WEBVTT 00:00.000 --> 00:11.533 [Film leader] 00:11.533 --> 00:17.166 [This Audiovisual has been acquired for distribution by the National Medical Audiovisual Center] 00:17.166 --> 00:20.632 [...] 00:20.633 --> 00:27.266 [Sexuality in the Medical School Curriculum: An Introduction for Medical Educators] 00:27.266 --> 00:32.032 [From the Center for the Study of Sex Education in Medicine, University of Pennsylvania School of Medicine] 00:32.033 --> 00:35.366 [Produced by Ortho Pharmaceutical Corporation Department of Educational Services] 00:35.366 --> 00:36.932 [Dream sequence music] 00:36.933 --> 00:40.766 [Female Voice 1:] [Echo effect] It was nothing like I expected. What a disaster. 00:40.766 --> 00:43.599 [Male Voice 1:] [Echo effect] My timing is way off. No matter what I do, 00:43.600 --> 00:46.933 I just can't last long enough for her to have an orgasm. 00:46.933 --> 00:51.166 And by the time the foreplay is over, I am sure I am going to fail again. 00:51.166 --> 00:53.466 [Female Voice 2:] [Echo effect] There must be something wrong with me, 00:53.466 --> 00:56.132 because I'm never interested. 00:56.133 --> 00:59.599 I'm just kind of numb in that area. 00:59.600 --> 01:02.733 [Female Voice 3:] [Echo effect] I cannot stand to have him touch me. 01:02.733 --> 01:04.999 [Male Voice 2:] [Echo effect] I just can't seem to get it up anymore. 01:05.000 --> 01:06.500 We try to be romantic, 01:06.500 --> 01:11.800 and then I get flustered and she gets mad and that's all, that's all. 01:11.800 --> 01:16.400 [Male Voice 3:] [Echo effect] We've read all the books and nothing seems to go right. 01:16.400 --> 01:17.900 [Male Voice 4:] [Echo effect] We don't communicate. 01:17.900 --> 01:22.466 We never communicate, we never have, in bed. 01:22.466 --> 01:26.399 [Female Voice 4:] [Echo effect] The worst thing is, there's no one to talk to about it. 01:26.400 --> 01:29.333 All he does is turn away when I try to discuss it. 01:29.333 --> 01:34.166 [Narrator:] It has been estimated that 50 percent of all married couples in this country 01:34.166 --> 01:37.966 suffer from some form of sexual maladjustment. 01:37.966 --> 01:42.366 There is hardly a marriage in which sexual problems do not occur at one time or another 01:42.366 --> 01:44.099 in the course of the marriage. 01:44.100 --> 01:49.633 These problems result in unhappiness, anxiety and often, divorce. 01:49.633 --> 01:50.966 [Cosmopolitan magazine cover] 01:50.966 --> 01:54.499 The great advances recently made in research into human sexual behavior 01:54.500 --> 01:58.100 have been accompanied by a dramatic liberalization of attitudes 01:58.100 --> 02:01.833 within our culture towards sex and sexual practices. 02:01.833 --> 02:04.933 [Magazine articles on sexual topics] 02:04.933 --> 02:09.433 Needing help and becoming increasingly aware that help is possible, 02:09.433 --> 02:12.066 more and more people are turning to their physicians 02:12.066 --> 02:15.699 for guidance and for treatment of sexual problems. 02:15.700 --> 02:17.633 Yet in a recent survey, 02:17.633 --> 02:22.199 a majority of physicians felt they had no formal training in human sexuality. 02:22.200 --> 02:23.466 And what they did know, 02:23.466 --> 02:28.366 was more likely to have come from sources other than their professional medical education. 02:28.366 --> 02:33.666 [Female Patient:] And when we go to bed, he goes right to sleep. 02:33.666 --> 02:38.499 And I, I toss for hours. 02:38.500 --> 02:39.666 [...] 02:39.666 --> 02:46.466 I get up, I read, but it doesn't help, doctor. 02:46.466 --> 02:49.266 [Male Doctor:] I think you're unnecessarily upset. 02:49.266 --> 02:54.066 Why, at your age, should you still be concerned about sex? 02:54.066 --> 02:55.366 [Female Patient:] At my age? 02:55.366 --> 02:59.632 [Male Doctor:] Why don't we run some tests on you? 02:59.633 --> 03:01.599 [Female Patient sighs] 03:01.600 --> 03:07.700 [Female Patient:] All right, doctor, if you feel that's what I need. 03:07.700 --> 03:11.133 [Narrator:] Each medical student is a product of our times and culture, 03:11.133 --> 03:15.366 and of his or her own personal experience and background. 03:15.366 --> 03:23.966 As a group, they are no different from other students in their exposure to sexual attitudes and in their own sexual experience. 03:23.966 --> 03:27.699 [Female Student 1:] Sex is an area you don't talk about, you just do. 03:27.700 --> 03:33.366 [Female Student 2:] As far as my parents are concerned, sex is something that just happens and you don't need to talk about it. 03:33.366 --> 03:37.899 [Male Student 1:] My sex education was conspicuous by its absence. 03:37.900 --> 03:40.633 I mean, I just didn't have any. 03:40.633 --> 03:44.133 [Female Student 3:] How can you talk about something you're not supposed to have done? 03:44.133 --> 03:49.033 [Male Student 2:] And when I was examining him for a hernia, he just dropped it on me that he was a homosexual. 