curriculum that developed at the University of Minnesota Medical School and has continued through today. The sexual health course of study at the University was one of the first comprehensive curricula developed in the United States. In the 1970s, many medical students had great difficulty talking to their patients about sexuality - especially when it differed from their own. In the 1980s, there was a conservative swing in sexual politics and the medical school curriculum was sharply being attacked under the accusation of "irrelevancy." By the end of the 1980s, more attacks centered around issues of privacy which made conducting small group processing very difficult. In the 1990s, we saw a new kind of medical student who was more interested in holistic medicine and primary care. That shifted in the latter part of the 1990s and early part of the new millennium as students moved away from primary care due to low reimbursement rates and high student debt. Now we are seeing student motivation shift again - and we hope that health care reform will bring more emphasis on primary care that is holistic and focused on psychosocial issues as much as on new technologies. At each juncture, it has been a challenge to preserve and evolve the sexual health curriculum. Fighting for this and adapting our curriculum has made us one of the survivors and we have remained as a model program in the world.
We are at a period in time where we are facing a public health imperative to provide integrated health care services that address physical, mental, and sexual health. Yet we are losing ground in terms of comprehensive sexual health curricula in our medical schools. We are an endangered species! The movement towards integrated learning in medical schools makes "stand alone" courses very vulnerable. While integrated learning works for many issues, when integrated, the complexities and nuances of human sexuality tend to be over simplified or eliminated. We have seen a national trend to eliminate human sexuality courses - which were already too few and not very comprehensive. For example, I have been part of the human sexuality curriculum at Mayo Medical School for over 25 years and it has evaporated in the last two years.
While some of the current medical students are well informed by sexual information available through the Internet or a sound sexual health education, many students have had limited sexual health education because of "abstinence-only education" programs. In spite of a deficit in basic knowledge, we are seeing students who are eager to provide patient-centered, science-based care.
Due to all these factors, we are in desperate need of a revitalization of sexual health curricula across the country and around the world. New approaches need to be developed that fit within the new paradigms of medical school education. However, there is no forum or vehicle for strategizing how we might do this. I am eager to organize a summit of medical school educators, but I have yet to find a sponsor. With universities facing enormous financial crises and travel budgets slashed, it is difficult to find the resources to make this vision a reality. We are at a critical juncture, and I feel we are losing ground day by day. This is one of the many reasons that establishing the Joycelyn Elders Chair in Sexual Health Education is so very important. We need to find a champion for this cause.
I can only assure you that this issue is at the top of my agenda and I am trying to figure out a way to address this. If you have any thoughts or ideas on this I would love to hear from you firstname.lastname@example.org
PHOTO: Keith and Virginia Laken, authors of Making Love Again: Hope for Couples Facing Loss of Sexual Intimacy, help to instruct the 2010 U of M Medical School SAR. Keith Laken is an active memeber of the PHS Leadership Council.