German medical students' interest in and knowledge about human sexuality in 1972 and 2012

Paraphilic fantasies and behavior in attention deficit/hyperactivity disorder and their association with hypersexuality

Previous research has found some peculiarities in sexual functioning of adults with attention deficit/hyperactivity disorder (ADHD). Using a set of questionnaires that had to be answered online, we assessed the prevalence of paraphilic fantasies and behaviors in a sample of 160 adults with ADHD in comparison to 75 adults without ADHD and evaluated the association between paraphilias and hypersexuality in the ADHD group. Both groups reported high rates of paraphilic fantasies and behaviors. ADHD individuals were more likely to report about very sexually arousing paraphilic fantasies (ADHD: 58.2% vs. non-ADHD: 40.5%; χ2 = 6.323, p = 0.01) and behaviors (ADHD: 44.9% vs. non-ADHD: 28.4%; χ2 = 5.774, p = 0.02). Furthermore, ADHD individuals reported on average about more very sexually arousing paraphilic behaviors compared to non-ADHD individuals (ADHD: M = 1.28, SD = 0.10 vs. non-ADHD: M = 0.81, SD = 0.09; T = 2.68, p < 0.01). Furthermore, in ADHD individuals both very sexually arousing paraphilic interests in masturbation fantasies (r(158) = 0.17, p = 0.03) and in sexual behaviors (r(158) =0.19, p = 0.02) showed a significant correlation with hypersexuality. In non-ADHD individuals no such significant correlation could be found. Altogether, it can be concluded that individuals with ADHD seem to be more prone to develop and act out paraphilic sexuality than those without ADHD, however, found differences were rather small. The results of the present study add to the current trend to depathologize paraphilic sexuality in the general as well as in clinical populations.

Sexuality in Adults With ADHD: Results of an Online Survey

Establishing a secure sexual identity is a major developmental goal of an individual's transition from childhood to adolescence and the years that follow. Attention deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder defined by the core symptoms of inattention, hyperactivity, and impulsivity, but also with emotional dysregulation, oppositional behaviors, or disorganization appearing early in life, can affect several areas of an individual's personal and social development, including sexual health. Yet, the scientific knowledge about the relationship between ADHD and sexual functioning is still scarce. Using an anonymous online survey, we compared different sexual behaviors including risky sexual behaviors, hypersexual behaviors, and sexual dysfunctions between 206 individuals with (n = 139) and without (n = 76) ADHD. Individuals with ADHD reported significantly more hypersexual behaviors than non-ADHD individuals, whereas no differences were found concerning risky sexual behaviors or sexual dysfunctions. In women with ADHD, hypersexual behaviors, sexual risk-taking as well as sexual dysfunctions were closely related to symptoms of emotional dysregulation, impulsivity, and oppositional symptoms. In men with ADHD, the associations between ADHD symptomatology and the sexuality-related measures were less clear, however, signs of emotional dysregulation seemed to be relevant as well. Since individuals with ADHD seem to be at an increased risk of some peculiarities in sexual behavior, sexuality-related issues should be routinely addressed during clinical consultations to provide more holistic treatment in order to enhance individual well-being and quality of life.

Healthcare for Trans*gender People in Germany: Gaps, Challenges, and Perspectives

People whose gender does not correspond to the binary gender system, i.e., trans∗gender people, face two main problems when it comes to healthcare in Germany: (1) They often suffer from general psychiatric comorbidities as well as specific and significant mental distress due to gender dysphoria, and (2) the German healthcare system lacks sufficiently educated and clinically experienced medical personnel who are able to provide specialized healthcare. Aside from transition, it often is extremely difficult for trans∗gender people to get access to and be integrated into the medical system. Stigmatization and pathologization in treatment are widespread, as are long waiting times for specialized healthcare providers who are often only accessible to those trans∗gender people willing to travel long distances. Frequently, trans∗gender people face further difficulties and barriers after transition, as some healthcare professionals fail to provide suitable care (e.g., gynecological consultation for transmen). The ICD-11 German Modification (ICD-11-GM), which should be routinely used by 2022, implements a depathologization of trans∗gender people in the medical system. This paper compares the issues related to health and healthcare of trans∗gender people in Germany with those in other European countries. We review the care offered by specialized centers with regard to treatment of and support for trans∗gender people. We conclude with specific proposals that may contribute to establish an improved, up-to-date, gender-sensitive healthcare system.

