Sexual Medicine ETR

UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES
EUROPEAN UNION OF MEDICAL SPECIALISTS

Association internationale sans but lucratif International non-profit organisation
AVENUE DE LA COURONNE, 20 T +32 2 649 51 64
BE- 1050 BRUSSELS F +32 2 640 37 30
www.uems.net info@uems.net
UEMS 2020.13
Training Requirement in SEXUAL MEDICINE

Europeam Standards of Postgraduate Medical Training for mark
of excellence
FROM THE MULTIDISCIPLINARY JOINT COMMITTEE IN SEXUAL

MEDICINE
Table of Contents
Part 1. General information about the educational training in Sexual Medicine................4
Educational Training update preparation............................................................................ 4
Timelines in current educational training update preparation............................................4
Scope of the educational training update……………………………………………………………………….4
Generic competencies and roles................................................... …………………………………..5
Part 2. Domains and competencies in the training program ............................. ……………..6
Components of the Curriculum..................................................... …………………………………..6
Length of training..................................................................................................................6
Educational Framework………………………………………………………………………………………………….7
Progression of training……………………………………………………………………………………………………7
Standards of training………………………………………………………………………………………………………7
Standards for depth of knowledge…………………………………………..........................................7
Overview and objectives of the Sexual Medicine curriculum
(Definition of domains; Learning objectives) ..……………………………………………………………….8
The Scope and Standards of Practice in Sexual Medicine at the
time of FECSM……………………………………………………………………………………………………………..10
Learning objectives………………………………………………………………………………………………………11
Objective – Generic Competencies………………………………………….......................................12
Objective - Manage erectile dysfunction………………………………………………………………………13
Objective - Management ejaculatory dysfunction including
premature ejaculation, retrograde ejaculation, delayed
ejaculation, anejaculation and painful ejaculation……………………………………………………….16
Objective – Manage male sexual desire disorder……………..………………………………………….19
Objective – Manage penile deformity…………………………………………………………………………..22
Objective – Management of injury to male genitalia…………………………………………………….24
Objective – Manage male priapism………………………………………… ………………………………..….26
Objective – Manage male sexual disorder related to aging…………………………………………..28
Objective – Manage the patient with Gender Dysphoria/Gender
Incongruence (GD/GI)…………………………………………………………………………………………………..32
Objective – Manage the patient with compulsive and paraphilic
sexual behaviors…………………………………………………………………………………………………………34
Objective – Manage the woman with arousal disorder…………………………………………………36
Objective – Manage female desire disorder…………………………………………………………………39
Objective – Manage female orgasmic disorder…………………………………………………………… 42
Objective – Manage female sexual pain disorder…………………………………………..…………….46
Objective – Manage female sexual dysfunction related to
medication…………………………………………………………………………………………………………………..50
Objective - Manage female sexual disorders related to pregnancy,
menopause and aging………………………………………………………………………………………………….53
Objective – Manage female sexual disorders related to
gynaecological and endocrine diseases………………………………………………………………………..56
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Objective – Manage female sexual disorders in the context of
medical conditions……………………………………………………………………………………………………..59
Manage sexual consequences of patients at risk of sexually transmitted infections
(STI)……………………………………………………………………………………………………………………………62
INTRODUCTION : Sexual Medicine (SM) is a highly specialized post-graduate specialty dedicated to

quantitative and objective diagnostic examinations of various diseases and disorders, andpsycosocial
conditions affecting sexuality. Lately, the discipline has strongly extended also into diagnostics and
treatments. The specialty requires both depth in knowledge, clinical skills, attitude, and behavior. The
Multidisciplinary joint committee for Sexual Medicine has formulated a new curriculum for training in
SM. This document has the aim to present recommended standards and guidelines for training in SM
within the European Union (EU) to acquire specialist competence in SM. The primary goal is that this
curriculum in SM will constitute an approved training program in all countries within the EU where SM
is practiced. It is recognized that currently SM is not an independent specialty in EU countries. In
addition, there are several structural and operational differences in the health care systems,
appointment procedures, and training protocols in different countries. Thus, the second goal of this
curriculum is to harmonise as much as possible the education and training to achieve equal competency
among those medical doctors practicing SM in different EU countries. SM consists of several subfields
of services, called “modules” from here on in this document.
Currently there are more than 500 fellows of the MJCSM, worldwide, who fullfill the eiligbility criteria
and tokk the fellwoship exam which has been recently validated by CESMA. Their location and working
area in the field are available on the www.mjcsm.org website
Sexual medicine is an area of interest that follows training and certification in relevant medical
specialisation. Up to date is not recognised as medical speciality in any of the European states.
All medical specialties with patients contact related to SM can enter the program.
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Part 1. General information about the Curriculum
Curriculum preparation
The constant development of specialist training and practice dictates the need for a periodical review
of the Curriculum to ensure that they are consistent with current practice and fit for purpose. The
training curriculum in Sexual Medicine has been developed by the Multidisciplinary Joint Committee for
Sexual Medicine (MJCSM). The next review of the Curriculum in Sexual Medicine is planned in 3 years.
Timelines in current educational training preparation
The process of the Educational training development started in-depth in September 2018 and included
an extensive review of the status in care delivery and experiences regarding training requirements
across European countries. Extensive internal consultation within the MJCSM was followed by a review
of different areas of practice, specifically in sexual medicine, andrology, urology, endocrinology,
gynaecology, psychiatry and psychology. In March 2019 consensus was obtained within the MJCSM
regarding the TR. The consultation of the European Society of Sexual Medicine (ESSM) resulted in minor
revisions which have been approved by the MJCSM on 26 June 2019.
Scope of the educational training
This Educational training offers a comprehensive and robust overall training framework created by
medical specialists and based on assembled EU-wide educational and training experience. The
advantage of specialists trained according to the competency is the harmonization of professional
standards and professional mobility across Europe.
The Educational training in SM represents current training practice in most European countries and
supports high level of a medical training standard which will support patient safety and high quality of
care for the benefit of all European citizens. The expectations from the competencies is that all trainees
attain the minimum competencies with further expectations of specific competencies depending on the
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primary specialisation of the person, even achieving the highest level (level # 5 Entrustable Professional
Activity, EPA) in which the trainee can be trusted to perform with minimal or no supervision being able
to work as independent practitioner. It is not possible in a multidisciplinary field such as SM for all
practitioners to attain level 4 or 5 competencies in all areas. Therefore, not all competencies listed in
this document are level 4 or 5 (for definition see page 8).
Generic competencies and role
Sexual medicine is a postgraduate specialty dedicated to quantitative and objective diagnostic

examinations of various diseases and disorders affecting sexuality. While training may take place at any
time post registration, to be eligible to take the FECSM examination, the trainee must be either a
registered medical practitioner accredited as a medical specialist in their country of practice or a General
Practitioner/Family Physician with more than 5 years of clinical experience of unsupervised independent
practice.
The provision of excellente care for the patient with sexual difficulties, delivered safely, is at the heart of
the curriculum.
The aim of the curriculum are to ensure the highest standards of practice in sexual medicine by
delivering high quality training and to provide a programme of training culminating in the award of a
Fellowship in the European Committee of Sexual Medicine (FECSM).
The curriculum was founded on the following key principles that support the achievement of these aims:
• Systematic progression from the beginning of training through to completion.

• Curriculum standards that are underpinned by robust assessment processes.
• Regulation of progression through training by the achievement of outcomes that are specified
within the curriculum. These outcomes are competence-based rather than time-based.
• Delivery of the curriculum by physicians who are appropriately qualified to deliver training in sexual
medicine.
• Formulation and delivery of care by doctors working in a multidisciplinary environment.
• Collaboration with those charged with delivering health services and training at all levels.
Equality and diversity are integral to the rationale of the curriculum, which encourages a diverse
workforce and therefore policies and practices that:
• Ensure every individual is treated with dignity and respect irrespective of their age, disability,
gender, religion, sex, sexual orientation and ethnic, national or racial origins.
• Promote equal opportunities and diversity in training and the development of a workplace
environment in which colleagues, patients and who takes care of them are treated fairly and are
free from harassment and discrimination.
It is expected that these values will be realised through each individual training center’s equality and
diversity management policies and procedures.
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The curriculum reflects the most up-to-date requirements for trainees who are working towards a
FECSM. It is to be used by trainees as well as by trainers, supervisors and training centers that assist
trainees in reaching the required competencies.
Part 2. Domains and competencies in the curriculum
-Components of the Curriculum

The curriculum has been designed around four broad areas:
• Syllabus - what trainees are expected to know, and be able to do.

