EXECUTIVE SUMMARY

A new study revealed opportunities for improvement in OB/GYN knowledge of sexual health education.

  • OB/GYN residents, while knowledgeable on subjects like decreased sexual desire, sexual pain, contraception, and more, could benefit from learning more about transgender care, caring for sex trafficking survivors, and cultural competency in care.
  • The study results indicated these providers can become more competent through finding evidence-based information, learning about the care of LGBTQ+ patients, learning how to identify victims of sex trafficking, and by screening for intimate partner violence.
  • It is important to screen patients for these issues and concerns at each visit to build provider-patient trust.

Researchers found that more than half of OB/GYN resident physicians surveyed in a study lacked knowledge pertaining to sexual function disorders.1

Almost all the residents in the study felt comfortable obtaining a sexual history and providing counseling to a teenager seeking contraception. But fewer were comfortable counseling a young adult refugee or providing counseling to a teenager who is a victim of sex trafficking. Less than half of residents could handle working with a middle-age transgender patient.

“I think our study provided a very good assessment of the nation’s sexual health training for OB/GYN resident physicians,” says Brett Worly, MD, MBA, FACOG, lead study author, associate professor, and Learning Communities program director at The Ohio State University. “Important takeaways from our article are that resident physicians want to learn about sexual health and it is a priority to them,” he says. “They understand how important sexual health is to a person’s overall health.”

Most OB/GYN residents are knowledgeable about topics like decreased sexual desire, sexual pain, orgasm problems, contraception, and sexual problems related to menopause. “We also learned that there are opportunities for improvement, including in transgender care, caring for sex trafficking survivors, and cultural competency in care,” Worly says. For instance, residents may not know how to deal with patients who come from countries where they may have experienced something like female genital cutting.

Worly offers these suggestions for how reproductive health providers can learn more about these sexual health issues:

Find evidence-based information. The Association of Professors of Gynecology and Obstetrics created a series of videos to educate healthcare providers about topics such as transgender care and sex trafficking.

“There needs to be more recognition of that. Even more resources need to come to the forefront so that wherever you happen to be, you are able to have a specific resource to look up some of these conditions that can be rare for providers,” Worly explains. “For instance, providers are seeing more patients that have survived sex trafficking than they might think.”

Learn about care of LGBTQ+ patients. “As far as transgender and different sexual orientations, there are many different perspectives. If you don’t ask you’ll never know,” Worly says. “If you’re respectful and take time to listen to patients, they’ll tell you about their lives so you can have more background knowledge.”

One important technique is for providers to screen everyone repetitively, regardless of the provider’s opinion on whether the patient is having a certain type of sexual experience. It is essential for healthcare providers to build a trusting relationship with patients, he says.

When meeting with a patient who may be part of the LGBTQ+ community, the patient might not be ready to disclose information that is important to their sexual and reproductive health, Worly notes. The patient might have had negative experiences with providers in the past.

“Screening patients every time and talking and checking in with them from a contraceptive perspective helps ensure they have the contraception they need in order to accomplish the goals they have in their reproductive lives,” he says.

For providers who have difficulty understanding transgender patients and the various ways people are describing their gender, Worly recommends they look at the history of transgender people.

“Transgender people have been in existence for 1,000 years — it’s nothing new,” he says. “There are references in every culture of transgender people.”

In the past 50 years, transgender issues have not been discussed much in Western culture. People who have identified as transgender have been shamed by their family, friends, and even healthcare providers. They tend to keep their experiences private. However, in recent years, that cultural stigma has been changing. For example, openly transgender politicians, athletes, performers, and others are becoming role models for transgender youth.

“Now, we’re in a society that I think really believes people deserve our respect, attention, and care, and they don’t deserve to be treated improperly or insulted,” Worly says. “Transgender people have a much higher rate of depression, suicide, and interpartner violence.”

Healthcare providers can help save transgender patients’ lives and health by respecting them and their situations, he notes.

“Helping [LGBTQ] individuals in the area of contraception, future fertility, and stated desire to become pregnant is confusing for reproductive health providers,” says Robert A. Hatcher, MD, MPH, chairman of the Contraceptive Technology Update editorial board. “Listening carefully to patients is always important and cannot be stressed too much when providing services to LGBTQ clients.”

Identify victims of sex trafficking. It is rarely obvious that a particular patient is a victim of sex trafficking. Reproductive health providers need to be aware that anyone might be in that situation.

After moving to Columbus, Worly became more aware of sex trafficking situations and sought education.

“I went to a national conference and I started thinking about it more, realizing that I didn’t recognize situations of sex trafficking before,” he says. “There was a situation I had with a personal translator that made me uncomfortable because the translator would only talk with me and wouldn’t let me talk to the patient.”

Looking back at some of his earlier experiences as a new physician, Worly realized he might have missed opportunities to help a patient who was a victim of sex trafficking.

“Now, I know it exists and I know what to look out for,” World explains. “If you don’t go out of your way as a healthcare provider to find out about these things, then you will not know about it because it’s not well covered in medical training.”

For this reason, Worly believes it is important to speak with patients without a family member, including a family translator, present.

“It is important for practitioners who are on their own or in private practice to figure out a translation system that works for them,” Worly says.

Screen for intimate partner violence (IPV). “Screen every patient in a nonjudgmental way,” Worly says.

For example, providers can ask these questions:

  • Is someone touching you in a way you don’t want?
  • Are you sexually active?
  • Are you sometimes afraid during sexual relations?
  • Have you ever been hit or hurt by your partner?

“It’s important to screen patients at every visit to continue to build trust,” Worly explains. “Oftentimes, you can’t have a full conversation about some of these different situations. For some patients, you need to set up another appointment on a subsequent day to really get into these issues.”

The study is designed to help practicing OB/GYNs reflect on their training, strengths, and opportunities for improvement, Worly says. It might motivate some OB/GYNs to look up their old residency program (or a program nearby) and offer to provide a lecture on topics that need to be addressed better.

“Sexual health is challenging in that there are many social taboos, and these topics are not usually covered in residency education,” Worly says. “Few people feel like experts in these areas. OB/GYN physicians sometimes feel overwhelmed with clinical and academic work, so taking on a new topic may seem onerous.”

Now that the coronavirus pandemic has helped everyone learn how to obtain information via digital formats, providers can learn about these sexual health topics at their own pace and in places and at times that are convenient for them, Worly adds.

REFERENCE

  1. Worly B, Manriquez M, Stagg A, et al. Sexual health education in obstetrics and gynecology (Ob-Gyn) residencies — a resident physician survey. J Sex Med 2021;18: 1042-1052.