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Highlights from the ESSM Virtual Meeting: psychosexology

Filippo Nimbi

PhD, PostDoc, Lecturer, Psychologist (PsyD), and Psycho-Sexologist (ECPS)
University of Rome “La Sapienza”

The ESSM 2022 virtual congress has just ended, and I feel that my arousal for this event is still up and shows no signs of diminishing! Despite the Covid-19’s restrictions have impeded the possibility to meet all of you live once again, in my humble opinion this event was a great success. For once, I don’t refer to the numbers (of the congress, I’m still a researcher working mainly on quantitative data), but to the quality of the interventions and works presented by colleagues from all over the world.

The ESSM is increasingly giving importance to the psycho-sexological sphere, recognizing how the nature of sexuality integrates many fields of expertise, from the biological to the social one, passing through psychology. And, in reality, the number of fields of action is increasing more and more, day by day, involving other areas of research and application, to testify that the more we know about sexuality, the more it evolves and becomes complex and unique.

But going back to the congress, many contributions have captured my attention from the psycho-sexological side, touching both general and specific topics. In this sense, I would like to take the opportunity to thank Giovanni Corona and the whole scientific team, who have once again surpassed themselves in organizing such a rich experience on sexuality and sexual medicine.

Just by giving a first superficial glance at the program, it is possible to note how the number of psychological contributions has increased significantly compared to past editions. Specifically, I was positively impressed by the wide interest dedicated to the sexual health of Trans and gender non-conforming people, and more in general to women and sexual minorities, among other topics.

Moreover, the programme offered many varied and interesting topics, moving from from pleasure in different forms, to the role of thoughts and beliefs in sexuality, to inhibition and the increasingly intensive focus on the distress perceived by the person rather than only on the presence or absence of symptoms (“function primacy” as I call it). Let’s see the major contributions more in detail.

During the WAS (World Association for Sexual Health), great speakers such as Elna Rudolph, Ester Corona, Erick Janssen, and Alain Giami stressed the importance of sexual pleasure in many fields such as clinical practice, research, and educational programmes. Pleasure is something more than what happens in our bodies. It has to do with how much we are able to enable our patients to express themselves truly and openly, having access to higher standards of care and education for sexual health, to love ourselves and have kindness for ourselves and the others. This may happen if we are able to recognise that pleasure is a unique expression for every individual and to spare pleasure positive messages and communication, respecting the human and sexual rights, and adhering to a sex-positive view. This applies to comprehensive sexual education, in which a special place is devoted to understanding the role of pleasurable experiences that involve consent, awareness and pride for the personal sexual identity and expression. This applies particularly to research, in which pleasure has been overlooked for years and only recently there is an increasing number of studies focusing on pleasure, enjoyment and satisfaction. This may contribute to improve our understanding of the nature of sexual pleasure, the intra- and interpersonal processes that facilitate, prevent, or reduce pleasure and the relevance of pleasure to sexual health. This applies also to politics stressing the liberating role of pleasure and sexuality in general.

The European Federation of Sexology (EFS) session chaired by Francesca Tripodi has focused on the impact that Covid-19 in its various waves has brought on sexuality and sexual health, especially at the level of distress in the general population and sexual minorities. We are all aware on how the pandemic has led to the rise of new and specific clinical questions, placing itself above all in those already precarious or debilitated health and socio-economic contexts. Esben Esther Pirelli Benestad highlighted very well how the virus did not discriminate, while other forms of discrimination have found new opportunities to increase. Exclusion and segregation have improved the vulnerabilities and the inequities, sometimes putting sexual and human rights on the background scenery. In general, sexual and relational distress seem to have increased significantly, impacting even more people who were already in vulnerable conditions. Goran Arbanas talked extensively about the impact of Corona virus on sexual health and functioning. Symptoms and isolation diversly influenced our experience with sex: on the one hand increasing solitary and online sexual behaviours; on the other hand, decreasing sexual desire and the overall sexual response. Especially, this is the case of post covid syndrome, which should be treated using similar clinical suggestions to multiple sclerosis: there is a special need for attention to fatigue and pain management, sexual education, indication for sexual positions that may help to cope with physical symptoms, and work on sexual communication, now more than ever. Two years of pandemic have put a strain on people’s mental health; proof of this is the increase in rates of all those disorders related to anxiety, depression, and mood in general. As health care providers, we should be able to recognize and support what this also means for the different expressions of sexuality, bearing in mind that sexual satisfaction is often capable of improving our quality of life.

I loved the round table “Life isn’t binary” – The EPATH (European Professional Association for Transgender Health ) session chaired by Emmanuele A. Jannini and Guy Tsjoen, with Christina Richards, Surya Monro, Alessandra Fisher, and Müjde Özer. The focus of this session was on the growing clinical and research attention for the non-binary population, which we are getting to know more and more. Evidence is still poor on this topic, beside one central element: the high level of stress and sufferance for trans and gender non-conforming people in many contexts. Non-binary people may be significantly affected by minority stress, having significant negative outcomes in the mental health and social life. The question that thrilled my mind a lot was: “How much the standards of care for binary trans people that we have available today can be effectively translated to non-binary individuals as well?” To date, we have not much data about it, but we certainly need to improve our approach to care that should be always tailored to respond to individual needs and wishes, especially recognizing how much it could be difficult to be a non-binary individual in a largely binary scenery.

