Search

Introduction: Sexual health is an essential component of overall health and wellness. Sexual dysfunction is pervasive and there are barriers to adequate diagnosis and treatment, including lack of instruction for medical students. Previous work from our group assessed the curricula of all seven medical schools within the Chicago area and highlighted the need to standardize both preclinical and clinical materials to enhance student education, exposure, and preparation in female sexual medicine (FSM). The United States Medical Licensing Exam (USMLE) Step 1 significantly informs content of pre-clinical undergraduate medical education. Comprehensive USMLE Step 1 resources therefore assume an integral role in exposing medical students to key topics which may or may not be included in their individual school's curriculum. Thus, it is important to assess if information about FSM and female genital anatomy is delivered to medical students and to what extent in board exam materials. Objective: This study aims to assess the coverage of sexual medicine topics in a USMLE Step 1 resource and to compare the representation of male- versus female-specific content. Methods: Digital copies of First Aid for the USMLE Step 1 2020-2023 versions were collected and evaluated for inclusion of sexual medicine subjects and topics for both males and females. The content of the chapters titled "Reproduction" and "Psychiatry" were included. To standardize our data collection, existing literature was used to identify specific components of anatomy and physiology related to genital anatomy and orgasm. Additionally, the epidemiology, pathologies, and treatments of FSM were specifically searched for in this resource. Results: Across the four editions of the resource included for evaluation, all covered the physiology of the male orgasm, however, none included the physiology of the female orgasm. Moreover, the only mention of female sexual dysfunction (FSD) was in the psychiatry chapter which only briefly addressed the pathophysiology of FSD, but not the epidemiology nor the treatment of FSD. Furthermore, only one out of seven relevant anatomical terms describing parts of clitoral anatomy were included. Homologous male genitalia was consistently labeled for the glans penis, prepuce, corpora cavernosa, and corpus spongiosum as four out of six anatomical terms of interest. Additionally, all four editions from 2020-2023 included content on penile neurovasculature and a penile cross-sectional diagram; however, there was no mention of clitoral neurovasculature nor were there any cross-sectional diagrams of female anatomic components in any of the four editions evaluated. Conclusions: Despite this USLME Step 1 resource's over 840 pages, the representation of topics related to FSM is lacking compared to analogous male topics. Recent literature which has highlighted the gaps in FSM education and the importance of comprehensive sexual medicine training for physicians, however, there have been no significant changes to the content of this resource over the past four editions. USMLE Step 1 resources play a vital role in enhancing the understanding of FSM among medical students. Content expansion is needed to provide accurate information to patients, help patients make informed decisions about treatments, destigmatize reproductive and sexual health, and overall advance medical knowledge of FSM. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Clitoral phimosis describes an attachment of the clitoral prepuce to the glans. This severe form of clitoral adhesions prevents the mobility and retraction of the clitoris and can be accompanied with clitorodynia, persistent arousal, and/or muted or absent orgasm. It often presents with a buildup of smegma and keratin pearls. Previous research suggests that these adhesions are found in up to 22% of women seeking evaluation for sexual dysfunction. Objective: To describe a patient with a unique and severe presentation of untreated clitoral adhesions resulting in complete clitoral phimosis and a large pseudocyst, and to share an innovative and minimally invasive procedure option which preserved sexual function. Methods: A 60-year old female presented with as a clitoral mass to a urology and sexual medicine practice for consultation regarding surgical excision of the mass with hopes to preserve clitoral sensation. Following an abdominal hysterectomy and bilateral salphingoophrectomy in 2010, the patient of interest presented to her gynecologist for an enlarging clitoris which progressed to form a mass over the course of several years. In 2022 she established care with a new gynecologist who referred her to a gyn-oncologist for concern of the now large mass. She underwent an MRI