Training needs of German healthcare professionals regarding sexual health and sex workers: Results of a nationwide, cross-sectional survey

Training needs of German healthcare professionals regarding sexual health and sex workers: Results of a nationwide, cross-sectional survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Training needs of German healthcare professionals regarding sexual health and sex workers: Results of a nationwide, cross-sectional survey Sabrina Reinehr, Nina R. Neuendorff, Raquel Veen, Benedikt P. Langenbach, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4125234/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Dec, 2024 Read the published version in BMC Medical Education → Version 1 posted 15 You are reading this latest preprint version Abstract Background Sexual health is an important aspect of human well-being. In terms of sexual health and healthcare, sex workers might need more specialized care than others, given their higher risk for both discrimination and various sexually transmitted diseases. Yet, however, little is known about the quality of healthcare professionals’ training regarding sexual health and healthcare of sex workers in Germany. Methods In an online survey, 130 physicians, 63 psychotherapists, and 154 medical students reported their perceived quality of training regarding sexual health problems in all their patients and regarding sex workers’ health issues specifically. Results A substantial share of respondents reported to have experienced inadequate training regarding both sexual health problems in general and specific issues concerning sex workers. However, most respondents reported feeling rather comfortable when dealing with these topics. There was a positive correlation between feeling comfortable when treating sexual health problems/ sex workers and the perceived training on these topics. Conclusions The results of this study indicate that sexual health issues and sex workers’ specific healthcare requirements are not sufficiently addressed in the curricula of German healthcare professionals. Future adaptations of these curricula might be necessary. medical students physicians psychotherapists medical training medical education personalized medicine attitudes of healthcare personnel Germany Figures Figure 1 Figure 2 Figure 3 Background Sexual health and well-being play an important role for overall physical and psychological integrity, health equity, and public health actions ( 1 ). In healthcare, these issues are often neglected, which is surprising given the impact of sexual health on many aspects of health and well-being ( 2 – 4 ). Healthcare providers’ (HCPs) underutilization of and discomfort regarding sexual history taking was demonstrated to correlate with less training in patient communication ( 2 ), having a different gender than the patient ( 5 ), fear of intrusion and inadequacy, and cultural differences between HCPs and patients ( 6 ). In addition, with growing impact of personalized medicine ( 7 , 8 ), knowledge about specific health risks and preventive measures for societal minorities gain importance in healthcare. Sex workers belong to these minorities and have, for example, a higher risk than the general population for infectious diseases, such as human immunodeficiency virus (HIV), human papilloma virus (HPV), viral hepatitis ( 9 , 10 ), HPV-associated cancers (anal and cervical cancer) ( 11 ), and psychological disorders (anxiety disorders, depression) ( 12 ). Therefore, this minority most likely would profit from personalized healthcare including preventive measures ( 13 ). However, no explicit prevention program exists for sex workers in Germany. Instead, it is well-known that numerous barriers hinder sex workers’ healthcare utilization. These barriers include negative experiences with HCPs, anxiety associated with physical exams ( 14 , 15 ), and a general stigmatization by HCPs ( 16 , 17 ). To elucidate possible prejudices towards sex workers in HCPs, we recently conducted a cross-sectional online survey of German HCPs and found a similar prevalence of prejudices towards sex workers as in the general German population ( 18 ). In addition, we found that HCPs overestimated the prevalence of various mental and somatic disorders in sex workers. The latter finding was also influenced by the attitudes of HCPs towards sex work and sex workers. In sum, the results of our foregoing study suggested a knowledge gap among German HCPs about the specific health-related risks of sex workers. This knowledge gap most likely contributes to poor healthcare of sex workers. Previously, and somewhat in line with our findings, others have argued that sexual health is not sufficiently addressed in clinical practice ( 19 , 20 ), even though our results appear to be rather dated. As a part of the survey mentioned above, we therefore also asked about the perceived quality of graduate and postgraduate training in addition to desired training needs on sexual health in general and on sex workers health issues specifically among medical students, psychologists, and physicians themselves. Methods Study procedures This nationwide cross-sectional study was conducted over a period of 90 days in 2022. The online survey was generated with SoSci Survey and provided on www.soscisurvey.de ( 21 ). Participation was restricted to German HCPs as well as medical students. For detailed information, please refer to ( 18 ). All complete data sets of participants which stated to work in one of the professions of interest (HCPs who were involved in direct patient care) were included into the analysis. Incomplete surveys, and surveys of participants who did not meet the required characteristics (e.g., laboratory personnel without contact to patients) were excluded from the analysis. For the present analysis, only medical students, physicians, or a psychologists/ psychological psychotherapists were included. All participants took part voluntarily, did not report their name, and the information provided was not specific enough to identify individual participants. Still, the acquired data were only accessible to the designated researchers, as required by the local ethics committee at the Medical Faculty of the University Duisburg-Essen, Germany (ethics vote no.: 22-10678-BO). Questionnaire items As described previously ( 18 ), participants were asked to provide basic demographic information. Measurements of participants’ attitudes to both sex work and sex workers were acquired using the “Attitudes towards Prostitutes and Prostitution Scale (APPS)” by Levin and Peled ( 22 ). In addition, six questions about whether participants felt comfortable with and well-trained about sexual health problems of their patients and sex workers’ health issues specifically were included (see Supplement for questions in German): 1) “Do you feel comfortable when treating sexual problems in your patients?” 2) “Do you feel comfortable when treating sex workers?” 3) “Do you feel well-trained by your graduate training to treat problems of sexual health?” 4) “Do you feel well-trained by your graduate training to treat specific health problems of sex workers?” 5) “Do you feel well-trained by your post-graduate training to treat problems of sexual health?” 6) “Do you feel well-trained by your post-graduate training to treat specific health problems of sex workers?”). Responses were recorded using a 7-point Likert-Scale ranging from “do not agree at all” to “agree completely”. Data analysis Statistical analyses were performed using R (version 4.0.0) ( 23 ). In a first step, we computed descriptive statistics (percentages, mean, median, and standard deviation). To analyze whether age influenced the perception of training or level of comfort when dealing with sexual problems or sex workers, we calculated Pearson’s correlation coefficient. Similarly, we calculated Pearson’s correlation coefficient to check whether perceived training and attitudes towards sex workers were connected. To evaluate the influence of the number of sex workers treated on the perceived quality of training, we used Spearman’s correlation (as the number of sex workers treated had been assessed as an ordinal variable). P-values below 0.05 were considered significant, with * p < 0.050, ** p < 0.010, and *** p < 0.001. Results Study sample In total, 508 participants took part in our study and completed the survey ( 18 ). Of those, 347 were included in the current analysis. The excluded participants fell outside the scope of the article, which aimed to focus on physicians, psychologists, and medical students. However, the survey was also completed by, e.g., nurses or social workers. All participants gave their informed consent prior to participation. For demographic details of our