Read this article published on the Cercle Psy website.

No, there’s no such thing as ideal sexuality. And the one promoted in magazines is illusory. More and more people, dissatisfied with their sex life, are deciding to consult a sexologist. What are the main reasons for consulting a sexologist? Who practices sexology today? What tools does sex therapy use? To what extent do men and women invest sexuality differently? Answers from Marie Véluire, gynecologist-obstetrician, sexologist and co-author of Les adolescents et la sexualité – 101 questions de mères (with Catherine Siguret, Robert Laffont, 2009).

What is a clinical sexologist?

He is a therapist specializing in helping to resolve sexual problems. To do this, he or she focuses on the patient’s pleasure and the experience of this pleasure in a relational dimension. He or she can draw on a variety of theoretical approaches. Some clinical sexologists base their practice on a psychological orientation (from various theoretical currents), others on a medical one, depending on their original training. But this is of little importance. The most important thing is that the patient feels at ease with the therapist, whoever he or she may be. And above all, that the therapist has validated and effective training. It’s worth noting that, unlike the titles of psychologist or doctor, the title of sexologist is not protected by law.

Who practices sexology today?

Sexology training appeals to a wide range of professions: doctors, psychologists, social workers, physiotherapists, midwives, etc. The Diplôme Inter Universitaire de Sexologie (DIUS), offered in various French universities and recognized by the Conseil National de l’Ordre des Médecins, provides three-year training in sexology, but is only open to doctors. As an obstetrician-gynecologist, this is one of the courses I have taken myself. But there are other two- or three-year programs for other professions. Whatever the professional, the practice of sexology is often complementary to another activity. Very few practitioners devote their entire time to it.

What are the main reasons for women’s consultations?

Most women seek help for sexual desire problems, which can arise after childbirth or years of marriage. Although many women experience these difficulties, only a minority actually suffer from them in everyday life. These disorders, listed in the DSM-IV, can put a strain on the couple. I also see many women who are unable to have an orgasm through vaginal penetration, i.e. a coital orgasm. This difficulty, which stems from a difficulty in learning coital pleasure, can be resolved in just a few sessions of sex therapy. Finally, the third reason for consultation is, in my experience, vaginismus. This is defined as an involuntary muscular contraction of the pelvic floor muscles surrounding the vaginal opening. These are women who are often unaware of their body schema, and/or who have been marked by family traditions or traumatic events.

And for men?

Premature ejaculation, which affects almost one in three men, is undoubtedly the main reason for male consultations. It consists of involuntary ejaculation less than two minutes after the start of penetration. It is often the result of a learning disability. Treatment with SRIs (Serotonin Reuptake Inhibitors) from the antidepressant family can delay ejaculation by a further minute. However, the vast majority of premature ejaculators can be treated with just a few sessions of sex therapy. The second reason for consultation is erectile dysfunction, which affects all men, and increases with age.

What forms of sex therapy do you practice?

Whether or not to use a particular sex therapy depends on the practitioner’s initial training, sensitivity and values. As a surgeon myself, I have a real concern for short-term effectiveness. This is not necessarily the case for my counterparts. My therapies are therefore relatively short, lasting around ten sessions. My sex therapies are based on a combination of the different tools at my disposal: the sex-body approach, hypnosis and systemic therapy. Each practitioner uses his or her own tools. Practicing sex therapy is like solving a puzzle or conducting a police investigation: the aim is to identify the logic of the patient’s functioning, the better to support him in his approach. The sexo-corporal approach takes a holistic view of the individual, based on the concept that body and mind are mirrors of each other. Our intervention is based on the one hand on the person’s psychological components: awareness of their sexual pleasure and arousal, of their body, elaboration of their feelings of love, etc., and on the other hand on their physiological components, which include learning how their body works and how to mobilize it.

What is the key to successful sex therapy?

On two essential elements: the patient’s degree of motivation to change, and the bond of trust he or she establishes with the therapist. This varies greatly depending on the person I’m consulting. For example, if a woman comes for counselling on the instructions of her husband, who complains about her lack of desire, her capacity for change will be almost nil. Generally speaking, it’s a delicate matter to consult a sexologist. For a person to decide to take such a step, it’s because his or her sexual difficulties or disorders are the subject of real suffering on a daily basis.

How do you deal with patient discomfort and taboos?

It’s a whole art, a way of being, that’s difficult to express in words! The way in which I welcome the person’s words and emotions with serenity will, in turn, encourage them to express themselves more freely. This is the very principle of benevolent neutrality. Sexuality touches on a system of personal values that must be respected. For example, we won’t say the same things or set the same goals with a very religious person. We need to know how to adapt to a patient’s uniqueness, and not impose our own vision of sexuality.

To what extent do men and women invest sexuality differently?

Physiologically speaking, men and women function in the same way: you need to access a sexual arousal reflex, pass a point of no return and reach an orgasmic discharge. The whole process is fuelled by the imagination. The sexualization process is different. A man needs to perform, and his erection is his identity card, proof of his virility. A man who has an erectile or ejaculatory dysfunction is therefore greatly weakened. Conversely, a woman doesn’t need to cum during sex to feel like a woman and feel fulfilled. This is a fundamental difference between the two partners, who are not under the same pressure. But that’s not all. The way in which the sexual act is approached differs according to the partner. Hence the common idea that a man needs to make love in order to say I love you, whereas a woman needs to be told I love you in order to make love!

Many magazines deal with sexuality in couples. Is it beneficial?

Yes and no. I remain rather divided on the question. The emergence and plurality of articles on sexuality has led to a certain positive trivialization of the sexual act and related terms, and thus to an appreciable evolution in sexuality and its potential. I’m thinking in particular of women’s demand for pleasure. On the other hand, this overexposure of a fulfilled sexuality can be the source of suffering for individuals who reveal themselves to be under pressure. It should be noted that the sexuality thus put forward is often false, plunging the reader into a form of dictatorship of pleasure and performance. Because in real life, performance is of very limited importance! Here’s an example: when we ask women in detail about their sex lives, many complain about the lack of caresses, foreplay and tenderness from their partner during intercourse. And yet, when surveyed, they say they are generally satisfied with their sexuality. The reason? Quite simply, they confuse their sex life with their married life. For a majority of women, great affection within the couple is enough to satisfy them and make them forget about a moderately satisfying sexuality. Conversely, a woman who is sexually fulfilled but not emotionally, will remain unsatisfied.

What is a fulfilled sexuality?

First of all, let’s remember that there’s no such thing as good sexuality! After all, all sexuality is based on a system of very personal values and factors. This is one of the reasons why the one-size-fits-all sexuality promoted in magazines makes no sense and is far removed from reality. I would also say that a sexuality is fulfilled when both members of the couple are fulfilled. Some couples feel fulfilled with one sexual encounter a month, others need one a day. This mutual satisfaction remains relatively frequent. Our sexuality is based on a genuine personal process that we build up over the course of our lives. A fulfilled sexuality doesn’t just fall from the sky! It has to be cultivated, built up and learned, and requires a great deal of investment, curiosity and energy.

To find out more…

Philippe Brenot (2012, Petite Bibliothèque Payot). What is sexology? Petite Bibliothèque Payot.

Elisa Brune and Yves Ferroul (2011, Odile Jacob). The secret of women. A journey to the heart of pleasure and enjoyment.

Alain Héril (2012, Éditions Bussière). Sexothérapie: ces confidences qui soignent.

Pascal de Sutter and Catherine Solando (2011, Robert Laffont). The sexual mechanics of men. A second volume of « La mécanique sexuelle des hommes » will be published in September 2012.