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As I have said before, we are facing a crisis in declining curriculum on sexuality education in medical schools across the United States and Canada. There is a very clear need to better prepare medical students to be able to attend to the myriad of sexual health problems that their patients face. We have a public health imperative to address these problems.

Last fall we brought together 55 experts for a summit on medical school education in sexual health. The purpose of the summit was to examine the situation, discuss the challenges and opportunities, share lessons learned, and make recommendations for ensuring that physicians are properly trained to address the sexual health needs of their patients as they go into practice. In April the meeting report was published in the Journal of Sexual Medicine.

The expert consensus recommended:

•  Sexual health education should be integrated longitudinally throughout four years of medical school.

•  Sexual health education should be "introduced early and often."

•  Working together should be the norm and not the exception. There are other disciplines and experts who have an interest and a need in sexual health education.

•  Developing evaluation mechanisms incorporating multiple methods of measurement to help medical schools understand how to best teach sexual health.

•  Much like students, faculty members need content and curricula to build their skills and comfort in sexual health.

•  Create a cross-organizational effort using multiple partnerships to advance the cause.

•  Participants strongly endorsed an initiative to commission an Institute of Medicine (IOM) report, which would also describe the need to address sexual health education for health care providers. This IOM report would be a collaborative project.

One approach to building a healthier society is to better train physicians. The training of medical students is an essential step to advance sexual health. It is time to ensure that in our society new doctors as well as practicing health professionals are prepared to address the sexual health needs of their patients from adolescence through seniority.

As Joycelyn Elders, MD, said in the closing of the summit, "A society grows great when old men and old women plant trees under whose shade they will never sit. At least we're planting trees." The passion displayed by the summit participants needs to continue. The group is committed to carrying out the recommendations.

The Program in Human Sexuality has been on the forefront of sexual health education for medical students since it began in 1970. We have been able to preserve one of the country's premier courses and curriculum. With the support of the Joycelyn Elders Chair in Sexual Health Education, we are committed to taking a leadership role in ensuring that not only our curriculum remains the best, but that we foster the highest quality sexual health education for other medical students in the United States and around the world.

Coleman, E., Elders, J., Satcher, D., Shindel, A., Parish, S., Kenagy, G., Bayer, C. R., Knudson, G., Kingsberg, S., Clayton, A., Lunn, M. R., Goldsmith, E., Tsai, P., & Light, A. (2013). Summit on Medical School Education in Sexual Health: Report of an Expert Consultation. Journal of Sexual Medicine, 10(4), 924-938. doi:10.1111/jsm.12142

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Katie Spencer, PhD, assistant professor, is the new coordinator of Transgender Health Services at PHS. Spencer is eager to continue to bring the program in line with current best practices in transgender care, increase operational transparency, and deepen community collaborations.

Spencer believes that, "In recent years there has been a huge and welcomed shift in health care for transgender and gender nonconforming individuals. Across the nation and locally more physicians and mental health providers are being trained to provide quality care for transgender and gender nonconforming patients, which increases access for trans clients. Part of our role is to continue to engage in cutting-edge research, training, and clinical service to break down barriers to competent care for trans clients. We have also seen a ground swell in community organizations that provide support to individuals across the gender spectrum. It is an exciting time to be in transgender health care, with multiple opportunities for collaboration, capacity building, and expanding the framework of how we provide trans clients the best holistic health care."

Over the last month Spencer has started to systematically incorporate the recommendations from the revised Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People as well as science-based research on trans health into the operations of the Center for Sexual Health. This process includes updating staff and patient materials as well as clinical procedures. She is also meeting with community organizations, community health care providers, and colleagues in the region to discuss possible collaborations and partnerships. Spencer will be reviving a community advisory board to focus on the Transgender Health Services program. Spencer's longer-term goals include developing a patient peer mentor program, revamping the group therapy model, and creating a community support space for patients and families that would include a library or resource materials on health, legal, and social support issues.

Spencer believes in empowering patients to have more say in their own and their community's care, revising our model of care to reflect patient-centered, patient-informed, and collaborative models of care, consistent with feedback from trans health care advocates and research on best outcomes for patient care. Spencer said, "My goal is to build on our successes in developing innovative research and public policy in the area of transgender health and incorporate these principles into a strong and cohesive framework that supports all aspects of our work in clinical care, new research, and community advocacy."

