The George Washington University Medical Center

The George Washington University Medical Center

School of Medicine and Health Sciences

Human Sexuality

Introduction to Clinical Medicine

Course Meeting Dates and Times: Thursdays 1:30 -4pm

Course Director: Name: Charles P. Samenow, MD, MPH Phone: 202-741-2875

Email: Office Hours: Appointment

Course Coordinator: Name: Carla Piereck de Sa Phone: 202-994-1896

Email:

Course Overview:

This section is designed as an interdisciplinary course to furnish you with three essential areas of expertise. First, you will achieve a basic command of the biopsychosocial knowledge currently available in the area of human sexuality. This includes and introduction to the diversity of sexual behaviors, practice and pathologies. Second, you will be introduced into how human sexuality presents itself in the clinical environment – what patients say, what they don’t say, what practitioners experience and what to ask and look for. This includes both “normal” and more dysfunctional fantasies, beliefs and behaviors. Finally, you will explore your own thoughts, feelings and attitudes towards these issues in order to identify your own personal barriers and strengths to becoming a better healthcare provider.

This course is built upon the current scientific knowledge around human sexuality. It is devoid of any political, moral, religious or non-scientific theories or ideologies. At times, material in this course may conflict with your own personal belief system. Your personal feelings and beliefs should not impede you from becoming an effective clinician for your patients. It is our hope that this course will help you become tolerant and non-judgmental in your approach to patients with a variety of sexual behaviors and problems.

Curriculum Interface:

This course contributes to the following curriculum objectives:

Medical Knowledge:

·  Apply the scientific basis of the normal structure, development, function, and relationships among the major organ systems of the body to concepts of health and disease.

·  Link biochemical, physiological, neurological, and immunological mechanisms to their role in maintaining body homeostasis.

·  Apply principles of pathophysiology to diseases and disorders.

·  Interpret the role of normal human biological, cognitive, psychological, and behavioral development across the life span as determinants of health and illness.

Patient Care:

·  Formulate a plan for the diagnosis and treatment of common medical conditions.

·  Identify opportunities for early intervention, prevention, and health education taking into account barriers to change.

Practice Based Learning and Improvement:

·  Apply reflection and feedback to incorporate lessons learned into future practice.

·  Apply medical standards, clinical practice guidelines, and practice algorithms appropriately for individual patients or populations.

Systems Based Practice:

·  Use system resources available to patients and communities for health education, treatment, and rehabilitation of medical and psychiatric conditions.

·  Define the elements of the healthcare system that lead to disparities in health and access to healthcare.

·  Explain how diverse cultures and belief systems impact perception of health and illness and response to symptoms, diseases, and diagnostic and treatment interventions.

Professionalism:

·  Demonstrate ethical behavior including: Compassionate treatment of patients, Respect for privacy and dignity, Honesty and integrity, Truthfulness, Patient Advocacy, Confidentiality, Accountability

·  Demonstrate reliability, punctuality, dependability and integrity in all professional activities.

Note: The human sexuality also demonstrates (but does not assess) a wide variety of the Interpersonal and Communication Skills that you will be expected to demonstrate later in the curriculum in standardized patient scenarios and in your clerkship in order to master III.1, III.2,III.5, III.6 and III.8.

Course Learning Objectives:

By the end of this course, each student should be able to:

1. Identify important anatomical structures and physiological mechanisms in male and female sexual response.

2. Describe normal variability in sexual behavior and the biopsychosocial factors that influence that variability

3. Recognize the medical and behavioral issues related to the sexual health and practices of lesbian, gay, bi-sexual and transgendered populations

4. Recognize the medical and psychological issues related to sexuality across the developmental lifespan from adolescence to later in life.

5. Describe principles of counseling patients in the primary care setting on important sexual health topics such as sexual dysfunction, safe sex practices, and harm reduction strategies.

Required Materials: Please see the course schedule below. All materials will be made available to you online through Blackboard.

Course Requirements, Deadlines, and Grading Values:

Attendance: Human sexuality is an essential part of every medical discipline and is an area of consideration in most clinical encounters. Faculty have taken time from their private practices, public health administrative duties, and various other clinical roles to bring this material to us. Finally, patients have voluntarily agreed to share intimate aspects of their lives. Hence, the course is like a mini-clerkship and attendance for this course is mandatory at all sessions. Any absences must be approved by the course director ahead of time. If you miss a class due to an emergency, appropriate documentation will be required. Excused absences must be made up with the course director. PA students must also inform Dr. LeLacheur of any absence. Unexcused absences will be reported to the Dean’s office.

