Mindfulness-Based Group Therapy for Men With Situational Erectile Dysfunction: A Mixed-Methods Feasibility Analysis and Pilot Study.

INTRODUCTION: Recent advances in sexual health research support the benefits of mindfulness-based therapy (non-judgmental present-moment awareness) for the treatment of women's sexual dysfunction. AIM: To determine whether it is feasible to implement an adapted, empirically supported treatment protocol for female sexual dysfunction to the specific needs of men with situational erectile dysfunction (ED). METHODS: A mixed-methods approach was taken for this feasibility pilot study. A total of 10 men (Mage = 40.3, SD = 14.01, Range = 20-67) with a diagnosis of situational ED were recruited to participate in a 4-week mindfulness-based treatment group. The group was adapted from protocols shown to be effective for women with sexual dysfunction and edited to include content specific to situational ED. Sessions were 2.25 hours in length, included daily home-practice activities, and integrated elements of psychoeducation, sex therapy, and mindfulness skills. Men completed questionnaires (International Index of Erectile Functioning, Relationship Assessment Scale, Five Facets of Mindfulness Questionnaire, a treatment expectation questionnaire) at 3 time points (prior to treatment, immediately after treatment, and 6 months after treatment). 5 men (Mage = 44.4, SD = 15.76, Range = 30-67) participated in qualitative exit interviews. MAIN OUTCOME MEASURE: Findings support the feasibility of adapting a mindfulness-based group treatment for situational ED. RESULTS: With respect to feasibility, the dropout rate was 10%, with 1 participant who did not complete the treatment. Comparisons between Time 1 and Time 3 self-reports suggested that this treatment protocol holds promise as a novel means of impacting erectile functioning (Cohen's d = 0.63), overall sexual satisfaction (Cohen's d = 1.02), and non-judgmental observation of one's experience (Cohen's d = 0.52). Participants' expectations for the treatment were generally positive and correlated to self-reported outcomes (r = .68-.73). Qualitative analyses revealed 6 themes: normalization, group magic, identification of effective treatment targets, increased self-efficacy, relationship factors, and treatment barriers. CLINICAL IMPLICATIONS: In a shift toward a biopsychosocial framework for the treatment of men's sexual dysfunction, clinicians may consider incorporating mindfulness to address psychosocial and psychosexual components of dysfunction. STRENGTH & LIMITATIONS: This is the first study-to our knowledge-to adapt mindfulness protocols for use with men's sexual dysfunction. Because this is a pilot study aimed at feasibility, the sample size is small and no control group was included, thus conclusions about efficacy and generalizability cannot be made. CONCLUSION: The current study suggests that a mindfulness group therapy framework offers a feasible and potentially promising treatment avenue for men with situational ED. Bossio JA, Basson R, Driscoll M, et al. Mindfulness-based group therapy for men with situational erectile dysfunction: A mixed-methods feasibility analysis and pilot study. J Sex Med 2018;15:1478-1490.

Global health in Canadian medical education: current practices and opportunities.

PURPOSE: Globalization is altering health and health care. At the same time, prospective and current medical students are increasingly requesting global health training and creating opportunities when these are not provided by medical schools. To understand the type and amount of global health activities provided in Canadian medical schools, the authors undertook a survey of global health educational opportunities available at all 17 medical schools during the 2005-2006 academic year. METHOD: Using a structured questionnaire, information was collected from deans' offices, institutional representatives, faculty, students, and medical school Web sites. RESULTS: All 17 medical schools participated. Canadian medical schools vary widely in their approach to global health education, ranging from neither required nor elective courses in global health to well-developed, two-year electives that include didactic and overseas training. There is no consensus on the educational content covered, the year in which global health issues are taught, whether materials should be elective or required, or how much training is needed. Of the 16 Canadian medical schools that allow students to participate in international electives, 44% allow these electives to occur without clear faculty oversight or input. CONCLUSIONS: Despite both the strong, growing demand from medical students and the changing societal forces that call for better global health training, Canadian medical school curricula are not well positioned to address these needs. Improving global health opportunities in Canadian medical school curricula will likely require national leadership from governing academic bodies.