In addition to her clinical work, Spencer works with multiple community organizations working to educate about LGBT healthcare issues and primarily transgender healthcare. She works with the Minnesota Trans Youth Support Network on the Community Hormone Access Project, partnering with community advocates and trans youth to develop community based hormone protocols for transgender care, in hopes to increase access to competent care and hormone provision for trans youth. She recently participated in the development of a theatre educational project for high schools on transgender youth issues. Spencer provides training, education, and consultation on sexual health and transgender issues, and has worked with the Family Tree Clinic, Face to Face Health and Counseling Services, Fairview Clinics, the University of North Dakota, and the Minneapolis Veterans Administration. Spencer often speaks about the intersections of LGBT rights and impact on wellbeing, and recently presented a First Friday Forum for the Minnesota Psychological Association on the psychological research on same sex marriage.

Spencer received her MA and PhD in counseling psychology from the University of Missouri-Columbia. She received her BA in women's studies and psychology from the University of Wisconsin-Madison. Her internship was completed at the University of Illinois-Chicago Counseling Center, and she was a postdoctoral fellow at PHS. She has a strong interest social justice, and education and training of therapists and medical providers in sexual health and transgender health care competency. Her primary clinical practice is working with transgender and gender non-conforming, adolescents, and adults, women's sexual health, and LGBT sexual health and wellbeing. She co-facilitates several groups, including the gender exploration group for youth and their families, the women's sexual health group, and transgender adult interpersonal groups. She has experience working with compulsive sexual behavior and general sexual dysfunction concerns. Her research and clinical interests focus on cultural competency in working with LGB and transgender populations, LGBT sexual health, sex therapy with LGBT couples, trans youth, and feminist embodied approaches to sexual health.

Spencer became coordinator of Transgender Health Services in October 2012, when the former coordinator Walter Bockting, PhD, joined the Initiative for LGBT Health a new program at the New York Psychiatric Institute and the Columbia University.

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Walter Bockting, PhD, was appointed to the American Psychological Association (APA) Task Force on Guidelines for Psychological Practice with Transgender and Gender Non-conforming Clients.  

Earlier, Bockting also served on the APA Task Force on Gender Identity and Gender Variance that released a report in 2008 that made several recommendations, including the recommendation to develop practice guidelines.  The new guidelines will help psychologists and students develop cultural competence for working with transgender clients and their families.

The group had their first face-to-face meeting February 10-12, 2012, in Atlanta, GA.  Bockting described the meeting as very productive.  He said, "Our task came into focus when we heard from individuals from the Atlanta transgender community about what is important to them and the challenges they have faced in their interactions with psychologists.  These guidelines are long overdue."  Once the guidelines are published, the next step will be to develop training for psychologists and students to develop their competence in treating transgender individual with respect and sensitivity.

The task force is a joint effort between Division 44 and the American Psychological Association Committee on Lesbian, Gay, Bisexual, and Transgender Concerns.  Group members include lore m .dickey (co-chair), Anneliese A. Singh (co-chair), Walter Bockting, Sand Chang, Kelly Ducheny, Laura Edwards-Leeper, Randall Ehrbar (PHS postdoctoral fellowship alumnus), Max Fuhrmann, Michael Hendricks, and Ellen Magalhaes.

In January 2012 the APA published practice guidelines in several areas, including revised "Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients."

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The faculty of the Program in Human Sexuality invite you to explore the latest in sexual health research. PHS faculty, postdoctoral fellows, and research collaborators will present their work at our monthly faculty research presentations.

Join us: Noon-1 pm at PHS, 1300 South 2nd Street, Room 142, Minneapolis, MN 55454.

Reserve your seat today--email phsresearch@umn.edu

April 11, 2012
Peter M. Eckman, MD
Assistant Professor of Medicine, Cardiovascular Division

"Sexual Function in Heart Failure Patients with Left Ventricular Assist Device"

Left ventricular assist devices (LVADs) are an important therapeutic option for patients with end-stage heart failure, and more than 600 have been implanted at the University of Minnesota since 1995. Unfortunately, little is known about the impact of these devices on the sexual health of recipients. We surveyed patients with LVADs at 7 centers around the United States to learn about their sexual health. Preliminary results suggest preserved desire coupled with impairments in arousal and orgasm. Multivariate analysis suggests that age and medical comorbidities are important factors in predicting impaired sexual health after LVAD.

