The George Washington University Medical Center
School of Medicine and Health Sciences
Human Sexuality
Introduction to Clinical Medicine
Course Meeting Dates and Times:
Course Director:
Thursdays 1:30 -4pm
Name: Charles P. Samenow, MD, MPH
Email: csamenow@mfa.gwu.edu
Course Coordinator: Name: Carla Piereck de Sa
Email: msdcpp@gwumc.edu
Phone: 202-741-2875
Office Hours: Appointment
Phone: 202-994-1896
Course Overview:
This section is designed as an interdisciplinary course to furnish you with three essential areas of
expertise. First, you will achieve a basic command of the biopsychosocial knowledge currently
available in the area of human sexuality. This includes and introduction to the diversity of
sexual behaviors, practice and pathologies. Second, you will be introduced into how human
sexuality presents itself in the clinical environment – what patients say, what they don’t say,
what practitioners experience and what to ask and look for. This includes both “normal” and
more dysfunctional fantasies, beliefs and behaviors. Finally, you will explore your own
thoughts, feelings and attitudes towards these issues in order to identify your own personal
barriers and strengths to becoming a better healthcare provider.
This course is built upon the current scientific knowledge around human sexuality. It is devoid
of any political, moral, religious or non-scientific theories or ideologies. At times, material in
this course may conflict with your own personal belief system. Your personal feelings and
beliefs should not impede you from becoming an effective clinician for your patients. It is our
hope that this course will help you become tolerant and non-judgmental in your approach to
patients with a variety of sexual behaviors and problems.
Curriculum Interface:
This course contributes to the following curriculum objectives:
Medical Knowledge:
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Apply the scientific basis of the normal structure, development, function, and relationships
among the major organ systems of the body to concepts of health and disease.
Link biochemical, physiological, neurological, and immunological mechanisms to their role
in maintaining body homeostasis.
Apply principles of pathophysiology to diseases and disorders.
Interpret the role of normal human biological, cognitive, psychological, and behavioral
development across the life span as determinants of health and illness.
Patient Care:
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Formulate a plan for the diagnosis and treatment of common medical conditions.
Identify opportunities for early intervention, prevention, and health education taking into
account barriers to change.
Practice Based Learning and Improvement:
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Apply reflection and feedback to incorporate lessons learned into future practice.
Apply medical standards, clinical practice guidelines, and practice algorithms appropriately
for individual patients or populations.
Systems Based Practice:
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Use system resources available to patients and communities for health education, treatment,
and rehabilitation of medical and psychiatric conditions.
Define the elements of the healthcare system that lead to disparities in health and access to
healthcare.
Explain how diverse cultures and belief systems impact perception of health and illness and
response to symptoms, diseases, and diagnostic and treatment interventions.
Professionalism:
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Demonstrate ethical behavior including: Compassionate treatment of patients, Respect for
privacy and dignity, Honesty and integrity, Truthfulness, Patient Advocacy, Confidentiality,
Accountability
Demonstrate reliability, punctuality, dependability and integrity in all professional activities.
Note: The human sexuality also demonstrates (but does not assess) a wide variety of the
Interpersonal and Communication Skills that you will be expected to demonstrate later in the
curriculum in standardized patient scenarios and in your clerkship in order to master III.1,
III.2,III.5, III.6 and III.8.
Course Learning Objectives:
By the end of this course, each student should be able to:
1. Identify important anatomical structures and physiological mechanisms in male and female
sexual response.
2. Describe normal variability in sexual behavior and the biopsychosocial factors that influence
that variability
3. Recognize the medical and behavioral issues related to the sexual health and practices of
lesbian, gay, bi-sexual and transgendered populations
4. Recognize the medical and psychological issues related to sexuality across the developmental
lifespan from adolescence to later in life.
5. Describe principles of counseling patients in the primary care setting on important sexual
health topics such as sexual dysfunction, safe sex practices, and harm reduction strategies.
Required Materials: Please see the course schedule below. All materials will be made
available to you online through Blackboard.
Course Requirements, Deadlines, and Grading Values:
Attendance: Human sexuality is an essential part of every medical discipline and is an area of
consideration in most clinical encounters. Faculty have taken time from their private practices,
public health administrative duties, and various other clinical roles to bring this material to us.
Finally, patients have voluntarily agreed to share intimate aspects of their lives. Hence, the
course is like a mini-clerkship and attendance for this course is mandatory at all sessions. Any
absences must be approved by the course director ahead of time. If you miss a class due to an
emergency, appropriate documentation will be required. Excused absences must be made up
with the course director. PA students must also inform Dr. LeLacheur of any absence.
Unexcused absences will be reported to the Dean’s office.