of the pelvis in September 2022 which revealed a 1.7 x 3.5 x 1.9 cm cystic lesion projecting from the prepuce. This was felt to be an epidermoid cyst or proteinaceous or hemorrhagic cyst arising from the vagina. After speaking to many specialists the plan was to undergo surgical excision, though preservation of sensation could not be guaranteed. The patient canceled surgery to obtain more information as preservation of clitoral sensation was a priority, at which point she presented to our clinic in April of 2023. Results: On exam, there were normal labia majora and resorbed labia minora fusing with the clitoral mass. On further examination, complete phimosis with a pinpoint and closed phimotic ring visible and a large smegmatic pseudocyst that was not adherent to the clitoris was appreciated. Clitoral phimosis was discussed at length and as an innovative, yet relatively straightforward solution, our urological surgeon proposed a dorsal slit (in the operating room) procedure for removal of smegma and small excision of excess surrounding tissue. This approach would have little to no known effect on the clitoral nerves as they course dorsally and terminal at the clitoral glans and would allow full retraction of the clitoral prepuce. The procedure was performed in May 2023 under IV sedation. Copious amounts of smegma were irrigated from the cyst and no adhesions were appreciated. After the removal of the smegmatic pseudocyst, our patient reported improved sensation and orgasm without pain or cystic reaccumulation. She was instructed to dilate the opening to avoid re-adherence. Conclusions: There is no standardized treatment for clitoral adhesions. This procedure improved our patient's sexual function and orgasm ability and was spared from a major surgery with significant risks. Equipping physicians with fundamental knowledge about clitoral adhesions would likely result in earlier and more frequent intervention, preventing large and atypical masses like the one observed in this case. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Female sexual dysfunction (FSD) affects 30-50% of women. Despite the fact that doctors from all specialties are likely to encounter patients with sexual health difficulties, just half of U.S. medical schools currently offer formal teaching in sexuality. Due to insufficient training in the female pelvic physical exam and minimal training on sexual health, FSD has been substantially underdiagnosed and undertreated. Objective: The aim of our study was to assess the knowledge and confidence of residents on how to conduct a comprehensive vulvar examination, as well as to assess the comfortability with diagnosing and managing conditions of FSD. Methods: This cross-sectional analytical survey study used Qualtrics to administer the survey. The target audience included urology residents, obstetrics and gynecology residents, dermatology residents, internal medicine residents, family medicine residents, and emergency medicine residents. The survey link and a brief description of the project were emailed to all residency program directors in these specialties who had valid email addresses provided in the FREIDA American Medical Association Residency Database. Program directors were requested to share the link to the anonymous online survey with their current resident cohorts. Results: In total, n=141 residents completed the survey (n=19 OBGYN, n=18 urology, n=5 dermatology, n=37 family medicine, n=27 internal medicine, n=35 emergency medicine). Less than half of all respondents indicated they had received prior formal training in physical examination of the clitoris (23%), vulvar vestibule (45%), and pelvic floor (36%). Regarding FSD, the following percentage of respondents indicated they had received prior training in these conditions: 78% genito-pelvic pain/penetration disorder, 36% hypoactive sexual desire disorder, 24% female orgasmic disorder, 33% female sexual arousal disorder. The majority of respondents reported feeling uncomfortable with the diagnosis and management of these conditions. Conclusions: Residents are uncomfortable with diagnosing and managing common female sexual dysfunctions, owing to a lack of training in both vulvar examination and these conditions of FSD. This educational shortcoming persists across several specialties. Awareness of this knowledge and comfortability gap is critical for implementing the appropriate changes to resident education. Improving residents' ability to diagnose and treat FSD is important for preparing the next generation of physicians to appropriately attend to the needs of female patients. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: The labia minora (LM) is a part of the external female genitalia that varies greatly in form and appearance, and changes at each developmental stage of a woman. Its highly neurovascular nature and proximity to the clitoris allows it to play a vital role in sexual function. Along with the labia majora, it helps to protect the opening of the urethra and vagina. The perception of a normal LM is dependent on cultural and social context and influences the kinds of procedures that are done on the LM. Objective: This study aims to comprehensively review labial anatomy, development, pathology, its role in sexual function, perceptions of labial appearance, and labial procedures. The goal is to understand the mechanism and purpose of the evolution of the LM and its effects on anatomical and sexual function. Methods: We reviewed journal articles from 1988 to 2023 concerning labial anatomy, physiology, pathology, piercings, tattoos, and labial procedures such as labiaplasty, genital mutilation, episiotomies. We also reviewed cultural perceptions of its structure, its role in sexual function and its composition and function in the transgender population. Results: The LM is highly neurovascular and engorges with blood with sexual stimulation. The structural changes are influenced by hormone levels. Perception of normal appearance varies by cultural and societal norms, influencing procedures performed in the area. Due to the histological composition of the LM, it has many manifestations of dermatological diseases. The LM is also susceptible to infectious, neoplastic, drug-induced, inflammatory, autoimmune and other systemic diseases. Limited information exists on LM piercing and tattoos. The size discrepancies of the LM may cause psychological distress, with conflicting research on its impact on sexual sensitivity or function. Labial procedures such as labiaplasty may enhance sexual satisfaction while female genital mutilation may reduce sexual satisfaction. There is a lack of comprehensive documentation of techniques of LM creation in transgender women and a lack of long-term follow-up studies post-vaginoplasty. The lymphatic structure within the LM is poorly understood, emphasizing the need for further research. Conclusions: The labia minora is important for arousal and sexual function and its changes over time is dependent on hormone levels. The appearance and structure drive the kinds of labial procedures that are conducted and significantly affects sexual health. There is a need for further studies of the labia minora to understand its complexities and evolution. Disclosure: No. [ABSTRACT FROM AUTHOR]

Competing Interests: Disclosures The authors have no conflicts of interest to report.

Introduction: Mentorship plays a valuable role in medical education by helping students navigate significant career decisions and cultivate enhanced professional networks. We sought to implement and evaluate a surgical mentorship program for medical students., Materials and Methods: Student members of the Surgery Interest Group and faculty surgeons were invited to participate in a mentorship program. Mentees were randomly paired with a mentor and instructed to schedule three meetings with their mentor and attend four structured group sessions. Pre-program and post-program surveys were administered and were standardized using a five-point Likert scale. Post-program interviews were conducted with willing participants., Results: Forty three mentees and 21 mentors were enrolled. Thirty two mentees (74.4%) and nine mentors (42.9%) completed both pre-surveys and post-surveys. In pre-surveys, strong communication was rated as a top factor of importance by mentors and mentees (76.2% versus 95.3%, P = 0.03). In post-surveys, seven mentors (77.8%) and 20 mentees (62.5%) found communication with their mentee or mentor to be effective. Seven mentors (77.8%) and 17 mentees (53.1%) gained a connection with a mentee or mentor. Mentees critiqued mentor communication in comments (9, 28.2%) and interviews (2, 33.3%). Mentors critiqued student communication and initiative in comments (4, 44.4%) and interviews (2, 66.7%)., Conclusions: Our findings suggest a semi-structured mentorship program can provide meaningful network connections to medical students interested in pursuing surgery. However, it is critical to ensure adequate communication and sufficient commitment from mentees and mentors., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Although approximately 41% of women experience sexual dysfunction, limited education on female sexual medicine (FSM) in medical school results in underpreparedness among physicians when addressing these bothersome conditions., Aim: This study aims to evaluate the extent to which FSM is represented in medical education by examining current preclinical and