Knowledge guides

LG12: Scientific foundations and basic principles of sexual health medicine

Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have in-depth knowledge of the topics listed under each clinical sciences heading.

For the statistical and epidemiological concepts listed, trainees should be able to describe the underlying rationale, the indications for using one test or method over another, and the calculations required to generate descriptive statistics.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis, management and outcomes.

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  • Anatomy and physiology of anal, genital, neogenital, and oropharyngeal structures and skin
  • Behavioural, biological, and disease-related changes of ageing in relation to sexual health and sexuality
  • Biological and endocrinological basis of sexual development from fetus to adulthood and influencing factors, both common and less common
  • Epidemiology of sexually transmitted infections (STIs) and HIV locally, nationally, and globally
  • Immunology of HIV
  • Pathophysiology of STIs

Investigations

  • Point-of-care tests, such as:
    • bench top microscopy
    • pregnancy testing
    • urinalysis
  • Relevant tests for screening, diagnosis and monitoring of STIs, including awareness of issues relating to:
    • cost
    • patient convenience
    • predictive values:
      • negative
      • positive
    • reproducibility
    • sensitivity
    • specificity

Procedures

  • Anogenital examination
  • Bimanual examination
  • Cryotherapy
  • Features and purpose of colposcopy and high resolution anoscopy
  • Genital biopsy
  • Proctoscopy
  • Vaginal speculum examination
  • Attitudes and beliefs of health care workers working with patients with sexual health-related issues
  • Concepts, possible implications, and terminology of alternative sexual lifestyles and sexuality, including:
    • fetish
    • kink
    • non-monogamy
  • Confidentiality regarding sexual health, including dissemination of information to other health professionals or public health units
  • Evaluation of current research base and evidence on sexual health-related topics, and apply this to own personal and professional environment
  • Gender:
    • concepts of binary and non-binary gender, development of gender expression, and variation throughout life
    • concepts of social, legal, and medical gender transition, and how this may change over time for the individual and society
    • gender dysphoria, and impact of medical intervention on sexual wellbeing and sexuality
    • impact of cultural influences
    • social and psychological factors that influence expression of gender roles in the community
    • terminology of gender discourse
  • Impact of cultural, relationship, and social factors on patient concepts of:
    • conception
    • contraception
    • fertility
    • pregnancy
  • Impact of embarrassment, guilt, shame, and stigma regarding sexuality and gender and sexual expression, and how these will vary across different cultures, sub-groups, and age groups, and their relationship to sexual behaviours and health-seeking behaviours
  • Impact of past abuse, neglect, and trauma on:
    • health-seeking behaviours
    • sexual behaviours
    • sexuality
  • Impact of sexual health and sexuality on general health and mental health
  • Impact of variations in ability and disability on sexual health and sexuality
  • Issues and management of intimacy, sexual function, and sexuality in older adults, including in the context of aged care facilities and nursing homes
  • Local social and subculture issues regarding priority populations, and how they relate to public health and delivery of health interventions to those populations
  • Range of gender, and sexual differences, sexual orientation, and sexual practices in the community, and factors affecting expression in the community
  • Recognition of sexual difficulties and concepts of management
  • Rights and dignity of index case and contacts
  • Role of chaperone in clinical examinations as a support person for patients
  • Sexual health counselling:
    • common models of counselling, including acceptance and commitment therapy, cognitive behavioural therapy (CBT), and interpersonal therapy, and how these may apply to different areas of sexual health
    • concepts of transference and countertransference, and how these may impact therapeutic relationships with sexual health physicians
    • possible issues in counselling, such as cross-cultural and religious factors related to sexual expression
  • Sexuality:
    • how sexuality varies throughout life
    • ‘nature versus nurture’ issues in the genesis and management of sexuality
    • variance of sexual diversity and sexuality
  • Sociocultural factors of gender, sexual development, and sexuality
  • Strategies for prevention of future acquisition of STIs, blood-borne viruses (BBVs), and unwanted pregnancies
  • Variations between management guidelines in different jurisdictions, and the rationale for these variations