[Knowledge levels and attitudes of nursing trainees regarding sexuality in old age - An explorative quantitative survey]

Knowledge levels and attitudes of nursing trainees regarding sexuality in old age - An explorative quantitative survey Abstract. Background: In professional geriatric nursing, sexuality in old age is often tabooed - in spite of this demographic group having the desire to live their sexuality. Generally, the possibility to experience sexuality - for example in nursing homes - is limited. Aim: The main objective of this study is to portray the knowledge and attitudes of geriatric nursing trainees towards sexuality in old age in cross section, and to analyze possible differences between training years. Methods: A cross-sectional study was conducted with written standardized surveys of 420 trainees on three research questions: (1) sexuality in old age and its role during class, (2) subjective vs. objective sex education, and (3) sexual assistance and attitudes towards it. Differences between years of education and subgroups were analyzed statistically (Kruskal-Wallis- and chi-square tests). Results: Results showed that addressing sexuality in old age during lessons was perceived to increase with a higher training year. However, 15.1 % experienced it as being exclusively negative. Concerning objective sex education, 15.7 % misjudged frequent masturbation as being psychologically harmful or did not know better. Furthermore, 9.3 % believed homosexuality to be a disease. Differences between years of training could not be found in these variables. The knowledge about sexual assistance increased with higher training years. Conclusions: Regarding these results, we suggest that the subject of sexuality in old age should be intensified as part of the curriculum for geriatric nursing from an early stage on. The aim should be to reduce tabooing and to increase the level of knowledge.

Stigma Surrounding Sexually Transmitted Infections among Medical Students in Germany

Stigmatization by health care professionals leads to decreased help-seeking behaviors in those being stigmatized. Prejudicial attitudes are especially pronounced concerning sexually transmitted infections (STIs), which is crucial in light of rising prevalence rates of STIs in recent years. We aimed to examine stigmatization against patients with sexually versus non-sexually transmitted infections among medical students in Germany. We also assessed how a person's sexual orientation or gender might contribute to stigma. Medical students (N = 332) read about a fictious patient with symptoms of pharyngitis after having had a casual sex encounter. Gender (female/male) and sexual orientation (hetero-/bi-/homosexual) of the patient as well as the pathogen causing the infection (gonococcus/H1N1-virus) were randomly varied. Afterwards, stigma against the patient was assessed. Patients with a gonococcal pharyngitis were perceived as more prone to engage in risky behavior, dumber, and less responsible than patients with a H1N1-virus pharyngitis. Bisexual patients were perceived as more prone to engage in risky behavior than hetero- and homosexual individuals. The predictability of the consequences of the patient's actions was rated higher in bisexual patients. Stigmatizing attitudes toward patients with a STI were frequent, especially against bisexual patients. More education should be dedicated to sexual/LGB health during medical school to reduce existing stigma.

Connaissances, attitudes et pratiques des étudiants en médecine en matière de sexualité

La sexualité est un aspect central de la personne humaine qui, devant des problèmes sexuels, va fréquemment se tourner vers une source qu'elle considère compétente et bien informée, son médecin. Les objectifs de notre étude étaient d’évaluer les connaissances, les attitudes et les pratiques des étudiants en médecine en termes de sexualité et d’identifier les principaux déterminants du manque de connaissances basiques à ce sujet. Notre étude était descriptive et analytique, menée auprès des étudiants à la faculté de médecine de Sfax (Tunisie). Le questionnaire, rempli individuellement et de manière anonyme par chaque étudiant, recueillait les données sociodémographiques, les connaissances en matière de sexualité ainsi que leurs sources, les attitudes adoptées par les étudiants vis-à-vis de la sexualité et les pratiques sexuelles. La note totale moyenne relative aux questions de sexologie était de 11,05/20. Les facteurs corrélés à un score moyen élevé aux questions de sexologie étaient le sexe masculin (p=0,003), le statut de marié (p=0,012), le niveau socio-économique élevé (p=0,02), les livres comme source d’informations (p=0,041) et la présence de pratiques sexuelles (p<0,001). Ces pratiques étaient toutes significativement plus fréquentes chez les étudiants de sexe masculin (p<0,001). Des lacunes dans les connaissances en matière de sexualité existent chez les étudiants en médecine, du moins dans certains de ses aspects. Un programme d'enseignement complet et uniforme sur la sexualité humaine, surtout dans ses aspects physiologiques, peut sensiblement améliorer la capacité des futurs médecins à fournir des soins optimaux à leurs patients.

Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University

INTRODUCTION

The quantity and quality of education in the field of human sexuality vary greatly in medical education programs in the United States and Europe.

AIM

The current state of medical school education with regard to human sexuality was assessed at an Austrian medical university.

METHODS

Self-constructed questionnaires and the Beliefs About Sexual Functioning Scale were filled out by 391 medical students (mean age = 24.0, SD = 2.5; 52.4% women, 47.6% men). Descriptive statistics are reported for summarizing students' responses, and structural equation models were calculated to reveal associations between variables of interest.

MAIN OUTCOME MEASURES

The outcome variable in the structural equation models was students' confidence in addressing sexual health concerns of patients.