• Teaching and learning - how the content is communicated and developed, including the methods by
which trainees are supervised.
• Assessment and feedback - how the attainment of outcomes are measured/judged with formative
feedback to support learning.
• Training systems and resources - how the educational programme is organised, recorded and quality
assured.
In order to promote high quality and safe care of patients, the curriculum specifies the parameters of
knowledge, clinical skills, professional behavior and leadership skills that are considered necessary to
ensure patient safety throughout the training process and specifically at the end of the training.
Therefore, the curriculum provides the framework for physicians to develop their skills and judgement
and a commitment to lifelong learning in line with the service they provide.
-Length of training
Trainees progress through the curriculum by demonstrating competence to the required standard.
Training can take a variable time, given that it will likely occur in parallel with clinical practice. However,
in general terms, by the end of the training, physicians will need to demonstrate :
• Theoretical and practical knowledge related to sexual medicine.

• Clinical skills and judgement related to sexual medicine.
• Show of Entrustable Professional Activity (EPA)
• Generic professional and leadership skills.
• An understanding of the values that underpin the profession of sexual medicine and the responsibilities
that come with being a member of the profession.
• The special attributes needed to be a sexual medicine physician.
• A commitment to their on-going personal and professional development and practice using reflective
practice and other educational processes.
• An understanding and respect for the multi-professional nature of healthcare and their role in it.
• An understanding of the responsibilities of being an employee of a state healthcare system trust,
hospital and/or a private practitioner.
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-Educational Framework
The educational framework is built on three key foundations that are interlinked :
• Progression in the development of competent practice.

• Standards in the areas of specialty-based knowledge, clinical skills, judgement and professional behavior
and leadership.
• Framework in assessment, appraisal and feedback.
• Appraisal of research evidence in the field of sexual medicine
-Progression of training
The curriculum framework has been designed to define progression in the development of competent
practice. This provides a mean of charting progress through the various stages of the training in the
domains of specialty-based knowledge, clinical and professional behavior and leadership (including
judgement).
-Standards of training
Sexual medicine physicians need to be able to perform in various conditions and circumstances, respond
to the unpredictable and make decisions under pressure, frequently in the absence of all the desirable
data. They use professional judgement, insight and leadership in everyday practice, working within
multi-professional teams. Their conduct is guided by professional values and standards against which
they are judged.
The acquisition of the necessary level of training will be assessed by the Examination Committee also
by revising the logbook and evaluating attainment of EPA competency. According to the MJCSM rules
(available on the www.mjcsm.org website, section EXAM - “eligibility criteria”) each candidate also
need to fill out minimum 12 cases in the logbook available at the MJCSM website. The Head of the
Training Programme or Tutor officially will revise the candidate’s level of Competence by signing EPA
items in the Logbook. The cutoff for considering a candidate eligible to sit the exam will be decided by
the Examination committee when the exam Webpage goes online.
The syllabus lays down the standards of knowledge, clinical judgement, technical, operative and
professional skills and behavior that must be acquired at each stage in order to progress. The syllabus
comprises the following components:
• An overview that describes the following points:

o Details of the sexual medicine as practised in Europe.
o The scope of practice within Sexual Medicine.
o The key topics that a trainee will cover by the end of the training.
o An overview of how, in general terms, the training is shaped.
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• Key topics that all trainees will cover by certification and will be able to manage independently, including
complications. These are also referred to as essential topics.
-Summative Assessment : The Exam Committee of MJCSM (available on the www.mjcsm.org website -
Exam Committee) is in charge of setting up and preparing the Exam. All the procedure for sitting the
exam are available on the www.mjcsm.org website –section Exam. Briefly, evaluation of knowledge and
competency on the sexual medicine curriculum is finally assessed through a written exam consisting of
100 multiple choice questions (MCQ) also including clinical cases with extending matching questions
(EMQ), to be answered in 3 consecutive hrs. In particular, every question, except the last clinical cases
question (EMQ), has four response options of which, one option is the correct. More details will be
available on the www.mjcsm.org website. Exam will be made digital. The content of the examination
will be according to the curriculum of Sexual Medicine. Indeed, the 100 MCQ will focus in the 5 domains
of Sexual Medicine that are clearly detailed in the MJCSM website. An electronic score calculation
(utilising optical scanning of answer sheets) will be used. The cutoff for of the exam would be range
from 65-80% ; the Exam Committe will precisely set it as an arbitrary value by evaluating the previous
year’s candidates’ data and notify at the website as soon as the Exam webpage goes online. Therefore,
it would possibly vary from year to year. To ensure quality, the exam will always be conducted by
independed professional organization which also advice on the most appropriate standard setting and
objective conducation of the exam. The process and assesment is conducted according to the
guidelines and approval of the UEMS-CESMA.
- Governance
Sexual Medicine is an area of interest followed the core specialist training according to the country of
citizenship/ working place. The Fellowship is a mark of excellence in the field.
Due to this situation no speciality trianing is offered but a fellowship framework which is covered by the
local centers of training or supported by local and international relevant scientific societies. The mark
of excellence (FECSM) is recognised by the UEMS and monitored by the MJCSM. A training agreement
has to be signed between the Supervisor (EPR) and the trainee.
-Standards for depth of knowledge
During the training, the appropriate depth and level of knowledge required can be found in the texts
listed below. We expect trainees to gain knowledge from these texts in the context of practice defined
in the curriculum.
The curriculum requires a professional approach from trainees who will be expected to have an in-depth
understanding of the subjects, to the minimum standard laid out below. It is expected that trainees will
read beyond the texts below and will be able to make critical use out of it, where appropriate of original
literature and peer scrutinised review articles in the related scientific and clinical literature such that
they can aspire to an excellent standard in clinical practice.
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The texts are not recommended as the sole source within their subject matter. Infact, there are
alternative textbooks and web information that may better suit an individual’s learning style. Overtime,
it will be important for associated curriculum management systems to provide an expanded and
critically reviewed list of supporting educational material.
Standard Operating Practice in Sexual Medicine (2006)
Edited H Porst J Buvat
Blackwell Publishing
The ESSM Manual of Sexual Medicine (2015)
Editors Y Reisman, H Porst etal
Medix Publishers
The EFS-ESSM syllabus of clinical sexology (2013)
Editors: PS Kirana, MF tripod et al
Medica Publishers
Standards for Clinical skills
The purpose and Structure of the Training programme
The Training Pathway
The Syllabus
- Requirements for trainers and training centers (TPSM)
PREREQUISITES
1. A Training Program in Sexual Medicine must provide a balanced education in the knowledge,
skill, attitudes and behaviors required for the practice of modern Sexual Medicine.
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2. At the end of the training period and the assessment, trainees will be qualified to provide high
quality care to sexual medicine patients.
3. The training program should provide exposure to the whole breadth of sexual medicine.
4. The minimum duration of Sexual Medicine training is 18 months.
CRITERIA & GUIDELINES

ORGANISATION
1. Institutions and trainers taking part in the training of Sexual Medicine trainees must be able to
provide broad-based opportunities that include both clinical and academic experiences in Sexual
Medicine.
2. Positions with exposure to a limited area of sexual medicine should seek collaboration with
others such that together they provide exposure to the whole breadth of sexual medicine.
3. Rotations must be based on a clear statement of the value of each position to the teaching
program as a whole.
4. Each position should offer significant educational opportunities relevant to the overall program.
5. There should be one trainer (Program Director) with primary responsibility for the entire
program.
6. There should be one trainer (Educational Supervisor) with primary responsibility for a trainee
for the duration of training in a particular position.
7. All trainers in the program should demonstrate commitment to the program in terms of clinical,
educational and academic support.
8. The training capacity of the program will be determined by the number, qualifications and
commitment of the faculty and the workload of the various departments.
FACILITIES AND RESOURCES