clinical curricula., Methods: Preclinical curriculum materials on female sexual anatomy, physiology, and pathology, as well as obstetrics and gynecology clinical materials (syllabi, lecture materials, and supplemental resources), were collected from medical schools in the Chicago area. We utilized previous literature to identify specific components of medical school content to evaluate., Outcomes: Upon reviewing each institution's curricula, we evaluated materials for topic saturation and assessed goals of each syllabus in terms of required content., Results: Curriculum materials were collected from 7 medical schools. In the preclinical assessment, 1 institution identified all anatomic components of the clitoris in our review, 4 discussed the physiology of the female orgasm, 3 highlighted the prevalence and epidemiology of female sexual dysfunction (FSD), 3 addressed treatments for FSD, and 1 instructed a genitourinary physical exam specific to assessing FSD. When assessing obstetrics and gynecology clinical materials, 5 institutions included topics related to FSM. Of these, only 1 institution had corresponding required synchronous clerkship time dedicated to these topics as a 1-hour lecture, in addition to an optional online training to third-year clinical students in comprehensive sexual history-taking practices, including screening for FSD. One other institution offered supplemental case-based gynecology modules including vulvovaginal diseases and chronic pelvic pain, though sexual pleasure, arousal, and libido were not included., Clinical Implications: The results of this study highlight the need for the inclusion of standardized curricula related to FSM in medical education to equip future physicians to treat patients with sexual dysfunction., Strengths and Limitations: The strengths of this study include that it is the first of its kind to complete a comprehensive review of FSM curricula at a cohort of undergraduate medical institutions. Its limitations include a small sample size of 7 medical schools limited to 1 geographical area., Conclusion: Our focused needs assessment of medical schools in the Chicago area reveals inconsistencies in outlined institution-specific course goals related to FSM and thus highlights the need for restructuring the curricula to prepare future physicians to recognize and treat patients with sexual dysfunction., Competing Interests: None declared., (© The Author(s) 2023. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)

Background: Although infertility affects an estimated 6.1 million individuals in the United States, only half of those individuals seek fertility treatment and the majority of those patients are White and of high socioeconomic status. Research has shown that insurance mandates are not enough to ensure equal access. Many workplaces, schools, and medical education programs have made efforts in recent years to improve the cultural humility of providers in efforts to engage more racially and economically underrepresented groups in medical care. However, these efforts have not been assessed on a population of patients receiving fertility care, an experience that is uniquely shaped by individual social, cultural, and economic factors., Objective: This study aimed to better understand the racial, cultural, economic, and religious factors that impact patient experiences obtaining fertility care., Study Design: A cross-sectional self-administered survey was administered at an academic fertility center in Chicago, Illinois. Of 5000 consecutive fertility care patients, 1460 completed the survey and were included in the study sample. No interventions were used. Descriptive univariate frequencies and percentages were calculated to summarize sociodemographic and other relevant patient characteristics (eg, race or ethnicity, age, household income, religious affiliation, insurance coverage). Rates of endorsing perceived physician cultural competency were compared among demographic subgroups using Pearson chi-squared tests with 2-sided P<.05 indicative of statistical significance. To identify the key determinants of patient-reported worry regarding 9 different fertility treatment outcomes and related concerns, a series of multiple logistic regression models were fit to examine factors associated with patient report of being "very worried" or "extremely worried.", Results: Members of our sample (N=1460) were between 20 and 58 years of age (mean adjusted , 36.2; standard deviation, 4.4). Among Black participants, 42.3% reported that their physician does not understand their cultural background compared with 16.5% of White participants (P<.0001). Participants who identified as Latinx were significantly more likely than White participants to