RESULTS

Most students were not instructed in sexual history taking (96.9%), sexual behavior (94.3%), love (97.4%) or sexuality in elderly persons (95.1%), and they reported having poor knowledge of these topics. Most students (72.5%) reported having little or no confidence in addressing patients' sexual health concerns. The number of addressed topics was positively associated with male (β = 0.47, P < .001) and female students' (β = 0.52, P < .001) knowledge. Knowledge was positively associated with male (β = .49, P < 0.001) and female students' (β = 0.33, P < .001) confidence in addressing sexual health concerns and was negatively associated with stereotypical sexual functioning beliefs in the male subsample (β = -0.26, P = .009).

CONCLUSIONS

Most medical students revealed that the teaching of important sexual health content (eg, sexual history taking) was deficient at this medical university. Education in sexual health issues needs to be increased to positively influence students' knowledge of and consequently their confidence regarding dealing with patients' sexual health concerns. Komlenac N, Siller H, Hochleitner M. Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University. Sex Med 2019;7:318-325.

Male Medical Students' Gender-Role Conflict Is Associated With Their Discomfort With Dealing With Patients' Sexual Health Issues

Recommendations suggest that more sexuality education be implemented in medical school curricula to increase students' comfort with regard to dealing with sexual health issues. For male medical students the adherence to masculine gender-role norms may also contribute to discomfort regarding dealing with this intimate topic. The current study analyzed whether male medical students' knowledge or masculine gender-role conflict (GRC) was associated with their comfort with regard to asking future patients about sexual health issues. A total of 164 male medical students (M_age = 24.4, SD = 2.4) participated. A questionnaire assessed students' self-perceived knowledge of sexual health, how prepared they felt with regard to this topic, and their comfort with regard to asking future patients about sexual health issues. The Gender Role Conflict Scale-Short Form (GRCS-SF) was used to assess GRC. Knowledge was positively associated with comfort. Male students who indicated difficulty expressing affection toward men or expressing emotions were likely to report being uncomfortable asking patients about sexual health issues. Students should be made aware of gender-role norms. Alongside knowledge transfer, the discussion of strategies for overcoming the barriers set by gender-role norms should be part of sexuality education.

Needs and concerns of transgender individuals regarding interdisciplinary transgender healthcare: A non-clinical online survey

This study investigates the needs and concerns transgender (short: trans) individuals have concerning trans healthcare (THC) in interdisciplinary THC centres. Trans individuals' gender does not (fully/constantly) match their sex assigned at birth. To be able to live in their gender role and to prevent or minimise gender dysphoria, they might require a multidisciplinary set of transition related healthcare services. The current shift from the traditionally highly regulated, hierarchical and pathologising approach to THC towards a more patient-centred approach has highlighted the importance of trans patients' satisfaction with treatment processes and results. As the still influential regulations have a negative effect on patient satisfaction, and might also keep trans individuals from seeking transition related treatment, it is crucial to investigate what trans individuals, whether patients or not, need and fear regarding transition related healthcare. Against the backdrop of mixed reactions received from the local trans community regarding the foundation of the Interdisciplinary Transgender Healthcare Centre Hamburg (ITHCCH), Germany, this study seeks to determine what trans individuals need with respect to THC in order to guarantee for high quality service provision at the ITHCCH. To this end, an online questionnaire was developed. The researchers employed a participatory approach to questionnaire development by involving a working group consisting of local trans support group representatives and (THC) specialists (N = 4). The sample consisted of N = 415 trans-identified individuals aged between 16 and 76. Most of them were based in Germany. 85.2% (n = 382) reported experience with transition related healthcare and 72.5% (n = 301) had (additional) treatments planned. Analysis revealed a need for communication and feedback opportunities. Furthermore, during the treatment process, addressing individual needs was considered crucial by participants. They agreed moderately with concerns towards THC centres. 96.5% of participants would like high decision-making power concerning treatment-associated decisions. The results demonstrate the importance of patient-centred THC that takes patients' individual needs and realities into consideration and involves patients in decision-making processes.

[The roots of sexual medicine in Germany : A personal retrospective]

The first steps toward an academic sexual medicine were made half a century ago in the Federal Republic of Germany. After the so-called sexual revolution, the first approaches to an academicization of the field of sexual science were located in Hamburg and Frankfurt, where independent institutes and chairs were set up. Through empirical studies, the ignorance of physicians and medical students in sexuality-related topics could be demonstrated and subsequently addressed. In the early 1970s a journal named Sexualmedizin was founded, the first education courses for physicians in sexual medicine were held and in Frankfurt the first "special" university outpatient clinic in the country was opened with a department for sexual science. During the following decades, several textbooks were published and the professional training of physicians was expanded. As a university specialty, however, sexual medicine is still one of the most threatened medical subjects, being represented in only a few German faculties.Prof. Dr. Volkmar Sigusch, a pioneer of modern sexual research, looks back on events and personal experiences and gives an overview of the actors and sexual-scientific publications of the time.