Rubio‐Aurioles, Eusebio

Abstract Introduction Sexual problems are common throughout the lifespan. Therefore, it is important for medical students and other health professionals to receive instruction in sexual medicine that is sufficient to prepare them to address these issues as a routine part of practice. Objectives To consolidate and update recommendations published from prior International Consultations on Sexual Medicine and other consensus-based recommendations from across the world for standards of sexual health education (SHE) among medical students. To evaluate the status of recommendations for various health professionals and of existing training and educational platforms. Methods A conceptual review of previous reports on curriculum standards of SHE in medical schools and an updated literature review from 2016 to current was conducted. Results We provide a summary and comprehensive recommendations based on expert opinion, accumulated experience, and literature review for a sexual health curriculum for medical students, including how it should be taught, recognizing that curricula are diverse worldwide. Scant research exists regarding the impact of sexual medicine training on sustained clinical skills and patient outcomes. Existing sexual medicine education platforms can be applied, adapted, and optimized across training levels, disciplines, and geographic locations. We discuss opportunities to improve evaluation of knowledge and competency, as well as the importance of studying methodologies to improve curriculum and methods of evaluation, particularly for disciplines in which these curricula have not previously been evaluated. Conclusions Sexual medicine societies are encouraged to implement previous recommendations and make medical student SHE a priority. Extending these recommendations to post-graduate and practicing clinician and other health professionals’ education would help close education and clinical practice gaps. Future training interventions should incorporate assessment of skill acquisition and meaningful patient outcomes, as well as integrate educational platforms including web-based formats, interactive technology, and experiential learning strategies. Recommendations of Expert Consensus Committee Sexual health educational curricula should be expanded to include sexual well-being and pleasure in addition to pregnancy and sexually transmitted infection (STI) prevention. (Strong) ISSM and affiliated sexual medicine societies (ASMS) should follow through on previous recommendations (ICSM 2009, 2016) and prioritize sexual health education in their missions. (Strong) Sexual medicine societies should join with other organizations to promote standards through position statements and other joint efforts. (Strong) ISSM/ASMS should play a key role in setting curriculum standards, promoting sexual health education in medical schools and other health professions, providing teaching methods and materials, and training of educators. (Strong) ISSM/ASMS are encouraged to establish standing committees promoting sexual medicine education in medical schools, other health professions, and graduate/postgraduate training. (Weak) ISSM/ASMS should utilize international, regional, and virtual meetings as vehicles for disseminating updated knowledge and training educators. (Strong) ISSM/ASMS should advocate to regulatory organizations that set standards for the requirement of sexual health training and assessment of competency in all professions. (Strong) The committee encourages exploration of the use of digital interactive platforms and modern technologies (avatars, AI -artificial intelligence, NLP -natural language processing) and inclusion of quality assurance of virtual domains. (Weak) Beyond the evaluation of student and postgraduate trainee performance and curricula effectiveness, the committee urges research on the impact of educational interventions on sustained clinical practices and patient outcomes in sexual health. (Strong)

Abstract Introduction As the field of sexual medicine continues to grow, there has been increasing attention on methodological integrity and rigor of sexual medicine research, including an emphasis on guidelines for quantitative research design and standards for assessing clinical trial outcomes. However, qualitative research (QR) methodology has garnered relatively scant attention in comparison. Objectives To clarify the value of QR and provide recommendations for improving implementation of QR methods in sexual medicine research. Methods A PubMed review was conducted. Expert opinion was based on a process of literature review and expert consensus. Results An essential goal of QR is to describe and explain unknown or insufficiently understood phenomena through detailed investigation of subjective human experience. Results from QR allow for generating hypotheses that may then be tested. More recently, mixed-methods research, ie, research integrating both qualitative and quantitative methods, is being increasingly used across domains of biomedical and health science research. While there remain differences of opinion regarding use of qualitative methodology in sexual medicine, best-practice models of QR underscore the principle of trustworthiness and include ethics and transparency in protocols for data collection and analysis. It is recommended that established QR frameworks for developing a research question are utilized and that consolidated criteria for reporting research results are employed. Furthermore, authors and reviewers need training in both QR methods and qualitative reporting frameworks to be able to adequately report and review this type of research. Specific areas in sexual medicine that would ideally benefit from QR methods are suggested. Conclusion As the field of sexual medicine continues to expand, qualitative methodologies including mixed-methods research, offer significant value for understanding domains of inquiry that have not been thoroughly investigated. To achieve these targets, training of authors and reviewers on QR is needed.