1. Each participating institution/trainer must provide adequate clinical facilities. These will include
diagnostic and therapeutic facilities.
2. Each participating institution/trainer must provide adequate educational facilities. These will
include space, educational aids, office space, computer access and library facilities including online
access to the major international journals.
3. Each participating institution/trainer must provide adequate administrative support.
4. Research facilities, although not mandatory for accreditation, are desirable in that they enrich
the academic environment of the program.
FACULTY
1. Program Director
Each center should be headed by a Program Director. The Program Director
a. Will oversee the whole programme
b. Will ensure that trainees have access to a balanced and comprehensive experience
c. Will allocate an Educational Supervisor for each trainee
d. Will ensure that the progress of trainee is regularly evaluated
2. Educational Supervisor
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Each Trainee will have an educational supervisor. The Educational supervisor will provide educational
support for the trainee for the duration of the training. This will include:
a. Regular meetings with the trainee
b. Setting of educational objectives
c. Providing regular feedback to the trainee
d. Mentoring where appropriate.
3. Trainer. The other trainers, those with special expertise in different sexual medicine domains,
should contribute to the education/experience of the trainee in order to provide a significant depth of
knowledge in a variety of subjects, and will provide assessment and feedback for the trainee.
4. Trainee. The trainee will be expected to agree learning objectives at regular intervals with their
educational supervisor. These will be appraised and assessed at regular intervals. They will keep a
learning record and a logbook of their clinical experience.
APPLICATION & CERTIFICATION PROCEDURE

1. To apply for certification a Program seeking accreditation should submit the following
documents (in English):
a. Contact details for the Training Program
b. A description of the Training Program. This will include, as a minimum:
i. A description of all the posts
ii. Timetables within each post
iii. Clinical facilities
iv. Workload figures
v. Educational facilities
vi. Academic facilities
vii. A named Program Director
viii. A list of Trainers and Educational supervisors with their areas of expertise
ix. List of publications of each trainer in the last two years
x. Previous teaching experience of each trainer
xi. Certification of patrticipation in tarin the trainer/Teach the teacher program
2. The training Program is evaluated on the basis of a scoring system which assesses the following
domains:
a. Educational program
b. Supervising staff
c. Educational support
d. Clinical and educational facilities
e. Academic support
f. organisatuion of 360grade feedback procedure for the center and the trainers
3. A review visit to the center by MJCSM representative will follow before the final decision
4. The MJCSM will make the final decision about accreditation of the program and duration of that
accreditation.
5. The usual duration of accreditation is 5 years.
6. A response letter will be forwarded to the Program Director. It will include
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a. A statement of approval if the application is successful
b. For failed applications, areas of non-compliance with the criteria and suggestions to
improvement will be stated
7. If there are substantial changes to the program during the certification period, it is the duty of
the Program Director to notify the MJCSM.
8. Before the end of the certification period, the Program Director will be notified about the need
for re-certification.
-Overview and objectives of the Sexual Medicine curriculum (Definition of domains; Learning objectives)
Trainees in sexual medicine will undergo a minimum of 18 months training following either certification
in a primary medical discipline or in general practice.
The purpose of the curriculum is to train sexual medicine physicians who will be able to work
independently to a standard equivalent to a hospital specialist in a primary medical discipline. As such,
most of their skills will relate to the management of “everyday” sexual medicine and this creates the
basis of the main part of the curriculum, with the competences being completed by the end of the
training.
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The Scope and Standards of Practice in Sexual Medicine at the time of FECSM
This list defines, in general terms the essential skills and levels of clinical expertise that shall be learnt
by a physician in Sexual Medicine when the training is complete. It is unlikely that their expertise will be
confined to the descriptions that follow, as most physicians will have developed additional interests and
competences by the time they complete the training. There is flexibility within the curricula to
accommodate this.
It should be understood that as one’s career develops following FECSM, the range and levels of expertise
will change in response to the demands of the service, personal aspirations, the needs of patients and
the developments in the specialty.
As Sexual Medicine is a multidisciplinary speciality, it is recognised that the level of competence in

specific aspects of the patient care will vary depending on the physician’s primary speciality. The
minimum level of competence and higher level depending on the scope of the work is set within the
syllabus.
While it is recognised that gender is not binary, much of the currently available scientific evidence
focuses on a binary division. Moreover, there are biological differences in gender that need to be taken
into consideration while managing patients. Therefore, the terms “male” and “female” have been used
to indicate biological gender, for conditions where there is a difference in the medical approach to the
management. The specialist clinician is expected to adapt the management approach with the individual
patient whose self-identification does not fall within the gender binary.
The levels of expertise expected are further expressed within the detail of the syllabus.
At the end of the training, all sexual medicine physicians will have an in-depth knowledge, be able to
assess and investigate, treat or refer patients with the following list of conditions:
• hypoactive sexual desire disorder

• hyperactive sexual disorder
• male erectile dysfunction
• male ejaculatory dysfunction (premature ejaculation, retrograde ejaculation, delayed ejaculation,
anejaculation, and painful ejaculation)
• male genital injury (such as penile fracture)
• penile deformity
• priapism
• penile deformity including Peyronie’s disease and congenital curvature
• penile dysmorphophobia
• sexual disorders related to medication including contraception
• sexual disorders related to urological disease including prostate disease and penile disease
• sexual dysfunction secondary to endocrine diseases (hypogonadotropic hypogonadism,
hypergonadotropic hypogonadism, hyperprolactinemia, diabetes mellitus, metabolic syndrome, obesity,
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thyroid diseases, adrenal diseases, growth hormone alterations, delayed and precocious puberty, disorder
of sexual development)
• female sexual desire disorder (according to ICD11)
• female sexual arousal disorder
• female orgasmic disorder
• female sexual pain
• female sexual disorders related to medication including hormonal contraception
• sexual disorders related to pregnancy, menopause and aging
• sexual disorders related to gynaecological disease
• sexual disorders related to dermatological disease
• sexual consequences of sexually transmitted infections
• gender dysphoria/gender incongruence (GD/GI)
• non-intercourse sexual behaviors
• differing sexual preferences
• sexual trauma and violence
• paraphilia
• cancer
• sexual dysfunctions in different ethical and sociocultural contexts
-Learning objectives
Training includes acquisition of knowledge and expertise in all patient groups undergoing assessment
for sexual dysfunctions as well as in all subjects requiring support and medical care for gender
incongruence.
For each domain, learning objectives are divided into “knowledge, skills and attitudes” that are deemed
necessary to achieve the required level of competencies, as defined by the UEMS:
• Level 1: observer level (has knowledge of, describes)
• Level 2: performs, manages, demonstrates under direct supervision
• Level 3: performs, manages, demonstrates under distant supervision
• Level 4: performs, manages, demonstrates independently
• Level 5: shows entrustable professional activity
a. Knowledge competencies are per definition required at a level of competence 1.

