Support for affirmative actions to increase inclusivity of intersex* persons at an Austrian medical university.

BACKGROUND: Since the ruling handed down by the Austrian Constitutional Court in 2018 intersex variation has been recognized under Austrian law as a "third sex". In order to ensure that people with intersex variation are not discriminated against based on their group membership affirmative actions (i.e., proactive practices to avert discrimination) can be implemented. The current study explored whether students and employees at an Austrian medical university know about intersex variation. Furthermore, the study investigated what affirmative actions are practiced at the medical university to be inclusive for intersex persons and students' and employees' support for such affirmative actions. METHODS: All students and employees of a medical university in Austria were invited by e-mail to participate at the current study that included a self-constructed knowledge test on intersex variation with ten true-false questions. On five-point Likert scales participants reported for each of twelve listed affirmative actions whether they had seen a certain affirmative action at their university and how important they thought the implementation of an affirmative action was. Finally, participants' gender, age, sexual orientation, highest level of education, and nationality was assessed. A cluster analysis was performed to determine groups of people with different degrees of support for affirmative actions for intersex persons. RESULTS: 220 students (62% cisgender women, 38% cisgender men) and 200 employees (72% cisgender women, 28% cisgender men) participated. Participants responded correctly to three out of ten knowledge test questions. The cluster analysis revealed that participants could be clustered as heterosexual cisgender women (Cluster 1; 55%), heterosexual cisgender men (Cluster 2; 30%), or sexual minority cisgender women and men (Cluster 3; 15%). Sexual minority persons knew more about intersex variation than did heterosexual participants. On average, affirmative actions for the inclusivity of intersex people have not been encountered (M = 1.5, SD = 0.4) at the studied university. Participants, especially those in Cluster 3, believed that the listed actions are moderately important. CONCLUSIONS: At the medical university many actions should be taken to increase inclusivity for intersex people. Increasing the knowledge of university staff and students concerning intersex might help increase their support for such actions.

Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone.

Background: Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT). Aim: This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist. Methods: The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36. Expected results: Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT. Discussion: This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT05435222.

Not Always a "Buffer": Self-Compassion as Moderator of the Link Between Masculinity Ideologies and Help-Seeking Intentions After Experiences of Intimate Partner Violence.

Many women and men experience intimate partner violence (IPV) during their lifetime. However, only relatively few people actually seek formal help after such an experience. The current study applied the mediated-moderation model of self-compassion and stigma that has previously been used to explain men's help-seeking behavior for depressive symptoms. The current study analyzed whether conformity to masculinity ideologies (CMI), self-stigma, and self-compassion were related to women's and men's intention to seek formal help after IPV experiences. A cross-sectional online questionnaire study was conducted with 491 German-speaking participants (65.8% women/34.2% men; age: M = 36.1 years; SD = 14.2). Participants read three vignettes about experienced IPV and then indicated how likely they would be to seek medical or psychological help if they were in the main character's situation. Additionally, the Conformity to Masculine Norms Inventory, Self-Stigma of Seeking Help Scale, and Self-Compassion Scale were used. Separate manifest path models for women and men revealed that strong CMI was linked to strong self-stigma in women and men. In turn, strong self-stigma was linked to weak intentions to seek formal help after IPV experiences. In men, strong self-compassion weakened (i.e., "buffered") the link between CMI and self-stigma. However, direct associations between strong CMI and weak intentions to seek formal help remained, especially for those participants with strong self-compassion. The current study adds to the existing literature on associations between CMI, self-compassion, and self-stigma by showing that those links are also relevant in women. However, self-compassion might not always act as a "buffer" and mediators that explain links between strong CMI and weak intentions to seek formal help in people with strong self-compassion need to be found in future studies.

How do traditional masculinity ideologies and emotional competence relate to aggression and physical domestic violence in cisgender men?

