LGBTQ Health

Colleague Interview: A Conversation with Eli Coleman, PhD

Eli Coleman, PhD, (Pronouns: he/him/his) is Professor and Director of the Program in Human Sexuality in the Department of Family Medicine and Community Health, University of Minnesota Medical School. He holds the first endowed academic chair in sexual health in the country. Dr. Coleman is the author of numerous articles and books on compulsive sexual behavior, sexual offenders, sexual orientation, gender dysphoria, chemical dependency, family intimacy, and on the psychological and pharmacological treatment of a variety of sexual dysfunctions and disorders. He is one of the founding editors of the International Journal of Transgenderism and is the founding and current editor of the International Journal of Sexual Health. He is one of the past-presidents of the Society for the Scientific Study of Sexuality, the World Professional Association for Transgender Health (WPATH), the World Association for Sexual Health, the International Academy for Sex Research and the Society for Sex Therapy and Research. He is currently the Chair of the WPATH Standards of Care Revision Committee. He has been a frequent consultant to the World Health Organization (WHO), the Pan American Health Organization (the regional office of WHO), and the Centers for Disease Control and Prevention.

How did you begin a career in sexual health?

It was mostly accidental. I was training to become a psychologist and came to the University of Minnesota to finish my doctorate where I discovered the Program in Human Sexuality (PHS). I was looking for a dissertation topic and decided to study sex therapy. Keep in mind, at that time very little was known, and it was a wide-open area for research. Afterwards, the PHS was offered a faculty position. I took the position thinking I would take it for a year or two, however, I am still faculty 40 years later. The reason I stayed on as faculty was the work. My work is about a very central aspect of people’s lives and examines the essence of being human.

The University of Minnesota Program for Human Sexuality recently celebrated 50 years. How has the program changed over time?

It has changed a great deal. The program was established in the 1970s, on the wings of the sexual revolution. It was really started to train medical students. At that time LGBTQ + issues were new in public discussion and physicians didn’t have needed training. Minnesota was an early pioneer in establishing this type of program. This was made possible through new federal and foundation grant funding for medical training and research in sexuality throughout the 1970s. However, in the 1980s much of this national funding disappeared and other medical schools had to close their training programs. At Minnesota, we were able to build up our clinical services and our teaching and research efforts “survived” on clinical revenue. The 1980s was a difficult time for sex research. During the Reagan-Bush era we saw very little funding for human sexuality studies on a national level and there was less emphasis on research. However, the HIV/AIDS epidemic was a turning point and there was again recognition that research in human sexuality was an important part of improving human health. We developed funding for post-doctoral fellows and rebuilt a robust research program.

What has the program achieved?

The Program for Human Sexuality is the largest sexual health institute in the United States. We have taught human sexuality to every medical student at the University of Minnesota since 1970. The program has also trained more postdoctoral fellows in human sexuality than any other institution. We also created the first two endowed academic chairs in sexual health in the United States. Our publications have advanced sexual science and have been cited more than 12,000 times.

How did Minnesota become a thought leader on the topic of human sexuality?

A core group of interdisciplinary visionaries came together and set down some fundamental principles that have guided us throughout the history. It is particularly interesting that the program began with a synergy of faculty from the Medical School and local faculty from several theological seminaries.

How has research surrounding human sexuality changed since the 1970s and 1980s?

Much of the recent funding for HIV/AIDS has gone toward biomedical projects; therefore, we have shifted toward research on sexual abuse and aggression and compulsive sexual behavior. There is a renewed focus on women’s sexual health issues and we have a very strong research program focusing on transgender health. We also have a new NIH funding grant to develop models of training health professionals in sexuality.

How has sex and sexuality research based at the University of Minnesota improved the lives of people both within Minnesota and globally?

The early efforts of the program were focused on training medical students. Minnesota was a pioneer; we published a lot of work that had a big impact on medical education throughout the country. Through our research and training, we have had profound impact on a variety of issues: physical disability and sexuality, family sexual abuse, gay affirmative health care, sexual offending, chemical dependency and family intimacy, sexual aggression, compulsive sexual behavior, HIV prevention, women’s sexual health and transgender health. These are issues that directly or indirectly impact every individual, family and community in Minnesota and around the world. We have changed and improved lives through our research, education, clinical services and advocacy efforts. How has the care provided to LGBTQ + people changed over time within the field?

I would say the 1980s was a time when people, including myself, were really promoting gay-affirmative approaches to therapy. Around that same time the Program in Human Sexuality took on the Gender Program from the Department of Psychiatry and shifted the focus not only on gender affirming surgery but working to establish standards of care that were evidence based for hormone and mental health therapy and holistic aspects of care. I would say today there is an emphasis on wellness and evidence-based medicine that wasn’t present 20 years ago. I like to make an “outrageous” claim that our program has changed the climate for LGBTQ + people in our state through the education of doctors and other healthcare providers. They were opinion leaders that contributed to the passage of marriage equality referendum.

How have conversations surrounding race and sexuality changed since the death of George Floyd?

They have completely changed. We have been talking about and looking at race and sexuality before the term “intersectionality” was invented but we realize now that we were still only scratching the surface. Our programs and research need to have a diversity of races, ethnicities and sexualities. One thing we are looking at is helping people understand that implicit bias is not just about sexual orientation or gender identity but race and understanding how those interact. There is not a simple solution, however we are looking at what we are doing right currently and how we can make lasting changes within the program. It is an ongoing discussion, and we have a lot to learn. There is greater support for us to address race more directly.

What past policy/legislation changes are you most proud of?

I was the senior scientist and editor of former US Surgeon General David Satcher’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior in 2001. This document is still the most comprehensive vision of sexual health promotion for our country. Since then, there is much more recognition that sexual health is fundamental to overall health and well-being. Sexual health has been legitimized as a national health issue and recognized need for research and education.

Colleague Interview (Continued from page 9)

What has been a difficult part of being in your position as director?

We went through a very rough time in the 1980s both in terms of our education and research efforts. It was a conservative time and we faced a lot of criticism of the value of our course from our own medical students. Ultimately, we gained support from faculty who were practicing physicians, had taken the course previously, and knew the value. Research funding was challenging but we persevered and came into a better era that helped us grow and become what we are today.

What are the next steps to improving sexual health within the United States?

Education. Education. Education. We also need to conduct research with public health implications, translate our research and inform leaders involved in public policy, and develop evidence-based treatments for clinical care. This is how we move forward.

How have trainees’ and physicians’ attitudes toward LGBTQ + people changed since you first started teaching?

They have changed tremendously. Our course from the very beginning addressed diversity. It started with teaching students to have a professional attitude and helping students become comfortable talking about sexuality. Over time, the program has had a tremendous impact on physicians within our state. We could tell easily in residency programs who came from the University of Minnesota compared to other medical schools who had lost their sexuality training programs. Our research showed that students at the University of Minnesota were more comfortable bringing up topics about sexuality and being sensitive with patients. I remember when we would discuss treatment for transgender patients, students in the 1980s would give us a look as if we were doing something inconceivable. However, we provided education and powerful patient testimonials. It was about getting a real person in front of students and having that person share their story. It becomes less abstract that way. Today, students are already familiar with transgender issues and typically have a sense of activism and social justice perspective. Instead of being resistant to working with sexual and gender minorities, they want to know how they can do more and learn more. I feel students today appreciate what we do and push us to do more—it is really nice.