BEIRUT: How do you deal with sexual dysfunction or safe sex when even the mention of it at home is enough to elicit gasps of embarrassment and shock?
Sandrine Atallah, a clinical sexologist, has some of the answers. The Lebanese doctor studied sexology for three years in France before opening shop here in 2007. There are few sexologists in Lebanon who practice the discipline exclusively.
Atallah’s clientele spans the age spectrum from late teens to old age, though she sees more men than women. Men, she said, speak more easily about sexual problems, probably because issues like erectile dysfunction, where a man is unable to maintain an erection during sex, can prevent them from having sex at all, whereas women who have trouble with arousal can still have intercourse, and therefore consult doctors less.
In Lebanese society, sexual performance is so intertwined with masculinity, whereas female sexuality is frowned upon, making women feel like they don’t have the right to seek professional help, she told The Daily Star.
Among men in Lebanon, Atallah said the most common issues tend to be erectile dysfunction or premature ejaculation, followed by lacking sexual desire, which she said can often be related to conflict in marriage or relationships.
Both erectile dysfunction and premature ejaculation, she said, are linked to pressures on men to perform – in prior generations, sex was primarily about having a family. In addition, the increased prevalence of pornography creates skewed impressions of how well men can perform, making them believe they are not doing as well as they should.
On the other hand, women tend to have more problems with sexual desire because they are often raised with the impulse to repress, she said.
“Women are raised inhibiting their desire, because it’s negatively perceived,” she said. “A man who has a lot of partners is strong and a woman who has a lot of partners is considered a prostitute, so you have this negative perception of women who have desire.”
Atallah said vaginismus is the one of the main ailments women come to her clinic for – certainly more women seek treatment for it in Lebanon than in the West.
Vaginismus is an involuntary contraction of the vagina’s muscles, one that prevents penetration during sex. Like many other sexual dysfunctions, it can have both physical and psychological causes – as a defense mechanism against abuse, for instance, or due to fear of sex.
“You have a lot of cases in Lebanon because we have a lot of taboo around virginity, there are a lot of negative messages about the first time, and so women think it is painful and are afraid of penetration,” she said.
Atallah estimates that between 60 and 70 women out of 100 will come to her for treatment for vaginismus, which is often done through psychotherapy that helps them learn how to control their muscles better and ease their fears of sex.
Many women also complain of an inability to reach orgasm, she said, primarily because many do not know that women often cannot reach orgasm through intercourse alone.
Younger individuals who seek help, on the other hand, usually come with performance issues or misconceptions caused by pornography, she said.
These are usually related to misconceptions about normal penis size, how long it takes to ejaculate during sex, quality of erections, and the reactions of their sexual partner – many young men think women are supposed to shout and scream during sex, just like in porn.
Pornography can also promote the view among men that women are sexual objects, or give false expectations about beauty and what a woman’s body ought to look like.
In addition, Atallah said she has to stress safe sex to younger visitors.
“You have to stress about condoms because people tend to think ‘ok I know her parents and she’s my neighbor and doesn’t have STIs, so we don’t need protection,’” she said, adding that many do not know that some sexually transmitted infections don’t show obvious symptoms, particularly early on.
In addition, many young women don’t realize they are supposed to do yearly gynecological exams once they become sexually active, or do pap smears and take vaccines against HPV, which helps reduce the risk of cervical cancer.
But she said part of the blame lies with health workers who are often judgmental toward sexually active women. Even minor issues can prevent women from seeking their gynecologist, like calling a sexually active woman “madame” even if she isn’t married, or calling a single woman a “bint” or virgin girl because they assume she isn’t sexually active.
“A woman is a woman, it’s not because she is a virgin that she isn’t a woman,” she said.
Another area where Atallah said she tries to clear misconceptions is homosexuality.
“Sometimes the mother will come alone and say I think my boy is gay, what can I do and is there any treatment?” she said. “I’ll tell her it’s not a disease or a disorder, we cannot cure it because it’s not a disease or a disorder. He can need therapy if he’s not at ease or cannot accept himself but we cannot change it.”
Both the Diagnostic and Statistical Manual of Mental Disorders, the veritable bible of psychiatry, and the Lebanese Psychiatric Society do not consider homosexuality a disorder.
Still, Atallah said some will seek out disreputable therapists who claim to be able to reverse homosexuality.
When treating sexual disorders, Atallah said she first tries to eliminate all of the “organic” reasons. Erectile dysfunction, for instance, can be linked to health issues like being overweight, hypertension, diabetes, high cholesterol, old age or smoking.
Then, she looks at the psychological factors, like performance anxiety, depression or relationship trouble.
After that, she determines whether the individual needs medication or psychotherapy, or even couples therapy.
Most sexual dysfunctions do have a psychological element, Atallah said, because once a person has trouble having sex he becomes less at ease afterward.
Atallah said the proper place for sex education is at home and school, and should begin at a young age until puberty, when youngsters often stop seeking advice from parents.
“It should not be a single talk, it should be talks,” in order to help them figure out what to expect when they reach puberty, she explained.
She stressed that it is important for parents to deliver a positive view of sexuality, even if they are conservative. There is another advantage to good sex education, she said – it usually means youth will start having sex later in life, because it loses the forbidden, taboo quality.
“They will be empowered to say yes or no, not to be a victim or be pressured by a boyfriend or friends,” she said. “They will be more confident also.”
To her patients, Atallah usually makes that point that it’s normal to have sex, sexual desires and be aroused, and that preserving virginity ought to be a personal conviction.
And while many who remain virgins until marriage do not experience sexual dysfunction, it is important not to completely repress sexuality, she said.
“If a woman gets married at 30 and from 15 to 30 she got used to inhibit all sexual desires and behaviors, how could she develop sexually?” she asked.