Opinions24 August 2026
Medical school taught us to prevent disease, not to talk about desire
Sexual healthPhysician‐patient relations
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Clinicians need more training when it comes to discussing sexual wellbeing with their patients
Authored byArmin Ariana
Ask any Australian medical student what they learnt about sex during their degree, and you will hear a familiar list: contraception, sexually transmitted infections, safe-sex counselling, cervical screening and HIV. All of it is important and necessary, but all of it is framed around a single logic: something has gone wrong, and here is the swab, the pill, or the referral that will fix it
Ask that same student what they learnt about desire, arousal, painful intercourse, or the sexual life of a 62-year-old man after prostate surgery, and the room goes quiet
I know because I have been in those rooms for 20 years. I teach medical students at Griffith, and I run a clinical sexology practice on the side. What I have watched is good doctors going quiet the moment a patient’s problem cannot be fixed with a script
We are comfortable with ulcers because antibiotics fix them. Comfortable with herpes, chlamydia, strep throat. There is a test, a diagnosis, a treatment. When a woman in her fifties tells us intercourse has become painful, or a man says he cannot keep an erection, most of us feel the ground shift. We refer, prescribeecause we were never taught what to say next
A workforce underprepared to talk about sex
Three Australian
Wynn and colleagues surveyed 913 medical students across 21 of 23 Australian medical schools. 89% of senior clinical students reported no teaching specific to LGBTQIA+ health. Coverage of transgender and intersex health sat below 16%
Seidler and colleagues surveyed Australian medical students on men’s health. 65% reported minimal or no formal teaching. Most graduated feeling unequipped to raise sexual concerns with male patients at all
The Australian Medical Students’ Association, in a submission to Victoria’s inquiry into women’s pain, reported that around half of surveyed students felt inadequately trained to recognise and diagnose gynaecological and non-gynaecological causes. Only one in four said their education adequately addressed gender variation in pain presentation
Three populations, one pattern. Sexual health appears in every MD curriculum in the country. In practice it is diluted, taught by clinicians without expertise in the field, and rarely formally assessed. Students graduate underprepared. Patients read the silence as a verdict
The consequences show up in clinical rooms every day. In a program of qualitative research I supervise, among Australian breast cancer survivors aged 32 to 72, sexual wellbeing was one of the most consistently unmet needs of survivorship. One participant said: “They talked about saving my life, not about living my life.” Another described the silence around it: “After my surgery, no one asked how I felt about my body or my relationship. I didn’t even know whom to ask about intimacy.”
The clinicians in these stories were not being cruel. They were doing what most of us do when a patient walks toward the edge of our training. They looked away
Equipping clinicians with the tools to start conversations
The evidence that this is fixable is Australian and peer-reviewed. In a pre-post study I designed and led, 137 medical students completed a five-hour online LGBTQIA+ Health training. It was not a pronoun course. It covered what LGBTQIA+ patients carry into consults but rarely disclose: chronic minority stress, avoidance of routine care, higher rates of anxiety and self-harm, and physical health burdens that go under-recognised because the person has learned that clinicians do not ask. We noticed real shifts in knowledge, attitudes, and everyday assumption-making. What we set out to change, we changed.
Five hours will not produce a sexologist. It will produce a doctor who is comfortable asking the question, and who knows what to do with the answer
Australia’s National Women’s Health Strategy 2020–2030 and National Men’s Health Strategy 2020–2030 both name sexual and reproductive wellbeing as core across the lifespan. Both identify workforce training as a lever. The evidence base is Australian. The infrastructure to act on it is not
First, an Australian Medical Council review of sexual health competencies across MD programs. Not an audit of what appears on paper, but an audit of how it is taught, by whom, how many hours, and whether students can actually take a sexual history when asked
Second, dedicated OSCE stations for sexual history-taking. We do not need a sexologist in every OSCE room. We need scenarios developed by specialists, briefed examiners, and standardised rubrics. Assessment does not require rare people. It requires good design
Third, structured CPD for doctors already in practice. Today’s GPs and specialists were not taught this either. Waiting for the next graduating cohort is a 30-year plan. Patients do not have 30 years. Well-designed digital modules can scale without needing a specialist in every room
Most of the doctors I meet through CPD are not resistant. They are under-equipped. What they want is a script that fits inside a real consult, and permission to open the topic without feeling they have to solve it in the same visit
Patients deserve more than a prescription and a shrug. Doctors deserve more than being sent into consulting rooms without the training. The problem is not a lack of care. It is a lack of preparation
That is fixable. It is well past time we started fixing it
Dr Armin Ariana is a medical doctor and accredited clinical sexologist. He is Associate Professor in Medical Education at Griffith University’s School of Medicine and Dentistry, and the only Australian elected to both the Executive and the Advisory Board of the World Association for Sexual Health, the global peak body in the field. He runs a clinical sexology practice, and a CPD course for GPs on sexual health consultations, which includes an AI-based simulated patient lab where doctors practise the conversation before applying it in the room. These are declared as competing interests.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
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Authored byArmin Ariana
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