La profession de sexologue en Europe : diversité et perspectives communes

The Euro-Sexo study was conducted in seven European countries (Denmark, Finland, France, Italy, Norway, United Kingdom and Sweden) using a protocol first developed in France in 1999. The objective of this survey was to define sexologists as a professional group, and in terms of their social and demographic characteristics, their level of training in sexology, the conditions under which they practice and their professional identity. The results of the survey showed that the number of sexologists per million inhabitants varies enormously from one country to another (fewer in the South of Europe and significantly more in Finland). Most sexologists are health practitioners (but not physicians), and mainly women, except in France, which is the exception. Nurses, midwives, marital counsellors and to a lesser extent psychologists are the most commonly represented professions, but the extent varies according to the country. Most sexologists working in Europe are not physicians. More than two-thirds of sexologists (particularly the non-physicians) have been trained in sexology and/or human sexuality. For a majority of respondents to the questionnaire, sexology represents less than 25% of their professional activities and (with the exception of France and Denmark) most of them do not call themselves either sexologists or sex therapists. The diversity of the professional profiles observed in the different countries raises questions concerning the status of this profession: is it a fully-fledged profession in itself, or rather a specialization within the framework of mainstream health professions?     

Sexology as a profession in France

A national survey of sexologists was carried out in France in 1998–1999, among the individuals listed in the professional directories and the telephone book as sexologists. It described the sociodemographic characteristics of sexologists, their initial profession and training in sexology, sex therapy and psychotherapeutic techniques, and how they practice sexology. A total of 959 individuals were identified and surveyed. The response rate was 63%. Two thirds of the sexologists were physicians and 60% were men. French sexologists appeared to be segmented into three subgroups: (1) one-third were general practitioners, trained in sexology and psychotherapeutic approaches, recognized themselves as sexologists, and devoted 40% of their professional activity to sexology. Men were about two thirds of this group; (2) one-third were nonphysicians (including psychologists and other health professionals, such as social workers and nurses), recognized themselves as sex therapists and devoted one third of their time to sexology. Men and women were equally represented in this group; (3) one-third were specialists, with less training in sexology and psychotherapeutic techniques, and did not generally recognize themselves as sexologists. They devoted a lesser part of their time to sexology and had academic and hospital practice. Men comprised more than 75% of this group. This study raised the issue of the diversity of primary professions involved in the field of sexology and showed that sexology is a secondary professional choice for the majority of sexologists.     

Danish sexologists—who are they and what are they doing?

The aim of the study was to describe the professional group of individuals working as sexologists in Denmark and to describe their training and professional activity. The study was performed as part of a European survey on sexology as a profession. Questionnaires were mailed to members of the Danish Association for Clinical Sexology (DACS) and other sexologists identified from the “yellow pages” of the Danish telephone directory. 215 questionnaires were mailed overall and 129 were returned. Of these 48% were physicians and 19% were psychologists. 42% were men. The mean age was 53.4 years (S.D. 7.6). Three-quarter of the respondents were living with a partner, and 90% had children. Most worked part time in sexology, only 11% nearly full time. The majority had personal experience of supervision and personal psychotherapy. The most frequently presented problems in the physicians practice were emotional and relational problems and erectile dysfunction for men, and emotional and relational problems and low desire for women. The non-physicians treated fewer males with erectile dysfunction, fewer females with dyspareunia but more victims of sexual abuse. More than half of the non-physicians considered that the etiologies of sexual disorders were predominantly psychologically grounded in both genders, whereas less than 25% of the physicians shared this opinion. Most Danish sexologists including physicians have some training in psychotherapy and sexology. There are some differences between the patient groups treated by physicians and non-physicians.     

Swedish clinical sexologists. Who are they? Who do they treat?

The objectives of this national survey of clinically working Swedish sexologists were to identify (1) their educational background, and (2) the types of sexual problems they see in their practice. The investigation is part of a comparative pluri-country survey of European sexology. With a response rate of 80%, 157 answered a multi-item mailed questionnaire, and 143 of these (91%) were active in clinical sexology. A minority (24%) of these were physicians, 36% were categorized as therapists/counsellors while the remaining 40% were nurses or midwifes. The recruitment (graduate) background of Swedish sexologist and their distribution upon gender (78% women, 22% men) differ considerably from those in France and to some extent from those in the UK. The number of Swedish sexologists per million inhabitants is low, but is near those observed in France and UK. Moreover, only a minority—about 25%—devoted 75% or more of their working time to sexological practice. The three different groups of sexologists differed considerably in several aspects concerning basic therapeutic competence, age of their clientele and the sexual problems treated. It can be concluded that not only are there marked inter-European differences in the educational background of sexologists; but also within Sweden important differences in sexologists' education, training and clinical practice. Is, “sexologist” a profession or a label?     