Professional Attire: When patients are present, students may be dressed in casual attire that is
professional in presentation. This includes long pants and shirts without prints/graphics. No
athletic wear or shorts. White coats are not required.
Participation: Much of the course will be conducted in discussions, panels, and interactive large
group formats. While you will not receive an individual participation grade, your experience in
the course (and that of others) will be greatly enhanced if you share you ideas, attitudes, and
values with others.
Blackboard Discussion Forum: This course is expected to raise, confirm, and even challenge a
variety of viewpoints, perspectives, beliefs and values. While the predominant focus of the
course is on understanding the science and behavior of human sexuality in the context of medical
practice, such a discussion cannot take place in the absence of culture, religion, politics, etc…
The online discussion forum is an area for you to share you viewpoints in a safe, moderated
forum and to spur dialogue about issues and topics raised. It is also an area where you can post
questions about course materials and receive direct feedback from the course director and other
community members. Anonymous posting will be allowed. However, all postings will be
screened by the course director for appropriateness in tone, language, and content. This is not to
censor ideas, but rather to promote a safe and constructive environment. If you have concerns
about why a comment you have posted was not shared, you may address this concern with the
student ombudsperson. Participation is encouraged, but voluntary.
Grading:
The Human Sexuality section is a component of the Introduction to Clinical Medicine course
(IDIS 301). A grade for ICM is awarded at the end of the spring semester.
You will be tested on the content of the Human Sexuality section by a 50 question multiple
choice section examination. Scores will be reported for your performance on this examination as
normalized/standardized scores. PA students will be graded according to the criteria listed in
their PA 225 syllabus.
An unexcused absence from required section learning activities will results in a CN grade for the
ICM course, which will require remediation.
Honor Code:
All examinations, papers, and other graded work products and assignments are to be completed
in conformance with the George Washington University School of Medicine and Health Sciences
Honor Code.
Course Faculty:
Jehan El-Bayoumi, MD – Associate Professor of Medicine MFA/GWU. Director, Internal
Medicine Residency Training Program.
Thomas Coughlin, LPC – Psychotherapist and Patient Advocate for Transgender Health,
Whitman-Walker Clinic
Meghan Davies, MPH – Deputy Director of Community Health, Whitman Walker Clinic
Stephen Forssell, PhD – Department of Psychology, George Washington University
Julia Frank, MD – Associate Professor and Director of Medical Student Education, Department
of Psychiatry and Behavioral Sciences MFA/GWU
David Frankfurter, MD – Medical Director, IVF; Director, Donor Egg Program; Professor of
Obstetrics and Gynecology, MFA/GWU
Nancy Gaba, MD, Associate Dean of Graduate Medical Education, Associate Professor of
Obstetrics and Gynecology; MFA/GWU
Justin Goforth, RN, BSN – Director, Medical Adherence Unit, Community Health Division, Gay
Men’s Health and Wellness Clinic, Whitman Walker Clinic
Mary Kendell, MS, WHCNP, Sexuality Counselor, Center for Integrative Medicine GWU
Michael Irwig, MD – Assistant Professor of Medicine and Director of Andrology, Department of
Endocrinology MFA/GWU
Barbara Lewis, PA - C – Co-founder, Lesbian Health Program at Whitman Walker Clinic
Raymond Martins, MD – Chief Medical Officer, Whitman Walker Clinic. Assistant Clinical
Professor of Medicine MFA/GWU.
Michael Phillips, MD – Clinical professor of Urology, MFA/GWU
Spencer Olson, Community Engagement Coordinator, Metro TeenAIDS
Katalin Eve Roth, JD, MD –Director, Division of Geriatrics and Palliative Medicine MFA/GWU
Charles P. Samenow, MD, MPH – Assistant Professor, Department of Psychiatry and Behavioral
Sciences MFA/GWU; Editor, Sexual Addiction and Compulsivity; Board Member, Society for
the Advancement of Sexual Health
Class Schedule:
October 13: Human Sexuality Overview
1:30 – 3:00: Introduction to Human Sexuality 2010 – Activity and Discussion
(SAMENOW)
3:00 – 4:00: Sex on the Net (SAMENOW)
Readings:
1. Screening for HIV infection: A Healthy “Low Risk” 42 Year Old Man (JAMA, 2011)
2. A National Strategy to Improve Sexual Health (JAMA, 2010)
Video Homework: Patient Sexual History: What You Need to Know to Help (American Medical
Association)
October 20: The Sexually Active Adolescent
1:30 – 2:15: Adolescent Panel and Discussion (SAMENOW)
2:15 – 2:45: Expert Opinion (DAVIES, GOFORTH, OLSEN)
2:45 – 3:15: Safer Sex Demonstration (DAVIES, GOFORTH, OLSEN)
3:15 – 4:00: Break Out Groups
4:00 – 4:!5: Large Group/Transfer (SAMENOW)
Readings:
1) Shafii and Burstein. The Adolescent Sexual Health Visit. Obstet Gynecol Clin N Am.