sample, see Table 1 . Table 1 Participants’ characteristics. Participants’ characteristics Variable Absolute Number (%), N = 347 Medical students N = 154 (44.4%) Median age (± SD, range) 23.9 (± 3.34, 18–35) Gender (female/male/other) 116/36/2 Pre-clinical part of their studies (first 4 semesters) N = 41 (26.6%) Clinical part of their studies (last 8 semesters) N = 109 (70.8%) No information N = 4 (2.6%) Physicians N = 130 (37.5%) Median age (± SD, range) 40.4 (± 11.5, 23–75) Gender (female/male/other) 84/45/1 Speciality: general practitioner/internal Medicine 47 Speciality: Obstetrics/gynaecology 16 Speciality: Ophthalmology 10 Speciality: psychiatry/psychosomatic medicine 22 Speciality: others 35 Psychologists/psychological psychotherapists N = 63 (18.1%) Median age (± SD, range) 38.1 (± 11.2, 25–85) Gender (female/male/other) 49/11/3 Perceived treatment of sexual health problems and sex workers Most participants felt rather comfortable when treating sexual health problems (~ 70% stated to feel “somehow comfortable” to “strongly comfortable”). However, ~ 17% of participants reported some level of discomfort in this context (Fig. 1 A-C). Similarly, most participants felt comfortable treating sex workers (69.5% stated to feel “somehow comfortable” to “strongly comfortable”), while 9.5% reported at least some level of discomfort in this matter (Fig. 1 D-F). Perceived training regarding sexual health problems and sex workers Graduate training In contrast to the overall comfort with the treatment of sexual health problems/sex workers, participants showed a less positive perception regarding the quality of their graduate training regarding sexual health problems and sex workers. Of all respondents, almost 60% reported some level of feeling inadequately trained, and almost one in five physicians ( ~ 19%) said he or she did not feel “trained at all” during his or her university studies to deal with sexual health problems (Fig. 2 A-C). Even more apparently, more than one in three respondents (~ 35%) felt “not trained at all” regarding the specific health problems of sex workers and ~ 77% reported insufficient training to some degree (Fig. 2 D-F). Of note, the answers were similar in the subgroups of medical students, psychologists, and physicians. Treating more sex workers did not influence participants evaluation of their training, r = 0.004, p = 0.9446. Postgraduate Training We also asked participants about their postgraduate training (i.e., residency for physicians; psychotherapeutic training after receiving M.Sc. for psychologists). Answers were mixed, but a substantial portion of respondents (~ 38%) felt that they had received inadequate training regarding sexual health and ~ 52% regarding sex workers (Fig. 3 A-F). Of note, psychologists apparently felt better trained during their postgraduate training regarding sexual health issues than physicians (with ~ 40% versus ~ 28% feeling at least to some extent adequately trained). Again, treating more sex workers did not influence participants evaluation of their postgraduate training, r = -0.034, p = 0.5272. Influence of age on level of comfort and perceived training regarding treating sexual health problems and sex workers To evaluate whether age was connected to participants’ comfort and their perceived level of training on the matter, we conducted additional correlation analyses: First, we analysed whether age was related to the reported level of feeling (un)comfortable when treating sexual health problems in general or when treating sex workers, respectively. Second, we analysed separately whether the perceived level of education during academic/graduate (i.e. university studies) and postgraduate training regarding sexual health problems and sex workers was influenced by age. There was no relation between age and feelings while treating sexual health problems, r = 0.013, p = 0.805, or sex workers, r = -0.058, p = 0.282. Similarly, there was no relation between age and perceived quality of academic training regarding sexual health, r = 0.077, p = 0.151, or sex workers, r = 0.116, p = 0.108. Finally, there was no relation between age and academic training regarding sexual health, r = 0.012, p = 0.825. While there was a statistically significant connection between age and perceived level of postgraduate training regarding sex workers, r = 0.14, p = 0.047, this finding did not remain significant after conducting the Bonferroni-correction for multiple tests. Correlation between level of comfort and perceived training regarding treating sexual health problems and sex workers We also analysed whether the level of comfort when treating sexual health problems or sex workers correlated with the perceived training on these topics. Indeed, a small statistically significant correlation was detected between the level of comfort when treating sexual health problems and the perceived training, both for graduate training, r = 0.24, p = 0.000, and for post-graduate training r = 0.30, p = 0.000. Similarly, there was a small, but statistically significant correlation between the level of comfort when treating sex workers and the perceived training, again both for graduate, r = 0.19, p = 0.000, and for post-graduate training, r = 0.23, p = 0.001. (For analysis of post-graduate training, students were not included as they – for obvious reasons – did not receive a post-graduate training). Correlation between perceived training and attitudes towards sex workers Finally, we analysed whether the perceived level of training was related to participants’ attitudes towards sex workers. Interestingly, we found no connection between participants’ self-reported quality of training regarding sex workers and their estimation of sex workers as victims vs. self-choosing agents, neither for graduate, r = -0.07, p = 0.185, nor for post-graduate training, r = -0.12, p = 0.085. Similarly, there was no connection between the perceived level of training and participants’ ratings of sex workers as (morally) deviant vs. normative, neither for graduate, r = 0.046, p = 0.39, nor for post-graduate training r = -0.081, p = 0.26. (Again, for analysis of post-graduate training, students were not included). Discussion This cross-sectional online survey examined how comfortable German HPCs feel when treating sexual health problems and sex workers. Moreover, their perceived training on these topics was assessed. The main findings were ( 1 ) that most participants felt rather comfortable when treating sexual health problems or sex workers, ( 2 ) that most participants reported not being well-trained on these topics, ( 3 ) that there was a significant correlation between feeling comfortable when treating sexual health problems/sex workers and the perceived training regarding these topics. Moreover, our study found ( 4 ) no correlation between the perceived training and attitudes towards sex workers. Several studies have shown that the lack of training is one reason for HCPs’ discomfort in regard to diagnosis and treatment of sexual health issues ( 24 – 26 ). Our finding that participants felt rather comfortable when treating sexual health issues in general or sex workers specifically is a bit surprising because most participants reported that they felt rather poorly trained on these topics. According to the literature ( 24 – 26 ), one would expect that our cohort would feel rather uncomfortable when treating patients with sexual health issues. One explanation to that could be that most of our study participants stated to treat very few or no sex workers ( 18 ), implicating that they maybe did not know the (real) profession of their respective patients. Thus, they might simply not recall a situation in which they knowingly treated a sex worker and felt uneasy. In addition, we showed in our foregoing study (with the same participants) that German HCPs have objectifiable knowledge deficits about the specific health risks of sex workers ( 18 ). This is in line with a recent German survey among medical students which assessed basic knowledge about sexual health and found major deficits on important aspects, such as psychosexual development and relative safety of different contraceptives ( 27 ). In the present analysis, a high percentage of German HPCs reported to be only poorly trained regarding the treatment of sexual health issues or sex workers, but we found a positive correlation between feeling comfortable when treating sexual health problems or sex workers and the perceived level of training. In other words, HCPs which felt to be better trained on these topics felt more comfortable when treating the respective patients. This observation is in line with similar results from the study of Mkonyi and colleagues: The confidence of medical history-taking regarding sexual