03:49.033 --> 03:51.333 Man, this really threw me. 03:51.333 --> 03:56.599 [Female Student 4:] This is something we just never talked about. My parents never discussed sex in front of me, 03:56.600 --> 04:01.500 and even at high school, we didn't talk about it, like it seemed boys do. 04:01.500 --> 04:04.700 [Female Student 5:] Do people really do that? 04:04.700 --> 04:07.000 [Male Student 3:] Where do you look for help? 04:07.000 --> 04:12.766 Or who can you turn to get really straight ideas about dealing with sex? 04:12.766 --> 04:17.166 So many professors I've talked to were embarrassed about sexual problems, 04:17.166 --> 04:22.899 and when you present them with one of our critical experiences, they just turn you off. 04:22.900 --> 04:29.333 [Dr. Harold Lief:] The goals of a sex education program in a medical school are on three levels. 04:29.333 --> 04:35.733 The acquisition of information, the modification of attitudes, and the learning of necessary skills 04:35.733 --> 04:40.066 in dealing with sexual, marital, and family planning problems. 04:40.066 --> 04:46.066 Of these three, the modification of attitudes already acquired is the most difficult, 04:46.066 --> 04:48.499 and in many ways, the most important. 04:48.500 --> 04:55.300 Without comfort with one's own feelings, one cannot absorb information or make use of it effectively. 04:55.300 --> 05:00.433 A first step is to gather information about the medical student himself. 05:00.433 --> 05:06.766 Here at the center, we have devised the Sex Knowledge and Attitude Test. 05:06.766 --> 05:12.432 The SCAT, is a multipurpose instrument which enables us to conduct general research 05:12.433 --> 05:14.866 and to disseminate information. 05:14.866 --> 05:18.532 Its primary value for teaching is that through its use, 05:18.533 --> 05:24.699 the student becomes aware of his or her own attitudes and knowledge about sex, 05:24.700 --> 05:31.033 and how these compare where they was generally held by society and by his peer group. 05:31.033 --> 05:35.733 [Narrator:] This instrument has established that almost one out of five medical students 05:35.733 --> 05:40.799 still believe that masturbation is ideologically related to mental illness. 05:40.800 --> 05:46.366 30% still believe that direct stimulation to the clitoris is necessary for orgasm. 05:46.366 --> 05:53.632 Over 13 percent still believe that the condom is the most reliable contraceptive device. 05:53.633 --> 05:58.433 Six percent still believe that venereal disease can be contracted from dirty toilet seats. 05:58.433 --> 06:00.299 [David M. Reed, MD, Ph.D.] 06:00.300 --> 06:05.133 The first step in sex education is attitude modification. 06:05.133 --> 06:12.266 This is accompanied by information, feedback in discussions between faculty and students. 06:12.266 --> 06:16.399 Through SCAT, and in discussion with an instructor, 06:16.400 --> 06:21.733 students become aware of their own attitudes, and where these attitudes lie in comparison 06:21.733 --> 06:26.599 with those generally held by their peers and society at large. 06:26.600 --> 06:34.400 The goal of attitude modification is to free students of anxiety, fears, and discomfort in sexual matters, 06:34.400 --> 06:40.466 and to move them toward ease and comfort when dealing with sexual problems. 06:40.466 --> 06:48.566 The next step in attitude training concerns the process of sensitizing the student to his or her own feelings. 06:48.566 --> 06:51.966 There are a number of techniques for accomplishing this goal. 06:51.966 --> 06:55.166 One of these is confrontation in group discussions. 06:55.166 --> 06:56.866 [Confrontation] 06:56.866 --> 07:02.099 In discussion groups, the students learn to explore their feelings and attitudes 07:02.100 --> 07:08.666 about the emotionally charged areas of sexuality with which they will have to deal in their professional role. 07:08.666 --> 07:15.899 [David Reed:] Now let's talk about the whole issue of premarital sex and whether or not we're caught in a variety of value systems. 07:15.900 --> 07:22.500 Now try and answer this question. Whether your parents would have a particular reaction 07:22.500 --> 07:26.833 if you wanted to bring someone home with whom you were in love or whatever 07:26.833 --> 07:28.633 and wanted to have relations. 07:28.633 --> 07:32.333 What would be the reaction do you think of your parents, not yourselves now? 07:32.333 --> 07:35.033 How do you see your values from your parents' point of view? 07:35.033 --> 07:38.833 Anybody want to? Did you want to start off, Paul? 07:38.833 --> 07:45.233 [Paul:] Yeah. I think if I brought someone home, I don't think my parents would really object. 