Background: Men are disproportionately often perpetrators of physical domestic violence (DV). Gender role constructs, such as traditional masculinity ideologies (TMI), are broadly accepted as an explanation for this effect. Emotional competence further constitutes an important role in TMI and the prevention of DV. However, the interactions between these constructs remains unclear. Objective: The present study aims to investigate associations of TMI with aggression, DV perpetration, and emotional competence, while also examining emotional competence as a potential moderator. Method: A sample of 428 cisgender men (M age = 43.9 ± 15.3) from German-speaking countries in Europe completed an anonymous online survey that assessed TMI, aggression, and DV perpetration as well as alexithymia, emotion regulation, and self-compassion as indicators of emotional competence. Results: Strong TMI were associated with high levels of aggression and overall reduced emotional competence, as reflected by high levels of alexithymia, frequent use of expressive suppression, and low levels of self-compassion. Strong conformity to TMI was associated with a higher likelihood for DV perpetration when considering relevant sociodemographic covariates. Moderation analyses revealed that expressive suppression buffered the association between TMI and DV perpetration. Conclusion: Men with strong TMI report high levels of aggression and impaired emotional competence. While strong conformity to TMI was associated with more frequent perpetration of DV, higher expressive suppression seems to buffer the association between TMI and DV perpetration. The present study highlights the importance of addressing gender ideologies when working on aggression, DV perpetration and emotional competence in men.

Explorative Questionnaire Study About Education with Regard to the Health of Sexual Minorities at an Austrian Medical University.

Physicians can play a critical role in helping lesbian, gay, and bisexual-identified (LGB) individuals face minority stress. The current questionnaire study among 305 medical students (62.6% women/37.4% men; Mage = 23.4, SD = 3.2) assessed whether medical students learn about LGB-specific concepts at an Austrian medical university. Students reported that their education contained little content about LGB-specific concepts. The majority of students did not hold negative attitudes toward homosexuality and they would like a larger range of courses concerning LGB-specific topics. The barrier most strongly associated with the intention to ask future patients about their sexual orientation was the belief that sexual orientation was irrelevant for clinical practice. Future education programs on LGB-specific topics may not need to focus on reducing negative attitudes toward sexual minorities, but should contain more facts on LGB individuals' specific healthcare needs and explain to students why a patient's sexual orientation is important to healthcare.

Family Supportive Supervisor Behaviors Moderate Associations between Work Stress and Exhaustion: Testing the Job Demands-Resources Model in Academic Staff at an Austrian Medical University.

The time-intensive work of publishing in scientific journals is an important indicator of job performance that is given much weight during promotion procedures for academic positions. The current study applied the job demands-resources model and analyzed whether family supportive supervisor behaviors (FSSB) moderated associations between work stress and feelings of exhaustion as a job resource and whether feelings of exhaustion ultimately mediated the link between work stress and academic employees' publication activity. The current online cross-sectional questionnaire study was conducted in 133 academic employees (65.4% women, 34.6% men; Mage = 41.9, SD = 10.1) at an Austrian medical university and assessed employees' numbers of publications, H-index, work stress, feelings of exhaustion, FSSB, and work-family services used. Manifest path models revealed that FSSB moderated the link between experiencing high levels of work stress and strong feelings of exhaustion, especially in employees who had at least one child below the age of 18. Part-time employment was most strongly linked with lower numbers of publications and lower H-index levels. The finding that FSSB acted as a job resource mostly for employees with at least one child below 18 underlines the fact that FSSB is different from other forms of supervisor support. The current study supports recommendations to increase the amount of work-family services and to change organizational norms to be supportive of the successful management of family and work obligations.

Associations Between Pornography Consumption, Sexual Flexibility, and Sexual Functioning Among Austrian Adults.

To date, only a few studies have examined the associations between pornography consumption and sexual functioning. The Acquisition, Activation, Application Model (3AM) indicates that the frequency of pornography consumption and the perceived realism of pornography may influence whether sexual scripts are acquired from viewed pornography. Having sexual scripts that are alternative to their preferred sexual behaviors may help people switch to alternative sexual behavior when sexual problems arise. The current study analyzed whether frequent pornography consumption was associated with greater sexual flexibility and greater sexual functioning. Additionally, the perceived realism of pornography consumption was tested as a moderator of those associations. At an Austrian medical university, an online cross-sectional questionnaire study was conducted among 644 medical students (54% women and 46% men; Mage = 24.1 years, SD = 3.8). The participants were asked about their pornography consumption, partnered sexual activity, sexual flexibility, perceived realism of pornography, and sexual functioning. Manifest path analyses revealed direct and indirect associations between frequent pornography consumption and greater sexual functioning through greater sexual flexibility in women but not in men. Perceived realism did not moderate those associations. In conclusion, our study was in line with previous studies that found no significant associations between men's pornography consumption and sexual functioning in men. However, some women may expand their sexual scripts and learn new sexual behaviors from pornography consumption, which may help with their sexual functioning.

