Online Training Program on Sexual Disorders for Primary Care Physicians

Although sex was depicted by the ancient Egyptians with tomb carvings/paintings, papyrus, and sculptures—The Turin Erotic Papyrus dating back to 1105 BC illustrated at least 12 sex positions, followed by the first sex manual in history “The Kama Sutra” written in India in second century BC entwining mind body and soul in techniques of sexual pleasure enhancement—yet sex is still a taboo wrapped in holy myths for many societies awaiting to be unraveled and justified as if we are experiencing regression on this subject matter. ¹

Epidemiologically, the few scarce studies that assessed prevalence of sexual disorders in males and females revealed 40% to 50% prevalence of a diagnosable sexual disorder in adult men and women life span, respectively, with negative sequels on their quality of life. Yet, most clinicians seem to be less than adept at obtaining a sexual history and discussing sexual health. Most likely, this is due to poor training on this topic during their early educational years at medical school. Given the fact that most physicians may understand the many advantages of taking a sexual history, yet some physicians object to spending time discussing sex-related topics, claiming it is uncomfortable for both patient and practitioner and takes time away from “real” medical topics.^{2, 3}

Hence, promoting psychosexual health and knowledge poses a challenge for professionals in societies charged with cultural, religious, and traditional misconceptions about sex and how it should be practiced within “the right frame” usually a religious one—“the right way” that acknowledged by their own society—banning certain practices like oral or anal sex and condemning homosexuals for choosing a sexual orientation that is religiously forbidden or socially stigmatizing, not to mention patients suffering from gender dysphoria and the entire spectrum of LGBTQ individuals.

Sadly, those views and practices are not only harbored by lay people and the public but also the views of many physicians in those societies as well, physicians who are still dealing with ego syntonic homosexuality as a disorder and gender dysphoria as a delusional manifestation, overlooking all contemporary state of the art and diagnostic statistical manuals revisions that contradicts such faulty notions.^{4, 5}

The criminal practice of female genital mutilation also known as female circumcision in many countries is conducted under religious pretests by physicians who believe it could be better for the female victim in order to decrease her damage and risk of infection during the procedure, for if left alone or reported the family; the operation would still be done by the family in a nonsterile environment, where the female would bleed to death or die from sepsis. Is the physician overlooking the drastic biological and psychological sequels that will affect that female and her possible future partner? Is the physician involved in such crime? Could that be considered a form of medical harm reduction?^6–9

Attempts to reach out to the public to raise awareness about sexual health and its practices as well as the need for sex education have been conducted by various psychiatrists, psychologists, andrologists, sexologists, mental health professionals, and health institutions’ advocates on television and media portals funded by governments like www.lovemattersafrica.com ¹⁰ on social media platforms for some decades now—with some success in highlighting the need to revisit faulty preconceived notions and views about sex—those inherited over the years that lead to disease and miserable unhappy lives. Promising public interaction is reported to be encouraging on Google engines on those platforms. However, no specific program was developed and published to address the real need of physician for a formational concise education on sexual health and disorders, a program designated to develop primary care physician’s (PCP) own agency for adequate assessment and appropriate management including referral to specialists when required.

Those inquiries hand in hand with the increasing demand on basic specialized education underscore the importance of fostering sexual health knowledge among health professionals. A journey that should have started while studying medicine at the university during the early years of formal educational formation to substantiate an adequate mindset and rectify wrongful preconceived notions before the student becomes an actual physician and is ready to handle patients. Nevertheless, this seems like a far-fetched goal now, viewing the current syllabi at many medical universities and since changing those to get them to include mental health repertoire demonstrating sexual health and its disorders may take decades to be achieved. We are faced with the need to find another way to reach out to the PCP to substantially touch the widest range of their patients’ population in need for this kind of care.

The World Psychiatric Association (WPA) recognized its responsibility to play a role in this crucial mission—by fostering mental health education for the medical student and the PCP, so offered free of charge registration for all medical students around the world in all its scientific meetings and recently joined forces with the American College of Cardiology (ACC) steering Non-Communicable Diseases (NCD) Academy to address mental health issues on the academy platform.

Mental health issues including sexual disorders take a significant toll on the people they affect and those around them. In fact, serious mental disorders have been shown to reduce life expectancy by as many as 25 years. Improving early intervention and access to treatment at the primary care level has been recognized by global health actors including the World Health Organization (WHO) as critical to achieving universal coverage of essential health services. This requires that primary care providers learn and integrate strategies to identify, assess, and support patients experiencing psychological distress into routine practice.

WPA reached out to the quorum of its scientific sections to develop six courses addressing mental health care—increasing awareness, erasing stigmas encompassing roughly three hours of clinical education covering five mental health domains: major depressive disorders, unhealthy substance use, memory disorders, sexual disorders, and trauma. The course concludes with an exam and certificate of completion. This course was developed by 17 experts from WPA sections and partner societies around the world.

The course will form part of NCD Academy, a partnership between major medical societies steered by the ACC to overcome the geographic and financial barriers that have historically disenfranchised providers in rural and resource-constrained settings from professional development opportunities. NCD Academy lessons are interactive, filled with case-based practice, and available on-demand via mobile app or the program website and last but not least all courses are free and will be available in different languages. The aim is to implement an effective quick strategy to reach the largest possible number of PCP around the world hoping that the impact will tangibly make a difference in the near future.

To share more information about the course on sexual disorders in particular and its backstage making: it is currently in its beta version and will soon be launched online on NCD Academy site https://www.acc.org/ncdacademy. ¹¹

Dr Radwa S Abdelazim Elfeqi WPA section on Psychiatry and Human Sexuality (co-chair)—Psychiatry Consultant at Cairo University Hospital Egypt and Dr Adarsh Tripathi Associate Professor of Sexology at King’s College—India were appointed by Prof Afzal Javed WPA president to develop the course in collaboration of an esteemed technical team appointed by NCD Academy—the course was developed over 8 months duration of continuous work and refinement to offer a capsule of intense education in an interactive fun format with many clinical and practical examples—true stories from the clinic for any participant to enjoy and learn from, since the Academy is open and free to the public.

Yet, this course was particularly designated to take the PCP into a hands-on journey into human sexuality and its disorders—starting from definition of love and commitment to sexual response cycle, factors affecting sexuality, related comorbidities, epidemiological variations with gender, sexual history taking—interview implementing the PLISSIT model, many real-life clinical cases and its management including pharmacotherapy and other contemporary state of the art techniques. ¹²

Finally, I would like to conclude this article with two notions: One reiterating the famous definition of WHO regarding health stating that there is no health without mental health and adding on that there is no mental health and happiness without sexual fulfillment.A second notion is that the NCD/WPA course on sexual disorders should only be the startup of a worldwide move of educational courses on the matter. These courses are professionally developed to take us back to the Pharaoh’s wisdom and Kama Sutra’s erotic prescriptions, hoping to meet a skillful PCP in sexual history-taking or receiving a referral from one who was able to adequately diagnose and refer—that would be a victory day for the profession and a happy day for everyone.