I am not sure when exactly, but it was sometime during medical school that I started to joke around about my intention of becoming a sexologist. Not that I was particularly worldly on the matter, the whole thing was more me being silly. Whenever someone would ask me ‘what are you going to do after medical school?” I would say “I want to become a sexologist”. And people would laugh! Of course, no one around me, including myself, actually knew at the time that ‘sexologist’ was a real legitimate thing (still many people don’t know, I believe!). As I moved towards the end of medical school, somewhere along the line the joke became serious and I made a genuine decision to become a sexologist. Now I was actually serious but it was still seen as a joke by my colleagues, sometimes an ‘offensive’ one. By the way, I am from Iran.
Although I don’t remember when exactly I decided to become a sexologist, I do remember why. I think my decision was partly influenced by the fact that I had always been (and still am) fascinated by ‘relationships’.
Although I don’t remember when exactly I decided to become a sexologist, I do remember why. I think my decision was partly influenced by the fact that I had always been (and still am) fascinated by ‘relationships’, all sorts of them: friendships, close friendships, very close friendships, intimate and sexual relationships, relationships with older people, relationships with younger people, parent-child relationships, work relationships, spiritual relationships, … all sorts of them. I remember one day in medical school during a grand round (a formal meeting at which physicians discuss the clinical case of one or more patients) our lecturer was discussing a medical procedure and I was looking, instead, at the patient and his wife, thinking how their relationship would change after the operation. I was that sort of person.
Along with having an ‘interest’ in relationships (which I think is an important aspect of being a sexologist), there was another reason: ‘need’. I finished high school sexually illiterate. No one had ever explained to me how things work and there was no source of sexuality education. It was during the early years of medical school that I started to educate myself on sexual and relationship matters. During the final years of medical school as a junior doctor, one thing that particularly caught my attention was how little we could do to help individuals and couples on issues concerning sexual and marital difficulties. This frustration of not knowing what to do was a painful experience, which added to my ambitions to become a sexologist. But what on earth is sexology?
The term ‘sexology’ is a general term referring to the many forms of scientific study of sex and sexuality. This study is diverse and multidisciplinary and includes scholars, researchers, and clinicians working within the many branches of the natural and social sciences and humanities.
As a branch of sexology, clinical sexology is an umbrella term referring to a wide range of clinical interventions concerning sexual health and wellbeing. It can be broken into two major categories: one, rooted in the natural sciences and medicine, concerned with the biophysical and physiological aspects of sexual health and function (this is often referred to as sexual medicine or medical sexology); and the other, rooted in the social sciences and talking therapy traditions, dealing with the social and psychological aspects of sexual health and wellbeing (this is referred to in many ways including sex therapy, sexual psychotherapy, psychosexual therapy psycho-sexology, and so forth).
I was already trained in medicine, so it was perhaps easier for me to pursue the medical branch of clinical sexology (sexual medicine or medical sexology). But there were two major issues. First, I was unable to find a comprehensive and professionally recognised training in sexual medicine. In the medical world, sexual medicine wasn’t (and still isn’t) seen as an independent discipline, but often as an auxiliary activity within other disciplines such as urology, psychiatry, andrology, genitourinary medicine, and so forth. As a result, the comprehensive and recognised years-long training available in other medical specialities does not exist in sexual medicine. Although independent organisations such as the British Society for Sexual Medicine (BSSM) or its European sister organisation (European Society for Sexual Medicine [ESSM]) has made notable progress in making sexual medicine recognised, it is still far from being independent from other medical branches with its own proper training courses.
Second, I was as interested (if not more) in the psychosocial aspects of sex and sexuality as I was in the medical aspects. The thing about sex and sexuality is that it is arguably one of the most (if not THE most) bio-psycho-social aspects of being a human: First, it is biomedical in that genetic, hormonal, neurological, physical and physiological aspects of being a human are highly influential in regulating sex and sexualities; second, it is psychological in that the majority of psychological states (pathological or otherwise) such as depression, anxiety, psychosis, etc. influence sexual functions and dysfunctions; and third, it is socially shaped and constructed, coming in all forms of varieties and colours across geographical and historical axes.
