Happy endings: the ins and outs of clinical sexology

Sexology is the interdisciplinary scientific study of human sexuality, including sexual behaviours, interests and function. A sexologist is a trained professional who specialises in human sexuality.

There are many different ways a sexologist may work, and many different areas she may work in – in clinical settings, in education, and in research. Here’s the type of couple a clinical sexologist may encounter.

A consultation

Sarah and John have been together for two years and have recently become engaged. Generally, they’re very happy with their lives, with satisfying careers, good relationships with their families, and many shared interests. They’re even hoping to start their own family but the one area of their lives that things don’t work so well in is the bedroom.

Sarah has always experienced pain during penetrative sex. She believes it’s connected to her early sexual experiences when her boyfriend at the time was rough during sex and she didn’t express her feelings. She always saw it as “part of making him happy”.

Now she’s realised that she could have said something, and is more willing to talk about her experiences with John. She wants to have penetration with John, but is fearful that it will hurt and hence avoids doing it.

Richard von Krafft-Ebing’s 1886 work, Psychopathia Sexualis, established sexology as a scientific discipline.Wikimedia Commons

John was a virgin until he met Sarah. He had “made out” with girls but had never gone further than that. He always wanted to be sexually active but the opportunity did not arise for him to experience sex before he met and fell in love with Sarah.

Although Sarah and John are sexually active together, their attempts at sexual intercourse have been fraught with difficulties. As John is inexperienced sexually, he feels anxious about hurting Sarah and he wants to “get it right”.

This anxiety stops him enjoying himself and being “present” during sex, so he has developed erectile difficulties. He can attain an erection both during masturbation and oral sex with Sarah, but when they begin the penetration he loses his erection.

Sarah and John have heard that they can talk to someone about their concerns and they make an appointment to see a sexologist.

A growing field

Books on sexuality and love, such as the Kama Sutra, the Ars Amatoria, and The Perfumed Garden of Sensual Delight, have been around for centuries. But they’re not framed within a formal field of scientific or medical research.

During the late 1800s – despite the social attitudes of sexual repression in the Victorian era – more liberal attitudes towards sexuality began to be presented in England and Germany. In 1886, for instance, Richard Freiherr von Krafft-Ebing (1840-1902) published Psychopathia Sexualis, which is considered to be the leading work that established sexology as a scientific discipline.

Havelock Ellis challenged the sexual taboos of his era.Stefano Bolognini/Wikimedia Commons

Within a decade or so, English medical doctor and sexologist Havelock Ellis (1859-1939) challenged the sexual taboos of his era, specifically regarding masturbation and homosexuality. His 1897 book Sexual Inversion, described the sexual relations of homosexual males and is considered to be the first objective study of homosexuality. He actually coined this term and, despite the prevailing social attitudes of the time, did not consider homosexuality as a disease, as immoral, or as a crime.

Throughout the following decades, many other scientists expanded our understanding of human sexuality. Some noteworthy names are Sigmund Freud (1856-1939), Alfred Adler (1870-1937), Wilhelm Stekel (1868-1940), Ernst Grafenberg (1881-1957), after whom the G-spot is named, Alfred Kinsey (1894-1956), John Money (1921-2006), and the American duo William H. Masters (1915-2001) and Virginia E. Johnson (1925-2013).

Although sometimes controversial, these scientists and practitioners contributed greatly to the development of the discipline of sexology.

A happy couple

In 2015, there are many practising sexologists around the world. Those like the practitioner Sarah and John would access are typically called clinical sexologists because they work with the diagnosis and treatment of sexual concerns and dysfunctions, among other sexual health presentations. But they may go by other titles such as sex therapists, for instance, or psychosexual therapists.

Most use the Ex-PLISSIT model of sex therapy when working with clients. Originally developed by Jack Anon in the 1970s, and later expanded by Sally Davis and Bridget Taylor in 2006, the letters of the model refer to four different levels of possible intervention.

They are Extended (Ex) and Permission (P) – meaning to give permission throughout the work with clients for them to discuss sexual behaviour and sexuality issues, as well as to support the client in their experiences of sexual behaviours (as long as they are not harmful); Limited Information (LI) - clarifying any misinformation, dispelling myths, and providing factual information in a limited manner; Specific Suggestions (SS) - providing specific suggestions relating to the particular issue; and Intensive Therapy (IT) - providing highly specialised therapy for more complex presentations to the individual(s). The key aspects of this model includes being aware of and providing explicit permission throughout the work with the client or clients so the client(s) can work through their personal issues as a core feature of the other stages in Ex-PLISSIT.

This requires the practitioner to be reflective about all interactions with her clients, with the intention of increasing self-awareness by challenging assumptions.

The Ex-PLISSIT model helps practitioners with a framework to help them identify their role in the assessment and conceptualisation of an individual’s sexual well-being needs; not all practitioners are equipped to work with all clients' issues. The model also highlights that not all clients need to experience each of these levels to resolve their situation.

In order to help Sarah and John, their sexologist would have taken a thorough sexual history for them both, and worked with them to understand their sexual difficulties. It seems likely that they were reinforcing each other’s experiences and unknowingly contributing to each other’s anxiety about sex.

With John, the sexologist would have focused on his “performance anxiety”. They would help both Sarah and him recognise and manage any unwanted thoughts, and help them to be more mindful during their sexual experiences.

Sexologists are specialists in human sexuality and hold specific knowledge and skills. They study people’s sexual behaviours, feelings and interactions, and assist them to reconcile any issues they have about their sexual experiences, with the aim of improving their lives.

Matt Tilley is an academic in the Department of Sexology at Curtin University, and runs private practice as a Clinical Sexologist and Clinical Psychologist. He is a Director for the Society of Australian Sexologists Ltd. and the WA Branch President.