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The World Professional Association for Transgender Health (WPATH) released a newly-revised edition of the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC), on September 25, 2011, at the WPATH conference in Atlanta. This is the seventh version of the SOC.  The original SOC were published in 1979.  Previous revisions occurred in 1980, 1981, 1990, 1998 and 2001.

The SOC is considered the standard document of reference on caring for the transsexual, transgender, and gender nonconforming population. The newly-revised SOC will help health professionals better understand how they can offer the most effective care to these individuals.  The SOC focuses on primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services and hormonal and surgical treatment.

"The latest 2011 revisions to the SOC realize that transgender, transsexual, and gender nonconforming people have unique health care needs to promote their overall health and well-being, and that those needs extend beyond hormonal treatment and surgical intervention," said SOC Committee Chair, Eli Coleman, PhD, Professor and Director at Program in Human Sexuality, University of Minnesota. 

"The previous versions of the SOC were always perceived to be about the things that a trans person must do to satisfy clinicians, this version is much more clear about every aspect of what clinicians ought to do in order to properly serve their clients. That is a truly radical reversal . . . one that serves both parties very well," said Christine Burns, SOC International Advisory Committee Member.

More than any other version, 2011 revisions also recognize that gender nonconformity in and of itself is not a disorder and that many people live comfortable lives without having to seek therapy or medical interventions for gender confusion or unhappiness.

This version provides more detailed clinical guidelines to address the health care needs of children, adolescents, and adults with gender dysphoria who need assistance with psychological, hormonal, or surgical care. 

In addition to clearly articulating the collaborative relationship needed between transsexual, transgender, and gender nonconforming individuals and health care providers, the new, 2011 revisions provide for new ways of thinking about cultural relativity and culture competence. 

The document includes a call to advocacy for professionals to promote public policies and legal reforms that promote tolerance and equity for gender and sexual diversity.  This document recognizes that well-being is not obtained through quality health care alone but a social climate that eliminates of prejudice, discrimination, and stigma and promotes a positive and tolerant society that embraces sexual and gender diversity.

WPATH, formerly known as the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity disorders.  As an international multidisciplinary professional Association the mission of WPATH is to promote evidence based care, education, research, advocacy, public policy and respect in transgender health.

The World Professional Association for Transgender Health. (2011). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th Version.  Retrieved from http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf

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A study conducted at the Stanford School of Medicine confirms that a majority of American medical schools are lacking LGBT-related health curriculum in the classroom and in clinical training. The study findings were published on September 7, 2011, in the Journal of the American Medical Association.

The Stanford research team surveyed deans of medical schools in Canada and the United States.  Of the complete responses the group received (132 = 75%) they found that of the entire medical school curricula the median reported time dedicated to LGBT-related content was 5 hours.  Some schools reported dedicating no time to LGBT-related content in the classroom or the clinic.

At this time, most schools (128) teach student that when taking a patient's sexual history students should ask the question, "Do you have sex with men, women, or both?"  However, on a list of 16 LGBT-specific topics,* only 11 schools reported covering all 16 topics in their curricula.  The topics covered most frequently by schools are sexual orientation, HIV, and gender identity, and the topics covered least often by schools are genital reconstruction surgery, body image, and transitioning.

*LGBT specific curricula topics:  barriers to Care, body image, chronic disease risk, coming out, DSD/intersex, gender identity, HIV, LGBT, adolescents, mental health issues, safer sex, sexual orientation, SRS, STI, substance use, transitioning, unhealthy, and relationships/IPV

Obedin-Maliver, J., Goldsmith, E. S., Stewart, L., White, W., Tran, E., Brenman, S., . . . Lunn, M. R. (2011). Lesbian, Gay, Bisexual, and Transgender-Related Content in Undergraduate Medical Education. JAMA, 306(9), 971-977. doi: 10.1001/jama.2011.1255

Photo: PHS faculty teaching the human sexuality course at University of Minnesota Medical School

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