As folks have mentioned, the most common routes into the Sexual Medicine field are through Psych, OB/Gyn, FM and Uro. While *anyone* can hang up a shingle saying they're a sex therapist,
AASECT offers a more formalized training to folks with a legitimate certification and with a representative professional organization. Most patients and insurances will want someone with a professional background to help with their issues and if many meds are involved, then the MD will be required somewhere in the mix.
I only know of the Sex therapy certification program at University of Michigan but I believe there are others out there in the works. The program at U-M has a few graduating Psychiatry residents that are doing this as a sort of post-psych-residency fellowship:
http://www.ssw.umich.edu/programs/ce/UMSHC/UMSHCP.pdf
The feedback I've heard has been positive so far. As the name implies this is more for enhancing your skills as a counselor/therapist with regard to sexual problems. It doesn't train you to how to evaluate pelvic floor musculature or peyronie's disease or physically teach patients to use their new pump or dilator. This kind of hands-on stuff takes place in specialty offices and is handled by MD's and NP's ... Training for this can be had here (or during the residency training itself in that given field):
http://www.sandiegosexualmedicine.com/?page=education/clinical-fellowships
As one might expect, training is limited to what is in-scope for a given specialty (they don't teach psychiatrists how to do penile microvascular surgery ... that's reserved for uro's
🙂
Options to consider as a med student are the "Sexual Problems in Clinical Medicine" elective at U-Minnesota, which is available to outside 4th year students:
http://www.meded.umn.edu/clerkships/FMCH_7585.php
I'd also recommend the following book --
Sexual Health in Primary Care by William Maurice
From my own research, I've found that those practicing as "sexual health specialists" tend to function (and bill) according to their given background. For example, urologists may specialize in men's sexual dysfuction and provide ED treatments in the way of penile injections/prostheses, as well as managing testosterone patches and injections. They do very well, but tend to farm out all the talk-therapy to a hired-on MSW or psychotherapist with a background in sex therapy. If you're interest is in talk therapy for a patient or couple, then psych might be your best way in. Psychiatry-trained sex docs tend to do more talk therapy with patients/couplea themselves as well as write for ED pills or hormones where appropriate. OB/Gyn-trained sex docs tend to focus on vulvodynia/dsypareunia/vaginisumus, pelvic pain, and often work with a specialized pelvic floor Physical Therapist. Primary Care/ Fam docs can sort of "do it all" but might have a hard time getting trained in procedures that are the turf of Uro/OB. They may also have a hard time billing for extended talk therapy without the formal training in psychotherapy. Anyway, from what I gather, sexual medicine is a new and growing field and it's more about your experience and street cred than anything else. Most of the fellowships are relatively new and run by people that acquired their experience through clinical practice and personal interest rather than through a fellowship.
best of luck!
