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ESSM becomes of age: a look to the Past, Present and Future of our Society

Y. Reisman, ESSM President

ESSM From Past To Present

The history tells us that in 1994 during the ISIR (now ISSM) Annual Congress in Singapore, the impregnation of the ESIR (European Society for Impotence Research) started by young urologists from Europe. The founders of the idea were Dimitris Hatzichristou, Yoram Vardi and Inigo Saenz deTejada, who unfortunately too early passed away. Serval reasons justified such effort; important one, was that the contribution of European investigators to this field is strong and growing and the European chapter would strengthen both ISIR and a unified European effort. This idea was quickly transferred to action and in 1995 ESIR was born with the first Congress in Porto Carras, Greece. The final program of that meeting included citation from Hippocrates (460-377BC) “veins and nerves from all over the body come together in the genitals; as they rubbed and warmed, they swell up and a kind of irresistible itching feeling is created, bringing great pleasure and warmth to the whole body” A wonderful sentence which still describe the target of our research and clinical work. As you can see from the pictures, this meeting was largely attended and the first president (Gorm Wagner) and Secretary (Dimitris Hatzichristou) have been chosen.

Two years later the second Congress was held in Madrid with Inigo Saenz de Tejada as president. More than 800 participants took part of the congress and more than 100 journalists show interest in our field. ESIR that was founded on the idea of promoting research within the area of impotence (as ED was named that time) and to broaden the awareness within the European region of the necessity to target this sexual dysfunction as an integrated part of medicine.
The following Congress was in 2000 in Barcelona to which the intended 1999 congress in Turkey needed to move after a tremendous earthquake of 1999.
The Society started to grow and moving from infancy to childhood more broader perspectives in the field were visible. In 2001 the name of the Society changed into ESSIR (European Society for Sexual and Impotence Research) in order to embrace more deeply the broad field of sexual medicine, both male and female.

This brought also to the need to be held our congresses each year, so in 2001 the Congress was held in Rome and the year after, in 2002, in Hamburg. Starting from 2001 the Society continued its development, changing again its name into the actual ESSM (European Society for Sexual Medicine) in 2003. According to publication of Alan Riley, the first professor of sexual medicine in the UK, the term “Sexualmedizin” was first published in German literature as early as 1908 and it encompassed both organic and psychological issues of sexual function and its problems and was more popularized in the 1970s. The change of the name of our society was characterizing once again the need to improve and spread the research into sexual medicine, a field which is continuously developing across the world, bringing sexual awareness to light more and more not only in the medical field but also among people.

In 2003 ESSM President, Dimitrios Hatzichristou, approached the past president of that time John Pryor, with an idea of seeking to develop a regulatory framework for Sexual Medicine. The Healthcare Professionals (HCP) who provide this care have largely been self-taught and come from a variety of medical disciplines including urology, gynecology, venereology, psychiatry, primary care and latterly, the fields of endocrinology and cardiovascular medicine have also contributed to the development of the specialty. The quality of care provided by these physicians has thus far been unregulated and has only been demonstrable by audit, by presentation of data at meetings, by publication in peer-review journals, and by the publication of guidelines by scientific societies.

In 2004, during the presidency of Francesco Montorsi, The European Academy for Sexual Medicine (EASM) was established as an independent, not-for-profit, charitable organization that intend to “promote and encourage the highest standards of practice, education, training and research in the field of sexual medicine.” Its founder trustees, from ESSM and EFS, were John Bancroft, Hartmut Bosinski, Ian Eardley, Kerstin Fugl-Meyer, Marc Ganem, Dimitrios Hatzichristou, Willi Pasini, Robert Porto, John Pryor (chair), and Gorm Wagner. Soon after, the EASM have agreed upon a definition of sexual medicine and a short descriptive curriculum have been developed to guide clinicians from different specialty backgrounds, to have basic education in human sexuality and sexual function, in order to provide a holistic, patient-centered management of sexual health problems.

The curriculum has been developed for the guidance of candidates preparing for the European Examination in Sexual Medicine to become a Fellow of the European Academy of Sexual Medicine. Although the candidates may have different specialty backgrounds, they all need to have basic education in human sexuality and sexual function, in order to provide a holistic, patient-centered management of sexual health problems.

The year 2005 marked the 10th anniversary of ESSM, a society which is always stronger and more deeply rooted across Europe, with 13 National Societies affiliated to ESSM and about 1400 members.

In this period negations has been started with different related European Boards, to develop a regulatory framework for Sexual Medicine under the auspices of the European Union of Medical Specialists (UEMS) In 2007, under leadership of Ian Eardley, the first Director of Education, John Dean, have been appointed to organize the first teaching course in Sexual Medicine that found place at Oxford, UK, in July 2007.