health problems increased with professional experience ( 24 ). These results might be important for evaluating medical curricula. Indeed, specialised medical societies have argued for more room for sexual health in medical education ( 28 ). Our results support their claim since HCP themselves often regard their training as insufficient. In our study, interestingly no correlation was found between participants’ perceived training regarding sex workers and their estimation of sex workers as victims vs. self-choosing agents. Similarly, there was no correlation between the perceived training and participants’ ratings of sex workers as (morally) deviant vs. normative. This contrasts with results from a study from Hong Kong which found a relationship between nursing students' knowledge of and attitudes against sex workers. In that study, final-year students (who were assumed to have received more training on sex workers’ specific health issues) had more positive attitudes towards sex workers than first-year students ( 29 ). The contrasting results of our study may have several reasons. Firstly, it is known that information alone often is not sufficient to change stereotypes and, secondly, it is known that stereotypes depend on societal norms ( 30 ). The latter most likely differs between Hong Kong and Germany which makes a direct comparison difficult in this matter. In conclusion, our data provide evidence that German HCPs feel only poorly trained concerning the treatment of sexual health issues in general and sex workers specifically. The current findings complement and extend the results of our foregoing study which found objective evidence for knowledge gaps in German HCPs regarding the specific health risks of sex workers. Taken together, improvements in graduate and postgraduate training of German HCPs about the specific health risks of sex workers and sexual health problems in general seem necessary. Conclusions Sexual health is an important aspect of human well-being. For sex workers, adequate medical care might often be inaccessible, and stigmatisation seems common. Thus, for both these topics, medical professionals should receive adequate training. However, in this non-representative nation-wide survey, a large share of healthcare providers in Germany reported insufficient training regarding sexual problems in general, and regarding sex workers specifically. Additionally, those who experience better sexual health-related training felt more comfortable when dealing with these issues. Thus, sexual health should be more prominently addressed during university as well as post-graduate training in the medical sector. Abbreviations HCPs health care providers HIV human immunodeficiency virus HPV human papilloma virus APPS attitudes towards prostitutes and prostitution scale Declarations Ethics approval and consent to participate This study was approved by the ethics committee of the Medical Faculty of the University Duisburg-Essen, Germany (ethics vote no.: 22-10678-BO). The study was conducted in accordance with the local legislation and institutional requirements and did conform with the principles laid down in the Declaration of Helsinki in its current form. The participants provided their written informed consent to participate in this study prior to any study related procedures. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyses performed in the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Mercur Research Center Ruhr (Essen, Germany) as part of the “Global Young Faculty VII” program. The funder of the study had no role in study design, data collection, analysis, and interpretation, writing of the report, or in the decision to submit the paper for publication. NN and AT held a position that was funded in part by the German Research Foundation (DFG) and the University Medicine Essen Clinician Scientist Academy (UMEA; grant no. FU356/12-2). SR was funded by the DFG (grant no. RE4543/1-1). Authors' contributions SR, NN, BL, AT: Conceptualization, formal analysis, funding acquisition, methodology, project administration, visualization, writing - original draft, and writing - review and editing. RV: data curation, methodology, and project administration. All authors contributed to the article and approved the submitted version. Acknowledgements Translation of APPS was performed by a professional scientific translator, Alexa Trost. References Mitchell KR, Lewis R, O'Sullivan LF, Fortenberry JD. What is sexual wellbeing and why does it matter for public health? Lancet Public Health. 2021;6(8):e608–13. Do K, Minichiello V, Hussain R, Khan A. Sexual history taking in general practice: managing sexually transmitted infections for female sex workers by doctors and assistant doctors in Vietnam. Int J STD AIDS. 2015;26(1):55–64. Verhoeven V, Bovijn K, Helder A, Peremans L, Hermann I, Van Royen P, et al. Discussing STIs: doctors are from Mars, patients from Venus. Fam Pract. 2003;20(1):11–5. Bilen H, Dayanan R, Ciftel E, Bilen A, Ciftel S, Mercantepe F, et al. Do We Care Enough About the Presence of Sexual Problems in Diabetic Patients? Int J Gen Med. 2023;16:5147–56. Burd ID, Nevadunsky N, Bachmann G. Impact of physician gender on sexual history taking in a multispecialty practice. J Sex Med. 2006;3(2):194–200. Temple-Smith M, Hammond J, Pyett P, Presswell N. Barriers to sexual history taking in general practice. Aust Fam Physician. 1996;25(9 Suppl 2):S71–4. Bhutani M, Blue BJ, Cole C, Badros AZ, Usmani SZ, Nooka AK, et al. Addressing the disparities: the approach to the African American patient with multiple myeloma. Blood Cancer J. 2023;13(1):189. Spaeth G. Angle-closure glaucoma in East Asian and European people. Different diseases? Eye (Lond). 2007;21(1):99–100. author reply. Farahmand M, Moghoofei M, Dorost A, Abbasi S, Monavari SH, Kiani SJ, et al. Prevalence and genotype distribution of genital human papillomavirus infection in female sex workers in the world: a systematic review and meta-analysis. BMC Public Health. 2020;20(1):1455. Mc Grath-Lone L, Marsh K, Hughes G, Ward H. The sexual health of female sex workers compared with other women in England: analysis of cross-sectional data from genitourinary medicine clinics. Sex Transm Infect. 2014;90(4):344–50. Lazcano-Ponce E, Salmeron J, Gonzalez A, Allen-Leigh B, Leon-Maldonado L, Magis C, et al. Prevention and control of neoplasms associated with HPV in high-risk groups in Mexico City: The Condesa Study. Salud Publica Mex. 2018;60(6):703–12. Rossler W, Koch U, Lauber C, Hass AK, Altwegg M, Ajdacic-Gross V, et al. The mental health of female sex workers. Acta Psychiatr Scand. 2010;122(2):143–52. Rekart ML. Caring for sex workers. BMJ. 2015;351:h4011. Rosenheck R, Ngilangwa D, Manongi R, Kapiga S. Treatment-seeking behavior for sexually transmitted infections in a high-risk population. AIDS Care. 2010;22(11):1350–8. Phrasisombath K, Thomsen S, Hagberg J, Sychareun V, Faxelid E. Knowledge about sexually transmitted infections (STIs) and attitudes toward female sex workers with STI symptoms among health care providers in Laos. Asia Pac J Public Health. 2012;24(6):940–52. Jeal N, Salisbury C. Self-reported experiences of health services among female street-based prostitutes: a cross-sectional survey. Br J Gen Pract. 2004;54(504):515–9. Lazarus L, Deering KN, Nabess R, Gibson K, Tyndall MW, Shannon K. Occupational stigma as a primary barrier to health care for street-based sex workers in Canada. Cult Health Sex. 2012;14(2):139–50. Langenbach BP, Thieme A, van der Veen R, Reinehr S, Neuendorff NR. Attitudes towards sex workers: a nationwide cross-sectional survey among German healthcare providers. Front public health. 2023;11:1228316. Strauss B. Fort- und Weiterbildung in Sexualberatung und Sexualtherapie. Psychother im Dialog. 2001;2(3):333–6. April K, Bitzer J. Sexuelle Gesundheit in der ärztlichen Praxis - A Call to Action. Schweiz Med Forum. 2014;14(41):760–3. Leiner DJ. SoSci Survey (Version 3.4.06) [Computer software]. Available at https://www.soscisurvey.de 2019. Levin L, Peled E. The Attitudes Toward Prostitutes and Prostitution Scale: A New Tool for Measuring Public Attitudes Toward Prostitutes and Prostitution. Res Social Work Pract. 2011;21(5):582–93. Team RC. R: A language and environment for statistical computing. MSOR connections. 2014;1. Mkonyi E, Trent M, Mwakawanga DL, Massae AF, Ross MW, Bonilla ZE, et al. Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners. East Afr J Health Sci. 2023;6(1):133–48. Bourne SJF, Lee CM, Taliaferro E, Zhang AY, Dalomba NF, Panton C, et al. Impact of Teaching Sexual Health Education on Medical Students. Fam Med. 2020;52(7):518–22. Beebe S, Payne N, Posid T, Diab D, Horning P, Scimeca A, et al. The Lack of Sexual Health Education in Medical Training Leaves Students and Residents Feeling Unprepared. J Sex Med. 2021;18(12):1998–2004. Turner D, Jopt K, Nieder TO, Briken P. German medical students' interest in and knowledge about human sexuality in 1972 and 2012. J Sex Med. 2014;11(8):1914–26. April K, Bitzer J, editors. Sexuelle Gesundheit in der ärztlichen Praxis - Call to Action Te il 2: Verbesserung der ärztlichen Versorgung, Sexualanamnese2014. Ma H, Loke AY. Knowledge of, attitudes towards, and willingness to care for sex workers: Differences between general and mental health nursing students. J Prof nursing: official J Am Association Colleges Nurs. 2020;36(4):264–77. Blum J. Stereotypes And Stereotyping: A Moral Analysis. Philosophical Papers. 2004;33(3):251–89. Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterial.docx Cite Share Download PDF Status: Published Journal Publication published 30 Dec, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 23 Oct, 2024 Reviews received at journal 10 Jul, 2024 Reviews received at journal 06 Jul, 2024 Reviewers agreed at journal 06 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviews received at journal 28 Jun, 2024 Reviewers agreed at journal 27 Jun, 2024 Reviews received at journal 27 Jun, 2024 Reviewers agreed at journal 26 Jun, 2024 Reviewers agreed at journal 20 Jun, 2024 Reviewers invited by journal 20 Jun, 2024 Editor assigned by journal 11 Jun, 2024 Editor invited by journal 21 Mar, 2024 Submission checks completed at journal 21 Mar, 2024 First submitted to journal 18 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4125234","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":283287130,"identity":"d18cf356-fbdf-4144-9a47-e30bac648f3d","order_by":0,"name":"Sabrina Reinehr","email":"","orcid":"","institution":"University Eye Hospital, Ruhr-University Bochum","correspondingAuthor":false,"prefix":"","firstName":"Sabrina","middleName":"","lastName":"Reinehr","suffix":""},{"id":283287131,"identity":"59d6dedd-2b8b-4fe4-a76f-0da51db53c5c","order_by":1,"name":"Nina R. Neuendorff","email":"","orcid":"","institution":"University Hospital Essen, University of Duisburg-Essen","correspondingAuthor":false,"prefix":"","firstName":"Nina","middleName":"R.","lastName":"Neuendorff","suffix":""},{"id":283287132,"identity":"a5a6e1f1-bd95-4784-b7b1-ed54692dd569","order_by":2,"name":"Raquel Veen","email":"","orcid":"","institution":"University Hospital Essen, University of Duisburg-Essen","correspondingAuthor":false,"prefix":"","firstName":"Raquel","middleName":"","lastName":"Veen","suffix":""},{"id":283287133,"identity":"181352c0-ff69-493c-920f-aba671397649","order_by":3,"name":"Benedikt P. Langenbach","email":"","orcid":"","institution":"University Hospital Essen, University of Duisburg-Essen","correspondingAuthor":false,"prefix":"","firstName":"Benedikt","middleName":"P.","lastName":"Langenbach","suffix":""},{"id":283287134,"identity":"d09287d6-e006-47b7-bb20-d48d427a7483","order_by":4,"name":"Andreas Thieme","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIiWNgGAWjYHACAwglwdgAJG0YJOASBwho4YFoSSNJC5g6TFgL/+zmbR8+1NQx2Es3Nz66UXE+cWYD8+GPPyruMPAdb8CqReLOseKZM44dZuCROdhsnHPmduJsBrY0aZ4zzxgkz+Cw5kaOMTMP2wGgwxLbpHPbbifOk39jxszYdpjB4EYCVh3yIC1//tWBtLT/zv13LnEeA//njz//AbXcf4Dd7yAtjG3MYFuYcxsOAB3GwyDB2wCyBbu7DG+kFTP29h3m4bmR2CydcyzZeGYDm5k0z7HDPJJnsDtM7kbyZoYf3+rk2GekP/ycU2MnO+MA8+OPP2oOy/Edx+F9KOAhQmQUjIJRMApGAdEAANCtYYcz89XXAAAAAElFTkSuQmCC","orcid":"","institution":"University Hospital Essen, University of Duisburg-Essen","correspondingAuthor":true,"prefix":"","firstName":"Andreas","middleName":"","lastName":"Thieme","suffix":""}],"badges":[],"createdAt":"2024-03-18 17:58:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4125234/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4125234/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-06551-3","type":"published","date":"2024-12-30T15:57:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53500656,"identity":"6685f00b-49da-45f2-b233-341c59fa52af","added_by":"auto","created_at":"2024-03-26 18:12:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":466107,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLevel of comfort when treating sexual health issues and sex workers.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA-C:\u003c/strong\u003e Most participants felt rather comfortable when treating sexual health problems. However, some of participants reported some level of discomfort in this context. \u003cstrong\u003eD-F:\u003c/strong\u003e Similarly, most participants felt comfortable treating sex workers, while a minority reported at least some level of discomfort in this matter.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4125234/v1/fe430eeacede65ddd2e9151b.png"},{"id":53500657,"identity":"7a4511b1-e5ce-42fa-a3bd-72c000a18972","added_by":"auto","created_at":"2024-03-26 18:12:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":489100,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePerceived level of training in treating sexual health issues and sex workers.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA-C:\u003c/strong\u003e Of all respondents, almost 60% reported some level of feeling inadequately trained, and almost one in five physicians said he or she did not feel “trained at all” during his or her university studies to deal with sexual health problems. \u003cstrong\u003eD-F:\u003c/strong\u003e Even more clearly, about 34% felt “not trained at all” regarding the specific health problems of sex workers and about 77% reported insufficient training to some degree.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4125234/v1/57af2d7f7aaf31aed3069e4a.png"},{"id":53501494,"identity":"90767ff4-c59d-403f-a063-2f3a3faa5513","added_by":"auto","created_at":"2024-03-26 18:20:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":513054,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLevel of postgrad education in treating sexual health issues and sex workers.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA-F:\u003c/strong\u003e A substantial portion of respondents felt that they had received inadequate training regarding sexual health and regarding sex workers' health issues.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4125234/v1/3755e8714403b9f43c2f3649.png"},{"id":73093322,"identity":"a5d83d8f-0a54-44c5-8425-1927a9ce6c2b","added_by":"auto","created_at":"2025-01-06 16:13:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1908576,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4125234/v1/495a4091-609b-4db1-89bf-0f1751a657bd.pdf"},{"id":53500660,"identity":"720aa3f8-f163-4c44-bc79-1c7e2baaae59","added_by":"auto","created_at":"2024-03-26 18:12:15","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":15282,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-4125234/v1/37418be024b36b3493e64311.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Training needs of German healthcare professionals regarding sexual health and sex workers: Results of a nationwide, cross-sectional survey","fulltext":[{"header":"Background","content":"\u003cp\u003eSexual health and well-being play an important role for overall physical and psychological integrity, health equity, and public health actions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In healthcare, these issues are often neglected, which is surprising given the impact of sexual health on many aspects of health and well-being (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Healthcare providers\u0026rsquo; (HCPs) underutilization of and discomfort regarding sexual history taking was demonstrated to correlate with less training in patient communication (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), having a different gender than the patient (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), fear of intrusion and inadequacy, and cultural differences between HCPs and patients (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In addition, with growing impact of personalized medicine (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), knowledge about specific health risks and preventive measures for societal minorities gain importance in healthcare. Sex workers belong to these minorities and have, for example, a higher risk than the general population for infectious diseases, such as human immunodeficiency virus (HIV), human papilloma virus (HPV), viral hepatitis (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), HPV-associated cancers (anal and cervical cancer) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and psychological disorders (anxiety disorders, depression) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Therefore, this minority most likely would profit from personalized healthcare including preventive measures (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). However, no explicit prevention program exists for sex workers in Germany. Instead, it is well-known that numerous barriers hinder sex workers\u0026rsquo; healthcare utilization. These barriers include negative experiences with HCPs, anxiety associated with physical exams (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), and a general stigmatization by HCPs (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). To elucidate possible prejudices towards sex workers in HCPs, we recently conducted a cross-sectional online survey of German HCPs and found a similar prevalence of prejudices towards sex workers as in the general German population (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). In addition, we found that HCPs overestimated the prevalence of various mental and somatic disorders in sex workers. The latter finding was also influenced by the attitudes of HCPs towards sex work and sex workers. In sum, the results of our foregoing study suggested a knowledge gap among German HCPs about the specific health-related risks of sex workers. This knowledge gap most likely contributes to poor healthcare of sex workers. Previously, and somewhat in line with our findings, others have argued that sexual health is not sufficiently addressed in clinical practice (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), even though our results appear to be rather dated. As a part of the survey mentioned above, we therefore also asked about the perceived quality of graduate and postgraduate training in addition to desired training needs on sexual health in general and on sex workers health issues specifically among medical students, psychologists, and physicians themselves.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy procedures\u003c/h2\u003e \u003cp\u003eThis nationwide cross-sectional study was conducted over a period of 90 days in 2022. The online survey was generated with SoSci Survey and provided on \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://www.soscisurvey.de\" target=\"_blank\"\u003ewww.soscisurvey.de\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.soscisurvey.de\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Participation was restricted to German HCPs as well as medical students. For detailed information, please refer to (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). All complete data sets of participants which stated to work in one of the professions of interest (HCPs who were involved in direct patient care) were included into the analysis. Incomplete surveys, and surveys of participants who did not meet the required characteristics (e.g., laboratory personnel without contact to patients) were excluded from the analysis. For the present analysis, only medical students, physicians, or a psychologists/ psychological psychotherapists were included.\u003c/p\u003e \u003cp\u003eAll participants took part voluntarily, did not report their name, and the information provided was not specific enough to identify individual participants. Still, the acquired data were only accessible to the designated researchers, as required by the local ethics committee at the Medical Faculty of the University Duisburg-Essen, Germany (ethics vote no.: 22-10678-BO).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire items\u003c/h2\u003e \u003cp\u003eAs described previously (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), participants were asked to provide basic demographic information. Measurements of participants\u0026rsquo; attitudes to both sex work and sex workers were acquired using the \u0026ldquo;Attitudes towards Prostitutes and Prostitution Scale (APPS)\u0026rdquo; by Levin and Peled (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In addition, six questions about whether participants felt comfortable with and well-trained about sexual health problems of their patients and sex workers\u0026rsquo; health issues specifically were included (see Supplement for questions in German): 1) \u0026ldquo;Do you feel comfortable when treating sexual problems in your patients?\u0026rdquo; 2) \u0026ldquo;Do you feel comfortable when treating sex workers?\u0026rdquo; 3) \u0026ldquo;Do you feel well-trained by your graduate training to treat problems of sexual health?\u0026rdquo; 4) \u0026ldquo;Do you feel well-trained by your graduate training to treat specific health problems of sex workers?\u0026rdquo; 5) \u0026ldquo;Do you feel well-trained by your post-graduate training to treat problems of sexual health?\u0026rdquo; 6) \u0026ldquo;Do you feel well-trained by your post-graduate training to treat specific health problems of sex workers?\u0026rdquo;). Responses were recorded using a 7-point Likert-Scale ranging from \u0026ldquo;do not agree at all\u0026rdquo; to \u0026ldquo;agree completely\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using R (version 4.0.0) (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In a first step, we computed descriptive statistics (percentages, mean, median, and standard deviation). To analyze whether age influenced the perception of training or level of comfort when dealing with sexual problems or sex workers, we calculated Pearson\u0026rsquo;s correlation coefficient. Similarly, we calculated Pearson\u0026rsquo;s correlation coefficient to check whether perceived training and attitudes towards sex workers were connected. To evaluate the influence of the number of sex workers treated on the perceived quality of training, we used Spearman\u0026rsquo;s correlation (as the number of sex workers treated had been assessed as an ordinal variable). P-values below 0.05 were considered significant, with * p\u0026thinsp;\u0026lt;\u0026thinsp;0.050, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.010, and *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy sample\u003c/h2\u003e \u003cp\u003eIn total, 508 participants took part in our study and completed the survey (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Of those, 347 were included in the current analysis. The excluded participants fell outside the scope of the article, which aimed to focus on physicians, psychologists, and medical students. However, the survey was also completed by, e.g., nurses or social workers. All participants gave their informed consent prior to participation. For demographic details of our sample, see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eParticipants\u0026rsquo; characteristics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsolute Number (%), N\u0026thinsp;=\u0026thinsp;347\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical students\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;154 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age (\u0026plusmn;\u0026thinsp;SD, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.9 (\u0026plusmn;\u0026thinsp;3.34, 18\u0026ndash;35)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (female/male/other)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116/36/2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-clinical part of their studies (first 4 semesters)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;41 (26.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical part of their studies (last 8 semesters)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;109 (70.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;4 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;130 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age (\u0026plusmn;\u0026thinsp;SD, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.4 (\u0026plusmn;\u0026thinsp;11.5, 23\u0026ndash;75)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (female/male/other)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84/45/1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpeciality: general practitioner/internal\u003c/p\u003e \u003cp\u003eMedicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpeciality: Obstetrics/gynaecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpeciality: Ophthalmology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpeciality: psychiatry/psychosomatic medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpeciality: others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychologists/psychological psychotherapists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;63 (18.