Links between Virginity Beliefs, Negative Feelings after Virginity Loss and Sexual Performance Anxiety in a Sample of German-Speaking Heterosexual-Identified Women and Men.

Gender norms can influence women and men adopting different beliefs toward their own virginity. The current online cross-sectional questionnaire study was applied in a sample of German-speaking heterosexual-identified women (n = 536) and men (n = 181; Mage = 23.6, SD = 3.7). In men negative virginity loss experiences and sexual performance anxiety were especially prevalent when virginity loss occurred at an age that was inconsistent with men's virginity beliefs. In women age at virginity loss was not linked to virginity loss experiences or sexual performance anxiety, but the holding of virginity beliefs that deviated from gender norms was associated with those variables.Supplemental data for this article is available online at https://doi.org/10.1080/0092623X.2021.1958963 .

A Vignette Study Analyzing Contextual Factors that Influence Emerging Adults' Definitions of Virginity Loss in German-Speaking Countries.

Past research on virginity loss definitions revealed that emerging adults' definitions of virginity loss are associated with emerging adults' own sociodemographic characteristics. However, previous research has not systematically studied whether emerging adults applied different criteria for virginity loss depending on the context of the judged behavior. The current study used vignettes to explore which contextual factors of an intimate partnered behavior influence emerging adults' definition of virginity loss. Each of the 987 participants (75% women/25% men; Mage = 23.7, SD = 3.8) was assigned to one of 16 vignette conditions. The main character's gender, sexual orientation, and commitment to the partner were manipulated in the vignettes, describing the main character engaging in intimate partnered behavior with either a woman or a man. Participants had to indicate whether 13 intimate partnered behaviors qualified as virginity loss in the given context. Emerging adults applied different standards for virginity loss definitions depending on the involved partners' gender. They counted more behaviors as virginity loss in conditions where two people of the same gender engaged in intimate partnered behavior. Healthcare practitioners concerned with emerging adults' sexual health should be aware of these double standards for virginity loss definitions.

Men's Psychotherapy Use, Male Role Norms, and Male-Typical Depression Symptoms: Examining 716 Men and Women Experiencing Psychological Distress.

Men as compared to women are half as often affected by depressive and anxiety disorders and seek significantly less help for mental health issues than women. Adherence to traditional male role norms (AtTMRN) may hinder men from describing prototypical depression symptoms and from seeking psychotherapy. The current study compared whether AtTMRN, gender role identity, or the experience of prototypical or male-typical externalizing mental health symptoms were associated with psychotherapy use in men and women. In an anonymous online survey, 716 participants (37% men) reporting to currently experience psychological distress were examined. Information was obtained on psychotherapy use, depression and anxiety symptoms, gender role identity, and traditional male role norms. Although experiencing similar levels of depression, men compared to women showed a reduction in psychotherapy use by 29%. Masculine role identity was directly associated with reduced psychotherapy use in men (ß = -0.41, p = 0.029), whereas AtTMRN was not (men: ß = -0.04, p = 0.818; women: ß = -0.25, p = 0.064). Higher externalizing depression symptomatology (ß = -0.68, p = 0.005), but not prototypical depression symptomatology (ß = -0.02, p = 0.499), was associated with reduced psychotherapy use in men but not women (p > 0.05). Interactions revealed that men, but not women, with high AtTMRN use psychotherapy only when exhibiting elevated symptom levels. The results corroborate previous reports showing reduced psychotherapy use in men as compared to women and identify elevated masculine role identity and male-typical externalizing depression symptomatology as direct factors associated with reduced psychotherapy use in psychologically distressed men. AtTMRN interacts with mental health symptoms to predict psychotherapy use, indicating that men with high AtTMRN only use psychotherapy when exhibiting high symptomatology.

Psychometric Analysis of a German-Language Version of the Work-Family Conflict and Family-Work Conflict Scale.