07:45.233 --> 07:51.166 I think the way they'd handle it would be to kind of ignore it until it happened, 07:51.166 --> 07:53.666 or until it's time to go to sleep or something. 07:53.666 --> 07:56.799 And then they'd, I don't they'd mind much. 07:56.800 --> 07:57.533 [David Reed:] What is it, what do they believe? 07:57.533 --> 08:00.966 What do you think they believe about premarital sexuality? 08:00.966 --> 08:08.999 [Paul:] Well, from my point of view, from the point of view of having a son, I think it's OK with them. 08:09.000 --> 08:11.433 Probably would be desirable. 08:11.433 --> 08:15.599 [David Reed:] Now You say them. Are you speaking for your mother or your father, both the same? 08:15.600 --> 08:21.033 [Paul:] Well, sexuality, sex is something that was never really discussed openly in my house. 08:21.033 --> 08:26.833 But I just have a feeling that both of them kind of had the same attitude. 08:26.833 --> 08:28.966 [David Reed:] Any one of you want to speak as a parent? 08:28.966 --> 08:31.732 How your parents might attack this situation? 08:31.733 --> 08:35.699 [Male Student 4]: I think my mother would probably say, well, you can do what you want, 08:35.700 --> 08:37.700 but kind of don't take it in the house. 08:37.700 --> 08:41.833 Like I think if my sister came home with a guy, I don't think they'd like that too much 08:41.833 --> 08:43.866 if they slept in the same room. 08:43.866 --> 08:46.966 Probably if I came on with a girl, they wouldn't like it either. 08:46.966 --> 08:52.866 They'd probably set up separate rooms for us and sneaking into each other's bedroom at night would be, you know... 08:52.866 --> 08:54.132 [David Reed:] That'd be better. 08:54.133 --> 08:55.233 [Male Student 4:] That would probably be better. 08:55.233 --> 08:58.366 As long as you don't come out of the same bedroom in the morning. You know, just. 08:58.366 --> 08:59.299 [David Reed:] Leave before breakfast. 08:59.300 --> 09:00.800 [Male Student 4:] Yeah, right, yeah. 09:00.800 --> 09:04.700 [David Reed:] OK. And they would both feel this way? 09:04.700 --> 09:07.966 [Male Student 4:] Well, my father's not alive, but my mother would. 09:07.966 --> 09:09.899 [David Reed:] OK, all right. Anybody else? 09:09.900 --> 09:15.500 [Male Student 5]: I think the whole business is though that we just haven't confronted them 09:15.500 --> 09:19.533 with any situations that would make them uptight. 09:19.533 --> 09:24.766 And so it may seem like they wouldn't be upset in some respects. 09:24.766 --> 09:29.499 But if we were suddenly to come and say, this is what we've been doing for the past five years, 09:29.500 --> 09:34.000 all kinds of emotional things about how we should be, 09:34.000 --> 09:36.000 even though we're supposedly growing older, 09:36.000 --> 09:37.133 but we're not. 09:37.133 --> 09:40.999 And back then when we thought you were such a nice young person. 09:41.000 --> 09:43.066 You know, you were doing this and you let us down. 09:43.066 --> 09:46.966 I think that still would be involved in what their feelings would be like. 09:46.966 --> 09:53.199 [Narrator:] The medical educator leading such group discussions must be particularly able to assist the students 09:53.200 --> 09:55.800 in reaching an awareness of their feelings and attitudes. 09:55.800 --> 09:59.533 And must take into account his own in the process. 09:59.533 --> 10:04.866 Just as physician comfort is the most important factor in the management of sexual problems. 10:04.866 --> 10:10.032 So is teacher comfort the most important factor in sex education. 10:10.033 --> 10:15.333 The next step and confrontation moves from the abstract and verbal to the visual. 10:15.333 --> 10:16.266 [Visual Confrontation] 10:16.266 --> 10:19.566 Films and other visual aids made specifically for the purpose, 10:19.566 --> 10:22.466 and showing different forms of sexual behavior 10:22.466 --> 10:28.166 have a profound impact on students who are trying to come to grips with their own attitudes. 10:28.166 --> 10:29.632 [Rhythmic music] 10:29.633 --> 10:33.233 [Students watching an explicit film] 10:33.233 --> 10:37.633 [Rhythmic music] 10:37.633 --> 10:40.799 The visual experience brings students into contact [Students squirm in seats] 10:40.800 --> 10:46.166 with their subsurface attitudes more effectively than just talking about them. 10:46.166 --> 10:52.832 [Rhythmic music, explicit sex education film plays for students] 10:52.833 --> 10:56.866 Medical students must learn about and accept the great diversity 10:56.866 --> 11:01.899 of sexual behavior in order to evaluate properly the sexual experiences of patients 11:01.900 --> 11:05.133 who come to them later for help. 11:05.133 --> 11:08.999 [Rhythmic music] 11:09.000 --> 11:14.833 Confrontation and reflection lead to acceptance of what was once taboo 11:14.833 --> 11:21.266 or frightening or overly stimulating with an increasing comfort in the whole area. 11:21.266 --> 11:29.199 [Heterosexual couple embracing with male on top] 11:29.200 --> 11:38.333 [Couple appears to be having oral sexual relations] 11:38.333 --> 11:48.333 [Point of view of students watching the projector screen] 11:48.333 --> 11:50.266 [Film ends, screen goes dark] 11:50.266 --> 11:55.066 The showing of such a film should be followed immediately by a discussion. 