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian age (\u0026plusmn;\u0026thinsp;SD, range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.1 (\u0026plusmn;\u0026thinsp;11.2, 25\u0026ndash;85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (female/male/other)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49/11/3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePerceived treatment of sexual health problems and sex workers\u003c/h2\u003e \u003cp\u003e Most participants felt rather comfortable when treating sexual health problems (~\u0026thinsp;70% stated to feel \u0026ldquo;somehow comfortable\u0026rdquo; to \u0026ldquo;strongly comfortable\u0026rdquo;). However, ~\u0026thinsp;17% of participants reported some level of discomfort in this context (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA-C).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e Similarly, most participants felt comfortable treating sex workers (69.5% stated to feel \u0026ldquo;somehow comfortable\u0026rdquo; to \u0026ldquo;strongly comfortable\u0026rdquo;), while 9.5% reported at least some level of discomfort in this matter (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eD-F).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003ePerceived training regarding sexual health problems and sex workers\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eGraduate training\u003c/h2\u003e \u003cp\u003eIn contrast to the overall comfort with the treatment of sexual health problems/sex workers, participants showed a less positive perception regarding the quality of their graduate training regarding sexual health problems and sex workers. Of all respondents, almost 60% reported some level of feeling inadequately trained, and almost one in five physicians (\u003csup\u003e~\u003c/sup\u003e19%) said he or she did not feel \u0026ldquo;trained at all\u0026rdquo; during his or her university studies to deal with sexual health problems (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA-C).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eEven more apparently, more than one in three respondents (~\u0026thinsp;35%) felt \u0026ldquo;not trained at all\u0026rdquo; regarding the specific health problems of sex workers and ~\u0026thinsp;77% reported insufficient training to some degree (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD-F). Of note, the answers were similar in the subgroups of medical students, psychologists, and physicians. Treating more sex workers did not influence participants evaluation of their training, r\u0026thinsp;=\u0026thinsp;0.004, p\u0026thinsp;=\u0026thinsp;0.9446.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePostgraduate Training\u003c/h2\u003e \u003cp\u003eWe also asked participants about their postgraduate training (i.e., residency for physicians; psychotherapeutic training after receiving M.Sc. for psychologists). Answers were mixed, but a substantial portion of respondents (~\u0026thinsp;38%) felt that they had received inadequate training regarding sexual health and ~\u0026thinsp;52% regarding sex workers (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA-F). Of note, psychologists apparently felt better trained during their postgraduate training regarding sexual health issues than physicians (with ~\u0026thinsp;40% versus ~\u0026thinsp;28% feeling at least to some extent adequately trained). Again, treating more sex workers did not influence participants evaluation of their postgraduate training, r = -0.034, p\u0026thinsp;=\u0026thinsp;0.5272.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eInfluence of age on level of comfort and perceived training regarding treating sexual health problems and sex workers\u003c/b\u003e \u003c/p\u003e \u003cp\u003eTo evaluate whether age was connected to participants\u0026rsquo; comfort and their perceived level of training on the matter, we conducted additional correlation analyses: First, we analysed whether age was related to the reported level of feeling (un)comfortable when treating sexual health problems in general or when treating sex workers, respectively. Second, we analysed separately whether the perceived level of education during academic/graduate (i.e. university studies) and postgraduate training regarding sexual health problems and sex workers was influenced by age. There was no relation between age and feelings while treating sexual health problems, r\u0026thinsp;=\u0026thinsp;0.013, p\u0026thinsp;=\u0026thinsp;0.805, or sex workers, r = -0.058, p\u0026thinsp;=\u0026thinsp;0.282. Similarly, there was no relation between age and perceived quality of academic training regarding sexual health, r\u0026thinsp;=\u0026thinsp;0.077, p\u0026thinsp;=\u0026thinsp;0.151, or sex workers, r\u0026thinsp;=\u0026thinsp;0.116, p\u0026thinsp;=\u0026thinsp;0.108. Finally, there was no relation between age and academic training regarding sexual health, r\u0026thinsp;=\u0026thinsp;0.012, p\u0026thinsp;=\u0026thinsp;0.825. While there was a statistically significant connection between age and perceived level of postgraduate training regarding sex workers, r\u0026thinsp;=\u0026thinsp;0.14, p\u0026thinsp;=\u0026thinsp;0.047, this finding did not remain significant after conducting the Bonferroni-correction for multiple tests.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCorrelation between level of comfort and perceived training regarding treating sexual health problems and sex workers\u003c/b\u003e \u003c/p\u003e \u003cp\u003eWe also analysed whether the level of comfort when treating sexual health problems or sex workers correlated with the perceived training on these topics. Indeed, a small statistically significant correlation was detected between the level of comfort when treating sexual health problems and the perceived training, both for graduate training, r\u0026thinsp;=\u0026thinsp;0.24, p\u0026thinsp;=\u0026thinsp;0.000, and for post-graduate training r\u0026thinsp;=\u0026thinsp;0.30, p\u0026thinsp;=\u0026thinsp;0.000.\u003c/p\u003e \u003cp\u003eSimilarly, there was a small, but statistically significant correlation between the level of comfort when treating sex workers and the perceived training, again both for graduate, r\u0026thinsp;=\u0026thinsp;0.19, p\u0026thinsp;=\u0026thinsp;0.000, and for post-graduate training, r\u0026thinsp;=\u0026thinsp;0.23, p\u0026thinsp;=\u0026thinsp;0.001. (For analysis of post-graduate training, students were not included as they \u0026ndash; for obvious reasons \u0026ndash; did not receive a post-graduate training).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation between perceived training and attitudes towards sex workers\u003c/h2\u003e \u003cp\u003e Finally, we analysed whether the perceived level of training was related to participants\u0026rsquo; attitudes towards sex workers. Interestingly, we found no connection between participants\u0026rsquo; self-reported quality of training regarding sex workers and their estimation of sex workers as victims vs. self-choosing agents, neither for graduate, r = -0.07, p\u0026thinsp;=\u0026thinsp;0.185, nor for post-graduate training, r = -0.12, p\u0026thinsp;=\u0026thinsp;0.085.\u003c/p\u003e \u003cp\u003eSimilarly, there was no connection between the perceived level of training and participants\u0026rsquo; ratings of sex workers as (morally) deviant vs. normative, neither for graduate, r\u0026thinsp;=\u0026thinsp;0.046, p\u0026thinsp;=\u0026thinsp;0.39, nor for post-graduate training r = -0.081, p\u0026thinsp;=\u0026thinsp;0.26. (Again, for analysis of post-graduate training, students were not included).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional online survey examined how comfortable German HPCs feel when treating sexual health problems and sex workers. Moreover, their perceived training on these topics was assessed.\u003c/p\u003e \u003cp\u003eThe main findings were (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) that most participants felt rather comfortable when treating sexual health problems or sex workers, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) that most participants reported not being well-trained on these topics, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) that there was a significant correlation between feeling comfortable when treating sexual health problems/sex workers and the perceived training regarding these topics. Moreover, our study found (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) no correlation between the perceived training and attitudes towards sex workers.