b. Levels of skill competence are reported in the description of the domains.
c. Specific attitudes: per definition required at a level of competence 4 and 5
In brackets are reported the Level of Competency for those candidates with the specific speciality
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Objective Level of Assessment
competence
Generic Competencies
Knowledge • Use a bio-psychosocial model to 1

assess and manage patients
presenting with sexual problems
• Know how to structure a 1
consultation
• Be aware of and use validated 1
questionnaires when indicated
Skills • Establish a relationship with the 5
patient, listen actively and answer
the question with sensitivity
• Overcome barriers to effective 5
communication that may arise from
differences in gender, sexuality,
culture, language, and similar factors
• Be aware of the role of the multi- 5
disciplinary team as well as other
specialists and report, when
appropriate
Behavior • Show empathy, compassion, and 5
professionalism
• Respect the dignity of the patient 5
• Be non-judgemental especially when 4
one’s own beliefs conflicts with that
of the patient
• Use ethical consideration to evaluate 5
complex and conflicting situations
that arise during a medical
consultation
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competence
Manage erectile dysfunction
Knowledge Anatomy
MCQ
• Have a detailed knowledge of the 1
anatomy of the male genitalia (including
micro/macroscopic and embryology)
vascular, lymphatic and nerve supply to
the genitalia
Physiology
To have a detailed knowledge of the

following points:
• The physiology of normal male sexual 1

response
• Physiology and neurophysiology of 1
penile erection including the
neurotransmitters involved in penile
erection
• The endocrinology of the normal male
sexual response (Hypothalamic- pituitary 1
function, Endocrinology of the Testis,
Testosterone metabolism)
• Cardiovascular function relevant to 1
sexual dysfunction
Pharmacology

following points:
• Neuropharmacology and receptor 1

pharmacology
• Endothelial derived modulators of 1
corporal smooth muscle
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• Oral pharmacotherapy for erectile 1
dysfunction including basic
pharmacokinetics and
pharmacodynamics and adverse
events/drug interactions of commonly
used drugs
• Novel oral agents for the treatment of 1
MED
• Intracavernosal therapy, topical and 1
intraurethral treatments for MED
Pathology

following points:
• Pathophysiology of Male Erectile 1

Dysfunction (MED)
• Risk factors and aetiology of MED 1
• Sexual function and aging 1
• Cardiovascular and metabolic diseases
and sexual function 1
Risk and Contributing Factors
• Biological/Medical: cardiovascular risk,

1
endocrine factors, iatrogenic ED, medical
disorders.
• Psychological: performance anxiety,
1
personality characteristics, cognitive
factors and affective factors
• Relational: relationships, contextual
1
factors
• Sociocultural: sexual confidence, 1
performance demand, beliefs
Therapeutic Options
• Psychotherapy: Psychoeducation, CBT, 1

sensate focus, couple therapy, attention
exercise
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• Oral pharmacotherapy 1
• Intracavernosal injection 1
• Intraurethral pharmacotherapy 1
• Vacuum pump devices 1
• Penile implant 1
• Vascular surgery 1
• Novel approaches: Shockwave 1
Skills To be able to competently: MCQ
Educational
• Perform a structured diagnostic 4 supervisor
interview including listening to the story,
report
(narrative), summarizing, establishing a
comprehensive diagnosis with Logbook
contributing and risk factors
• Assess a man with ED including, where 4
appropriate, assessment of his partner
• Arrange appropriate investigation of 4
man with ED
• Assess or refer the appropriate use of 4
psychological therapy for a man with ED
• Be able to assess and manage ED by 1(4)
means of endocrine therapy
• Initiate and manage ED by means of oral 1(4)
pharmacological therapy
• Be able to administer and teach 1(4)
intracavernosal injection therapy, a
vacuum erection device
• Be able to determine the indications for 1(4)
surgical management of patient with
drug resistant ED
Behavior • To have an empathetic attitude towards 5 Educational
a man with ED and towards his partner supervisor
report
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competence
Management ejaculatory dysfunction including premature
ejaculation, retrograde ejaculation, delayed ejaculation,
anejaculation, and painful ejaculation
Knowledge Anatomy MCQ

anatomy and embryology of the genitalia
and reproductive system (including
microscopic, macroscopic and
embryology)
the genitalia and reproductive system
and abdominal/pelvic organs
Physiology

following:
• Physiology of the normal male sexual 1

response
• Neurophysiology of ejaculation 1
• Physiology ejaculation including
neurotransmitters and hormones 1
involved in ejaculation
• Endocrinology of male sexual function
(Hypothalamic- pituitary function, 1
Endocrinology of the Testis, Testosterone
metabolism)
Pharmacology

following:

pharmacology of ejaculation
• Pharmacotherapy (including topical 1
agents) for ejaculatory disorders
including basic pharmacokinetics and
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used drugs
Pathology

following:
• Pathophysiology and classification of

ejaculatory disorders including
premature ejaculation, retrograde 1
ejaculation, delayed ejaculation,
anejaculation and painful ejaculation
• Biological/Medical: genetic 1
predisposition, hormonal, penile
abnormalities, prostatic disease
• Psychological: personality characteristics,
1
cognitive and affective factors
• Relational: relationship expectations 1
• Sociocultural: beliefs and expectations
1
Therapeutic Options:
• Psychotherapy 1
• Topical treatments
1
• Oral pharmacotherapy
• Surgery 1
• Novel approaches
1

Educational
• Perform a structured diagnostic interview 4 supervisor
including listening to the story,
report
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• Assess a man with ejaculatory 4
dysfunction including, where
appropriate, assessment of his partner
4
• Arrange appropriate investigation of man
with ejaculatory dysfunction
• Assess the appropriate use of 4
psychological therapy for a man with
ejaculatory dysfunction
• Initiate and manage ejaculatory 4
dysfunction by means of pharmacological
therapy
Behavior • To have an empathetic attitude towards a 5 Educational
man with ejaculatory dysfunction and supervisor
towards his partner report
21
competence
Manage male sexual desire disorder
Knowledge Anatomy
MCQ
anatomy of the brain area related to
desire
neurotransmitters and endocrine factors
regulating sexual desire
Physiology
To have a detailed knowledge of the following

points:

response
• Physiology and neurophysiology of brain 1
area related to desire, including the
neurotransmitters and endocrine factors
involved in desire
• The endocrinology of the normal male 1
sexual response (hypothalamic- pituitary
function, endocrinology of the testis,
testosterone metabolism)
• Psychological and psychiatric factors 1
relevant to sexual dysfunction
Pharmacology

points:
• Neuropharmacology and receptor

pharmacology 1
• Hormones and their receptors 1
• Oral pharmacotherapy for desire 1
disorder, including basic
used drugs
22
Pathology

points:
• Pathophysiology of male sexual desire

disorder 1
• Risk factors and aetiology of male sexual 1
desire disorder
• Sexual function and aging 1
• Endocrine and psychiatric diseases and 1
sexual function
• Biological/Medical: endocrine disease, 1

systemic diseases, neurological
conditions, iatrogenic, substance misuse
• Psychological: cognitive and affective 1
factors
• Relational: relationship expectations, 1
partners’ sexual problems
• Sociocultural: beliefs and expectations 1
Therapeutic Options
1
• Psychotherapy
• Treating underlying condition 1
Educational
report
contributing and risk factors (we should
• Assess a man with sexual desire disorder 4 improve the
including, where appropriate, assessment way we
of his partner assess
• Arrange appropriate investigation of man 4 clinical skill)
with sexual desire disorder
• Assess the appropriate use of
4
sexual desire disorder
23
• Be able to manage sexual desire disorder 1(4)
by means of endocrine therapy
• Initiate and manage sexual desire
disorder by means of pharmacological 4
therapy

man with sexual desire disorder and supervisor
24
competence
Manage penile deformity
Knowledge Anatomy
MCQ
• Have a detailed knowledge of the
vascular, lymphatic and nerve supply to 1
the genitalia
Physiology

points:

response
• Physiology and neurophysiology of penile 1
erection including the neurotransmitters
involved in penile erection
• Cardiovascular function relevant to sexual 1
dysfunction
Pharmacology

points:
• The neuropharmacology and receptor 1

pharmacology of penile erection
• The pharmacology of the agents used for
1
the treatment of Peyronie’s disease
Pathology

points:
25
• The classification of penile deformity 1
• The pathophysiology of penile deformity 1
including Peyronie’s disease
• The risk factors and aetiology of penile 1
deformity
Be aware of the role of the following aspects:
• Psychological 1
• Relational 1
• Sociocultural 1
Therapeutic Options
• Medical and mechanical therapies for the 1