Despite this growth in the field of Sexual Medicine, it was not currently recognized in Europe (and indeed in other parts of the world) from a regulatory perspective as either a specialty or as a subspecialty of another discipline. In addition, significant differences exist between the regulation and recognition of medical specialties in the different European countries, and this has had a major impact on, firstly, the way that sexual medicine health care is provided, secondly, on the standard of care that is provided, and thirdly, on the way in which the population can access the service. One way to improve care is through evidenced-based education and other way of of promoting high standards of care is of promoting high standards of care is by the regulation and assessment of training. The objectives of assessment are to improve the professional performance of the individual clinician on knowledge, skills and attitude.
In 2009, during the presidency of Ian Eardley and Hartmut Porst, the decision to establish an ESSM education committee was taken to provide large farm work of educational possibilities in the field and to support trainees in sexual medicine by providing educational opportunities to help them to be successful HCP. I was appointed as the chair. In 2010 Ian Eardley was able to present to the UEMS the concept of an overarching regulatory structure of a Multidisciplinary Joint in Sexual Medicine (MJCSM) via UEMS. The MJCSM with representatives of the European Board of Urology (EBU), the European Board and College of Obstetrics and Gynaecology (EBCOG), and the European Board of Psychiatry (EBPsych) together with representatives of ESSM was unanimously approved, and in October
2011 the MJCSM met for the first time. The MJCSM bylaws were approved by the relevant Boards and by UEMS, with the appointment of Ian Eardley as Chairman, Yacov Reisman as Secretary. MJCSM aim to develop the highest possible standards of training in Sexual Medicine in Europe and decide to achieve this trough development of a extensive curriculum in Sexual Medicine, setting of educational standards for training institutions, accreditation of training institutions, identification of minimal requirements for training and development of an assessment framework, including development of an examination.

Meanwhile ESSM growing with 24 affiliated societies and during the congress Milan in 2011 the Educational Committee introduce the ABC master-course was introduced, which provided educational opportunities for both beginners and specialists in the field, and which incorporated endocrinological, urological, surgical, gynecological, psychological, and psychiatric components. This was the first multidisciplinary course that took place simultaneity with the congress.
In that time there are a few textbooks in sexual medicine that actually cover the whole of the discipline. In response to this challenge, the Education Committee developed “The Syllabus for Sexual Medicine,” a multiauthor and multidisciplinary textbook covering all the different aspects of Sexual Medicine for all genders according to the MJCSM curriculum. Editors were H. Porst (ESSM President) and Y. Reisman and most of the authors of this comprehensive syllabus were members of the ESSM Education Committee, and the timescales for the development of the book were extremely short. The book was presented during the ESSM meeting in Amsterdam 2012 where the first MJCSM examination to become a Fellow of The European Committee of Sexual Medicine (FECSM) took place with more than 350 candidates. Many of them were well known experts in our field. At the same year and prior to the exam the Educational Committee launched a 3-day “crash” course in sexual medicine. The course provided an overview of all the areas in the MJCSM curriculum and provided guidance about exam-taking skills and practice in completing a Sexual Medicine multiple choice question (MCQ). The objectives of the course were not only to revise the relevant knowledge in Sexual Medicine but also to enable attendees who routinely practice Sexual Medicine to improve their clinical skills.

As ESSM become more adult and discover more disciplines and genders involved in our field, in 2013 we introduced a joint committee of members from the EFS and ESSM educational committee joined forces to construct a syllabus for psychologists intending to take the first European examinations for psychologists in psychosexology under the European PsychoSexologists Accreditation Committee (EPSA). In the same year the EFS/ESSM Syllabus, which has been published as a multidisciplinary textbook, with 63 authors from 16 countries covering all aspects of clinical sexology. This with the aim to standardize the quality of mental health providers who practice clinical sexology in countries from different areas of the globe. It is our belief that this program is one of many educational activities that are needed in the field of sexual medicine and clinical sexology to raise the standard of care.

In the same year a new format of the ESSM School has been introduced. Under leadership of Y. Reisman and F. Tripodi a new format had been constructed in which during 10 days physicians and psychologists can interact and gain more knowledge and skills in our field. Each edition was evaluated and validated by the participants who indicated that participation in the School increased their involvement in the field, as clinical practitioners, teachers, and researchers, and increased the amount of time that they devoted to the care of patients with sexual concerns and dysfunction. In the recent years this educational course become a flagship of our society and each year many are in the waiting list for participation.

