Medical residency is an arduous journey filled with long hours, intense pressure, and the unyielding pursuit of knowledge and skill. However, beneath the facade of dedication and determination, there's a silent struggle that many medical residents face: sexual dysfunction. 

 

The extent of sexual dysfunction among HCPs

 

 

“Emotional and intimate connections play a greater role in women's sexual desire compared to men,” Sangeeta Hatila, MD, MBBS, a board-certified psychiatrist, tells MDLinx. “And constraints on free time hinder female trainees in forming stable relationships.”

Let's take a closer look at the data.

• International studies, as reported by Tunisian investigators, indicate that 30% to 80% of female doctors in training experience sexual dysfunction;

  Hentati S, Masmoudi R, Guermazi F, et al. The role of cognitive distraction in sexual dysfunction in female medical resident doctors. Arch Psychiatr Ment Health. 2022;6:017-020.

  a study done in Beirut found that 13% to 30% of male doctors in training experienced sexual dysfunction.

  Habis C, Maalouf RG. Impact of stress and burnout on the sexual desire of trainee doctors at Hôtel-Dieu de France hospital: a single-institution survey. L’Encéphale. 2019;45(5):371-375.

   

• Among the Beirut male interns and residents, 21% reported low sexual desire.

• A 2022 study by the Tunisian researchers identified 40% of female residents as experiencing sexual dysfunction. Cognitive distraction was a prominent underlying factor contributing to these symptoms.

• In the US, a study from Washington University in St. Louis showed that the incidence of sexual dysfunction among trainee doctors surpasses that of the general population of similar age.

  Ferguson GG, Nelson CJ, Brandes SB, et al. The sexual lives of residents and fellows in graduate medical education programs: a single institution survey. J Sex Med. 2008;5(12):2756-2765.

   

 

Sexual anxiety

 

Sexual anxiety refers to feelings of unease, fear, or apprehension related to sexual activities. A classic study from 1967 found that nearly half of medical trainees were experiencing significant sexual anxiety.

Woods SM, Natterson J. Sexual attitudes of medical students: some implications for medical education. Am J Psychiatry. 1967 Sep;124(3):323-332.

Their anxiety was related to various concerns, including difficulties with sexual performance and problems with intimate relationships, self-pleasure, sexual orientation, and managing patients with sexual issues.

 

 

 

Who is most at risk?

 

Young, healthy residents might not expect frequent sexual issues, in theory, unless there's an underlying physical problem. Yet, the harsh reality is that the demanding nature of residency, both physically and mentally, affects residents’ overall quality of life, including sexual well-being. As the Tunisian researchers discovered, residents' sexual well-being has a significant connection to burnout, stress, and anxiety.

Whether certain medical specialties have a higher prevalence of sexual dysfunction than others is unknown, as direct data on any such correlation is limited. However, according to Dr. Hatila, “Specialties marked by elevated burnout rates are prone to experiencing such issues.” 

A survey by the American Medical Association identified six medical fields with the highest burnout rates: Emergency Medicine (62%), Hospital Medicine (59%), Family Medicine (58%), Pediatrics (55%), Obstetrics and Gynecology (54%), and Internal Medicine (52%). Residents in these specialties contend with heightened stress, unpredictable schedules, emergencies, night shifts, and overtime.

Berg S. These 6 physician specialties have the most burnout. American Medical Association. August 29, 2023.

 

The COVID-19 pandemic contributed its share to the problem, too. In one Brazilian study conducted in 2020, almost 80% of female doctors met criteria for sexual dysfunction, attributed to depression, anxiety, and resultant burnout.

De Souza Ziegler N, Muller GC, Grossi FS, et al. Impact of the covid-19 pandemic on mental health and sexuality of female doctors. PLoS One. 2023;18(7):e0281321

 

 

 

Impact on personal and professional life

 

Long hours, relentless stress, and the perpetual pursuit of excellence don't exactly create a conducive environment for a flourishing sex life. Residents may find themselves battling feelings of isolation and the fear of being stigmatized. In a field where confidence is key, this can have a cascading effect on a doctor's mental well-being. 

Unresolved sexual health issues can strain relationships, leaving both partners grappling with the lack of intimacy. A decline in sexual desire and erectile dysfunction has also been linked to infertility.

Leeners B, Tschudin S, Wischmann T, et al. Sexual dysfunction and disorders as a consequence of infertility: a systematic review and meta-analysis. Hum Reprod Update. 2023;29(1):95-125.

 

 

 

Therapeutic interventions

 

“Sexual dysfunction isn't solely psychological,” Dr. Hatila says, “it can also stem from mental stress, depression, substance abuse, hormonal imbalances, diabetes, hypertension, and hyperlipidemia. The key to management lies in identifying and addressing the specific causes.”

Medications, such as phosphodiesterase type-5 inhibitors, could be considered for erectile dysfunction. Other integral parts of the treatment plan include lifestyle adjustments, stress management, and promoting open communication between partners. 

A proactive approach would involve a teaching plan where residents receive training on addressing and managing sexual anxiety. Training institutes and program supervisors must make sure the training emphasizes not just taking care of patients but also prioritizes residents' mental health.

Medical teaching centers should designate a dedicated counselor, ensuring strict confidentiality through established protocols. This initiative could equip residents with the necessary knowledge and support to handle the challenges of sexual health within the demanding healthcare environment.