Jillian Schneidman’s doctor failed to ask her a single question about her sexual health, until she had a partner.
“It was, ‘You’re using protection, right?’ And that’s where it ended,” she recalled.
Schneidman is now halfway through medical school at McGill University and finds nuanced discussion about sexual health is lacking there, too. As lectures steer toward anatomy, pharmacology, reproductive health and sexually transmitted infections, the student feels conversations about more complex issues are largely missing.
“Little focus was placed on 2SLGBTQIA+ health, sexual assault, trauma-informed care, consent, healthy relationships, chronic sexual health conditions or sexual pleasure,” Schneidman said. “There’s a lack of understanding that sexual health is an integral part of someone’s wellbeing.”
Without good training, health care providers can feel ill-equipped to raise such subjects with patients, experts say. On the other side, patients often don’t disclose sexual concerns to their doctors for fear of judgment or discomfort – sometimes leaving their appointments without the right information or treatment.
Schneidman is hoping to fill some of these knowledge gaps with her new sexual health education platform intended for healthcare practitioners, called Sex[M]ed. Her goal is to promote subjects misrepresented or absent from healthcare curriculums.
The website includes insights from clinicians and researchers who specialize in sexual health, as well as first-person stories from patients. Topics include everything from emergency contraception, IUDs, genital herpes and period pain (and why doctors need to treat it seriously), to care for sexual assault survivors in Quebec and navigating abortion access in the Maritimes.
Schneidman hopes healthcare providers will use the free website to educate themselves. Ultimately, she hopes to see such topics more fully integrated throughout medical training in Canada, so that emerging practitioners will be more comfortable discussing these sensitive subjects with their patients.
Aside from having a firm grasp on the best, most up-to-date information, health care providers need to build trust so “the patient – the person in front of you – feels at ease disclosing aspects of their relationship and life,” said Saleem Razack, a pediatric critical care medicine physician who wrote a piece for Sex[M]ed.
In a recent Canadian Medical Association Journal analysis, Razack argued for the creation of a national standard for inclusive medical education in this country.
“Students and new doctors will be looking after a very diverse population – a sexually-diverse and gender-diverse population as well,” said Razack, who is director of the office of social accountability and community engagement at McGill University’s faculty of medicine and health sciences.
“The ways in which we find pleasure in sex are very diverse. Much of that intersects with medicine. We need to equip students with the tools to think about sexual diversity and about how to ask, when to ask, what to ask.”
Although Sex[M]ed is intended for practitioners caring for all kinds of patients, particular focus goes to people historically underserved by medicine: women, LGBTQ+ patients and survivors of sexual violence. Pointing to women’s health, Schneidman noted that patients suffering from conditions such as endometriosis and vulvar pain often face delayed diagnosis – making the case for stronger teachings on these topics in medical school.
On transgender health, Schneidman said only two lectures addressed the issue in two years of study so far. She hopes to focus her own career on women’s health, trans health and power dynamics in medical encounters.
“There is still a long way to go in medical education with respect to comprehensive sexual and reproductive health education,” said Jenna Webber, a family physician and associate professor in family medicine at Queen’s University who is not affiliated with Sex[M]ed.
Webber, who served as national officer of reproductive and sexual health at the Canadian Federation of Medical Students, has taught nurses, physicians, paramedics, medical students and residents about LGBTQ+ health, sexual assault and trauma-informed care, among other issues. If medical curricula is to meaningfully address sexual and reproductive health rights, it has to be evidence-based, accessible, consistent and centred on the patient, Webber argued.
She lauded Sex[M]ed for highlighting patients’ experiences within the medical system and for widening “the narrow lens through which medical curricula have traditionally covered sexual and reproductive health.”
Part of the Sex[M]ed project involves extending sexual health education to medical disciplines where it has traditionally been absent. Halifax occupational therapist Bobbie Martin recently penned a piece for Sex[M]ed about the absence of sexual health training in her schooling. Ms. Martin wants occupational therapists to educate themselves so they can start to address their patients’ sexual concerns during initial assessments, “just like we do with any other activity of daily living, such as toileting, showering, dressing, sleeping, cooking.”
Some of her patients suffer from chronic pelvic pain, which can also mean painful intercourse. With stronger training, occupational therapists would be better poised to discuss ways to alleviate pain during sexual activity, Martin said.
“We’re still not tackling sexual health and sex,” she said. “It’s important to be able to talk openly and non-judgmentally with clients and to recognize, in yourself, your own values and positioning within that setting.”
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