11:55.066 --> 12:01.366 It is most desirable to have a woman and a man instructor lead the discussion as a team. 12:01.366 --> 12:03.566 [Students rearrange chairs for group discussion] 12:03.566 --> 12:07.166 [David Reed:] In order to discuss the movie the best way, 12:07.166 --> 12:10.132 there's a couple of things to keep in mind. 12:10.133 --> 12:14.333 One is your emotional reaction to the film at a spontaneous level. 12:14.333 --> 12:18.466 And the other is a technical, intellectual, maybe a professional way. 12:18.466 --> 12:22.166 We'd like you to try and tie these together in the discussion. 12:22.166 --> 12:23.766 Liz, what do you think they had to go for? 12:23.766 --> 12:26.766 [Elizabeth Stanley:] I think another point in particular that we want to go for, 12:26.766 --> 12:27.632 [Elizabeth M. G. Stanley] 12:27.633 --> 12:33.566 is to try and bring out the differences or maybe similarities, in how the women reacted to the films 12:33.566 --> 12:35.699 and how the men reacted to the films. 12:35.700 --> 12:40.866 [David Reed:] Let's, let's pitch in. What are your spontaneous feelings about the experience thus far? 12:40.866 --> 12:42.799 [Chairs clanging] 12:42.800 --> 12:46.166 Anybody want to start? 12:46.166 --> 12:49.066 [Male Student 6:] It's a little embarrassing for the first sex film you've ever seen 12:49.066 --> 12:49.932 [Laughter] 12:49.933 --> 12:53.633 with all your friends sitting around you have to talk about it. 12:53.633 --> 12:55.033 [David Reed:] Embarrassing in what way? 12:55.033 --> 12:59.666 [Male Student 6:] Well, I don't know quite. Just something I haven't done much before. 12:59.666 --> 13:02.832 A little curious about how everybody else took the film 13:02.833 --> 13:06.299 and a little afraid to put myself out first and see what happens. 13:06.300 --> 13:11.633 [Elizabeth Stanley:] Did it come over as being the real thing or what sort of label could you put on this? 13:11.633 --> 13:13.899 Would you call it pornographic? 13:13.900 --> 13:18.600 [Male Student 7:] It certainly wasn't anything like any pornographic films I'd seen before. 13:18.600 --> 13:19.566 [Elizabeth Stanley:] Mm-hmm. 13:19.566 --> 13:24.366 [Male Student 7:] This is sort of, you know, all happy and in nature 13:24.366 --> 13:27.832 and they both were enjoying themselves to a great extent. 13:27.833 --> 13:31.899 Where the stereotype-- porn film or blue flick that you'd imagine 13:31.900 --> 13:34.000 or just where two people suddenly meet. 13:34.000 --> 13:36.533 [Elizabeth Stanley:] Did you feel embarrassed at all? 13:36.533 --> 13:39.666 [Male Student 7:] Well, in a way I guess I was a little embarrassed. 13:39.666 --> 13:41.766 [David Reed:] How many here have seen stag movies? 13:41.766 --> 13:43.699 [One visible student raises his hand] 13:43.700 --> 13:45.666 And this was somewhat different? 13:45.666 --> 13:47.966 You girls didn't have a chance to say much. Sarah? 13:47.966 --> 13:50.199 How did it hit you? What was your reaction to it? 13:50.200 --> 13:52.600 [Sarah:] It was a happy movie. 13:52.600 --> 13:54.966 [Elizabeth Stanley:] How did it make you feel? How did it make you feel? 13:54.966 --> 13:56.166 [Sarah:] Made me feel embarrassed. 13:56.166 --> 13:58.332 It made me wonder what the people sitting next to me were thinking. 13:58.333 --> 13:59.833 [Laughter] 13:59.833 --> 14:04.333 [Elizabeth Stanley:] Was there any quality that you felt came over very strongly in this film 14:04.333 --> 14:07.133 that perhaps you don't notice in the stag films? 14:07.133 --> 14:09.433 [Male Student 8:] Well, the concept of innocence. 14:09.433 --> 14:11.833 And I think, that's why it was more difficult to watch it, 14:11.833 --> 14:16.933 because when you watch a stag film, it's obvious the objective of it. 14:16.933 --> 14:22.533 And it's kind of an understood agreement. But this one was more like just two people making love. 14:22.533 --> 14:29.866 And I identified with it. And it was difficult, because I felt I was watching myself or someone had caught me unawares. 14:29.866 --> 14:32.166 [David Reed:] That's a good point. How about you girls? 14:32.166 --> 14:33.466 You've been kind of quiet here. 14:33.466 --> 14:37.099 We got a double standard going, where other men do all the talking? 14:37.100 --> 14:39.100 What do some of you think? Either one. 14:39.100 --> 14:44.133 [Female Student 6:] I kind of thought the woman was embarrassed in making the film. 14:44.133 --> 14:46.233 [David Reed:] She was embarrassed in what sense? 