Pablo Fernández: "Sexuality is lived as a competition to do well".

Psychologist and sexologist Pablo Fernandez, from the Devidamente center, talks to us about sexology.

Sexology is a discipline that studies and intervenes in one of the most taboo areas of life. In part, it is precisely for this reason that many people do not consider seeking professional help from sexologists, even if they need it. Lack of knowledge means that this option does not "come to mind".

To clarify what are the types of problems that can be treated and overcome through sexology, on this occasion we talked to an expert on the subject: Pablo Fernández Álvarez, from the Devidamente psychology and sexology center..

Interview with Pablo Fernández Álvarez: when should we go to the sexologist?

Pablo Fernández Álvarez is a psychologist and sexologist with more than 20 years of experience treating patients, and a member of the Devidamente therapy center, located in Madrid. In this interview he talks to us about the type of problems and needs that constitute a reason to go to sexology professionals.

Is it usually difficult to know when to go to a sexologist in cases where there is no medical problem related to sexuality?

Yes, a resounding yes. But in addition to it being common to know or not to know when to go to the sexologist, which in fact we can understand as something completely normal and understandable since no one has to know what the figure of the sexologist implies or what problems or disorders he/she treats, what we find is that at the beginning it is common not to know how to define whether or not one has a sexual problem/disorder.

Although it may seem otherwise, there is a great lack of knowledge and much misinformation about sexuality and it continues to be a taboo subject.

Every day it is more evident that sexuality is lived as a competition to "do it right" or meet certain standards of performance, which in itself is the source of many of the disorders we encounter.

Moreover, as it is an area that is usually kept in silence, it is difficult to have references that help to define whether one has a disorder that can be treated.

What is the main idea to take into account as a criterion to know if it is time to go to a sexology professional?

The main idea, the central idea, is none other than: if you experience physical, emotional and/or psychological discomfort in response to some aspect of your sexual life that may not be working "as" expected, whatever it may be, it is time to see a sexology professional.

What at first may be an "anecdote", "a peculiarity" that "would be solved with time", becomes a barrier that affects not only sexual relations, but often leads to a decrease in self-esteem, anxiety about the possibility of sexual relations, low mood...

What are the most common problems treated in sex therapy?

We are finding more and more cases/disorders of Low Sexual Desire, both in men and women. This is very much related to lifestyle.

Another common problem is vaginismus and/or Pain in sexual intercourse in the case of women.

Erectile dysfunction and premature ejaculation are equally high incidence and common disorders, although the emergence and proliferation of testosterone hormonal treatment centers are causing many men to opt for an immediate solution that, without parallel psychological treatment/addressing, has a very high relapse rate.

How are sex therapy and psychotherapy related and do they overlap a lot?

Excellent question. Sex therapy and psychotherapy are totally related. It is not a question of overlapping, we have to think that we treat people, and that what happens is that on many occasions people's coping styles, fears, emotional management, relationship management, certain learning, experiences or past events..., derive, affect or are channeled into maladaptive or unhealthy sexual patterns.

In this sense, in practically 100% of the cases, together with the exclusive sexual techniques for the treatment of the different sexual disorders, it is necessary to address how sexual life is faced, with what demands, with what objectives, with what fears, and this is what we would call psychotherapy.

What are the problems that people do not usually associate with the field of sexology, and yet which can be addressed by it?

A delicate question, which must be approached and treated with care and rigor, has to do with what is understood as a problem, and above all, who understands it as a problem.

Often difficulties in reaching orgasm or having fully satisfying sexual relations tend to be normalized, interpreted as "well, we do not all respond in the same way", "sex is not that important for me".... Evidently, this is where the above comments become relevant, since individual differences do exist and must be rigorously evaluated.

Who determines the standard degree of pleasure and who establishes the relevance and importance that sexuality should have in a person's life? It is undoubtedly an important facet of a person's health and well-being, so it should be approached naturally and evaluated carefully.

Another issue for which it usually takes a long time to seek help, has to do with the level of sexual desire. This is mainly highlighted when living as a couple and there are differences in the demand, interest and desire for sexual relations. It is usual to enter into reproaches, force situations, reactions of loss of self-esteem for "not feeling desired". Many relationships would not have broken up, or would have found a healthy balance in their sexual life, if they had sought help from a sexology professional.

On the other hand, fears, misinformation, taboos around sex and sexuality, are aspects that if they were addressed naturally and if they went to a sexologist, many future problems around sex life would be avoided.

As a sexology professional, what techniques do you find most useful?

All techniques are useful, but if we have to highlight some, I would choose the following.

Working the paradoxical effect: some sexual disorders such as erectile dysfunction, some pain conditions (dyspareunia), and some cases of acquired and situational hypoactive sexual desire, among others, share the common denominator of living sexual relations with very relevant levels of demand with respect to their sexual performance. Therefore, the prohibition of sexual intercourse, in itself, by reducing this demand, provokes a paradoxical response that helps and allows to approach an effective treatment.

The Stop-Start Technique is also useful for the treatment of Premature Ejaculation.

Sensory Focusing consists of learning to focus attention on one's own sensations; it is an essential resource to train in most sexual disorders.

Systematic Desensitization for the treatment of vaginismus, along with training of the pubococcygeal/perineal musculature, with the Kegel exercise program, are widely used because they are effective. And also fantasy training and self-exploration.

Assertiveness training, which allows learning to say no and to express what you want and what you like and what excites you in sexual relations, is in many cases tremendously necessary and useful. In the same way, working and training in relaxation techniques is equally useful in many cases.

This is to highlight some of the most "frequent" techniques.