A review paper in the Canadian Journal of Psychiatry discusses "Why Psychiatrists Must Talk to Their Patients About Sex." It points out that "sex is a fundamental quality-of-life issue. Sexual problems are extremely prevalent among the general population and even more so among persons with psychiatric or medical illness." Taking a sexual history is often an overlooked or forgotten part of the clinical assessment. The article delineates several reasons why this is needs to be an standard part of a clinician's interview.
Also, a brief report in this month's Psychiatric Services describes a study of 200 women and men with a major mood disorder or schizophrenia who were interviewed about their sexual and reproductive behaviors. The responses were compared with the answers from a national health survey and matched for age and race. Results showed that "women with mental illness had fewer pregnancies and live births but were more likely to have had a pregnancy that did not result in a live birth. Women with mental illness had more lifetime sexual partners." The researchers concluded by suggesting that clinicians should pay attention to patients' sexual and reproductive health.
Finally, this coming January, Robert Wood Johnson Medical School presents Human Sexuality Week (January 3-7, 2005). This special course in Human Sexuality is in its 32nd year making it the longest running program of its type in the United States. Their approach is multi-disciplinary, with a strong emphasis on small group process. The cultural and attitudinal aspects of human sexuality are emphasized throughout.
Some of the goals of the course are to:
Foster Culturally-Sensitive Attitudes and Values
Develop Greater Self-Awareness to effectively counsel patients
Practice Applied Skills e.g. sexual needs assessment, history taking and problem solving.
Use Evidence-Based Learning.
Promote a Patient-Centered Approach to Clinical Treatment
According to the World Health Organization, "there exist fundamental rights for the individual, including the right to sexual health and a capacity to enjoy and control sexual and reproductive behavior in accordance with a social personal ethic - freedom from fear, shame, guilt, false beliefs and other factors inhibiting sexual response and impairing sexual relationships - freedom from organic disorders, disease and deficiencies that interfere with sexual and reproductive function."
Clinicians need to be more aware of the importance and impact of sexuality in an individual's life. The US Surgeon General wrote in 1994 "sexuality is an integral part of human life. It carries the awesome potential to create new life. It can foster intimacy and bonding as well as shared pleasure in our relationships. It fulfills a number of personal and social needs, and we value the sexual part of our being for the pleasures and benefits it affords us. Yet when exercised irresponsibly it can also have negative aspects such as sexually transmitted diseases--including HIV/AIDS--unintended pregnancy, and coercive or violent behavior. To enjoy the important benefits of sexuality, while avoiding negative consequences, some of which may have long term or even life time implications, it is necessary for individuals to be sexually healthy, to behave responsibly, and to have a supportive environment--to protect their own sexual health, as well as that of others."
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