14:46.233 --> 14:49.333 [Female Student 6:] I think she blushed when her pants were pulled down. 14:49.333 --> 14:52.966 And I identified with that. I think it would have been painful to make the film. 14:52.966 --> 14:56.066 [David Reed:] You think she was self-conscious about the film itself. 14:56.066 --> 14:59.499 [Female Student 6:] Yes, about being filmed. 14:59.500 --> 15:01.333 [David Reed:] Barbara, what did you think? 15:01.333 --> 15:05.466 [Barbara:] I guess I objected to the fact that the male was the aggressor in the film 15:05.466 --> 15:09.699 and he kept pulling her panties down and she kept pulling them back up. 15:09.700 --> 15:11.466 And she was put in a difficult position. 15:11.466 --> 15:18.966 And the cameraman spent much more time concentrating on her facial expressions and reaction to the orgasm than he did on his. 15:18.966 --> 15:22.232 And much more time concentrating on her naked body than on his. 15:22.233 --> 15:26.333 [Male Student:] I didn't see that at all, because after all, she went down on him. 15:26.333 --> 15:29.733 She wasn't just the passive one. It's true, he didn't go down on her. 15:29.733 --> 15:35.399 I mean, there's a little unevenness in it, but it didn't, didn't really hit me that way. 15:35.400 --> 15:39.133 [David Reed:] Was there anything in this kind of a movie for a doctor to know? 15:39.133 --> 15:41.299 [Female Student 7:] Well, I think the doctor has to see his own reaction, 15:41.300 --> 15:43.000 just like the fellow said. 15:43.000 --> 15:46.866 That they didn't notice that the woman was particularly the non-aggressor, 15:46.866 --> 15:49.432 so therefore when we talk about it afterwards, we then think, 15:49.433 --> 15:52.699 well, maybe we have been sensitized and programmed in various ways, 15:52.700 --> 15:56.066 thus not allowing us to see another side. 15:56.066 --> 15:59.232 Which I think, unless we sit down talk about it and bring these points out, 15:59.233 --> 16:00.366 then only do we see it. 16:00.366 --> 16:03.332 And we're going to be counseling, so we best see all sides. 16:03.333 --> 16:04.233 If that's possible. 16:04.233 --> 16:09.233 [Elizabeth Stanley:] Did anybody feel that any part of them was being suppressed? 16:09.233 --> 16:14.199 Saying, or your instinctive responses or the fact when you turn on, did you feel that in this setting 16:14.200 --> 16:18.100 that there was any suppression because of the setting? 16:18.100 --> 16:21.000 That somehow you felt it wasn't right that the film should turn you on, 16:21.000 --> 16:22.833 and therefore, you're shutting that reaction off. 16:22.833 --> 16:24.466 Did anybody have any? 16:24.466 --> 16:27.466 [Male Student:] I sort of thought in a way kind of the opposite. Like ah.... 16:27.466 --> 16:31.266 when I've seen stag films, I've been much more turned on than I was now. 16:31.266 --> 16:36.566 And I'm trying to figure out what's inside of me, maybe seeing in some sleazy place makes it more enjoyable. 16:36.566 --> 16:40.632 I don't know. I guess it has something to do with something in me. 16:40.633 --> 16:45.866 [David Reed:] Could this couple have ever gone to any one of you 16:45.866 --> 16:48.399 as a physician with a problem? 16:48.400 --> 16:52.566 Could they have ever had a problem as you see them in this movie? 16:52.566 --> 16:54.266 [Female Student]: Yes. [Overlapping] [Male Student:] You mean previous to this? 16:54.266 --> 16:57.799 [David Reed:] Yes, yes, sure. What might they have had? 16:57.800 --> 17:01.633 [Male student:] Exhibitionist problem. [Laughter] 17:01.633 --> 17:07.266 The thing that's in this movie that we were responding to, was the matched relationship in a way. 17:07.266 --> 17:14.066 We made comments about how there may have been exploitation or a game of rape me. 17:14.066 --> 17:19.732 But in general, the whole resonance of the film was that they were together 17:19.733 --> 17:22.633 and very much doing things that each found enjoyable. [Overlapping voices] 17:22.633 --> 17:23.966 [David Reed:] They never could have a problem. 17:23.966 --> 17:26.599 [Male Student:] Well, it doesn't it just doesn't look like they have now. 17:26.600 --> 17:32.166 And what they may have in the future to go along with some of your comments about older folks, 17:32.166 --> 17:34.032 you know, their relationship could change. 17:34.033 --> 17:40.366 [Narrator:] Exposure and discussion lead to a decrease of patterns of avoidance and overreaction, 17:40.366 --> 17:44.699 and enhance the potential for a future physician comfort in dealing with patients. 17:44.700 --> 17:46.333 [Role Playing] 17:46.333 --> 17:52.033 When the students achieve a level in which they become aware of their own feelings and responses, 17:52.033 --> 17:56.499 and thus become more sensitive to the feelings and attitudes expressed by others, 17:56.500 --> 18:00.933 they can move toward the acquiring of necessary skills. 