La professionnalisation de la sexologie au Québec

The process of professionalization of sexology in Quebec is analysed using the framework of sociology of professions. The elaboration and coordination of the practice of sexology are presented through six strategic steps: the identification of new sexual needs, the creation of sexology as a new branch of knowledge, the institutionalisation of sexology, the professional training of sexologists, the acquisition of a social reconnaissance, and the formation of a professional identity and autonomy. According to the interactionist approach, sexology built itself through the interactions bound between sexologists and concerned persons (namely the members of the university and the users of sexology services). The acquisition of graduate autonomy and the development of a professional organization allows one to assume that the above mentioned sexology strategies have succeeded, but the professionalization of sexology has not yet been accomplished.     

Characteristics of the sexology profession in Finland in the beginning of 2000s

Training clinical sexologists, sex therapists and sexual counsellors has improved a lot in Finland in the last 10 years. An important boost for this development was the common Nordic training and authorization program for sexologists in the late 1990s. The number of trained professionals has, since then, reached higher levels than ever before. However, few trainees have been able to realize their knowledge and skills of sexology and sexual issues requiring as a full-time commitment. Sexology is still mostly a part-time professional interest. Keeping this in mind, it was not surprising that most of the trained professionals (57%) did not have a distinct sexological professional identity. Nursing professionals, of which two thirds considered themselves as sexual counsellors, showed the strongest sexological identity. The sampling of the respondents in Finland was extended especially to those persons who were known to have participated in some sexological training. One of the consequences of this sampling approach was that only every second respondent had ever been practising clinical sexology. On the other hand, there was a lot of variation in the activities including professional sexological issues. Many trainees were partially devoted to providing sexual counselling, sexological training and teaching, and sex education. They also often utilized their expertise in the public media. Due to their high numbers the nursing professionals had taken over sexology in Finland since the 1990s. They had had the highest motivation to cultivate their expertise in sexology. These professionals were usually working usually in the public health care. In order to fully apply their sexological knowledge and skills, they need positions where they can better make use of their expertise.     

Sexology as a challenge to the health care system: the Norwegian version

Medical doctors and psychologist represent the largest groups of professionals working with sexological problems in Norway, with one third each. The last third consists of different health and educational professionals. Forty-three percent reported that they have undergone some training programs in sexology. This is the lowest educational level in all the countries surveyed in the context of the “Euro-Sexo” study. Seventy-one percent declared that they have had individual supervision and 49% had group supervision in sexology. 93.2% are in clinical practice, but for most of them, this is a minor part of their professional activity. Seventy-one percent reported that sexological activity represents less than 25% of their professional time. Gender differences are minor. Three percent work with sexology full time, all of these are women, and none are medical doctors. Not surprisingly, problems with orgasm (42.95) and sexual desire (60.7%) are among the most frequent problems presented among female clients, while erectile dysfunction (47.3%) is the most frequent problem among male clients. Emotional problems in the couple relationship is among the most frequent problem reported, 35% among male and 63% among female clients. The respondents also reported problems related to sexual violence or abuse, 18.1% among male and 42.9% among female clients. Thirty percent reported genital pain among their female clients. Sexological problems represent a substantial area of the clinical work for many therapists. Medical doctors represent an important part of the therapeutic field, while sexology is a less than a minor part of medical education, both pre and post graduate. Psychotherapy was reported as the most frequent treatment used by sexologists.     

Professional and clinical differences amongst clinicians dealing with sexual problems in the United Kingdom

The varied practices of physicians, psychologists, nurses and therapists were recorded as part of a collaboration between seven European countries. This paper describes sexual and relationship problems presented by patients to UK clinicians working in the field of human sexuality. Differences in the professional groups and approaches towards treating these problems by physicians and non-physicians are reported and discussed. The majority of clinicians working in human sexuality within the United Kingdom are female non-physicians. Nurses and marital counsellors were the largest professional group within the multidisciplinary profession of sexology working in the United Kingdom. Fewer UK clinicians have undergone training in sexology that their European counterparts and only 46% of clinicians working in the field describe themselves as a sexologist or sex therapist. The vast majority of clinicians did not devote more than a quarter of their work time to sexual problems and sexual dysfunction.     