treatment of penile deformity
• Surgery 1

Educational
including listening to the story, report
(narrative), summarizing, establishing a Logbook
comprehensive diagnosis with
• Assess a man with penile deformity 4
• Arrange appropriate investigation and 2(4)
manage with penile deformity
penile deformity
man with priapism and towards his penile supervisor
deformity report
26
competence
Management of injury to male genitalia
Knowledge Anatomy
MCQ
the genitalia
Physiology

following:
• The physiology of normal male sexual

1
response
• Physiology and neurophysiology of penile
erection including the neurotransmitters 1
involved in male sexual response
Pharmacology
To have a detailed knowledge of:
• The neuropharmacology and receptor

pharmacology of penile erection, 1
ejaculation, and orgasm
Pathology

points:
• The types and sites of injuries to the 1

genitalia
• The pathophysiology of injuries to the 1
genitalia
27
• The risk factors, aetiology and 1
consequences of injuries to the genitalia
• Psychological consequences of man with 1
injuries to the genitalia
• Psychological 1
• Relational 1
• Sociocultural 1
Therapeutic Options
• Range and place of medical,

psychological, mechanical, and surgical 1
therapies (including the surgical
techniques) for the treatment of injuries
to the genitalia
Educational
including listening to the story, report
• Assess a man with injuries to the genitalia 2(4)
• Arrange appropriate investigation of man 2(4)
with injuries to the genitalia Initiate and
manage penile deformity
injuries to the genitalia
man with injuries to the genitalia supervisor
report
28
competence
Manage male priapism
Knowledge Anatomy
MCQ
the genitalia
Physiology

following points:

response
• Physiology and neurophysiology of
penile erection including the 1
neurotransmitters involved in penile
erection
sexual response (hypothalamic- pituitary 1
• Cardiovascular function relevant to 1
sexual dysfunction
Pharmacology

following points:

pharmacology of penile erection
• Pharmacology of the agents used for the
treatment of priapism 1
29
Pathology

following points:
• Pathophysiology of priapism 1
1
• Risk factors and aetiology of priapism
Clinical knowledge
To have a detailed knowledge and

understanding of the following points:
• Classification of priapism 1
• Investigation of priapism including the 1
use and limitations of blood tests,
Doppler US, MRI and arteriography
• The range and the place of medical, 1
mechanical therapies and surgery
(including the surgical techniques) for
the treatment of priapism (all types) 1
• The outcomes, including complications
of all therapies for men with priapism
Educational
• Perform a structured diagnostic 4 supervisor
interview including listening to the story, report
• Assess a man with priapism 2(4)
• Arrange appropriate investigation of
2(4)
man with priapism
• Initiate and manage priapism 2(4)
• Be able to undertake cavernosal
irrigation and administer intracavernosal 2(4)
injection therapy
• Be able to determine the indications for
surgical management of patient with 2(4)
priapism
30
Behavior • To have an empathetic attitude to a man 5 Educational
with priapism and to his partner supervisor
report
31
competence
Manage male sexual disorder related to aging
Knowledge Anatomy
1
• Have a detailed knowledge of the
and the brain areas related to sexual
desire
the genitalia
Physiology

following:

response
• The physiopathology of aging 1
• Physiology and neurophysiology of
sexual response, including the
1
neurotransmitters and vascular
compartments involved in sexual
response
sexual response (hypothalamic- 1
pituitary function, endocrinology of the
testis, testosterone metabolism) and its
modification during aging
• Main cardiovascular, metabolic, and
neurological functions relevant to sexual 1
dysfunction
Pharmacology

following points, especially in the elderly:
• Neuropharmacology and receptor

1
pharmacology
• Endothelial derived modulators of
corporal smooth muscle 1
32
• Assess and manage endocrine diseases 1
related to aging, including hormonal
replacement therapies 1
• Oral pharmacotherapy for erectile
dysfunction including basic
used drugs
• Novel oral agents for the treatment of 1
man sexual dysfunction
• Intracavernosal therapy, topical and 1
intraurethral treatments for man sexual
dysfunction
Pathology

following points:
• Pathophysiology of male sexual

dysfunction during aging 1
• Risk factors and aetiology of male sexual
dysfunction during aging 1
• Sexual function and aging-related
hormonal alterations 1
• Sexual dysfunction and its relationship
with chronic diseases and hormonal
1
alterations
• Cardiovascular and metabolic diseases
and sexual function 1
• Biological/Medical: cardiovascular risk,

endocrine factors, iatrogenic ED, 1
medical disorders
• Psychological: Performance anxiety,
personality characteristics, cognitive 1
factors and affective factors
• Relational: Relationships, contextual
1
factors
• Sociocultural: sexual confidence,
performance demand, beliefs. 1
33
Therapeutic Options
• Range of medical, hormonal and

1
mechanical therapies for treatment of
sexual dysfunction
• Psychological therapies relevant to the
treatment of a man with sexual 1
dysfunction
• Surgery 1
Educational
• Perform a structured diagnostic
4 supervisor
interview including listening to the
story, (narrative), summarizing, report
establishing a comprehensive diagnosis Logbook
with contributing and risk factors (we should
• Assess a man with sexual dysfunction 4 improve the
including, where appropriate, way we
assessment of his partner during aging assess clinical
• Arrange appropriate investigation of
4 skill)
man with sexual dysfunction during
aging, including hormonal testing
• Assess the appropriate use of 1(4)
sexual dysfunction during aging
• Be able to manage sexual dysfunction by 1 (4)
means of endocrine therapy during
aging
• Initiate and manage sexual dysfunction
4
by means of pharmacological therapy
during aging
• Be able to administer and teach 2 (4*)
intracavernosal injection therapy or
vacuum erection device in the elderly
2 (4*)
drug resistant ED
a man with sexual dysfunction and supervisor
34
competence
Manage the patient with Gender Dysphoria/ Gender
Incongruence (GD/GI)
Knowledge Definitions MCQ
• Have a detailed knowledge about 1

diagnostic criteria
• Be familiar with nomenclature,
diagnostic work-up, standards of care 1
(WPATH)
• Have knowledge about the legal
situation and epidemiology 1
• Have knowledge about possible social
and occupational consequences of 1
transitioning
• Have knowledge about possible fertility
1
conservation options
Treatment

following:
• Medical interventions therapy for trans

1
individuals (efficacy, safety,
contraindications) during adolescence
and adulthood
• Transition-related surgeries (Which 1
techniques exist? What is the
outcome?)
• Options for fertility preservation 1
• Other confirming medical interventions 1
(such as techniques for hair removal and
speech therapy)
• Counselling or psychotherapy (coping 1
with GD/GI, risk factors for mental
health, co-occurring mental health
issues)
• Counselling side-effects of coming out in 1
relation to friends, family and
occupation Health care for GD/GI
children and adolescents (including
puberty suppression and gender-
affirming hormonal treatment)
35
Physiology

following points:
• Time course of hormonal effects (e.g.,

breast growth in trans women or facial 1
hair in trans men)
Clinical knowledge

understanding of the following:
• Classification of GD/GI 1
• The range of medical and mental health 1
care for the treatment of GD/GI
• The clinical management of therapies
1
(start of hormonal therapy, surgery etc.)
• The outcomes, including complications
of all therapies in the context of GD/GI 1
Educational
• Assess a person with GD/GI 4 supervisor
2 (4) report
hormonal and surgical management of
persons with GD/GI during adolescence Logbook
and adulthood
a person with GD/GI and towards supervisor
partners and family report
36
competence
Manage the patient with compulsive and paraphilic
sexual behaviors
Knowledge Definitions MCQ
• Have a detailed knowledge about 1

compulsive and paraphilic sexual
behaviors
• Be familiar with the difference
between paraphilic disorder and 1
paraphilia
• Have knowledge about the 1
prevalence of paraphilia-associated
thoughts and arousals
Treatment