\u003c/p\u003e \u003cp\u003eSeveral studies have shown that the lack of training is one reason for HCPs\u0026rsquo; discomfort in regard to diagnosis and treatment of sexual health issues (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Our finding that participants felt rather comfortable when treating sexual health issues in general or sex workers specifically is a bit surprising because most participants reported that they felt rather poorly trained on these topics. According to the literature (\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), one would expect that our cohort would feel rather uncomfortable when treating patients with sexual health issues. One explanation to that could be that most of our study participants stated to treat very few or no sex workers (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), implicating that they maybe did not know the (real) profession of their respective patients. Thus, they might simply not recall a situation in which they knowingly treated a sex worker and felt uneasy. In addition, we showed in our foregoing study (with the same participants) that German HCPs have objectifiable knowledge deficits about the specific health risks of sex workers (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This is in line with a recent German survey among medical students which assessed basic knowledge about sexual health and found major deficits on important aspects, such as psychosexual development and relative safety of different contraceptives (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In the present analysis, a high percentage of German HPCs reported to be only poorly trained regarding the treatment of sexual health issues or sex workers, but we found a positive correlation between feeling comfortable when treating sexual health problems or sex workers and the perceived level of training. In other words, HCPs which felt to be better trained on these topics felt more comfortable when treating the respective patients. This observation is in line with similar results from the study of Mkonyi and colleagues: The confidence of medical history-taking regarding sexual health problems increased with professional experience (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese results might be important for evaluating medical curricula. Indeed, specialised medical societies have argued for more room for sexual health in medical education (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Our results support their claim since HCP themselves often regard their training as insufficient.\u003c/p\u003e \u003cp\u003eIn our study, interestingly no correlation was found between participants\u0026rsquo; perceived training regarding sex workers and their estimation of sex workers as victims vs. self-choosing agents. Similarly, there was no correlation between the perceived training and participants\u0026rsquo; ratings of sex workers as (morally) deviant vs. normative. This contrasts with results from a study from Hong Kong which found a relationship between nursing students' knowledge of and attitudes against sex workers. In that study, final-year students (who were assumed to have received more training on sex workers\u0026rsquo; specific health issues) had more positive attitudes towards sex workers than first-year students (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). The contrasting results of our study may have several reasons. Firstly, it is known that information alone often is not sufficient to change stereotypes and, secondly, it is known that stereotypes depend on societal norms (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The latter most likely differs between Hong Kong and Germany which makes a direct comparison difficult in this matter.\u003c/p\u003e \u003cp\u003eIn conclusion, our data provide evidence that German HCPs feel only poorly trained concerning the treatment of sexual health issues in general and sex workers specifically. The current findings complement and extend the results of our foregoing study which found objective evidence for knowledge gaps in German HCPs regarding the specific health risks of sex workers. Taken together, improvements in graduate and postgraduate training of German HCPs about the specific health risks of sex workers and sexual health problems in general seem necessary.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eSexual health is an important aspect of human well-being. For sex workers, adequate medical care might often be inaccessible, and stigmatisation seems common. Thus, for both these topics, medical professionals should receive adequate training. However, in this non-representative nation-wide survey, a large share of healthcare providers in Germany reported insufficient training regarding sexual problems in general, and regarding sex workers specifically. Additionally, those who experience better sexual health-related training felt more comfortable when dealing with these issues. Thus, sexual health should be more prominently addressed during university as well as post-graduate training in the medical sector.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHCPs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehealth care providers\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHIV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehuman immunodeficiency virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehuman papilloma virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPPS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eattitudes towards prostitutes and prostitution scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the ethics committee of the Medical Faculty of the University Duisburg-Essen, Germany (ethics vote no.: 22-10678-BO). The study was conducted in accordance with the local legislation and institutional requirements and did conform with the principles laid down in the Declaration of Helsinki in its current form. The participants provided their written informed consent to participate in this study prior to any study related procedures.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe datasets used and/or analyses performed in the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis study was supported by the Mercur Research Center Ruhr (Essen, Germany) as part of the \u0026ldquo;Global Young Faculty VII\u0026rdquo; program. The funder of the study had no role in study design, data collection, analysis, and interpretation, writing of the report, or in the decision to submit the paper for publication. NN and AT held a position that was funded in part by the German Research Foundation (DFG) and the University Medicine Essen Clinician Scientist Academy (UMEA; grant no. FU356/12-2). SR was funded by the DFG (grant no. RE4543/1-1).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eSR, NN, BL, AT: Conceptualization, formal analysis, funding acquisition, methodology, project administration, visualization, writing - original draft, and writing - review and editing. RV: data curation, methodology, and project administration. All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eTranslation of APPS was performed by a professional scientific translator, Alexa Trost.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMitchell KR, Lewis R, O'Sullivan LF, Fortenberry JD. What is sexual wellbeing and why does it matter for public health? Lancet Public Health. 2021;6(8):e608\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDo K, Minichiello V, Hussain R, Khan A. Sexual history taking in general practice: managing sexually transmitted infections for female sex workers by doctors and assistant doctors in Vietnam. Int J STD AIDS. 2015;26(1):55\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerhoeven V, Bovijn K, Helder A, Peremans L, Hermann I, Van Royen P, et al. Discussing STIs: doctors are from Mars, patients from Venus. Fam Pract. 2003;20(1):11\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBilen H, Dayanan R, Ciftel E, Bilen A, Ciftel S, Mercantepe F, et al. Do We Care Enough About the Presence of Sexual Problems in Diabetic Patients? Int J Gen Med. 2023;16:5147\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurd ID, Nevadunsky N, Bachmann G. Impact of physician gender on sexual history taking in a multispecialty practice. J Sex Med. 2006;3(2):194\u0026ndash;200.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTemple-Smith M, Hammond J, Pyett P, Presswell N. Barriers to sexual history taking in general practice. Aust Fam Physician. 1996;25(9 Suppl 2):S71\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhutani M, Blue BJ, Cole C, Badros AZ, Usmani SZ, Nooka AK, et al. Addressing the disparities: the approach to the African American patient with multiple myeloma. Blood Cancer J. 2023;13(1):189.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpaeth G. Angle-closure glaucoma in East Asian and European people. Different diseases? Eye (Lond). 2007;21(1):99\u0026ndash;100. author reply.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarahmand M, Moghoofei M, Dorost A, Abbasi S, Monavari SH, Kiani SJ, et al. Prevalence and genotype distribution of genital human papillomavirus infection in female sex workers in the world: a systematic review and meta-analysis. BMC Public Health. 2020;20(1):1455.