Sexualwissenschaft und gesundheitswissenschaften

Sexology as a science in its own right originated in Berlin early in our century, and, since 1975, the WHO has considered it important for the training of health professionals. The respective WHO recommendations have, in part, been followed in several European countries, but not at all in Germany. The article discusses the major methodological problems in sexology and describes the potential positive contributions of sexology to public health.     

Italian forum of Europa Donna: a survey of breast cancer associations

Europa Donna is the first European woman's movement against breast cancer. It is a coalition of breast cancer associations and individual women and is active in 20 nations. Europa Donna is not intended to replace existing organizations. Rather, it provides a focus for the exchange of information and experiences between members and serves as a moving force for combined action. It promotes public awareness of breast cancer, advances in research and good clinical practice. In Italy there are more than 200 active breast cancer associations. The Italian forum of Europa Donna was formed in 1996. Between June and September 1996 a postal survey was conducted to research the characteristics and activities of the various breast cancer associations in Italy in order to help, inform and promote future initiatives of the Italian forum of Europa Donna. A total of 213 breast cancer associations were sent a postal questionnaire. Ninety-five of them (44.6%) participated in the survey. The results show that the breast cancer associations in Italy vary markedly in terms of their structure and organization. The associations perceive a variety of deficiencies in the prevention, diagnosis and treatment of breast cancer within the Italian National Health Service and they offer a wide range of services themselves. Their views of the relevance of the 10 goals of Europa Donna vary. In this paper, we discuss the implications of the low rate of participation in the survey and the heterogeneity of the breast cancer associations' structures, activities and views for the future activities of the Italian forum of Europa Donna.     

Une histoire de l'éducation sexuelle en France : une médicalisation progressive de la sexualité (1945–1980)

Sex education takes place in a broader historical process, in which, in the seventies, French sexologists became famous, in the course of the renewal of French sexology: at the time, the use of contraception became widespread, abortion was liberalized and the works of two major American sexologists, Masters and Johnson became famous. This article traces the history of sex education in France since 1945. During the first significant period, physicians, pedagogues, and psychologists were united to decry teenagers' sexual manifestations (masturbation and sexual intercourse). Their argumentation was based on a Christian inspired morality and on prevention against venereal diseases (sexually transmitted infections). During a second period psychoanalysts and psycho-pedagogues put forward the notion of psychosexual development to justify the need for limiting adolescent masturbation and sexual intercourse. Eventually, the emergence of sexologists in this field in the mid-seventies was marked by more liberal attitudes towards masturbation. They continued using the psycho-sexual argumentation to postpone teenage access to sexual intercourse. These sexologists' positions gave way to a great public debate opposing traditional morality proponents and those who were engaged in the sexual liberation process. The paper opens a discussion about the relations between normative arguments based on science (and on psychology) and sexual morality.     

Organ transplantation in Italy: Analysis of donors and recipients

The Istituto Superiore di Sanità (The Italian National Institute of Health) has been collecting information regarding organ donation and transplantation in Italy. Herein we describe organ procurement and transplant activity in Italy in the years 1992–1997 and show some of the characteristics regarding both donors and transplanted patients who received kidneys, hearts, livers and lungs. Although transplantation in Italy has been very difficult because of shortage of organ donors, national rates have been improving year after year. The present situation should ameliorate further to enable Italy to reach the same level of other advanced European countries.     

Trends in socioeconomic inequalities in self-assessed health in 10 European countries

BACKGROUND: Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries. METHODS: Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than 'good' was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs). RESULTS: Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase. CONCLUSIONS: The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.     

Three crises facing sexology

Three crises facing sexology are described: what is happening with sexuality in the culture, what is happening with sexuality in academia, and what is happening with sexuality in medicine. In each case, the response of sexology has been benign neglect, disinterest, and a failure to understand the profound implications of these challenges for a field that considers itself the premiere source of accurate facts and comprehensive theories about sexuality. As a consequence we are losing control of our subject matter, and we are losing our professional legitimacy. A wake-up call is offered for sexologists to become more knowledgeable, for our paradigms and organizations to become more inclusive, and for our research methods to become more sophisticated.This paper, slightly modified, was originally delivered as the Presidential Address to the International Academy of Sex Research, June 1993, Asilomar Conference Center, Pacific Grove, California.     