following points:
• When treatment is indicated

1
• Pharmacological options to reduce
sex drive (SSRI, antipsychotic 1
medications, cyproterone acetate,
GnRH-analogues)
• Side effects of these substances 1
• How patients with paraphilic arousal 1
patterns may benefit from counselling
and specific psychotherapy
Clinical knowledge

understanding of the following points:
• Classification of paraphilic disorders

and disorders of sexual preference (in 1
DSM-5, ICD-10/11)
• Being aware, that compulsive sexual
behavior is differently conceptualized 1
and viewed by various clinicians (as
addiction, OCD-spectrum disorder, or
disorder of impulsivity).
• Criteria for compulsive sexual
behavior/hypersexuality (suggested
37
hypersexuality criteria for DSM-5; 1
excessive sexual drive in ICD-10; and
compulsive sexual behavior in ICD-
11).
• Differences between paraphilic
disorders and sexual offending
• The role of different paraphilic 1
disorders (especially pedophilia,
sexual sadism, exhibitionism, 1
voyeurism, frotteurism) for the risk of
sexual (re)-offending
• The basic principles of risk, need and
responsivity for the assessment and
treatment planning 1
• The range of medical and
psychotherapies for the treatment of
paraphilic disorders 1
• The clinical management of atypical
interests
1
Educational
• Perform a structured diagnostic 4 supervisor report
Logbook
story, (narrative), summarizing,
establishing a comprehensive
diagnosis with contributing and risk
factors
• Assess a patient with paraphilic 4
interests or disorder
• Be able to determine the indications 2 (4)
for pharmacological or
psychotherapeutic therapies for
patients with paraphilic disorders
Behavior • To have an empathetic attitude 5 Educational
towards a patient with paraphilic supervisor report
interests and towards partners and
family
38
competence
Manage the woman with arousal disorder
The anatomy of the clitoris, vulva, the 1

vagina including
Differentiated knowledge about tissues,

innervation vascularisation, hormonal 1
receptors and hormonal activity
Physiology
Central and peripheral (neurological, 1

vascular, hormonal) mechanisms of
arousal including lubrication
Pathology
Definitions of DSMV and ICD 11 1
Pathophysiological mechanisms: 1
including neurovascular and hormonal
alterations
Risk and contributing factors SBA
Biological, Medical
• Hormonal alterations, including 1

menopause, premature menopause,
hypogonadotropic hypogonadism,
hyperprolactinemia, use of hormonal
contraceptives, alterations of growth
hormone, thyroid diseases
• Cardio-Metabolic diseases factors 1
(diabetes mellitus, obesity, metabolic
syndrome)
• Endocrine factors 1
• Smoking
1
• Pelvic floor disorders
• Lower urinary tract symptoms (LUTS) 1
• Pelvic surgery
39
• Neurological diseases 1
• Drugs: Anti-hormones, radio-,
1
chemo-therapy
Psychological:
• Anxiety, Depression 1
• Lack of knowledge and experience
(masturbation etc.) 1
• Traumatic sexual biography
(separation, violence, abuse) 1
Relational:
• Conflict about needs and

expectations 1
• Lack of communication skills to 1
negotiate about differences
Sociocultural:
• Poverty/Low income, working 1

conditions
• Sexual norms 1
Therapeutic options:
Systemic and Local hormonal treatment 1

(estrogens, testosterone, DHEA, SERM)
Drug Treatment (PDE-5-inhibitors;

calcium antagonists) Sexual counselling 1
1
Body centered sex therapy
Skills To be able to competently: EMQ, OSCE
Perform a structured diagnostic interview 4

contributing and risk factors.
40
General physical exam. 4
Specialised examinations in collaboration 1 (4)

with specialists to:
o examine female genitalia with special

focus on the vulva, clitoris, vestibule
and the vagina.
o suspect (Exclude) vulvovaginal
diseases, also towards referring to
perform colposcopy/vulvoscopy
whenever appropriate.
Develop a treatment plan together with 4
the patient based on shared decision
making.
Assess indication for hormonal treatment

and medical therapies considering 2 (4)
contraindications
Sensate focus, body centered

psychotherapy, sexocorporelle, 2 (4)
physiotherapy; masturbation exercises,
systemic couple therapy.
Behavior Empathic listening, encouraging to talk; 5 Role play

Offer feedback opportunities, encourage
questions; Give follow up dates ;Be
patient regarding change
41
competence
Manage female desire disorder
The anatomy of the brain, enhancing and 1

inhibiting pathways and networks.
Physiology
Endocrine and neurotransmitter

1
pathways and actions involved in the
subjective experience of desire.
Pathology
Definitions of DSMV and ICD 11 1

Pathophysiological mechanisms 1
(stimulating and inhibiting pathways)
SBA
Risk and contributing factors
o Diseases and drugs. 1

o Hormonal alterations, including
menopause, premature menopause, 1
contraceptives, alterations of growth
hormone, thyroid diseases.
o Cardio-metabolic diseases factors
(diabetes mellitus, obesity, metabolic 1
syndrome).
Psychological:
• Understanding the sexual biography

(Negative sexual learning, traumatic 1
life events, vulnerability, sexual
temperament).
42
Relational:
• Partner conflicts about different 1

needs, communication difficulties.
Sociocultural: Lack of sex education; Rigid

1
sexual norms
• Drugs 1
• Hormonal treatment
1
• Sexual Counselling
• Masturbation exercises 1
• Working with fantasies
1
• Body centered psychotherapy
(sexocorporelle) 1
Perform a structured diagnostic 4

interview including listening to the story,
Differentiate between primary and

secondary, recent, or longstanding, 4
Specialised examinations in collaboration


focus on the vulva, clitoris, vestibule, 2(4)
and the vagina.
2(4)
43
Develop a treatment plan together with 4
making.
Assess indication for hormonal or drug 1 (4)

treatment considering contraindications
etc.
Sensate focus, body centered

psychotherapy, sexocorporelle, 1 (4)
physiotherapy; masturbation exercises
Systemic couple therapy 4

questions; Give follow up dates ;Be
patient regarding change
44
competence
Manage female orgasmic disorder
The anatomy of the brain, enhancing 1

and inhibiting pathways and networks;
neuroendocrine control; anatomy and
physiology of the vagina and the pelvic
floor.
Physiology
1
Vascular and muscular response,
subjective experience
Pathology
Definitions of DSMV (ICD 11) 1
Pathophysiological mechanisms 1
(inhibiting pathways)
Risk and contributing factors

1 SBA
Biological, Medical
1
o Hormonal alterations, including
menopause, premature
menopause, hypogonadotropic
hypogonadism,
hyperprolactinemia, use of
hormonal contraceptives,
alterations of growth hormone,
thyroid diseases
o Cardio-Metabolic diseases factors 1
(diabetes mellitus, obesity,
metabolic syndrome) 1
• neurovascular factors)
• Antidepressant medication 1
45
Psychological
• Lack of education, experience 1
• Partner conflict 1
• Performance anxiety 1
Relational:
• Inadequate stimulation
1
Sociocultural:
• Lack of sex education 1

• Rigid sexual norms
1
• Sexual Counselling
• Masturbation exercises
• Working with fantasies 1
• Body centered psychotherapy
(sexocorporelle) 1
• Physiotherapy Pelvic floor
1
46
• Perform a structured diagnostic 4

woman story, (narrative),
summarizing, establishing a
• Differentiate between primary and 4
secondary
4
General physical exam.
Specialised examinations in
collaboration with specialists to:
o examine female genitalia with 2(4)

special focus on the vulva,
clitoris, vestibule and the
vagina.
o suspect (Exclude) vulvovaginal 2(4)
diseases, also towards referring
to perform
colposcopy/vulvoscopy
whenever appropriate
• Develop a treatment plan together
with the patient based on shared 2 (4)
decision making.
• Assess indication for hormonal
treatment considering
2 (4)
contraindications etc.
• Sensate focus, body centered 2 (4)
psychotherapy, sexocorporelle,
physiotherapy; masturbation
exercises
• Systemic couple therapy 2 (4)
47
Behavior • Empathic listening, encouraging to 4 Role play
talk
• Offer feedback opportunities, 4
encourage questions
• Give follow up dates 4
• Be patient regarding change
4
48
competence
Manage female sexual pain disorder
Knowledge Anatomy
Nociceptors and general nerve supply 1

to the vulva, vagina, parametrial tissue
Pain transmission via peripheral nerves,

spinal cord, neuronal pathways and 1
networks, limbic system, prefrontal
cortex
Hormones and neurotransmitters

involved 1
Pathology
Mechanisms of chronic pain in 1

comparison to acute pain
Pain memory, amygdala, and

1
hippocampus
Nociceptive, neuropathic and central

pain 1
Clinical types of sexual pain 1

(localisation, differential diagnosis
1
Superficial (Vulvar and vestibular)
1
Deep pain (vaginal, pelvis)
Risk and contributing factors:

1
Biological, Medical
• Vulvovaginal atrophy
• Genitourinary syndrome of 1
menopause
• Endometriosis 1
49
• PID 1
• Prolapse
• Infectious, premalignant and 1
dermatological disease
• Pelvic floor disorder 1
• Hormonal alterations, including
1
menopause, premature
menopause, hypogonadotropic
hypogonadism,
hyperprolactinemia, use of 1
hormonal contraceptives,
alterations of growth hormone,
thyroid diseases
• Cardio-metabolic diseases factors 1
(diabetes mellitus, obesity,
metabolic syndrome)
Psychological:
• Anxiety
• Posttraumatic reaction 1
• Vicious circle of pain-
1
catastrophizing-tension, attention,
more pain etc.
1
• Depression
• Hypervigilance 1
Relational:
1
• Separation, Rejection
Sociocultural
• New sexual norms of functioning 1

and performing
• Local treatment of the mucosa and 1

skin (hormones, local analgetics)
• Drug treatment of neuropathic pain 1
• Anaesthetic intervention (nerve
blockade)
50
• Physiotherapy 1
• Cognitive behavioral pain therapy
• Hypnotic techniques 1
Surgery (vestibulectomy)
1
Perform a structured diagnostic 4

woman story, (narrative), summarizing,
establishing a comprehensive diagnosis
with contributing and risk factors
4
secondary
Specialised examinations in 2 (4)

collaboration with specialists to:
o examine female genitalia with

special focus on the vulva,
clitoris, vestibule, and the
vagina.
diseases, also towards referring
to perform
colposcopy/vulvoscopy
Develop a treatment plan together with 2 (4)

making. 2(4)
Establish and form a multidisciplinary
team to assess the indications for local
treatment of the mucosa and skin
(hormones, local analgetics) 2(4)
Drug treatment of neuropathic pain.
Anaesthetic intervention, (nerve

2(4)
blockade)
51
Physiotherapy; Cognitive behavioral 2(4)
pain therapy
Hypnotic techniques 2(4)
Surgery (vestibulectomy)
2(4)

Offer feedback opportunities,
encourage questions; Give follow up
dates; Be patient regarding change
52
competence
Manage female sexual dysfunction related to medication
Knowledge Basic mechanisms of interaction 1 MCQ

between drugs and sexual physiological
response
Impact on peripheral response (Mucosa, 1

blood supply, peripheral nerve signal
transmission)
Impact on central mechanisms

(Hormonal changes, impact on limbic 1
system, neurotransmitters)
Drug categories and their impact on

sexual function:
1
• Antidepressants
• Antihormones 1
• Antipsychotics
• Hormonal contraception 1
• Hormone Replacement therapy
• Antidiabetics 1
• Cardiovascular drugs
• Corticosteroids 1
Diagnosis:
Comprehensive diagnosis
1
Biopsychosocial model including drug
1
specific impact to understand interaction
of different factors.
Therapy: 1 SBA
Basic counselling 1
53
Changes in drug treatment through 1
dosage or type of drug and/or other
therapeutic method in combination with
other forms of seX therapy
• Perform a structured diagnostic 4

interview
• Describe the drug specific action 4
contributing to the sexual
dysfunction
Specialised examinations in collaboration 2 (4)

- examine female genitalia with special

focus on the vulva, clitoris, vestibule and
the vagina.
- suspect (Exclude) vulvovaginal diseases,

also towards referring to perform
colposcopy/vulvoscopy whenever
appropriate.
Assess medical history and perform a

2 (4)
general medical education
4
Refer
2 (4)
Develop a treatment plan together with
making.
Establish collaboration with other 2 (4)

medical specialists
Explain to the patient the impact of drug 2 (4)

treatment
Offer alternatives and give balanced

2 (4)
benefit/risk evaluation
54
Behavior • Empathic listening, encouraging to talk 4
• Offer feedback opportunities, 4
encourage questions
• Give follow up dates 4
• Be patient regarding change 4
55
competence
Manage female sexual disorders related to pregnancy,

menopause, and aging
Knowledge Anatomy and physiology 1 MCQ
Pregnancy specific biological changes with a 1

possible impact on sexual function
Menopause specific biological endocrine

changes with a possible impact on sexual 1
function
Impact of Hormonal alterations, including 1

menopause, premature menopause,
contraceptives, alterations of growth hormone,
thyroid diseases
Impact of Cardio-Metabolic diseases factors 1

(diabetes mellitus, obesity, metabolic
syndrome)
Aging specific impact on sexual function 1
Psychology:
• Psychological and social changes having an 1

impact on sexual function during
pregnancy, menopause, and aging
• Empirical knowledge about frequency
1
(epidemiology) of sexual dysfunction during
pregnancy, menopausal transition and
aging.
Risk and contributing factors 1 SBA

Biological factors 1
• Structural changes of organs 1
• Hormonal changes
• Cardiometabolic changes
56
• Physiological changes 1
• Depression
• Psychological factors 1
• Developmental tasks
1
• Stressors and Coping
• Relational factors
1
• Support, Lack of support, Sexual
dysfunction of the partner 1
• Sociocultural factors
• Lifestyle 1
• Role expectations
1
Therapeutic options: 1
• Basic counselling and education of couples

about changes, empowerment
• Sexual education during pregnancy
• Local treatment, physiotherapy
• Menopause and aging:
• Hormonal treatment (HRT, estrogen,
testosterone)
• Local estrogen (androgen) treatment,
• Other local treatment options (DHEA et al)
• Counselling for better aging
• Systemic couple therapy
• Treatment of the partner
• Communication training
57
Skills To be able to competently: EMQ,
OSCE
• Perform a structured diagnostic interview including 4
listening to the woman story, (narrative), summarizing,
establishing a comprehensive diagnosis with contributing
and risk factors
• Differentiate between primary and secondary 4

4
Specialised examinations in collaboration with specialists to:
2 (4)
o examine female genitalia with special focus on the
vulva, clitoris, vestibule, and the vagina.
o - suspect (Exclude) vulvovaginal diseases, also towards
referring to perform colposcopy/vulvoscopy
• Develop a treatment plan together with the patient based 2 (4)

on shared decision making.
• Asses indication for hormonal treatment taking into 2 (4)
account contraindications etc.
• Communication with a couple 2 (4)
• Moderating and facilitating communication
• Systemic couple therapy 2 (4)
Behavior Empathic listening, encouraging to talk, Offer feedback 5 Role play

opportunities, encourage questions; Give follow up dates; Be
patient regarding changes
58
competence
Manage female sexual disorders related to gynaecological

and endocrine diseases
Knowledge Anatomy, Pathology, Pathophysiology, 1 MCQ

Diagnosis and Treatment of:
• Endometriosis,
• Fibroma
• PID
• Prolaps
• Vulvar and vaginal diseases
• Miscarriage
Anatomy, Pathology, Pathophysiology, 1

Diagnosis and Treatment of endo-
gynaecological diseases such as:
• Polycystic ovary syndrome (PCOS)