Professional Attire: When patients are present, students may be dressed in casual attire that is professional in presentation. This includes long pants and shirts without prints/graphics. No athletic wear or shorts. White coats are not required.

Participation: Much of the course will be conducted in discussions, panels, and interactive large group formats. While you will not receive an individual participation grade, your experience in the course (and that of others) will be greatly enhanced if you share you ideas, attitudes, and values with others.

Blackboard Discussion Forum: This course is expected to raise, confirm, and even challenge a variety of viewpoints, perspectives, beliefs and values. While the predominant focus of the course is on understanding the science and behavior of human sexuality in the context of medical practice, such a discussion cannot take place in the absence of culture, religion, politics, etc… The online discussion forum is an area for you to share you viewpoints in a safe, moderated forum and to spur dialogue about issues and topics raised. It is also an area where you can post questions about course materials and receive direct feedback from the course director and other community members. Anonymous posting will be allowed. However, all postings will be screened by the course director for appropriateness in tone, language, and content. This is not to censor ideas, but rather to promote a safe and constructive environment. If you have concerns about why a comment you have posted was not shared, you may address this concern with the student ombudsperson. Participation is encouraged, but voluntary.

Grading:

The Human Sexuality section is a component of the Introduction to Clinical Medicine course (IDIS 301). A grade for ICM is awarded at the end of the spring semester.

You will be tested on the content of the Human Sexuality section by a 50 question multiple choice section examination. Scores will be reported for your performance on this examination as normalized/standardized scores. PA students will be graded according to the criteria listed in their PA 225 syllabus.

An unexcused absence from required section learning activities will results in a CN grade for the ICM course, which will require remediation.

Honor Code:

All examinations, papers, and other graded work products and assignments are to be completed in conformance with the George Washington University School of Medicine and Health Sciences Honor Code.

Course Faculty:

Jehan El-Bayoumi, MD – Associate Professor of Medicine MFA/GWU. Director, Internal Medicine Residency Training Program.

Thomas Coughlin, LPC – Psychotherapist and Patient Advocate for Transgender Health, Whitman-Walker Clinic

Meghan Davies, MPH – Deputy Director of Community Health, Whitman Walker Clinic

Stephen Forssell, PhD – Department of Psychology, George Washington University

Julia Frank, MD – Associate Professor and Director of Medical Student Education, Department of Psychiatry and Behavioral Sciences MFA/GWU

David Frankfurter, MD – Medical Director, IVF; Director, Donor Egg Program; Professor of Obstetrics and Gynecology, MFA/GWU

Nancy Gaba, MD, Associate Dean of Graduate Medical Education, Associate Professor of Obstetrics and Gynecology; MFA/GWU

Justin Goforth, RN, BSN – Director, Medical Adherence Unit, Community Health Division, Gay Men’s Health and Wellness Clinic, Whitman Walker Clinic

Mary Kendell, MS, WHCNP, Sexuality Counselor, Center for Integrative Medicine GWU

Michael Irwig, MD – Assistant Professor of Medicine and Director of Andrology, Department of Endocrinology MFA/GWU

Barbara Lewis, PA - C – Co-founder, Lesbian Health Program at Whitman Walker Clinic

Raymond Martins, MD – Chief Medical Officer, Whitman Walker Clinic. Assistant Clinical Professor of Medicine MFA/GWU.

Michael Phillips, MD – Clinical professor of Urology, MFA/GWU

Spencer Olson, Community Engagement Coordinator, Metro TeenAIDS

Katalin Eve Roth, JD, MD –Director, Division of Geriatrics and Palliative Medicine MFA/GWU

Charles P. Samenow, MD, MPH – Assistant Professor, Department of Psychiatry and Behavioral Sciences MFA/GWU; Editor, Sexual Addiction and Compulsivity; Board Member, Society for the Advancement of Sexual Health

Class Schedule:

October 13: Human Sexuality Overview

1:30 – 3:00: Introduction to Human Sexuality 2010 – Activity and Discussion (SAMENOW)

3:00 – 4:00: Sex on the Net (SAMENOW)

Readings:

1. Screening for HIV infection: A Healthy “Low Risk” 42 Year Old Man (JAMA, 2011)

2. A National Strategy to Improve Sexual Health (JAMA, 2010)

Video Homework: Patient Sexual History: What You Need to Know to Help (American Medical Association)

October 20: The Sexually Active Adolescent

1:30 – 2:15: Adolescent Panel and Discussion (SAMENOW)

2:15 – 2:45: Expert Opinion (DAVIES, GOFORTH, OLSEN)