18:00.933 --> 18:05.833 Role playing is an effective connecting training technique. 18:05.833 --> 18:08.833 Students are given a sexual problem. 18:08.833 --> 18:12.599 Playing the role of patients, they present the problem to, 18:12.600 --> 18:15.800 another student who is acting as the therapist. 18:15.800 --> 18:21.500 [Mike:] Well, Mr. Jones, just what is it exactly that brought the two of you in to see me? 18:21.500 --> 18:26.666 [Male Student / Patient:] Well, my wife and I thought that you might be able to help us. 18:26.666 --> 18:30.032 You see, we got married about a month ago. [Mike:] Mm-hmm. 18:30.033 --> 18:37.766 [Male Student / Patient:] And a friend of hers sort of recommended you to us to help us with this little problem we seem to have developed. 18:37.766 --> 18:38.732 [Mike:] Mm-hmm. 18:38.733 --> 18:49.033 I don't know where to begin. We got married just the first of last month. 18:49.033 --> 18:54.166 And you know, we're very happy together. And well. 18:54.166 --> 18:56.899 [Mike:] You have a good sex life? 18:56.900 --> 19:04.400 [Male Student / Patient:] Uh, well, you know, we try it every night. 19:04.400 --> 19:09.600 [Mike:] There's problems in your sexual relationship? 19:09.600 --> 19:13.833 [Male Student / Patient:] Yes. That was sort of why we came here tonight, 19:13.833 --> 19:21.033 to talk about this difficulty that we seem to have. 19:21.033 --> 19:25.199 [Mike:] It's a problem with your wife and you? 19:25.200 --> 19:32.800 [Male Student / Patient:] Mm-hmm. It's just that we don't seem to be getting together. 19:32.800 --> 19:36.733 [Mike:] Having trouble with an orgasm? 19:36.733 --> 19:42.066 [Male Student / Patient:] Well, sort of having trouble with orgasm. 19:42.066 --> 19:51.766 You see, when we go to bed at night, we just, well, doctor, I just don't know. 19:51.766 --> 19:54.599 [Mike:] This must be very difficult. 19:54.600 --> 19:58.166 [Male Student / Patient:] Well, it's never happened to me like this before you see. 19:58.166 --> 20:04.032 I had a great college career, you know, and I had no trouble with anything. 20:04.033 --> 20:06.899 And got through all right. 20:06.900 --> 20:14.166 And we just, ever since we got married, something's not quite right, if you know what I mean. 20:14.166 --> 20:16.399 What do you think, dear? 20:16.400 --> 20:23.133 [Sarah:] Everything was OK until our honeymoon, and then it just wouldn't work out. 20:23.133 --> 20:24.066 [Mike:] Mm-hmm. 20:24.066 --> 20:27.666 And just what exactly was the problem on your honeymoon? 20:27.666 --> 20:33.066 [Male Student / Patient:] Well, we, you know, it wasn't quite the same as before we were married. 20:33.066 --> 20:38.166 You know, I was naturally nervous about spending all that money down there and everything. 20:38.166 --> 20:45.599 I was sort of, didn't know how to make of it. I couldn't think of myself as being married when I got up in the morning. 20:45.600 --> 20:46.400 [Mike:] Mm-hmm. 20:46.400 --> 20:49.400 [Elizabeth Stanley:] OK, let's just cut it there for the time being. 20:49.400 --> 20:51.733 Do you think he was making the couple comfortable? 20:51.733 --> 20:53.666 [Male Student:] He's making me seasick with his nodding. 20:53.666 --> 20:54.999 [Laughter] 20:55.000 --> 20:56.700 [Elizabeth Stanley:] What do you think that indicated? 20:56.700 --> 21:01.633 [Male Student:] Well, he's, I suppose he's apprehensive about dealing with [?] 21:01.633 --> 21:02.899 He's guarding and he's nodding along. 21:02.900 --> 21:04.933 [Elizabeth Stanley:] Do you think the patients are also feeling apprehensive? 21:04.933 --> 21:06.299 [Male Student:] Yeah, he's not helping them. 21:06.300 --> 21:09.900 [Elizabeth Stanley:] Mm-hmm, mm-hmm. OK, but a whole gamut of things here that. 21:09.900 --> 21:10.900 [Unidentified student:] [?] a patient. 21:10.900 --> 21:12.300 [Elizabeth Stanley:] Mm-hmm. 21:12.300 --> 21:16.733 [Female Student:] I don't think he tried to help draw out the problem in a gentle and easy way. 21:16.733 --> 21:18.266 He made it very hard for them. 21:18.266 --> 21:24.366 Mike, you kept pinning him down to say that he was impotent. I think that's... 21:24.366 --> 21:26.266 [Male Student:] Right. 21:26.266 --> 21:29.366 [Male Student:] Seemed also that Mike's real problem was in dealing with the woman. 21:29.366 --> 21:32.166 He addressed all his first remarks to the man... [Elizabeth Stanley:] Good point, good point. 