“We do not have the perception that sexual life is a medical issue, but just as your doctor asks you or you explain your digestive and urinary habits, he should be interested in your sexual activity, or you should tell him if you do not feel like (relationships)” .
The gynecologist Manel Honrado (Barcelona, 1050) presides over the collegiate section of medical sexology at the Col·legi de Metges de Barcelona (CoMB), from where he ensures the regulation and dissemination of the figure of the sexologist, convinced that there is not enough perception even in society. nor in the medical profession about the relevance of sexuality for physical and mental health.
You claim that sexology is a medical issue, which professional should you go to if you have sexological problems?
It is usually addressed by gynecologists and psychologists, but the section of the Col·legi de Metges, which was created in 2008, welcomes other doctors who, due to their experience, specific training or specialty, address areas related to sexuality or practice sexology. Currently the section brings together 76 members among whom, in addition to gynecologists and psychologists, there are urologists and specialists in general medicine.
And we are promoting the training of all doctors in this area and we have spoken with the Generalitat to introduce the figure of the sexologist into public health, because sometimes doctors do not ask their patients about this topic because they do not know where to refer them. And mutual insurance companies do not cover sexological therapy either.
Based on your experience as a gynecologist, has the taboo on talking about sex in consultations been broken? Do your patients bring up their sexological problems with you?
Unfortunately, no. They don't ask, except when you help them bring up the topic. And I detect that part of that old imaginary that links gynecology and shame is maintained because in the clinic I see women who, when making an appointment, specify that they want to see a gynecologist, and they prioritize that the specialist be a woman even though they have to wait longer for the specialist to be a woman. they attend to them. That is one of the sociological changes that I perceive in the consultation, and it is a behavior that is especially observed in mothers who request visiting time for their daughters.
He comments that this is one of the sociological changes he observes. What are the others?
The demonization of hormones. When choosing oral and vaginal treatments for menopause, the balance clearly tips towards non-hormonal. And younger women tell you that they don't want to take pills (not even the morning after pill) because “I don't take hormones.” And they present it as an unquestionable concept that, when you investigate why they have decided that, is supported by a statistic of cases or opinions of two or three friends, no more.
You comment that women still do not ask about sexological issues in consultations. And the doctors? Do you inquire about your patients' sexual lives?
No. Family doctors could do it because they have more direct and frequent treatment, but it is difficult for them. Among other reasons, because if they ask questions and detect problems, where do they refer that person?
What are the most frequent sexological problems?
For women, everything that refers to desire, sexual interest and excitement. Secondly, issues related to pain during intercourse, both during penetration and genital pain in general.
And in the case of men?
First of all, erectile dysfunction. And secondly, premature ejaculation, both the one assumed by the patient and the real one.
Supposed? What does it mean?
There are young people who think they have premature ejaculation and in reality they do not; They are afraid of relationships or they assume that there is a certain amount of time that an erection can last because they are greatly influenced by what they see in porn, by a fiction that transmits (false) concepts to them that no one denies. And how long an erection lasts is something personal.
And regarding the real dysfunctions?
There is a large section that is those induced by medications. It is something that is not thought of but that affects many diabetics, hypertensive people, who follow psychological treatments... Because many medications affect sexuality.
And is that noted at the time of prescribing them?
When a treatment is prescribed, it should always be assessed after a while how it works, in all its aspects, but the patient is not asked if it is having an impact on their sexual sphere.
Because? Due to taboo or ignorance of the doctors themselves?
Well, I would say that half because they do not know what it affects and the rest because they do not want to get involved in a longer consultation, because addressing this issue requires time that they cannot dedicate to attending to the list of patients they have.
Do sexological problems usually have a physical or psychological cause?
They are both very close together. In addition to the factors that we have already mentioned, behind it there may be relationship problems, religious and cultural ideas, the vulnerability of a specific person... Mind and body are very mixed in all this.
And do they have treatment?
Yes. In sexology there are fewer medications than in other specialties. The most important thing is a good diagnosis, seeing all the implications that may exist in each case. Then you can help with treatment. In the case of women's lack of desire, things are being tried, but there is no adequate medication.
Does psychological therapy work for sexual pathologies?
Yes. First of all because the patient sees all the implications and where the problem may come from. And also because sometimes it is detected that there is a relationship problem and what needs to be done is send that person to couples therapy.
