Assessing comfort levels with female sexual dysfunction among medical residents: a nationwide cross-sectional survey study and its implications for medical education

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BACKGROUND: Female sexual dysfunction (FSD) affects 30%-50% of women but is substantially underdiagnosed and undertreated due in large part to the fact that just half of US medical schools offer formal sexual health teaching with an overwhelming skew toward male sexual health. AIM: The aim of this study is to assess the knowledge and confidence of residents in conducting a comprehensive pelvic examination and their comfortability diagnosing and managing conditions of FSD. METHODS: In June 2023, the authors used Qualtrics to administer this cross-sectional survey. The target audience included resident physicians in Urology, Obstetrics and Gynecology, Dermatology, Internal Medicine, Family Medicine, and Emergency Medicine. The authors emailed a survey link and brief description of the project to all residency program directors in these specialties with valid email addresses in the FREIDA American Medical Association Residency Database. Program directors shared the link to the anonymous online survey with their current resident cohorts. RESULTS: In total, n = 128 residents completed the survey. Less than half of all respondents indicated they had received prior formal training in physical exam of the clitoris (23%), vulvar vestibule (45%), and pelvic floor (35%). Regarding FSD, the following percentage of respondents indicated they had received training in these conditions: 78% genito-pelvic pain/penetration disorder, 38% hypoactive sexual desire disorder, 23% female orgasmic disorder, and 30% female sexual arousal disorder. The majority of respondents reported feeling uncomfortable with diagnosis and management of these conditions. CLINICAL IMPLICATIONS: Improving residents' ability to diagnose and treat FSD is essential for preparing the next generation of physicians to appropriately attend to the needs of female patients. STRENGTHS AND LIMITATIONS: One limitation of this study is the low survey response rate despite outreach to all relevant US residency programs. Additionally, our study did not account for the potential impact of different educational backgrounds on respondents' comfort levels with FSD, which could be addressed in subsequent research. A major strength of this study is being the first study to survey residents across specialties about their knowledge of FSD. CONCLUSION: Residents across several specialties are uncomfortable with diagnosing and managing common FSDs owing to a lack of training in both pelvic examination and conditions of FSD.

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