21:32.166 --> 21:35.332 [Male Student:] and then when the husband actually brought in the woman, 21:35.333 --> 21:40.366 he sort of blocked out the woman with his knee like that and drew back and sort of said, 21:40.366 --> 21:42.632 well, I'll ask you a question because your husband wants, 21:42.633 --> 21:45.566 and goes right back to the question after, to the husband I mean, 21:45.566 --> 21:48.499 after the wife makes a few remarks. [Elizabeth Stanley:] Good. 21:48.500 --> 21:50.433 [Sarah:] He was being very non-receptive. 21:50.433 --> 21:54.366 [Elizabeth Stanley:] I was just going to say that. How did you feel as the wife? Did you feel? 21:54.366 --> 21:57.499 [Sarah:] I would feel disgusted at him as he was of him. [Laughter] 21:57.500 --> 22:04.966 [Mike:] Thanks a lot. Yeah, I can see that, that I made that mistake with getting in with. 22:04.966 --> 22:09.899 [Elizabeth Stanley:] Were you aware, did you find yourself noticing this during the interview or 22:09.900 --> 22:11.666 [Mike:] No, just when it was mentioned, yeah. 22:11.666 --> 22:12.432 [Elizabeth Stanley:] When it was mentioned. 22:12.433 --> 22:14.333 [Male Student:] Were you feeling nervous, Mike? 22:14.333 --> 22:17.833 [Mike:] Yeah, just a little bit. You know, I mean, this whole thing is a little nervous, 22:17.833 --> 22:19.933 you know, makes you a little nervous. 22:19.933 --> 22:25.133 [Narrator:] The objective is to achieve a comfortable balance between objectivity and compassion 22:25.133 --> 22:28.333 in the taking of a sex history and the management of the patient 22:28.333 --> 22:29.199 with a problem. 22:29.200 --> 22:30.566 [...] 22:30.566 --> 22:36.299 Another step in the acquiring of skills is the observation of therapy sessions 22:36.300 --> 22:38.866 with actual patients presenting problems, 22:38.866 --> 22:42.832 which might be new or uncomfortable to some students. 22:42.833 --> 22:47.599 [Female Patient:] I can't tell you how much better I feel about this already. 22:47.600 --> 22:50.500 At least I'd have some hope now. 22:50.500 --> 22:54.366 [Dr. Harold Lief:] Fine. We'll talk about it further at our next session. 22:54.366 --> 23:01.566 And as we discussed earlier, I think the next time you come with your husband. 23:01.566 --> 23:04.432 [Female Patient:] With my husband? 23:04.433 --> 23:05.233 [Dr. Harold Lief:] Yes. 23:05.233 --> 23:06.266 [Female Patient:] Together? 23:06.266 --> 23:08.866 [Dr. Harold Lief:] Yes. 23:08.866 --> 23:10.199 [Female Patient:] I'll talk to him about it. 23:10.200 --> 23:15.366 [Dr. Harold Lief:] Fine. Suppose we see if my secretary will make the next appointment. 23:15.366 --> 23:17.366 [Female Patient:] Thank you, doctor. 23:17.366 --> 23:18.399 [Footsteps] 23:18.400 --> 23:23.066 [Students observing from behind a barrier] 23:23.066 --> 23:25.632 [Dr. Lief turns on light and addresses students] 23:25.633 --> 23:30.999 [Dr. Harold Lief:] Well, I'm sure the problems of this particular patient are intriguing, 23:31.000 --> 23:35.366 but that's not the real reason we're here today. 23:35.366 --> 23:39.166 We're concentrating on the role of the physician. 23:39.166 --> 23:43.466 His comfort, the ease with which he handles the situation, 23:43.466 --> 23:47.132 the technical interventions he makes and so on. 23:47.133 --> 23:53.133 Now one of the most important things that we want to concern ourselves with is physician comfort. 23:53.133 --> 23:56.866 Ann, do you have any comments to make on that? 23:56.866 --> 23:59.866 [Ann:] Well, seeing that during the interview, 23:59.866 --> 24:03.732 she developed, the patient developed a certain dependence on you. 24:03.733 --> 24:09.266 As her therapist, it seems perhaps both as an authority figure and as a male. 24:09.266 --> 24:13.299 And it would seem that this would be a problem that any therapist would fall into. 24:13.300 --> 24:17.466 Insofar, especially interviewing I think someone of the opposite sex. 24:17.466 --> 24:20.999 [Dr. Harold Lief:] And this might be somewhat seductive for the male therapist. 24:21.000 --> 24:24.000 I think it's something we always have to be concerned with. 24:24.000 --> 24:26.033 Mike, what things did you see? 24:26.033 --> 24:31.699 [Mike:] They're obviously going to have a different approach to you. 24:31.700 --> 24:36.233 And the wife is going to be back involved in her marital situation. 24:36.233 --> 24:41.533 I could see your role changing to try and come in on both sides of their problem. 24:41.533 --> 24:47.766 [Dr. Harold Lief:] Right, right. During this first initial session, I had two major goals. 24:47.766 --> 24:56.332 To make the patient comfortable and to set up a situation so that her husband would come in the next time. 24:56.333 --> 25:01.033 Because with this sexual problem, we have to deal with the couple. 