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Scope to make a difference

Karen Burge
Med J Aust
Published online: 19 November 2012

Other doctors may not know exactly what they do, but sexual health physicians love the diversity of their work

From infectious diseases and dermatology to reproductive health and family planning, a career in sexual health medicine is as diverse as it is challenging.

Despite its importance in public and personal health, the broad scope of the specialty and its potential isn’t all that well known due to the confidential nature of much of the work, Associate Professor Richard Hillman says.

Professor Hillman, president of the Royal Australasian College of Physicians (RACP) Australasian Chapter of Sexual Health Medicine, says many health care professionals have only a hazy idea of what sexual health physicians do.

“They may not realise that our practice is very similar to that of other physicians, but with an additional bonus of an eclectic mix of other specialties, such as gynaecology, psychiatry, dermatology, urology and public health”, he says.

“It’s the mix of acute medicine, public health and dealing with very vulnerable populations that makes it a particularly rewarding specialty to work in.”

Professor Hillman says sexual health medicine is a specialised form of general medical practice. While the specialty plays a strong role in preventing and managing HIV infections, it also focuses on healthy sexual relationships, including freedom from sexually transmitted infections (STIs), unplanned pregnancy, and coercion and physical or psychological discomfort associated with sexuality.

The potential scope of practice is huge, encompassing individual care, microbiology, immunology, sexuality and population dynamics, Professor Hillman says.

“There are amazing opportunities to make a real difference in very disadvantaged communities — both in Australia and overseas.”

Emerging issues

This fast-paced specialty is at the cutting edge, with new treatments able to dramatically improve the lives of patients.

Like many sexual health physicians, Dr Melanie Bissessor, who practises at Melbourne Sexual Health Centre, enjoys the challenge of keeping pace with new advances.

“The microbiological diagnosis of most STIs is now made by molecular methods in the laboratory as well as by rapid point-of-care tests made at the time of initial consultation”, Dr Bissessor says.

“Keeping up to date with the influx of new tests and ensuring their validity and appropriate use, while at the same time making sure adequate patient education is provided and safer sex practices are reinforced is challenging.”

Professor Hillman says time pressure can be an issue. “In a short consultation, you have to rapidly gain the confidence of complete strangers and help them disclose some of the most intimate and private aspects of their lives”, he says. “In addition to delivering very bad news (such as newly diagnosed HIV infection), you may also have to deal with issues such as the disclosure of sexual abuse.”

Misconceptions

One misconception is that the discipline is all about STIs. While most sexual health physicians work in this area, some specialists, such as Dr Michael Lowy from Sydney Men’s Health, specialise in men’s health conditions.

“My particular interest and training involves male sexual dysfunction, which includes problems with libido, ejaculation and erection issues”, Dr Lowy says.

“Relationship counselling is an integral part of this area of medicine as sexual and relationship difficulties with couples are often closely connected.”

Dr Lowy is able to spend a lot of time with his patients. “I enjoy assessing and treating the combination of physical and psychological components of male sexual dysfunction and getting into the psyche of my patients and their partners”, says Dr Lowy, who completed a postgraduate degree in psychological medicine.

Training in sexual health

Doctors can apply to join the three-year program as advanced trainees after completing the RACP basic training or with an appropriate Fellowship from another medical college (for a list of accepted Fellowships, go to www.racp.edu.au/page/australasian-chapter-of-sexual-health-medicine). At least two years of the program will be spent in sexual health work.

Some trainees will be given exemption from all or part of the third year to recognise prior learning, but will be required to undertake their placements in an area with which they are less familiar. For example, an infectious diseases physician with HIV experience would be required to spend two years in sexual and reproductive health clinics. The RACP does not restrict the number of places offered in the sexual health training program, but numbers depend on available clinical placements.

The inside story

Professor Richard Hillman suggests aspiring trainees gain broad experience in sexual health to help them better understand the field as well as enhance their chances of being accepted into the sexual health training program.

He says they could consider a family planning certificate, a subject or two in public health medicine at university, and a rotational term in a sexual health clinic.

Dr Melanie Bissessor says a registrarship in a sexual health clinic or a GP clinic with a high caseload of STI/HIV patients would provide “an invaluable insight into the field”.

  • Karen Burge


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