• Hypothalamic amenorrhea
• Hypogonadotropic hypogonadism
• Primary ovarian insufficiency
• Adrenal diseases (21-OH deficiency)
• Delayed puberty
• Precocious puberty
• Hyperprolactinemia
Medical treatments and surgical

interventions (like hysterectomy, vulvar and 1
vaginal interventions) for the appropriate
diseases.
Impact of each disease, diagnosis and

treatment on sexual function on a 1
peripheral and central level:
• Danger and threat of the disease

• Destruction of organs and structures
involved in the sexual response
• Disfigurement (visible changes of the
body, body image threat)
59
• Disability and pain (reduced mobility,
pain)
• Dysfunction (impact on
neurovegetative, neuromuscular and
central nervous system function)
• Dysregulation (endocrine and
cardiometabolic disruptions)
• Disease load (fatigue, bladder and gut
dysfunction etc.)
• Drugs (see above)
1
• Disease specific drug treatment
(including specific hormonal and
metabolic treatments for the diseases)
• Sexual counselling, education and
empowerment
• Supportive psychotherapy
• Coping Counselling
• Development of new concepts of love
and sex
• Rehabilitation
• Eventually treatment of mental or
physical co-morbities
Perform a structured diagnostic interview 4

including listening to the woman story,
comprehensive diagnosis with contributing
and risk factors

4
secondary disorder
4
2 (4)
Specialised examinations in collaboration
o examine female genitalia with

special focus on the vulva, clitoris,
vestibule and the vagina.
60
• Establish a multidisciplinary team

• Develop a treatment plan together with
2 (4)
making to the individual needs of the 2 (4)
patient integrating the above-
mentioned interventions.

questions ;Give follow up dates ;Be patient
regarding change
61
competence
Manage female sexual disorders in the context of medical

conditions
Knowledge Anatomy, Pathology, Pathophysiology, Diagnosis 1 MCQ

and Treatment of medical conditions:
• Neurological disorders (MS, M Parkinson

etc.)
• Endocrine disorders (Hyperprolactinemia,
metabolic disease, Obesity, PCOS, Diabetes,
precocious and natural menopause, Thyroid
Dysfunction, Hypotalamic amenorrhea,
Hypogonadotropic hypogonadism, adrenal
disease etc.)
• Cardiovascular diseases
• Psychiatric diseases
• Dermatological conditions (vulvar disease,
Autoimmune diseases etc.)
• Oncology (Breast cancer, gynaecological
cancers etc.)
• Urological disorders (Incontinence, OAB)
Impact of each disease, diagnosis and treatment 1

on sexual function on a peripheral and central
level:
• Danger and threat of the disease

• Destruction of organs and structures
involved in the sexual response
• Disfigurement (visible changes of the body,
body image threat)
• Disability and pain (reduced mobility, pain)
• Dysfunction (impact on neurovegetative and
neuromuscular function)
• Dysregulation (endocrine and central
nervous system disruptions)
• Disease load (fatigue, bladder, and gut
dysfunction etc.)
• Drugs (see above)
1
62
• Sexual counselling, education, and
empowerment
• Supportive psychotherapy
• Disease specific drug treatment
• Coping Counselling
• Development of new concepts of love and
sex
• Rehabilitation
• Eventually treatment of mental or physical
comorbities.
Skills To be able to competently:
• Perform a structured diagnostic interview 4 EMQ, OSCE

including listening to the woman story,
comprehensive diagnosis with contributing
and risk factors
Apply the medical sexology algorithm

considering: 4
• Pre-existing sexual health or sexual disorders

(Body image, gender)
• Disease specific factors (8 levels see above)
• Response to disease (Affective response,
body image, couple dynamics, individual
coping)
Comprehensive medical sexology diagnosis 4
Specialised examinations in collaboration with

specialists to:

focus on the vulva, clitoris, vestibule, 2 (4)
and the vagina.
o - suspect (Exclude) vulvovaginal 2(4)
• Establish a multidisciplinary team 4
63
• Enlarging and modifying the explanatory 2 (4)
diagnosis according to the specialists’
contributions 2 (4)
• Develop a treatment plan together with the
patient (or couple) based on shared decision
making to tailor the therapy to the individual
needs of the patient integrating the above
mentioned interventions

questions; Give follow up dates.
Adapt and modify the working hypothesis
and diagnosis; Be patient regarding change
64
competence
Manage sexual consequences of patients at risk of or with

sexually transmitted infections (STI)
Knowledge • Epidemiology, risk factors and common 1 MCQ

presentations of STI
• STI and other infections to consider in 1
common presentation such abnormal
vaginal discharge, vulvar irritation,
urethritis and pelvic pain
1
• Association between sexual functioning
and STI
• Principles of management of STI including
partner notification and future risk 1
reduction
• Therapeutic options: 1
-Antibiotic, antiviral treatment and other
pharmacological treatment for infections
-Cryotherapy and surgery
-Prophylaxis: pharmacological and
vaccination
-Counselling to cope with diagnosis and
for future risk reduction
• Take a history to evaluate risk of STI 4

taking into consideration the incubation
period, site of exposure and post
exposure prophylaxis
• General physical exam
4
• Genital examination, with specialist help
when necessary to take appropriate 2(4)
samples for tests
• Offer treatment for various infections 2(4)
when identified and after consultation
with or referral to STI specialist
• -Treatment of sexual consequences of STI
Behavior Non- judgemental; Empathy; 5 Role play
65

Sexual Medicine ETR

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UNION EUROPÉENNE DES MÉDECINS SPÉCIALISTES

EUROPEAN UNION OF MEDICAL SPECIALISTS

Training Requirement in SEXUAL MEDICINE

FROM THE MULTIDISCIPLINARY JOINT COMMITTEE IN SEXUAL

INTRODUCTION : Sexual Medicine (SM) is a highly specialized post-graduate specialty dedicated to

Timelines in current educational training preparation

Scope of the educational training

Generic competencies and role

Sexual medicine is a postgraduate specialty dedicated to quantitative and objective diagnostic

• Systematic progression from the beginning of training through to completion.

Part 2. Domains and competencies in the curriculum

-Components of the Curriculum

• Syllabus - what trainees are expected to know, and be able to do.

• Theoretical and practical knowledge related to sexual medicine.

• Progression in the development of competent practice.

• An overview that describes the following points:

-Standards for depth of knowledge

Standard Operating Practice in Sexual Medicine (2006)

Edited H Porst J Buvat

The ESSM Manual of Sexual Medicine (2015)

Editors Y Reisman, H Porst etal

The EFS-ESSM syllabus of clinical sexology (2013)

Editors: PS Kirana, MF tripod et al

Standards for Clinical skills

The purpose and Structure of the Training programme

The Training Pathway

- Requirements for trainers and training centers (TPSM)

CRITERIA & GUIDELINES

FACILITIES AND RESOURCES

APPLICATION & CERTIFICATION PROCEDURE

As Sexual Medicine is a multidisciplinary speciality, it is recognised that the level of competence in

• hypoactive sexual desire disorder

• Level 1: observer level (has knowledge of, describes)

• Level 2: performs, manages, demonstrates under direct supervision

• Level 3: performs, manages, demonstrates under distant supervision

• Level 4: performs, manages, demonstrates independently

• Level 5: shows entrustable professional activity

a. Knowledge competencies are per definition required at a level of competence 1.

Knowledge • Use a bio-psychosocial model to 1

To have a detailed knowledge of the

• The physiology of normal male sexual 1

To have a detailed knowledge of the

• Neuropharmacology and receptor 1

To have a detailed knowledge of the

• Pathophysiology of Male Erectile 1

Risk and Contributing Factors

• Biological/Medical: cardiovascular risk,

• Psychotherapy: Psychoeducation, CBT, 1

Knowledge Anatomy MCQ

• Have a detailed knowledge of the 1

To have a detailed knowledge of the

• Physiology of the normal male sexual 1

To have a detailed knowledge of the

• Neuropharmacology and receptor 1

To have a detailed knowledge of the

• Pathophysiology and classification of

Risk and Contributing Factors

Skills To be able to competently: MCQ