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMc Grath-Lone L, Marsh K, Hughes G, Ward H. The sexual health of female sex workers compared with other women in England: analysis of cross-sectional data from genitourinary medicine clinics. Sex Transm Infect. 2014;90(4):344\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazcano-Ponce E, Salmeron J, Gonzalez A, Allen-Leigh B, Leon-Maldonado L, Magis C, et al. Prevention and control of neoplasms associated with HPV in high-risk groups in Mexico City: The Condesa Study. Salud Publica Mex. 2018;60(6):703\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRossler W, Koch U, Lauber C, Hass AK, Altwegg M, Ajdacic-Gross V, et al. The mental health of female sex workers. Acta Psychiatr Scand. 2010;122(2):143\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRekart ML. Caring for sex workers. BMJ. 2015;351:h4011.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRosenheck R, Ngilangwa D, Manongi R, Kapiga S. Treatment-seeking behavior for sexually transmitted infections in a high-risk population. AIDS Care. 2010;22(11):1350\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhrasisombath K, Thomsen S, Hagberg J, Sychareun V, Faxelid E. Knowledge about sexually transmitted infections (STIs) and attitudes toward female sex workers with STI symptoms among health care providers in Laos. Asia Pac J Public Health. 2012;24(6):940\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeal N, Salisbury C. Self-reported experiences of health services among female street-based prostitutes: a cross-sectional survey. Br J Gen Pract. 2004;54(504):515\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazarus L, Deering KN, Nabess R, Gibson K, Tyndall MW, Shannon K. Occupational stigma as a primary barrier to health care for street-based sex workers in Canada. Cult Health Sex. 2012;14(2):139\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLangenbach BP, Thieme A, van der Veen R, Reinehr S, Neuendorff NR. Attitudes towards sex workers: a nationwide cross-sectional survey among German healthcare providers. Front public health. 2023;11:1228316.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrauss B. Fort- und Weiterbildung in Sexualberatung und Sexualtherapie. Psychother im Dialog. 2001;2(3):333\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApril K, Bitzer J. Sexuelle Gesundheit in der \u0026auml;rztlichen Praxis - A Call to Action. Schweiz Med Forum. 2014;14(41):760\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeiner DJ. SoSci Survey (Version 3.4.06) [Computer software]. Available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.soscisurvey.de\u003c/span\u003e\u003cspan address=\"https://www.soscisurvey.de\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevin L, Peled E. The Attitudes Toward Prostitutes and Prostitution Scale: A New Tool for Measuring Public Attitudes Toward Prostitutes and Prostitution. Res Social Work Pract. 2011;21(5):582\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeam RC. R: A language and environment for statistical computing. MSOR connections. 2014;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMkonyi E, Trent M, Mwakawanga DL, Massae AF, Ross MW, Bonilla ZE, et al. Evaluating the History-Taking Process of Sexual Reproductive Health Problems in Tanzania: Lessons from a Study of Health Students and Practitioners. East Afr J Health Sci. 2023;6(1):133\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBourne SJF, Lee CM, Taliaferro E, Zhang AY, Dalomba NF, Panton C, et al. Impact of Teaching Sexual Health Education on Medical Students. Fam Med. 2020;52(7):518\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeebe S, Payne N, Posid T, Diab D, Horning P, Scimeca A, et al. The Lack of Sexual Health Education in Medical Training Leaves Students and Residents Feeling Unprepared. J Sex Med. 2021;18(12):1998\u0026ndash;2004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurner D, Jopt K, Nieder TO, Briken P. German medical students' interest in and knowledge about human sexuality in 1972 and 2012. J Sex Med. 2014;11(8):1914\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApril K, Bitzer J, editors. Sexuelle Gesundheit in der \u0026auml;rztlichen Praxis - Call to Action Te il 2: Verbesserung der \u0026auml;rztlichen Versorgung, Sexualanamnese2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMa H, Loke AY. Knowledge of, attitudes towards, and willingness to care for sex workers: Differences between general and mental health nursing students. J Prof nursing: official J Am Association Colleges Nurs. 2020;36(4):264\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlum J. Stereotypes And Stereotyping: A Moral Analysis. Philosophical Papers. 2004;33(3):251\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"medical students, physicians, psychotherapists, medical training, medical education, personalized medicine, attitudes of healthcare personnel, Germany","lastPublishedDoi":"10.21203/rs.3.rs-4125234/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4125234/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSexual health is an important aspect of human well-being. In terms of sexual health and healthcare, sex workers might need more specialized care than others, given their higher risk for both discrimination and various sexually transmitted diseases. Yet, however, little is known about the quality of healthcare professionals\u0026rsquo; training regarding sexual health and healthcare of sex workers in Germany.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn an online survey, 130 physicians, 63 psychotherapists, and 154 medical students reported their perceived quality of training regarding sexual health problems in all their patients and regarding sex workers\u0026rsquo; health issues specifically.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA substantial share of respondents reported to have experienced inadequate training regarding both sexual health problems in general and specific issues concerning sex workers. However, most respondents reported feeling rather comfortable when dealing with these topics. There was a positive correlation between feeling comfortable when treating sexual health problems/ sex workers and the perceived training on these topics.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe results of this study indicate that sexual health issues and sex workers\u0026rsquo; specific healthcare requirements are not sufficiently addressed in the curricula of German healthcare professionals. Future adaptations of these curricula might be necessary.\u003c/p\u003e","manuscriptTitle":"Training needs of German healthcare professionals regarding sexual health and sex workers: Results of a nationwide, cross-sectional survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-26 18:12:09","doi":"10.21203/rs.3.rs-4125234/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-23T04:27:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-10T12:35:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-06T20:39:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"131402819512155247410704599555193099127","date":"2024-07-06T10:41:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253610278985012574915559298167050682321","date":"2024-07-04T20:05:40+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-28T17:31:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253555623487377623358327043229173387316","date":"2024-06-27T15:01:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-27T12:58:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185236620523005161739292187021150288588","date":"2024-06-26T13:06:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13561558773209911628745334111864069709","date":"2024-06-20T16:22:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-20T14:27:56+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-11T05:30:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-21T18:26:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-21T18:23:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-03-18T17:56:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d208c7ee-4027-412c-a1fe-c0a857dbded1","owner":[],"postedDate":"March 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-06T16:02:48+00:00","versionOfRecord":{"articleIdentity":"rs-4125234","link":"https://doi.org/10.1186/s12909-024-06551-3","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-12-30 15:57:00","publishedOnDateReadable":"December 30th, 2024"},"versionCreatedAt":"2024-03-26 18:12:09","video":"","vorDoi":"10.1186/s12909-024-06551-3","vorDoiUrl":"https://doi.org/10.1186/s12909-024-06551-3","workflowStages":[]},"version":"v1","identity":"rs-4125234","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4125234","identity":"rs-4125234","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}