Abstract Background Erectile dysfunction (ED) is a common condition that may affect men of all ages; in 1999, a Process of Care Model was developed to provide clinicians with recommendations regarding the evaluation and management of ED. Aim To reflect the evolution of the study of ED since 1999, this update to the process of care model presents health care providers with a tool kit to facilitate patient interactions, comprehensive evaluation, and counseling for ED. Methods A cross-disciplinary panel of international experts met to propose updates to the 1999 process of care model from a global perspective. The updated model was designed to be evidence-based, data-driven, and accessible to a wide range of health care providers. Outcomes This article summarizes the resulting discussion of the expert meeting and focuses on ED evaluation. The management of ED is discussed in an article by Muhall et al (J Sex Med 2018;15:1280-1292). Results A comprehensive approach to the evaluation of ED is warranted because ED may involve both psychological and organic components. The updated process of care model for evaluation was divided into core and optional components and now focuses on the combination of first-line pharmacotherapy and counseling in consideration of patient sexual dynamics. Clinical Implications Patient evaluation for ED should encompass a variety of aspects, including medical history, sexual history, physical examination, psychological evaluation, laboratory testing, and possibly adjunctive testing. Strengths & Limitations This update draws on author expertise and experience to provide multi-faceted guidance for the evaluation of ED in a modern context. Although a limited number of contributors provided input on the update, these experts represent diverse fields that encounter patients with ED. Additionally, no meta-analyses were performed to further support the ED evaluation guidelines presented. Conclusion Comprehensive evaluation of ED affords health care providers an opportunity to address medical, psychological/psycho-social, and sexual issues associated with ED, with the ultimate goal being effective management and possibly resolution of ED. While some or all techniques described in the updated model may be needed for each patient, evaluation should in all cases be thorough.

Abstract Introduction Erectile dysfunction (ED) is a common condition the treatment of which over the years has expanded from specialty care settings to various other clinical settings. A Process of Care Model was developed in 1999 to provide primary care physicians with guidance in the diagnosis and management of ED. Aim This update to the Process of Care Model aims to reflect current ED management practices, because the study of ED has changed since 1999. Methods Updates to the Process of Care Model were developed during a meeting of international experts from diverse disciplines. The updated model is data-driven, evidence-based, and relevant to a wide range of healthcare providers. Main Outcome Measures This article summarizes the results of the expert meeting and focuses on ED management. The evaluation of ED is discussed in a separate article. Results The updated model presents modification of risk factors and correction of comorbidities frequently associated with ED as critical parts of patient management. Patients should be encouraged to make positive lifestyle changes such as improving diet and increasing physical exercise. Lifestyle changes may be accompanied by the first-line medical therapies of sexual counseling and therapy, which takes into consideration patient sexual dynamics and pharmacotherapy with phosphodiesterase 5 inhibitors (PDE5Is). Clinical Implications The updated model provides guidance regarding risk factors associated with ED, their modification, sexual counseling, and PDE5I selection, dosing, and patient education. Strengths and Limitations This update leverages the extensive clinical expertise and experience of the authors to provide updated, comprehensive guidance for ED management. The model reflects the views and experiences of a limited number of contributors; however, these authors draw upon a diverse array of clinical specialties and are regarded as experts in their fields. Additionally, no meta-analyses were performed to further support the ED evaluation guidelines presented. Conclusion Effective management of ED may be achieved through a combination of patient risk factor modification and first-line therapy, taking into consideration any patient comorbidities known to be associated with ED. Treatment goals should be individualized to restore sexual satisfaction to the patient and/or couple and improve quality of life based on the patient’s expressed needs and desires.