25:01.033 --> 25:02.933 Bob, anything you'd like to add? 25:02.933 --> 25:04.933 [Fade to black] 25:04.933 --> 25:06.933 [Silent] 25:06.933 --> 25:09.466 [Dr. Harold Lief joins other instructors for a review] 25:09.466 --> 25:10.499 [Elizabeth Stanley:] Hi. 25:10.500 --> 25:11.200 [Dr. Harold Lief:] Hi. 25:11.200 --> 25:13.833 [David Reed:] Harold, how do you think the course is going now? 25:13.833 --> 25:17.766 [Dr. Harold Lief:] Oh, fine. I'm really pleased with the way the students are into it. 25:17.766 --> 25:20.499 I know, there are a few things I think we've got to kick around, but-- 25:20.500 --> 25:25.100 You know, first I think it might be a good idea for us to review what we think 25:25.100 --> 25:28.766 are important for the medical educators seeing this film. 25:28.766 --> 25:30.766 Liz, why don't you start. 25:30.766 --> 25:36.832 [Elizabeth Stanley:] Well, I feel an important consideration is the selection of sex educators. 25:36.833 --> 25:39.766 They should not be selected from the faculty at random, 25:39.766 --> 25:47.699 but on the basis of relevant clinical skills with an emphasis on expertise in handling interpersonal relationships. 25:47.700 --> 25:52.233 [David Reed:] The effective sex educator is unique in needing 25:52.233 --> 25:57.033 to be aware of his own class-bound prejudices about sex. 25:57.033 --> 25:59.933 The main thing he teaches is his own comfort. 25:59.933 --> 26:04.066 The main thing he demonstrates is communication. 26:04.066 --> 26:08.166 [Elizabeth Stanley:] There is a very great value in the concept of team teaching. 26:08.166 --> 26:12.032 Having both a man and a woman acting as leaders of group discussion 26:12.033 --> 26:19.699 provides a freer and more comfortable atmosphere for fruitful exploration of attitudes and concerns. 26:19.700 --> 26:24.800 [David Reed:] The teaching faculty needs to deal not only with physiology, 26:24.800 --> 26:31.300 but sociology, ethics, psychology, and especially the normal aspects of sexuality. 26:31.300 --> 26:35.366 So an interdisciplinary faculty is best. 26:35.366 --> 26:39.499 And I'll second the motion that it's necessary to have women teach. 26:39.500 --> 26:44.266 We men cannot really get across the subtleties of female sexuality, 26:44.266 --> 26:47.432 particularly in today's sexual revolution. 26:47.433 --> 26:49.833 [Dr. Harold Lief stands up] 26:49.833 --> 26:53.833 [Dr. Harold Lief:] Medical students effectively trained in human sexuality 26:53.833 --> 26:58.199 are better equipped to integrate their knowledge, attitudes, and skills. 26:58.200 --> 27:03.666 They will have a greater ease and comfort in dealing with sexual, marital, and family planning problems, 27:03.666 --> 27:06.666 increasing their effectiveness as physicians. 27:06.666 --> 27:10.566 And this is just the beginning of their professional development. 27:10.566 --> 27:15.732 What we have shown you in this film is just an introduction to the subject. 27:15.733 --> 27:19.933 We will shortly produce other films that will cover specialized areas 27:19.933 --> 27:22.799 we were not able to include in this one. 27:22.800 --> 27:27.033 The field is wide open to a great deal more research and inquiry. 27:27.033 --> 27:28.966 We hope you will join us. 27:28.966 --> 27:35.332 [Narrator:] Sexual problems are among the most sensitive and anguishing patients bring to their physicians. 27:35.333 --> 27:39.566 Involving as they do, profound individual and family values. 27:39.566 --> 27:46.132 Medical intervention in this area affects the patient's and the family's entire well-being. 27:46.133 --> 27:50.533 [Instrumental music] 27:50.533 --> 27:54.366 [Narrator:] The physician who receives training in human sexuality 27:54.366 --> 27:58.432 and the skills of therapy during his professional training 27:58.433 --> 28:01.799 can help to alleviate much unnecessary suffering. 28:01.800 --> 28:06.633 And to preserve many marriages which are in serious jeopardy. 28:06.633 --> 28:12.099 The relevance of sex education and medical education is not debatable. 28:12.100 --> 28:14.633 We really have no choice. 28:14.633 --> 28:18.866 Sex education in some form goes on all the time. 28:18.866 --> 28:21.399 Usually it's the wrong kind. 28:21.400 --> 28:24.533 If the medical profession does not intervene, 28:24.533 --> 28:29.099 we will be abdicating a major medical responsibility. 28:29.100 --> 28:35.966 [Instrumental music] 28:35.966 --> 28:37.232 [...] 28:37.233 --> 28:43.633 [Harold I. Lief, M.D. Director of the Center] 28:43.633 --> 28:50.333 [David M. Reed, Ph.D., M.P.H. Assistant Director] 28:50.333 --> 28:52.499 [Elizabeth M.G. Stanley I.R.C.P., M.R.C.S. Research Associate] 28:52.500 --> 29:00.100 [Executive Producer: Charles Galbraith Producer-Director: Stan Carlson] 29:00.100 --> 29:07.700 [Written by: David V. Robison Video Tape Editor: Bob Howard] 29:07.700 --> 29:10.333 ["Rich & Judy" film courtesy of National Sex Forum] 29:10.333 --> 29:17.033 [Produced through the facilities of Northwest Mobile Television] 29:17.033 --> 29:19.766 [Music fades out] 29:19.766 --> 29:25.532 [Film leader] 29:25.533 --> 29:37.366 [...]