The Work-Family Conflict and Family-Work Conflict Scale (WFC & FWC Scale) is a questionnaire commonly used to assess conflicts that arise when required time devotion and strain for work obligations interfere with family responsibilities (work-family conflict) and conflicts that arise when family responsibilities interfere with work responsiblities (family work conflict). Past reports on the psychometric properties and recommendations for application of the WFC & FWC Scale mostly rely on samples from the United States. The current study is the first to report psychometric properties of a German-language version of the WFC & FWC Scale, including invariance analyses across women and men, and test-retest reliabilities. The analysis of the latent structure that was based on responses from 274 employes (77.0% women, 23.0% men) of a medical university in Austria revealed that the bifactor model had a satisfactory fit with the data. Configural and metric invariance indicated a similar factor structure and similar meaning in women and men. However, scalar invariance cannot be assumed. Thus, differences in scale scores between women and men might not adequately reflect level differences in the underlying latent factor. High internal consistencies and high test-retest reliabilities offer evidence for adequate reliability. Additionally, evidence for convergent (links to work stress and relationship satisfaction) and divergent validity (no links to career ambition) were found. In summary, the current study offers adequate evidence for validity and reliability of a German-language version of the WFC & FWC Scale.

Austrian University Hospital Physicians' Barriers to and Reasons for Assessing Their Patients' Sexual Orientation.

The current online-questionnaire study examined physicians' (N = 135; 51.9% women and 48.1% men) attitudes toward homosexuality and assessed physicians' barriers to and reasons for asking patients about their sexual orientation at an Austrian university hospital. Only 37.1% of female physicians and 27.7% of male physicians included questions about their patients' sexual orientation in everyday clinical practice. The most commonly reported barrier was the belief that sexual orientation was irrelevant for healthcare. Reported discomfort or negative attitudes toward homosexuality were low and did not play a role in the frequency of physicians' everyday assessment of patients' sexual orientation. Physicians mostly stated concerns for their patients' sexual health as reasons for assessing sexual orientation. Medical education or training programs need to include more thorough education with regard to sexual orientation, minority stress and health disparities. It is important that physicians recognize the relevance of assessing their patients' sexual orientation.

Attachment-related anxiety is associated with poor genital satisfaction and sexual problems in women.

BACKGROUND: Genital satisfaction has been found to influence women's sexual experience. We tested the Relational Bodily Experiences Theory (RBET) that predicts associations between women's genital satisfaction, attachment models, and sexual desire. We extended the model by additionally considering sexual arousal, orgasmic sensation, or the experience of pain during sexual activity as outcome variables. According to the RBET, women's attachment models are associated with their genital satisfaction and linked to women's sexual experience. METHODS: A cross-sectional online questionnaire study was conducted at an Austrian medical university. In total 294 women (Mage = 23.7, SD = 3.4) provided full responses. Women were asked about genital satisfaction and experiences of distressing sexual problems. Attachment-related anxiety and avoidance were assessed with the Experiences in Close Relationships-Relationship Structures Questionnaire. RESULTS: Results partially support the RBET. Attachment-related anxiety was associated with genital satisfaction which, in turn, was linked to experiences of frequent and/or distressing diminished sexual arousal, diminished sexual desire, or pain during sexual activity. CONCLUSIONS: These results suggest that clinicians should assess genital satisfaction when treating female sexual problems. Women with attachment-related anxiety may especially be prone to having poor genital satisfaction and may profit from body image interventions in order to improve their sexual experience.

Austrian male patients' gender role conflict is associated with their wish for interpersonal violence to be addressed during patient-physician conversations: a questionnaire study.