The highly bio-psycho-social nature of sex and sexuality necessitates a multidisciplinary approach when dealing with sexual problems in clinical settings. In fact, one of the most important reasons why many people with sexual difficulties fail to get their sexual problems sorted is because of the lack of a multidisciplinary and integrative approach. Sexual problems arise from a wide range of medical, psychological, and relational and social factors. Very often, there is a complex combination of several contributing factors. When these complexities are not understood well and addressed integratively, the result is often not satisfactory. This means although without a bio-psycho-social view and a multidisciplinary approach we may restore that aspect of sexual ‘function’, but we may not enhance a patients’ sexual satisfaction. In other words, although firmer erections, more reliable orgasms, or pain-free sex can be achieved through a specific clinical intervention, these changes are not necessary accompanied by a significant improvement in sexual relationship satisfaction and may even lead to more dissatisfactions (consider a women with undisclosed sexual pain issues whose partner’s ejaculation latency time is significantly increased to his desired expectations following a course of therapy).
In an ideal world, clinical sexology is an interdisciplinary branch in healthcare with bio-psycho-sociality being at its heart. As such, clinical sexologists understand and are knowledgeable to address the biomedical aspects of sex and sexuality whilst they also appreciate and take fully into account the psychosocial and relational aspects in their interventions. This was an ideal world.
In a real world, clinical sexology should be multidisciplinary and done by a team consisting of at least someone, medically-oriented, who deals with the biomedical issues (a sexual medicine consultant) and someone who understands and works with the psychosocial aspects (e.g. a psychosexual and relationship therapist). At the moment, sexual medicine is still a field in development; therefore, sometimes it is necessary that a sexual problem is treated by a multidisciplinary team of medics from various backgrounds.
Ok, let’s go back to my story. At the time that I wanted to pick the perfect course with a bio-psycho-social orientation, such a thing did not exist. The closest to the ideal that I found was a training programme in Sheffield, UK. This was a post-graduate diploma in sexual and relationship psychotherapy. Although the course had a predominantly psycho-social orientation, it had a comprehensive module on sexual medicine, thanks to its director who was a medic (a qualified psychiatrist) and knowledgeable in all aspects of sexual medicine. To my knowledge, among a handful of courses available at the time, this was arguably the closest to the ideal interdisciplinary bio-psycho-socially-oriented model. This was in 2007. I had further trainings in sexual medicine (medical sexology) in Oxford in 2010. This was provided by the European Society for Sexual Medicine. I then did a few other things, which is another story!
Now, July 2016, I am a sexologist and my approach is bio-psycho-social. Unfortunately, the Sheffield course does not exist anymore so I have responded to this gap in the education market by developing a clinical sexology diploma course myself, at a level that I wish was available when I was looking for my ideal training course. If you are a healthcare professional, have an interest in relationships (particularly intimate ones), enjoy interdisciplinarity and want to specialise in one of the most evolving and rewarding branch of healthcare, the Cambridge Institute of Clinical Sexology (CICS) is now recruiting students for its two-year diploma course in clinical psycho-sexology. Our view to sexual health and wellbeing in CICS is bio-psycho-social, integrative and pluralistic. We avoid using a purely medical model to avoid 'medicalising' sexual problems. But at the same time, we do not ignore the importance of biomedical aspects of sexual wellbeing to avoid 'psychologicalisation'. Our aim is to enable our trainees to understand the importance of medical aspects of sexual wellbeing, enabling them to confidently collaborate with medically oriented healthcare professionals. Our diploma course qualifies students to work with sex and relationships, with individuals and couples and it closely follows the College of Sexual and Relationship Therapists (COSRT) accreditation syllabus.
For more information, please see our website www.cambridgeinstitute.co.uk where you can find the course brochure and application form. You can email my colleague Julie Sale at firstname.lastname@example.org.