| Interview with Patrice Cudicio, MD, sex therapist, teacher (Inter academic Diploma of Sexology), by Mathieu Doumenge, executive editor of the website Mysmooze (very soon on line)
As sex therapist, how you would define your work, in particular with regard to the current problems of couple? In other words, that find with you the couples which come to consult you?
The skills of sex therapist doctor are plural, he (she) possesses vast medical knowledge: neurology, endocrinology, cardiovascular problems, gynaecology, urology, psychiatry. Sexual medicine also requires knowledge in sociology, history and naturally in psychology. As a consequence, the sex therapist doctor can approach in a pragmatic way all the sexual difficulties and provide medical and psychological therapeutic answers. The couples whitch consult present often complex problems, the sex therapist doctor can announce things, to carry a clear diagnosis, to propose an adapted therapeutic approach, to prescribe medicines, biological examinations, but also to practise brief therapies the TCC: cognitive and behavioral therapies, as well as couples therapies.
Do you identify the sexology as a simple extension of psychoanalysis or you would suggest another definition?
The sexology can be also practised by psychologists having completed a specific training course. For example, the Diploma inter academic of Sexology is opened to psychologists from the level MASTER DEGREE. Psycho sex therapists can operate therapies for couple, help them to better understand each other, express themselves, have a dialogue. The cognitive and behavioral Therapies are privileged.
The sexology is not an extension of the psychoanalysis, moreover, the psychoanalytical cure is not effective in majority of sexual problems. The confusion results from the fact that Freud pointed out the sexual causes in psychological and psychiatric disorders, but, you should not stop at this aspect, the real pioneers of the Sexology, Magnus Hirschfeld, Havelock Ellis, were also doctors.
What kind of works would prescribe a sex therapist to persons who consult?
Everything depends on the problem! Generally speaking, the patients are brought to understand the sense of their problem, and the sense of their sexuality. To do it, I use mainly hypnosis, which allows to obtain very fast results, I add some exercises to be realized at home, by oneself or with his(her) partner.
Is there a right "time" to consult a sex therapist? What could you say to reassure people who could be reluctant or worried and to incite them to consult if necessary?
Yes, it is necessary to consult as soon as we worry about one’s sexual health and sexuality, most earlier is best because it is necessary to avoid letting settle down a fear which is going to deteriorate the sexual symptom. The sex therapist, by bringing a precise diagnosis and clear answers can calm quickly the anxieties.
What is, generally, the biggest difficulty which meet your patients when they come to see you, and which is the biggest difficulty you face with them?
Here, as in many problems, the motivation of the patient plays a determining role. If the patient is not firmly decided to involve in the success of his treatment, it complicates things. I cannot obviously decide on their place in this domain.
Can you precise in which proportion a sex therapist works with couples, or with individuals?
The couple is always implied whether it is heterosexual or homosexual, even if we do not work with the couple but more often with an individual.
The ideal being naturally in couple because the sexuality of the one necessarily influences that of the other one.
Do your patients come mostly only or for two? Who decide? We often read in media that it is the woman, do you agree withe that?
Let us say that 20 % come spontaneously in couple, 30 % in our demand and the staying 50 % come by themselves, whether they have no regular partner , or they do not wish or to bring in her(him), or, finally, that this partner refuses. In my experience, the demand is as much male as feminine; everything depends on the initial motive for the consultation.
Do you still observe hesitations to come and consult? Is it still taboo, even humbling, to consult a sex therapist?
The patients for whom it is taboo, do not consult. Sometimes there is a gap of motivation within the couple, the sexual problem is then rather a problem of couple. But even at the moment, a majority of persons merged men and women refuse to approach their sexuality. A recent inquiry showed for the first time that 61 % of the individuals were not satisfied by their sexual life. My personal estimation would be closer from 75 to 80 %!
Do you notice differences of behavior in front of the therapy, at the man and the woman? Difficulties in speak about the problems, sexual inhibitions, facilitated to put into words possible grievances or loss of desire?
The men tend to see especially the mechanical aspect of their sexuality, a failure is lived as a wound of pride. The women have more often problems of absentia of desire, pleasure, even denial of their body, they put on the responsibility of this problem and feel guilty.
The difficulty making a report is more an individual affair, let us say that men and women do not speak about the same thing. I distinguish three levels of the sexuality: the instinctual strictly in connection with the hormonal climate, the compulsive which leads to look for the sedation in the enjoyment and the relational. Man man and woman do not obviously work at the same level what creates different problems and lead the sex therapist to find out differentiated answers.
Are there "typical" cases in which a couple comes to consult? Loss of libido, absentia of pleasure, impotence, premature ejaculation, inhibitions, adulterous? Are there other particular cases which you would like to point out?
They are indeed the main motives for consultation there, in it are added vaginismus, dyspareunias (pains during the sexual relations). At the man there are also problems of absentia of ejaculation, rarer, but often difficult. Often the initial complaint advances the impossibility to conceive a child.
There are also the questioning on the anatomical "normality" and naturally as doctor on IST.
Are there "typologies" of patients, according to the age, the situations, the number of last years together...?
Maybe not of real typologies, but problems connected to the age or the conditions of life, the stress level. Every case is particular because you should never lose sight that the sexual difficulty appears in a relation. So, it is not rare that a sexual breakdown raises in a certain type of situation and with a person in particular.
What are the problems that a couple can mostly meet in its sexuality?
When a couple forms, the sexual expectations can be different for each, at the beginning, there are problems in touch with the learning of the other one. A man who presents a premature ejaculation with a partner little motivated by the sexuality, will probably never ask any question on this subject. After a while of common life, frustrations can seem bound to a lack or an absentia of desire. The sex therapist has to avoid becoming widespread hastily and being interested in particular in every patient.
Beyond precise problems, what do you learn from your consultations, your patients generally and in particular on the evolution of the couple and of its sexuality?
The expectations are often less important than we believe it so much that we could speak about sexual dissatisfaction. A lot of people wishes to have a quiet sexual life without questioning, they often imagine themselves that it belongs to other one "to know". But, so that the sexual life is a way of self accomplishment, it requires efforts, creativity, and a real quality of presence to oneself and in the relation.
In the course of your career, did you distinguish through your patients a true evolution of the couple and its sexuality?
If the demands are almost the same today than 20 years ago, we notice nevertheless a certain evolution because of the medicalization of the sexology.
But especially what is dramatic to my opinion, it is that today, the sex and the sexuality became consumer goods and I would say even about big consumption in the same way that the food: odourless, colorless and tasteless!
Finally, to conclude, could we say (in a little bit coarse way) that there is a " rate of satisfaction " when one consults a sex therapist? Is the fact of making the decision to consult already a good option for solving the problems, either have you already seen the couples which left " beaten beforehand "? In brief, to consult a sex therapist, it is a panacea?
Of course there is no panacea and the satisfaction depends on what we are searching for and what we wait.
Except about questions that medicine can cure, sexology can give a more relevant vision of what we can expect from sex and from sexuality.
A fulfilling sexuality is closer to an "initiatory" progress than to a receipts book.
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