report being very/extremely worried about side effects of treatment, a miscarriage, ectopic pregnancies, and birth defects (P<.05, P=.02, P=.002, P=.001, respectively). Individuals who identify as Hindu were nearly 4 times more likely to report being very/extremely worried about experiencing an ectopic pregnancy than nonreligious participants (P<.0002). Respondents most strongly identified the biology or physiology of the couple (mean adjusted , 21.6; confidence interval, 20.4-22.7) and timing or age (mean adjusted , 27.8; confidence interval, 26.5-29.1) as being associated with fertility. Overall, respondents most strongly disagreed that the ability to bear children rests upon God's will (mean adjusted , 65.4; confidence interval, 63.7-67.1), which differed most significantly by race (P<.0001) and religion (P<.0001)., Conclusion: Of the patient characteristics investigated, racial and ethnic subgroups showed the greatest degree of variation in regard to worries and concerns surrounding the experience of fertility treatment. Our findings emphasize a need for improved cultural humility on behalf of physicians, in addition to affordable psychological support for all patients seeking fertility care., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: To better understand the beliefs about a causal role of emotional stress maintained by women seeking fertility care., Methods: A cross-sectional, self-administered survey was distributed to fertility care patients at an academic fertility center in Illinois. Of 5000 consecutive patients, 1460 completed the survey and were included in the study sample., Results: Members of our sample (N = 1460) were between 20 and 58 years (mean = 36.2, SD = 4.4). Most respondents were White (72.2%), were in a heterosexual relationship (86.8%), and felt that their physician understood their cultural background (79.4%). Of the sample, 28.9% believed emotional stress could cause infertility, 69.0% believed emotional stress could reduce success with fertility treatment, and 31.3% believed that emotional stress could cause a miscarriage, with evidence of significant racial differences. Less than a quarter (23.8%) of the sample believed emotional stress had no impact on fertility. Lower household income and educational attainment were associated with a greater belief in emotional stress as a causative factor in reproduction with regard to infertility, fertility treatment, and miscarriage., Conclusion: The majority of women seeking fertility care believe emotional stress could reduce the success of fertility treatment. Furthermore, beliefs about emotional stress and reproduction significantly differ based on race/ethnicity, income, and education. Particular attention should be paid to specific groups of women who may more likely not be aware of the lack of a proven biological relationship between emotional stress and reproduction.

Background: Polycystic ovary syndrome (PCOS) is a complex and multi-faceted endocrine disorder that affects 5-20% of women. Literature is limited regarding potentially differing PCOS phenotypes among women around the world., Objective: To use Flo app technology to understand the multifaceted characteristics of PCOS across several countries and identify contributing risk factors to the development of this condition., Study Design: Flo is a widely used female health and wellbeing app with period tracking functionality that provides a globally representative and medically unbiased perspective on PCOS symptomatology. A chatbot dialog on PCOS was subsequently administered on the Flo application (app) to users from 142 countries (with at least 100 respondents) who have the app running in English during September-October 2019., Results: For analyses, we selected the five countries with the greatest number of respondents: US (n = 243,238), UK (n = 68,325), India (n = 40,092), Philippines (n = 35,131), and Australia (n = 29,926). Bloating was the most frequently reported symptom among PCOS-positive women and appeared to be the main predictor of PCOS in our model (odds ratio 3·76 [95% CI 3·60-3·94]; p < 0·0001). Additional top predictors of PCOS are high blood cholesterol and glucose levels. As BMI increased, the percentage of women who reported a physician-confirmed PCOS diagnosis also increased. However, women in India did not follow this trend., Conclusion: Our findings are based on the largest known PCOS dataset and indicate that symptoms are more complex than previously understood. The most frequently reported symptoms (bloating, facial hirsutism, irregular cycles, hyperpigmentation, and baldness) are broader than those included in the Rotterdam criteria. Future work should reevaluate and refine the criteria utilized in PCOS diagnosis.

