Dr. Sònia Anglès Acedo: “Having positive sexual health results in a better quality of life”

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality, which requires the possibility of having pleasurable and safe sexual experiences, both by oneself and with other people.   It is about the person being able to enjoy his or her sexual activity in a satisfactory way. Therefore, it is not merely the absence of disease (sexual symptoms that cause concern).

It is important to care for it, because several studies have shown that better sexual health is associated with a better quality of life and better well-being.  Obviously, it all depends on each person and everyone can decide whether to exercise their sexuality or not, either with other people or individually. We provide care from a biopsychosocial point of view, which includes biological, psychosocial and also sociocultural aspects.  We look at what tools we can provide them with, so that they can have positive sexual health.

When I define sexuality to patients, I tell them that it is a physiological reward mechanism inherent to human beings with the objective of obtaining sexual pleasure.  We understand pleasure as “enjoyment", not exclusively as an orgasm, but as a satisfying experience.  So, positive sexuality is based on activities or behaviour, both individual and shared, that makes us feel pleasure and facilitate a satisfying sex life.  Enjoying positive sexuality is a right. In fact, sexual pleasure is one of the 11 sexual rights we all have, along with the right to sexual health care. In my practice, I work with my patients to identify what forms of sexual expression guarantee this positive sexuality.  For example, improving the proprioception of the pelvic floor muscles, working on the self-perception of body image or sensory-focusing techniques in couples.

We usually see women who have some kind of gynaecological disease and who report symptoms that worry them related to sexuality.  We come across women who notice a lack of sexual interest and that worries them, since they find that their lubrication and ability to become aroused are affected. We treat women who come to see us because they feel pain during sex... Others who do not have orgasms, or have difficulties achieving them, or report that they have decreased in intensity. However, their sexual health may also be affected by changes in their body image, which can sometimes have a negative impact on the woman’s identity and femininity, or on how attractive she feels to other people, to herself, to society, etc.

When a sexual health problem arises, the patient generally takes a long time to see a doctor, and we professionals are not used to asking about this systematically.   The problems are usually multifactorial, for example physical symptoms such as changes in the vaginal mucosa, changes in lubrication as a result of variations in hormone levels, for example during the postpartum period, or surgeries that have left a scarred area. But there are also other aspects, such as physical, emotional ones, or the person’s self-image, for example, when they have incontinence or prolapse and the genital area is affected.   For example, woman who have had breast cancer, who have undergone physical chances as a result of surgery, and their perception of femininity is affected, which has an impact on their sexuality.  

There are barriers for patients, professionals and the environment. In the institutional sphere, the resources may be insufficient, we may need more time in the consultation room than we amount we usually have in order to tackle the issue of sexuality.  Trust must be established in time that you may not have.

This is not discussed much because there is a series of barriers with regard to the patient, the professional and the environment/institutions. In terms of the patient, because this is an intimate part of life and sometimes it is hard to express what happens to them in this area. Often, they do not even know if the health professional to whom they turn is the right person to consult and, what is more, they frequently think there are no treatments available.  Moreover, the health professionals do not have specific training, and so the patients are not asked about these issues systematically.  However, we are contributing to the training.  For four academic years, we have been teaching classes in female sexual health as part of the gynaecology course at the University of Barcelona, so that medical students have a minimum of knowledge on these topics when they graduate.  We talk about positive sexual health, sexual violence and sexual pleasure, etc. At the hospital too, more and more sessions are being held during which this is discussed, and we organize training courses and congresses, which provide tools and resources to help professionals address these issues.   

We should promote education that addresses sexuality at every stage of life, from primary school to university education, according to the needs of each age group. In primary schools, for example, the talks focus on reproduction, safety and family planning. However, they should teach about what constitutes good affectivity towards others and towards oneself, and how each individual can feel satisfied with the sex life that they would like to have.

Frequently, in the consulting room, in addition to assessing and treating the specific sexual symptom, we have to identify the false myths about sexuality the patient expresses using a biopsychosocial approach and then carry out the treatment in parallel with this. We talk about “false myths” or beliefs that are generated throughout a person’s life as a result of their doubts and lack of knowledge.  

A year and a half ago, the Hospital Clínic in Barcelona approved the formation of the Clinical Sexology Working Group. A multidisciplinary group that includes health professionals with different specialities was formed, in order to provide integral care for people with changes in their sexual activity and/or function at the time of diagnosis, the treatment and follow-up of their basic problem, focusing efforts on promoting positive sexuality. It is not yet in place at a health care level, because firstly overall pathways need to be established to plan all this care, and that will take time. We hope that in the future we will be able to create a unit to treat all this, but now we are aiming to provide care from a positive point of view, to guarantee people’s pleasure and satisfaction.

We are carrying out the Eros study, which aims to determine the effect of the menopause on female sexual desire using functional magnetic resonance imaging (fMRI) of the brain. This allows us to observe the brain regions that are activated when a person has sexual desire.   The menopause is one of the stages of life when there is a noticeable change in sexual interest, women usually experience a decrease in sexual desire, and there are not many studies on this. Now we are waiting to finish recruiting all the participants and analyse the results.  Anyone interested can contact us by e-mail: ESTUDIOEROS@clinic.cat.