The “Transdiagnostic risk factors in sexual dysfunction” round table chaired by Kevan Wylie and Luca Incrocci shed some lights on the depicting the role of cognitions in sexual experience, as possible stressors, distractive thoughts, culturally rooted and emotionally significant strategies, and expression of the commonly reported performance anxiety. The lectures of Filippo Maria Nimbi, Pedro Nobre, and Goran Arbanas focus the attention on specific mechanisms and elements that could be gender specific and not, underlining the importance to devote part of the treatment to understand the patients’ specific beliefs, their own meanings and ways of understanding sex, and work on replacing that information and strategies that may limit their sexual expressions and satisfaction.

Many clinical updates and interesting internet-based approaches were presented by Stefano Eleuteri, Tillmann Krüger, and Elisa Maseroli about difficult issues such as Paedophilia, Compulsive Sexual Behaviour Disorder (CSBD) and Vaginismus in the “Online counselling and treatment” session chaired by Renee Steinmann and Francesca Tripodi. This session gave a special light to e-health approaches, methods, and available tools, both based on literature and on valuable personal experiences. The take home message here is that technology-based approaches may be important allies to care, especially when the health care professional are directly involved in their design and implementation.

Amazing discussion in the round table about how different types of traumatic experiences may affect sexual experience in adulthood by Michaela Bayerle-Eder, Erika Limoncin, and Giovanni Castellini, chaired by Woet Gianotten. Trauma and sexual stress may lead to a chronic dysregulation of the Hypothalamic–pituitary–adrenal (HPA) axis, which in turn can cause Hypoactive sexual desire disorder. What impressed me is that speakers have also highlighting how sexual orientation may have a different effect on stress and hormonal levels. A condition like Post-Traumatic Stress Disorder (PTSD) showed to be related to poorer sexual functioning, with specific paths for gender: lubrication and satisfaction seem to be mostly affected in women, while men seem to report high prevalence of hypersexual behaviour, with a crucial role of guilt, and depression, and insecure attachment. A specific form of traumatic experience is represented by sexual abuse in childhood. The consequences for these traumatic experiences may vary a lot among victims, based on protective factors and adaptation abilities to the traumatic experiences. Most victims may report altered expectations about relationships, distorted cognitions, and emotional regulation difficulties. Regarding sexual functioning, many studies seem to indicate a high prevalence of hyperactive sexuality and sexual dysfunctions in both genders.

Regarding sexual minorities, the round table about Women who have Sex with Women (WSW; It was amazing to have session dedicated to such a overlooked topic!) chaired by Cobi Reisman and Sam Ward, hosted the contribution of prestigious speakers such as Sharlini Andrews, Marieke Dewitte, Michal Lew-Starowicz and Jiska Ristori. Beside the focused on Sexually Trasmitted Infection (STI) risk such as HPV, Herpes simplex, Syphilis, and others, the main message of the round table was about the need to better understand this group, beside our scripts and stereotypes. Please, do not give for granted that WSW have only sex with women, because this umbrella term comprehends a wide variety of experiences, identities, and sexual practices (e.g., also women who may have sex with other genders). Women are generally more fluid and plastic regarding sexual and identity expressions than men. Some studies report that WSW have better sexual communication in their relationships, better sexual functioning, they are more able to effectively stimulate their female partners and to have pleasurable experiences confronted to women that have exclusively sex with men. An important message that I liked a lot was shared by Marieke Dewitte citing Ellen Laan and colleagues (2021): “Men and women do not differ in capacity for sexual pleasure, but in opportunities for sexual pleasure”. The “take home message” from this session is that we have still many heterosexual biases in research, and we need to invest on increasing studies on sexually diverse populations. From a clinical perspective, again the need of a tailored assessment and treatment (if needed) to respond to individual wishes and requirements of such diverse populations.

I take this opportunity only to underline how moved I was (as in this case cited above) by the great affection demonstrated by many colleagues in remembering during their presentations Professor Ellen Laan, recently passed away, for her impressive contribution in the research and clinical practice of sexuality, as well as to be a great woman.

Beside the significant scientific contents and contributions, in my opinion, it is precisely this sense of scientific community that soaking an ESSM event that distinguishes and gives relevance to updates and trainings. Thus, information can be conveyed by emotions, giving increasingly value to data and knowledge, without which they would soon be forgotten.

I look forward to seeing you live (fingers crossed) for the next congress where we could once again breathe the air of the ESSM family.

References

Laan, E. T., Klein, V., Werner, M. A., van Lunsen, R. H., & Janssen, E. (2021). In pursuit of pleasure: A biopsychosocial perspective on sexual pleasure and gender. International Journal of Sexual Health, 1-21.