SIBIL: an information tool for the information retrieval on bioethics

The article describes the main features of the website SIBIL (Sistema Informativo per la Bioetica In Linea) implemented within the framework of a research project of the ISS for collecting, indexing and disseminating Italian literature on bioethics since 1995 through an integrated electronic system. The site, addressed to a wide range of people interested at different degrees and levels in bioethics, offers a comprehensive overview of the activities, such as courses and meetings, on the major ethical issues at stake in Italy, as well as a survey of the most important activities both at national and international level. The main feature of SIBIL is a database of a large collection of documents retrieved through sources or exploitation of the most important international electronic databases. A thesaurus of 1,600 terms, available in Italian and English, was created in order to organize documents with standardized criteria currently adopted in the Italian scientific environment. Future trends of the website are also discussed for sharing experiences with other countries and laying the basis for a European portal on bioethics.     

Health Status in Immigrants and Native Early Adolescents in Italy

The aim of the study was to compare health status between native and immigrant early adolescents in Italy and to analyze related psychosocial factors. Data were taken from “Health Behavior in School Aged Children”, a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. A representative sample of 6,744 (50.4% males) Italian students (11, 13 and 15-years-old) completed a questionnaire. Students were assessed for demographics characteristics, socio-economic conditions, social support and bullying victimization, and, as dependent variables, for health complaints, self-reported health, life satisfaction and happiness. It turned out that immigrant adolescents, as compared to natives, are more often affected by psychosomatic symptoms, less satisfied about their health and about life, and less happy. A multiple regression model showed that migration itself is related to life satisfaction and happiness. Socio-economic inequalities, lack of social integration and victimization determine the differences between immigrants and natives in terms of health symptoms and self-reported health. Immigrant adolescents demonstrated worse health status then their native classmates. However, the differences in terms of subjective well-being are not explained by socio-economic differences, lack of social integration and discrimination.     

The pre-vaccination regional epidemiological landscape of measles in Italy: contact patterns, effort needed for eradication, and comparison with other regions of Europe

Background  

Strong regional heterogeneity and generally sub-optimal rates of measles vaccination in Italy have, to date, hampered attainment of WHO targets for measles elimination, and have generated the need for the new Italian National Measles Elimination Plan. Crucial to success of the plan is the identification of intervention priorities based upon a clear picture of the regional epidemiology of measles derived from the use of data to estimate basic parameters. Previous estimates of measles force of infection for Italy have appeared anomalously low. It has been argued elsewhere that this results from Italian selective under-reporting by age of cases and that the true measles force of infection in Italy is probably similar to that of other European countries. A deeper examination of the evidence for this conjecture is undertaken in the present paper.     

Molecular epidemiology of bluetongue virus serotype 1 circulating in Italy and its connection with northern Africa

Western BTV-1 emerged in the Mediterranean basin in 2006 and it has since been isolated in southern and northern European countries. Six BTV-1 strains isolated from infected sheep in Italy between 2006 and 2013 and a BTV-1 strain isolated from an infected sheep in Tunisia in 2011 were fully sequenced. The seven strains were shown to be nearly identical in each gene segment. The Seg-2 sequences of the BTV-1 strains group according to the year of isolation reflecting the time of BTV incursions in Italy. Combined results suggest that BTV-1 strains isolated in Sardinia, Sicily and mainland Italy in 2012 and 2013 have a direct northern African origin. The Italian strains originated from a strain closely related to a BTV-1 strain isolated in Tunisia in 2011. Better surveillance programs with northern and sub-Saharan African countries should be implemented making the control of spread of BTV easier and effective.     

Adolescents' attitudes to abortion in samples from Italy and Sweden

Both Italy and Sweden have legislated abortion without grounds since the 1970s but background conditions in the two countries are bipolar. The overall purpose of the present study was to investigate a sample of adolescents from Italy and Sweden regarding their attitudes towards abortion and their knowledge of family planning and to compare the results from the two countries. A questionnaire was distributed among 400 adolescents, 177 from Stockholm, Sweden and 223 from Rome and Locri, Italy. Whereas Sweden is a relatively homogeneous country. Italy has large regional differences regarding social and other aspects. For this reason two regions of Italy were studied separately. The participants were all secondary school students. The results indicated that nearly all adolescents in both countries were concerned about abortion and its consequences, although their concern was expressed differently, in accordance with their religious and cultural norms and also with their background in sexual education. The present study raises questions concerning the knowledge level as an outcome of sex education programs. In fact comparing the answers between the Italian and the Swedish samples no particular difference, in favour of the Swedish adolescents was noticed.