36(2009) 99-117, 2) Marshall Miller, Kenneth Mayer, MD, and Harvey J. Makadon, MD (1999)
Talking About Safer Sex With Your Patients. Fenway Institute; Boston, MA. 3) “Safer Sex”
Fenway Clinic (Boston, MA), 3) Antiretroviral Post-Exposure Prophylaxis After Sexual,
Injection-Drug Use and Other Non-occupational Exposure to HIV in the United States. MMWR.
Jan 2005: 54(RR02);1-20. 4) Fenway Safer Sex Brochure
October 27: A Gentleman with Erectile Dysfunction
1:30 – 1:40: Introduction (SAMENOW)
1:40 – 2:10: Urologist Interview (PHILLIPS)
2:10 – 2:40: Mental Health Interview (KENDALL)
2:40 – 3:00: Reflection/Breakout
3:00 – 3:45 Discussion (EL-BAYOUMI, ROTH, PHILLIPS, KENDALL, PATIENTS)
3:45 – 4:00 Wrap-Up./Transfer
Readings:
1) Zeiss and Kasl-Godley (2001) Sexuality in Older Adults’ Relationships. Generations. 25(2)
18-25, 2) A Man’s Shelf Life. Psychology Today. Sept/Oct 2007. 90-86. 3) Morgentaler. A.
(2004) Clinical Crossroads A 66-Year-Old Man With Sexual Dysfunction. JAMA .
291(24):2994-3003,
November 3: A Female with Pain on Intercourse
1:30 – 1:40: Introduction (SAMENOW)
1:40 – 2:10: Ob/Gyn Interview (GABA)
2:10 – 2:40: Mental Health Interview (KENDALL/FRANK)
2:40 – 3:00: Reflection/Breakout
3:00 – 3:45 Discussion (GABA, EL-BAYOUMI, KENDALL, PATIENTS)
3:45 – 4:00 Wrap-Up./Transfer
Readings:
1) Women's Sexual Desire: A Feminist Critique, Jill M. Wood, Patricia Barthalow Koch, and
Phyllis Kernoff Mansfield, The Journal of Sex Research, Vol. 43(3), August 2006. 2) Potter
(2007) Clinical Crossroads: A 60 year old woman with sexual difficulties. JAMA 297(6)
November 10: LGBT Health
1:30 – 1:40: Introduction (SAMENOW)
1:40 – 2:45: Gay Parenting (FORSSELL, FRANKFURTER)
2:45 - 3:50: Gay Relationships and Sexual Health (FORSSELL, MARTINS, LEWIS)
3:50 – 4:00: Wrap-up/Transfer
Readings:
1) Behavioral Medicine: A Guide for Clinical Practice (Online) – Chapter 14. Lesbian, Gay,
Bisexual and Transgendered (LGBT) Patients; 2) Makadon, Mayer and Garofalo (2006)
Optimizing Primary Care for Men Who Have Sex With Men. JAMA. 296(19)2362-2365, 3)
White JC, Levinson W. (1995) Lesbian health care -- What a primary care physician needs to
know. West J Med. 162:463-466.
November 17: The Transgender Patient
1:30 – 2:00: Introduction to Transgender Health (COUGHLIN)
2:30 – 3:50: Transgender Healthcare Panel Discussion:
Moderator: SAMENOW
Endocrine: IRWIG
Mental Health: COUGHLIN
Ob/Gyn: GABA
3:50 – 4:00: Wrap-Up/Transfer
Readings:
1) Lombardi (2001) Enhancing Transgender Healthcare. American Journal of Public Health.
91(6): 869-872, 2) Moore, et. al. (2003) Endocrine Treatment of Transsexual People: A Review
of Treatment Regimens, Outcomes, and Adverse Effects. The Journal of Clinical Endocrinology
& Metabolism. 88(8):3467-3473.
November 18: Wrap-Up
1:30 – 3:00 Sex and Culture Activity and Discussion (SAMENOW/FRANK)
3:00 – 4:00 Sexual Boundaries: Hazardous Affairs (SAMENOW)
Readings:
1) Fourcroy (2006) Customs, Culture, and Tradition – What Role Do They Play in a Woman’s
Sexuality? J Sex Med. 3:954-959.
Review Session: TBD
November 2X: Final Exam