BACKGROUND: Experiencing interpersonal violence and disclosing this experience to physicians can be associated with fear, shame, denial or emotional turmoil. Expressions of such feelings additionally conflict with masculine gender role ideologies and may be experienced as masculine gender role conflict. Masculine gender role conflict is often associated with men's unwillingness to seek professional help. The current study analyzed the association between masculine gender role conflict and men's wish for patient-physician conversations to include questions about interpersonal violence they might have experienced. METHODS: In structured closed-ended interviews conducted at an Austrian hospital 129 male patients (Mage = 59.4, SD = 14.7) were asked what forms of interpersonal violence they had experienced. Additionally, a study-specific questionnaire was used to find out whether male patients wanted future physician-patient conversations to include questions about interpersonal violence they might have experienced. Men's gender role conflict was assessed with the Gender Role Conflict Scale-Short Form. RESULTS: Half of the male patients (50%) reported having experienced at least one form of interpersonal violence. Nearly half of the men (48%) wanted their physician to ask them in future about any violence they might have experienced. One pattern of gender role conflict was positively associated with men's wish to be asked in patient-physician conversations about potential interpersonal violence. Namely, men who reported conflicts between work and family relations were more likely to state that they wanted such conversations (OR = 1.6, 95%CI = 1.1-2.4) than were men who did not often experience this pattern of gender role conflict. CONCLUSIONS: Experiences of interpersonal violence should be an important part of physician-patient conversations with male patients. Overall, male patients would welcome their physician initiating a potential conversation about violence. Using an approach that takes consideration of masculine gender role ideologies may further increase some men's willingness to approach the topic of interpersonal violence. Men who adhere to the norm of being preoccupied with work may be more willing to talk about this subject if healthcare situations are framed in a way that men perceive the possibility to uphold masculine gender role ideologies of self-sufficiency or of being in control.

Predictors for Low Frequencies of Patient-Physician Conversations Concerning Sexual Health at an Austrian University Hospital.

INTRODUCTION: Studies concerning barriers to patient-physician conversations about sexual health or, specifically, sexual functioning fail to go beyond descriptive analyses of such barriers. AIM: To identify barriers that predict the frequency of patient-physician conversations concerning sexual health or sexual functioning. METHODS: An online survey among physicians was conducted at an Austrian university hospital. Self-constructed questionnaires assessed physicians' sociodemographic information, frequency of holding a discussion on sexual health or sexual dysfunctions with their patients, and self-perceived barriers to asking patients about sexual health. Stepwise logistic regression models determined barriers that predicted the frequency of patient-physician conversations concerning sexual health or sexual dysfunctions in everyday clinical practice. MAIN OUTCOME MEASURE: The outcome variables in the structural equation models were frequency of patient-physician conversations concerning sexual health or sexual dysfunctions in everyday clinical practice. RESULTS: One hundred two physicians (53.9% women, 46.1% men; mean age = 41.3 years; SD = 10.6) provided full responses. Of these physicians, 61.8% reported having a discussion on sexual health or sexual dysfunctions with their patients at least rarely in their everyday clinical practice. The barriers most influencing the frequency of such patient-physician conversations were not feeling responsible for this health issue and expecting the patient to initiate such a conversation. Fear of offending the patient and the physician's own feelings of shame and discomfort were additional factors influencing the frequency of these patient-physician conversations. CLINICAL IMPLICATIONS: Future physician training should address physicians' responsibilities that include sexual health. Future physician training should also help physicians in overcoming fears of offending a patient, and one's own feelings of shame and discomfort when addressing patients' sexual health. STRENGTHS & LIMITATIONS: This study included physicians across a range of disciplines, who may encounter patients with sexual problems and with their treatments influence a patient's sexual health and sexual functioning. However, the low response rate and the limited number of participants prevented generalization of findings. CONCLUSIONS: At an Austrian university hospital, patient-physician conversations concerning sexual health are seldom part of a physician's everyday clinical practice. Future training for physicians should focus on demonstrating the relevance of sexual health in the physician's medical discipline and should tackle a physician's feelings of shame or how to handle patients' negative reactions during patient-physician conversations concerning sexual health. Komlenac N, Hochleitner M. Predictors for Low Frequencies of Patient-Physician Conversations Concerning Sexual Health at an Austrian University Hospital. Sex Med 2019; 8:100-106.

Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University.