2:45 – 3:15: Safer Sex Demonstration (DAVIES, GOFORTH, OLSEN)

3:15 – 4:00: Break Out Groups

4:00 – 4:!5: Large Group/Transfer (SAMENOW)

Readings:

1) Shafii and Burstein. The Adolescent Sexual Health Visit. Obstet Gynecol Clin N Am. 36(2009) 99-117, 2) Marshall Miller, Kenneth Mayer, MD, and Harvey J. Makadon, MD (1999) Talking About Safer Sex With Your Patients. Fenway Institute; Boston, MA. 3) “Safer Sex” Fenway Clinic (Boston, MA), 3) Antiretroviral Post-Exposure Prophylaxis After Sexual, Injection-Drug Use and Other Non-occupational Exposure to HIV in the United States. MMWR. Jan 2005: 54(RR02);1-20. 4) Fenway Safer Sex Brochure

October 27: A Gentleman with Erectile Dysfunction

1:30 – 1:40: Introduction (SAMENOW)

1:40 – 2:10: Urologist Interview (PHILLIPS)

2:10 – 2:40: Mental Health Interview (KENDALL)

2:40 – 3:00: Reflection/Breakout

3:00 – 3:45 Discussion (EL-BAYOUMI, ROTH, PHILLIPS, KENDALL, PATIENTS)

3:45 – 4:00 Wrap-Up./Transfer

Readings:

1) Zeiss and Kasl-Godley (2001) Sexuality in Older Adults’ Relationships. Generations. 25(2) 18-25, 2) A Man’s Shelf Life. Psychology Today. Sept/Oct 2007. 90-86. 3) Morgentaler. A. (2004) Clinical Crossroads A 66-Year-Old Man With Sexual Dysfunction. JAMA . 291(24):2994-3003,

November 3: A Female with Pain on Intercourse

1:30 – 1:40: Introduction (SAMENOW)

1:40 – 2:10: Ob/Gyn Interview (GABA)

2:10 – 2:40: Mental Health Interview (KENDALL/FRANK)

2:40 – 3:00: Reflection/Breakout

3:00 – 3:45 Discussion (GABA, EL-BAYOUMI, KENDALL, PATIENTS)

3:45 – 4:00 Wrap-Up./Transfer

Readings:

1) Women's Sexual Desire: A Feminist Critique, Jill M. Wood, Patricia Barthalow Koch, and Phyllis Kernoff Mansfield, The Journal of Sex Research, Vol. 43(3), August 2006. 2) Potter (2007) Clinical Crossroads: A 60 year old woman with sexual difficulties. JAMA 297(6)

November 10: LGBT Health

1:30 – 1:40: Introduction (SAMENOW)

1:40 – 2:45: Gay Parenting (FORSSELL, FRANKFURTER)

2:45 - 3:50: Gay Relationships and Sexual Health (FORSSELL, MARTINS, LEWIS)

3:50 – 4:00: Wrap-up/Transfer

Readings:

1) Behavioral Medicine: A Guide for Clinical Practice (Online) – Chapter 14. Lesbian, Gay, Bisexual and Transgendered (LGBT) Patients; 2) Makadon, Mayer and Garofalo (2006) Optimizing Primary Care for Men Who Have Sex With Men. JAMA. 296(19)2362-2365, 3) White JC, Levinson W. (1995) Lesbian health care -- What a primary care physician needs to know. West J Med. 162:463-466.

November 17: The Transgender Patient

1:30 – 2:00: Introduction to Transgender Health (COUGHLIN)

2:30 – 3:50: Transgender Healthcare Panel Discussion:

Moderator: SAMENOW

Endocrine: IRWIG

Mental Health: COUGHLIN

Ob/Gyn: GABA

3:50 – 4:00: Wrap-Up/Transfer

Readings:

1) Lombardi (2001) Enhancing Transgender Healthcare. American Journal of Public Health. 91(6): 869-872, 2) Moore, et. al. (2003) Endocrine Treatment of Transsexual People: A Review of Treatment Regimens, Outcomes, and Adverse Effects. The Journal of Clinical Endocrinology & Metabolism. 88(8):3467-3473.

November 18: Wrap-Up

1:30 – 3:00 Sex and Culture Activity and Discussion (SAMENOW/FRANK)

3:00 – 4:00 Sexual Boundaries: Hazardous Affairs (SAMENOW)

Readings:

1) Fourcroy (2006) Customs, Culture, and Tradition – What Role Do They Play in a Woman’s Sexuality? J Sex Med. 3:954-959.

Review Session: TBD

November 2X: Final Exam