In 2014 we had in Istanbul the 16th ESSM Congress which joint by the 12th Congress of the European Federation of Sexology. Here we hold the second examination to became a FECSM, together with the first examination to become an EFS & ESSM Certified Psycho-Sexologist (ECPS). Also, there we had a preparation course, this time even more multidisciplinary oriented. All this activities with the aim to facilitate the recognition and protection by the European authorities of medical doctors and psychologists in the field of sexual medicine and psychosexology.
In 2015, Copenhagen, we were celebrating the 20th anniversary of ESSM, always in shape, now with about 1700 members, and looking for sharing all our knowledge and innovation in the field of Sexual Medicine. In the same year an update of the ESSM syllabus of sexual medicine book has been published now under name of ESSM manual of Sexual Medicine.
In 2017, with Francois Giuliano as president, ESSM decide to defined our vision as “Sexual Health for everyone” and defined a mission statement “to promote sexual health and the highest standards of evidence based sexual medicine clinical care through education, research and the formulation of health care”.

Sexology and sexual medicine are multidisciplinary specialties and sexual health is an important aspect of quality of life. Our insight into the anatomy, physiology, psychology, pharmacology, pathophysiology, clinical features, and management of patients with sexual dysfunctions has advanced enormously in the past couple of decades, but sexual medicine and sexology remain fragmented, not overall recognized and are practiced by doctors and psychologists who have very different backgrounds and expertise. A sexual medicine physician with knowledge and skills across the breadth of sexual medicine would be able to offer considerable benefits to patients. However, whether the full breadth of sexual medicine can be sensibly practiced by a single physician or therapist is debatable and unrealistic. Such a physician could not realistically be trained, which means that we instead need to train several different types of sexual medicine physicians and sexologists, with different practical skills but with a common understanding of the nature of the field and with the ability to collaborate with each other. Furthermore, scientific improvement and achieving competence in daily clinical practice can only be accomplished through scientific societies that collaborate on national and international levels.

To be able to ensure the future of our important field many actions need to be taken. In the last 2 years ESSM established more activities to make it possible. The involvement of young medical doctors and psychologists in education, research, and promotional activities is essential. This future generation has the opportunity to acquire the knowledge, skills, and attitude needed for clinical practice from recognized specialists in the field and also to shape their own future and the future of sexual medicine. Thus, in 2018, the ESSM launched the Young Sexual Medicine Academy (YoSeMa), a new committee to involve young health-care professionals in the field of sexual medicine.

To increase scientific content and to help clinicians in area with limited evidence, the Scientific Committee, with Giovanni Corona as chair, develop each year number of new position statements.

With advice of professional, representatives of the executive committee (M. Dewitte, F. Tripodi, Y. Reisman) are seeking for recognition of sexologist among the European authorities.

Our educational efforts are continuing. This year we introduced an Advanced Course in Sexual Medicine parallel to the established ESSM school, where experienced HCPs are able to increase their knowledge and skills. Both the School and advanced course under leadership of F. Tripodi, H. Pastoor, M. Fode and Y. Reisman, have been assessed as good to excellent by the participants. The ESSM Surgical Academy is getting shape and soon will start with practical activities in which surgeons will be able to gain objective and validated knowledge, skills and attitude in genital surgery.
A petition to the European authorities on educational needs of sexual health of undergraduates medical and psychology students are launched in collaboration with MJCSM and EFS.

In January 2020 we are celebrating the ESSM 25 anniversary. ESSM is continue to work on our target of Education and Research to improve quality of care. ESSM count 34 affiliated societies in Europe, many members outside Europe and collaboration with many international and affiliated societies.

When combined, these initiatives should help to guarantee the future of the society and the profession of sexual medicine and offer a bright future for this new and evolving and important discipline.
It was great honor and a huge privilege to serve our society in all these years.
To be inspired by the experienced ones, to push the young ones and make many friends.

Your almost past-president
Cobi Reisman

HAPPY BIRTHDAY TO ESSM FAMILY

References

1. Lowenstein, L. et al. EFS/ESSM- certified psychosexologist with mark of excellence. J. Sex. Med. 2014;11: 2141–2142.
2. Lowenstein L, et al. Oxford School of Sexual Medicine: How are we doing? J Sex Med 2015;12:59–65.
3. Pryor J. A Brief Note on the European Academy for Sexual Medicine. J Sex Med 2007;4:310
4. Reisman, Y. et al. New developments in education and training in sexual medicine. J. Sex. Med. 2013;10: 918–923.
5. Riley A. The Birth and Development of Sexual Medicine: Reflections of My Personal Journey. J Sex Med 2007;4:815–821.

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