From adolescence onwards, the need for sexual health is particularly important. Yet information and healthcare services are limited, often leaving patients in distress and subject to misconceptions. What are the specific issues related to sexuality in adolescence, middle age and beyond? The French edition of Medscape interviewed Carol Burté, MD, a sexual medicine specialist from Monaco.
Medscape: As for young people: what about sex education in schools?
Farmer: The 2018 French law specifies that at least three annual sessions must be devoted to sex education in primary school, middle school and high school.
In practice, this is not always the case and interventions are strongly focused on prevention and rules. Sexuality is almost always missing from the program. Sexuality means: what does it mean to have desire? How does pleasure work? At what age do we have sex? etc. Young people receive prevention advice, but the link with sexuality is not made.
Sexuality remains taboo. You know, like in books: “They got married and had a lot of kids…” End of story, that’s all we know (laughs).
Medscape: And do doctors adequately address adolescent sexual health problems outside the school environment?
Seldom. I understand that a GP has little time, but if he has questions, they can still contact the young person. They can refer them to someone or give reading advice. When it comes to sex education on the Internet, there are many well-made websites, such as those of the National Education System.
It is also important to give young people lifestyle advice to combat obesity, sedentary behavior, etc., by explaining to them that these factors can later lead to sexual disorders and infertility.
Another very important point: there is inequality between boys and girls, but this time to the disadvantage of boys. We have a sexual health consultation especially for young girls because of the pill, but no one examines the boys. However, testicular cancer or undescended testicles can occur. I think we really need to change things and set up a clinical trial for adolescent boys.
Medscape: More and more young people identify as asexual. What do you think of this?
Burte: People who identify as asexual represent approximately 1% of the population. These are individuals who are not attracted to having sexual relations with anyone. This does not prevent them from having a boyfriend, a girlfriend, masturbating, etc. Sexual intercourse does not interest them. These young people often say that they have done it all. They have seen many images, seen sexuality as gymnastics with all the positions and tricks. They are bored. When you are confronted with an image that provides a very strong and rapid stimulation, human relationships seem much more difficult, because you will obviously never reproduce that sensation when you are with your partner with whom you need to connect. The relationship is no longer emotional and shared. Yet sexuality is emotional, relational and intellectual.
I think people go through phases. At some point they feel asexual, but they can change their minds and think differently when they have real encounters; encounters that become increasingly difficult. Today we are witnessing a loss of confidence. Young people, but also others, want to protect themselves against everything, especially against falling in love, and not enter into a relationship again because it is restrictive.
Medscape: Data shows that young people are being exposed to pornography at increasingly younger ages. Is this a problem for their future sexuality?
Burte: Exposure to pornography at a young age, around the age of eleven, has only become a reality in the past decade. It’s too early to say what impact this will have on their sexuality. When examining the literature on this subject, some publications show that the consequences for children can be dramatic. Others show that children can distinguish between reality and fantasy.
Whenever I see young people in consultation, I ask them whether they feel pornography has helped or hindered them, whether it is the cause of the problem they are facing. I would say that, apart from those who have viewed pornography under duress, which is on the order of violence, pornography does not seem to be a problem. It can even provide certain knowledge.
Medscape website: What about sexual violence among children? What are the consequences?
Burte: In sexual medicine, this is one of the questions we ask systematically, because it is very common. It’s important to keep in mind that this doesn’t just affect girls; Boys are also sexually abused. The consequences are dramatic in terms of psychosexual development. Every case is different.
Medscape: On the other side of life, is it “normal” to have sexual dysfunction at a certain age? Should we accept it?
Farmer: When it comes to sexuality, people have many misconceptions and beliefs that are conveyed through the media and the internet. One is that we believe that because we grow older, we cannot have true sexuality. Sexuality slows down with age, as all sensitivities diminish, but desire is something that is present throughout life. Yet seniors are rarely questioned by the media about their sexual health.
Note that elderly people in institutions face an additional obstacle: lack of privacy. Is this normal? Sexuality releases endorphins, oxytocin, it is well-being that costs nothing. It is something that must be prescribed!
Medscape: Chronic illnesses and disabilities that become more common with age – aren’t these inevitable obstacles to a fulfilling sexuality?
Burte: It is possible to have a sexual life regardless of the illness one has: cancer, diabetes, rheumatic diseases – regardless of the disability.
A collaboration with the National Cancer Institute on maintaining sexual health after cancer, in which I participated, shows that people are extremely demanding of care and that, unfortunately, this care is still very inadequate, even in the case of prostate cancer, for example. it should be clear.
Medscape: But growing older itself brings challenges when it comes to sexuality.
Burte: Yes, the consequences of low testosterone levels are known in men. That’s why we need to stop thinking that men don’t have their ‘menopause’. Men often have a testosterone deficiency after a certain age. This is very annoying because they have many symptoms that are really unpleasant and yet can be corrected by completely reliable treatments.
Men are very uninformed on this subject. We talk about gender inequality, but in this area, a young woman having her first period knows full well that one day she will go through menopause, but a boy has no idea that one day he will have hormone problems.
Medscape website: Is it therefore important to interview men over 50?
Yes. Faced with sexual symptoms or simply fatigue, or in people who are a little depressed, investigating a testosterone deficiency should be among the reflexes.
And if you ask a man in general: “How are things going from a sexual point of view”, and he answers that everything is going well, it means that he has good arteries, good veins, a good nervous system, enough hormones, and psychologically everything is going quite well Good. Conversely, erectile dysfunction can be one of the first symptoms of cardiovascular pathologies.
After a certain age, there is no test that provides as much information about people’s health as this question about sexual health.
Medscape: On their side: Are women better cared for during menopause?
Burte: Yes, but women still have no explanation. I work in sexual medicine and in my consultations I see women who come just to get information about menopause.
Women should know that menopause is a turning point in life because they will spend 30% to 40% of their lives without hormones.
It is important to explain that it is indeed not the same after menopause, without treatment. There are genital and urinary, psychological, sexual and skin consequences. It is important to provide real data on the influence of hormonal treatments. Today, the hormone scare is not over yet. I think we need to rehabilitate treatment and care for women.
Medscape: So we must not forget men and women.
Burte: Yes. It is also very important to take a perspective not only for the individual, but also for the couple. If you treat a man with testosterone, he will be in top shape after 3 months. However, if the couple has long been accustomed to a limited sexual life and the woman is not supported by her side, the couple will become unbalanced. The couple is concerned with controlling the hormonal changes of both.
Medscape: Sexual medicine is essential, yet it seems inaccessible.
Burte: There are very few specialists in the field of sexual medicine, because there is no legal regulation for this. This consultation takes a long time, but is not appreciated. Who wants to commit to this?
If there were reimbursement for sexual medicine consultations at the age of 15, during menopause and for men around the age of 50, this would change the mentality. Sexual medicine must be integrated into medicine. It should also be noted that not all sexologists are doctors.
Some people are very well educated through universities, and others are not. Ideally, someone with a sexual disorder should first have a sexual medicine consultation to understand the situation. The doctor can then refer the patient to a competent sexologist, because we work in a network.
Burté has no conflicts of interest regarding this topic.
This story has been translated from the Medscape French edition using various editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
.jpg)
