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Original papers: Romanus Ndubueze Nnaji and Trevor Friedman Sexual dysfunction and schizophrenia: psychiatrists’ attitudes and training needs Psychiatr Bull 2008; 32: 208-210 [Abstract] [Full text] [PDF]

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Need for training to deal with psychosexual and relationship problems

Kiran Rele, Prof Kevan Wylie   (21 July 2008)

Need for training to deal with psychosexual and relationship problems 21 July 2008
Kiran Rele, Consultant Psychiatrist , Prof Kevan Wylie Send letter to journal: Re: Need for training to deal with psychosexual and relationship problems Kiran.Rele{at}BarnsleyPCT.nhs.uk Kiran Rele, et al.	We read with interest the article on "Sexual dysfunction and schizophrenia: psychiatrists’ attitudes and training needs" We feel that the knowledge of psychosexual development and competency in the assessment and treatment of psychosexual disorder should be core components of a psychiatry-training curriculum. Research indicates that many psychiatric training schemes fail to teach a broad range of human sexuality issues and that expert supervision and clinical training opportunities are lacking (Verhulst, 1992). Scheiber and colleagues (2003) have proposed that the knowledge of psychosexual development and competency in the assessment and treatment of psychosexual disorder should be core components of a psychiatry residency curriculum. We undertook a study that monitored the evaluation of assessment and training of psychosexual and relationship problems in the general mental health services (Rele & Wylie, 2007). We devised a questionnaire that asked psychiatry trainees to report their perception of competency in dealing with sexual dysfunction and relationship problems; the need to discuss potential sexual side-effects before and after starting psychotropic medication and the importance of a readily available psychosexual disorder clinic. In addition, we enquired about the emphasis, or otherwise, on psychosexual disorders, and sexual medicine problems in general, and their management both in medical school and during current psychiatric training. All psychiatry trainees (both basic and Higher Specialist trainees in Adult & Old Age Psychiatry) in the Mid-Trent rotation were invited to complete a questionnaire. Results: Only 24% of trainees reported that they routinely ask patients about psychosexual history, 65% felt comfortable about taking a detailed psychosexual history.81% of trainees reported inadequacy whilst dealing with psychosexual disorder during their training in psychiatry. Only 30% of trainees reported asking patients about potential sexual side effects when on psychotropic medication. All the trainees (100%) preferred to refer the patient to a local psychosexual disorder clinic (if available) rather than treat the patients themselves. To our knowledge this was the first survey looking into the competency issues of UK based psychiatric trainees with regard to taking a sexual and relationship history and management of sexual dysfunction of their patients. Taking a sexual and relationship (both past and current) history should be an integral part of any psychiatric assessment. The authors have failed to highlight the importance of a healthy relationship. Health Care Professionals need to be alert to the possibility of a sexual problem and should be competent enough to be able to discuss the problem. Clinical Implications: Taking a sexual and relationship (both past and present) history should be an integral part of any psychiatric assessment. Training in human sexuality should be introduced in medical schools as a part of the undergraduate curriculum and is a core part of psychiatric training curriculum and trainees should be tested for their competency in dealing with sexual dysfunctions. References: RELE, K. & WYLIE, K. (2007) Management of psychosexual and relationship problems in general mental health services by psychiatry trainees. International Journal of Clinical Practice, 61,10, 1701-1704 SCHEIBER, S.C., KRAMER, TAM., ADAMOWSKI, S.E.(2003) The implications of core competencies for psychiatric education and practice in the US. Can J Psychiatry, 48, 215-21 VERHULST, J (1992) The sexuality curriculum in residency training. Acad Psychiatry, 16, 115-7 Declaration of Interest: None