INTRODUCTION: The quantity and quality of education in the field of human sexuality vary greatly in medical education programs in the United States and Europe. AIM: The current state of medical school education with regard to human sexuality was assessed at an Austrian medical university. METHODS: Self-constructed questionnaires and the Beliefs About Sexual Functioning Scale were filled out by 391 medical students (mean age = 24.0, SD = 2.5; 52.4% women, 47.6% men). Descriptive statistics are reported for summarizing students' responses, and structural equation models were calculated to reveal associations between variables of interest. MAIN OUTCOME MEASURES: The outcome variable in the structural equation models was students' confidence in addressing sexual health concerns of patients. RESULTS: Most students were not instructed in sexual history taking (96.9%), sexual behavior (94.3%), love (97.4%) or sexuality in elderly persons (95.1%), and they reported having poor knowledge of these topics. Most students (72.5%) reported having little or no confidence in addressing patients' sexual health concerns. The number of addressed topics was positively associated with male (ß = 0.47, P < .001) and female students' (ß = 0.52, P < .001) knowledge. Knowledge was positively associated with male (ß = .49, P < 0.001) and female students' (ß = 0.33, P < .001) confidence in addressing sexual health concerns and was negatively associated with stereotypical sexual functioning beliefs in the male subsample (ß = -0.26, P = .009). CONCLUSIONS: Most medical students revealed that the teaching of important sexual health content (eg, sexual history taking) was deficient at this medical university. Education in sexual health issues needs to be increased to positively influence students' knowledge of and consequently their confidence regarding dealing with patients' sexual health concerns. Komlenac N, Siller H, Hochleitner M. Medical Students Indicate the Need for Increased Sexuality Education at an Austrian Medical University. Sex Med 2019;7:318-325.

Male Medical Students' Gender-Role Conflict Is Associated With Their Discomfort With Dealing With Patients' Sexual Health Issues.

Recommendations suggest that more sexuality education be implemented in medical school curricula to increase students' comfort with regard to dealing with sexual health issues. For male medical students the adherence to masculine gender-role norms may also contribute to discomfort regarding dealing with this intimate topic. The current study analyzed whether male medical students' knowledge or masculine gender-role conflict (GRC) was associated with their comfort with regard to asking future patients about sexual health issues. A total of 164 male medical students (Mage = 24.4, SD = 2.4) participated. A questionnaire assessed students' self-perceived knowledge of sexual health, how prepared they felt with regard to this topic, and their comfort with regard to asking future patients about sexual health issues. The Gender Role Conflict Scale-Short Form (GRCS-SF) was used to assess GRC. Knowledge was positively associated with comfort. Male students who indicated difficulty expressing affection toward men or expressing emotions were likely to report being uncomfortable asking patients about sexual health issues. Students should be made aware of gender-role norms. Alongside knowledge transfer, the discussion of strategies for overcoming the barriers set by gender-role norms should be part of sexuality education.

Parenthood does not explain the gender difference in clinical position in academic medicine among Swedish, Dutch and Austrian physicians.

Studies have continuously shown that fewer women than men achieve leadership positions in academic medicine. In the current study we explored gender differences in clinical position among academic physicians at three university hospitals, each in a different European country. These countries, Sweden, the Netherlands and Austria, differ in terms of gender equality. We analyzed whether the number of children, working hours or publications could explain gender differences in physicians' clinical position. In this cross-sectional questionnaire study 1333 (54% female) physicians participated. Physicians were asked about their gender, age, number of children, working hours and clinical position. We used structural equation models to explore the influence of gender on the physicians' clinical position in each of the three countries. We explored whether the association between gender and clinical position could be explained by number of children, working hours or publication activity. The analyses revealed that at all three university hospitals gender influenced clinical position. These gender differences in clinical position could be partly explained by gender differences in publication activity. Female physicians as compared to male physicians were likely to publish fewer articles, and in turn these lower publication numbers were associated with lower clinical positions. The number of children or working hours did not explain gender differences in publication activity or clinical position. Therefore, factors other than unequal allocation of household labor, such as the academic working environment, may still disproportionately disadvantage women's progress, even at universities in countries with high rates of gender equality such as Sweden.

The importance of equal treatment: Medical students'opinions on affirmative action, equal treatment and discrimination.

We assessed medical students' opinion of affirmative action programs (AAPs), perception of gender equality and discrimination. 276 medical students (56.2% female) participated. Women considered AAPs to be more important than did men. Most women (62.6%) and men (71.9%) received equal treatment, but significantly more women (22.6%) than men (11.6%) experienced discrimination. It is necessary to convey the importance of gender equality and equal treatment, including discrimination and mistreatment. Thus, we have to raise awareness for gender equality and equal treatment not only in staff, in students or in health care but also among each other.