What happens in the sexologist’s office

Elena, in tights and a T-shirt, walks around the office. Observing this 35-year-old woman, the sexologist notes how she hides her femininity: pursed buttocks, subtle signs of sex, sunken breasts. Something is wrong in her personal life. “In bed with a partner, I have an incomprehensible anxiety,” Elena admits, “and I rarely, almost never experience an orgasm.”

Like 28-year-old Lilia, who “can no longer feign pleasure”, and Victoria, who at 40 is sure that she is frigid, and 38-year-old Roman with premature ejaculation, Elena also decided to take this step – to consult a sexologist.

overcome shame

The decision is not easy because in our culture, which is still heavily influenced by Christian morality, it is not customary to talk about such things. It is difficult to present to someone the intimate parts of the body, discarding any modesty. And finally, the third reason: we know almost nothing about what happens in the sexologist’s office. And this is not surprising: the topic of sex has long been a taboo.

Meanwhile, sexology, a science that studies all aspects of intimate relationships, has been developing in our country since the 1970s, says sexologist Irina Panyukova:

“At the same time, specialization appeared: a sexopathologist, a specialist in sexual disorders. And in the middle of the XNUMXs – sexology, a new, broader medical specialization. To become a sexologist, a gynecologist, urologist or psychiatrist receives additional psychotherapeutic education. So there is no sexologist without a medical education.”

What about in practice? Everything is rather vague: the treatment of sexual problems can take place both under the supervision of specialists – an endocrinologist, psychiatrist, gynecologist and others, and with a psychotherapist. However, physicians usually do not have training in psychotherapy, and in order to use psychotherapeutic techniques, they have to undergo additional training or work in tandem with a psychotherapist.

Good doctors can turn out to be mediocre psychotherapists. Conversely, without medical training, psychotherapists are not authorized to conduct medical examinations and may not be aware of functional failures.

What examinations will have to be done?

Serious sexologists insist on a complete medical examination in order to exclude those pathologies that may be the cause of the patient’s sexual difficulties. After that, you can move on to psychotherapy. There can be as many forms of therapy as there are doctors and patients.

“The scope of examinations depends on the nature of the problem,” explains Irina Panyukova. – It should not be excessive, we do not make appointments “just in case”, any examination must be justified. For example, with marital disharmony of healthy partners, there is no need for laboratory tests.

Sexologists, that is, doctors with psychotherapeutic training, determine the symptom, its cause and begin therapy so that the patient can eventually lead a satisfying sex life.

At the appointment, Elena felt relieved and instantly trusted the doctor. “Finally, there was someone who knows the topic, has the right to listen to everything and express his opinion,” she says.

The sexologist from the first meeting tried to find out the symptoms and establish their causes. Misunderstanding of your own body and the body of another person? Old injuries? Internal clips? Feeling of shame?

Telling the sexologist about her intimate life, about the acute feeling of dissatisfaction that she experiences again and again, Elena gradually realized that the basis of her difficulties was an erroneous attitude: “to love means to give pleasure to another.” Working with a sexologist helped her recognize that the starting point of an intimate relationship is herself and the pleasure she gets.

“The position of an altruist inevitably leads you to failure,” the sexologist explained to Elena.

“He instantly recognized me as a little brave soldier, ready to sacrifice himself,” Victoria recalls her first consultation, “and good-naturedly noted that military armor in bed causes inconvenience.”

Roman, on the other hand, was acutely worried that he was in a dead end: “Yes, I am in a hurry in love, but it takes women so long to reach orgasm, and they still don’t experience it when I penetrate them.” The sexologist explained to him that a woman needs more time to be aroused than a man, which implies the need for foreplay.

Gradually, Roman was able to admit his ignorance and fear of being an inept lover. With the help of drawings, the sexologist showed him the erogenous zones of a woman and explained how to excite a partner.

Learn to let go of control

To remove the clamps and blocks in the body, words alone are not enough. It is necessary to do exercises that help to weaken control, strengthen certain muscle groups.

Elena and Lilia learned to take poses that at first seemed indecent to them. For example, move your hips at an increasing pace. “In order to get deep pleasure, a woman needs to be active, learn to move her hips and her whole body, synchronize these movements with her breath,” the sexologist explained to them.

For the third time, Elena felt a bodily response. “I was caught by a wave of heat that slowly spread over the body, genitals, stomach, chest, neck,” Elena shared her feelings. Like the heat of an orgasm in slow motion. I understood in what way pleasure comes.

She also had three massage sessions. “At first I was constrained, and then I found zones in myself that reacted reactively with the appearance of goosebumps or a desire to burst into tears,” says Elena. “The shell I was hiding in has shattered. It was born from a strict upbringing and my lonely childhood. It took me considerable effort, involving even the skin, to drive away all fears.

Victoria learned to relax and thanks to this, she stopped constantly taking up all-round defense: “I finally gave up the desire to dominate, began to trust my partner more and stopped controlling him.”

“The sexologist explains sex therapeutic exercises at the appointment, and the patient performs them in a familiar home environment. After all, the task is for him to gain the ability to feel fully in closeness with a partner, and not in the doctor’s office, ”explains Irina Panyukova.

Elena, Lilia and Victoria completed a 6-month course of therapy with “homework”: training in vaginal contractions, practice in caresses and massage with their partner.

Roman, who cried for the first time at the reception, remembering how his father left him, also received his recommendations. But after a course of sex therapy, he also needed to undergo a course of classical psychotherapy.

And if the doctor oversteps the bounds?

The work of a sexologist today is a combination of psychotherapy, sex education and exercise. But the lack of a unified code of ethics has led to the fact that today the patient is faced with a serious problem: how to recognize abuse when using practices that are designed to relieve bodily and emotional clamps?

No sexologist will require the patient to completely undress.

“Nudity, not to mention touching and even more so sex, cannot be part of psychotherapeutic practice,” explains Irina Panyukova. “There should be no erotic overtones in it.”

Sometimes it’s just the fear that you will have to be naked at the reception that prevents you from deciding to visit a sexologist. “The patient never undresses,” experts say. “A medical examination is not much different from an examination by a gynecologist or a urologist,” explains Irina Panyukova. “But it is prescribed only for medical reasons.”

“I went through a course of ten sessions with a sexologist,” says 35-year-old Inna. One day he asked me to masturbate in front of him. This experience removed many inner inhibitions from me, and since then I have gained more freedom and looseness in sex.

“Here we are talking about a gross violation of their powers by a sex therapist,” explains Claire Gelman, a psychologist and sexologist. “In this situation, the patient may receive short-term relief, but may also become depressed or neurotic dependent on the therapist.”

“The idea that a doctor can participate in erotically colored exercises and actions during therapy is fed by fantasies and scenes from porn films,” adds Irina Panyukova, “But this is not true. In addition, in some patients, the characteristics of sexual desire are such that the procedure for medical examination and manipulation excites them, even if there is nothing erotic in it. Therefore, they can build conventional medical procedures into a sexual context.

For such people, a sexological examination is not indicated, or it is carried out by a doctor in the presence of other people, such as a nurse. That is why at the first meeting everyone can ask how the therapy will go. And decide whether to continue it.