Background: The experiences of Black children with food allergy (FA) are not well characterized, particularly with respect to bullying victimization and other psychosocial outcomes., Objective: To evaluate bullying experiences of Black and White children with FA, including associations with peer relationships, anxiety, and school policies., Methods: Surveys were administered to parents of 252 children with physician-diagnosed FA enrolled in the multisite FORWARD cohort. The surveys assessed demographics, atopic disease, bullying victimization, and school FA management practices and policies. Descriptive statistics of bullying by race were compared by χ 2 tests. Multiple logistic regression analyses adjusting for race, age, parental education, household income, child sex, and multi-FA compared adjusted probabilities of bullying victimization by school policies., Results: Nearly 20% of school-aged children were bullied for FA with no substantial racial differences overall, though for children ages 11 years and up, White children reported higher rates of bullying. However, Black children experienced non-FA-related bullying twice as frequently as White children (38.6% vs 17.7%; P = .002). Most of the caregivers (85.7%) who intervened in their child's bullying reported that it was helpful. Among parents, 17.3% reported that they were teased or bullied owing to their child's FA. More than half of the respondents (54.8%) reported that some allergens are banned from their child's school, most typically peanut. In schools banning peanuts, FA-related bullying was less frequently reported by all students who have food allergy., Conclusion: Bullying owing to FA is common, and caregivers, medical professionals, and school administrators can help reduce bullying by screening for bullying and supporting and educating school policies., (Copyright © 2020. Published by Elsevier Inc.)

Background: Food allergy (FA) is an increasing public health concern in the United States, affecting approximately 8% of children and 11% of adults. The United States currently lacks clear requirements for the use of precautionary allergen labeling (PAL) on packaged foods, such as "may contain" or "made on shared equipment." This lack of specific governmental policy results in inconsistent labeling practices and confusion., Objective: This study aimed to understand current knowledge and preferences for PAL statements among FA stakeholders., Methods: A cross-sectional survey was sent to FA stakeholders. Descriptive statistics and associations from logistic regressions were used to assess respondents' knowledge of PAL policy, shopping habits, and preferences around PAL., Results: Of 3008 respondents, 24.2% were able to correctly answer 4 questions surrounding PAL policies. When asked about their shopping habits, the majority of respondents never purchase products with a "May contain traces of allergen" label (85.5%) in comparison with never purchasing products with a "Good manufacturing practices used to segregate ingredients in a facility that also processes allergen" label (35.0%). Their top preferences for a PAL statement were "Not suitable for people with 'blank' allergy" (29.3%) and "May contain" (22.1%). Health care provider discussions around PAL varied and were strongly associated with purchasing behaviors., Conclusions: These results suggest that FA consumers are not aware of PAL policies and make decisions based on the words in the PAL. They prefer having clearer, more specific, and consistent labeling on products, indicating that explicit PAL policies are needed to allow customers to easily identify safe foods., (Published by Elsevier Inc.)

Objective: To study the racial and socioeconomic characteristics of women seeking fertility care in a state with mandated insurance coverage for fertility testing and treatment., Design: Cross-sectional, self-administered survey., Setting: Academic fertility center in Illinois., Patients: Of 5,000 consecutive fertility care patients, 1,460 completed the survey and were included in the study sample., Interventions: None., Main Outcome Measures: Details about demographic characteristics and health care access on the basis of patient race/ethnicity and socioeconomic status., Results: The mean age of participants was 36.1 years; 75.5% were White, 10.2% Asian, 7.3% Black, 5.7% Latinx, and 1.3% Other. Most women had a bachelor's (35.5%) or master's degree (40.5%) and an annual household income of >$100,000 (81.5%). Black and Hispanic women traveled twice as far (median 10 miles) as White and Asian women (median 5 miles for both) for treatment. Black women (14.7%) were more likely to report that their race was a barrier to getting fertility treatment compared with White (0.0%), Hispanic (5.1%), and Asian (5.4%) women. Black and Hispanic women were approximately twice as likely to report income level (26.5% and 20.3%, respectively) and weight (7.8% and 8.9%, respectively) as barriers compared with White and Asian respondents., Conclusions: Significant racial and socioeconomic disparities exist among fertility patients accessing care. Beyond providing all Americans with health insurance that covers fertility treatment, further research in the general population is needed to understand the complex social, cultural, racial, and economic factors that prohibit many individuals from accessing needed fertility care., (© 2020 The Authors.)