Dr. Catherine Solano is a sexologist. Trained in health ethics, she consulted in urology at the Cochin Hospital in Paris. She is the co-founder of Doctical, a telehealth platform that supports people affected by cancer in their intimate health. She is the author of numerous books, including Le grand livre de la puberté (Robert Laffont).
Who can you consult with confidence?
The term "sexologist" is not an officially recognized specialty. Anyone can call themselves a sexologist, warns Dr. Carol Burte, president of the National Union of Sexologists. It is thus possible to find complete charlatans, self-proclaimed "sexologists" with no training and who feel entitled to extract money from people in distress for advice that has no value other than that of a personal opinion. After following an unrecognized course lasting a few days, some even give themselves the pompous title of "doctor of sexology"...
This is not to say, however, that there are no serious training courses in the field of sexual health. Currently, in France, an inter-university diploma (DIU) - a national diploma awarded by a university after a national final examination and on the basis of a curriculum set and harmonized by a national commission - is recognized. Lasting three years, including the writing of a dissertation, it qualifies doctors in "sexology and sexual medicine" and non-doctors in "clinical sexology". They may include psychologists, midwives, nurses, physiotherapists, social workers or marriage counsellors.
Before consulting, it is therefore essential to ensure that the person is competent and has serious training. This is especially important since the field of sexual health can attract people who are manipulative, exhibitionist or voyeuristic. In addition to the devastating effects that this can have on a fragile person, consulting an incompetent or toxic person can also lead to disappointment, feed mistrust and lead to waiting many years before consulting again. In some cases, this can lead to very damaging delays in diagnosis, especially when sexual dysfunction is a warning sign of a medical condition.
This is why the first thing to do in the event of a sexual disorder is to start by simply going to see a doctor. He alone is authorized to carry out a clinical examination, to prescribe medical examinations or treatments. For example, the National Union of Sexologists offers a directory of doctors trained in sexual health. With the notable exception of midwives, other clinical sexologists are not allowed to examine or prescribe medication. Nevertheless, they are aware of the importance of medical work in this area, and if necessary refer the people who consult them to a medical colleague.
When should you consult a sexologist?
The patterns are very varied. These can include desire disorders, orgasm, pain during sexual relations, blockages, fears or real phobias, relationship difficulties, changes and adaptation of sexuality during a chronic illness, long-term treatment or after sexual assault. It can also be consulted for questions of sexually transmitted infections, prevention of HIV/AIDS or sexual addiction. Other problems are gendered: erection, ejaculation or andropause problems in men; vaginismus, menopause or resumption of sexual activity after pregnancy for women... It is also possible to consult if you are simply looking for information about sexuality.
In general, don't hesitate to consult. I meet many patients who have hesitated for years before coming and are relieved to have done so when the consultation is over. Sexuality is part of life, you shouldn't have any particular inhibitions. That's what sexologists are for.
What does a consultation involve?
The first step is listening. It is necessary to find out about past or chronic illnesses, operations undergone, medications taken, and also the emotional and romantic environment. The assessment of sexual dysfunction is therefore carried out in a global "bio-psycho-social" approach including five dimensions: physical organic factors (arteries, veins, tissues, hormones, adverse drug effects, neurology, etc.). etc.), psychological, relational, sexual and finally more general factors related to the living environment.
The sexologist will then explain to the patient the factors that may have led him to the difficulties observed. He can then prescribe exercises, medications, tests to be carried out or refer them to a specialist. They may also counsel or practice certain methods of therapy, including cognitive behavioural therapy (CBT), hypnosis, EMDR (trauma therapy), body-sex therapies or sex analysis, couples therapy, or refer patients to a therapist with an approach that will match their specific needs. The approaches are numerous and complementary. In the field of sexual health, networking is important.
What are the ethical rules?
You can find the code of ethics on the website of the National Union of Sexologists (SNMS). Let us insist on one point: if a sexologist doctor may ask you to undress and examine you, under no circumstances should he seek to provoke sexual arousal in you by touching, massaging or caressing, nor should he seek sexual arousal himself. If you ever encounter this type of practice, it is essential to inform the medical council.
Some practical tips to prepare for an initial consultation
Prepare a list of your illnesses and operations in chronological order. This saves the doctor time and gives you more time to talk. Write down the name of your medications and their dosage. It is indeed difficult for a doctor to tell if your medication is the cause of your difficulty if you explain to him "you know doctor, the little oval pink tablets". The doctor doesn't know the sizes, shapes, and colors of all medications... Also prepare a list of your questions. Too often, we forget to ask some of them and that's a shame. Bring your test results with you as well, as this can save you an additional consultation. All this advice is valid in a sexology consultation as well as for a consultation with any doctor, regardless of his specialty!