SUMMARY :
Various recent events have stressed the issue of medical ethics: the publication in December 2000 by the National Council of Medical Doctors of a report "Medical practice and sexuality" (of which the complete text is accessible on Internet on the website of the Ordre des Médecins) and the wide reporting by the press of complaints against sexologists of sexual abuse.
It appears essential to re-define the limits of what is allowed and what is forbidden in sexology as in therapy. Of course this has already been fully and precisely discussed in the past, but the subject deserves all our attention and the report of the commission of ethics, written by Nadine Grafeille in this same magazine, also referred to it.
In addition, the appearance of health sites on the Internet, (where much is made of sexuality in order to attract Net surfers), where sexologists¹ advice is proffered directly even on "chat lines", raises [deontological?] aspects that we cannot ignore. This is without mentioning those so-called "sexological sites", each one more eccentric or inaccurate than the last, which regular Net users have seen to multiply.
Our personal involvement must not let us forget that the serious nature of our area of practice is less transparent to non-sexologists. Particularly as the name "sexologist" is unprotected and anyone may appropriate the title without any specific training.
Medical sexology is now becoming officially recognized, so it is an appropriate moment to clarify and make known that which sexology and sextherapy are intended to cover so as to avoid confusion which would cast a slur upon the whole profession.
The assumption of responsibility in sexology is based upon the great confidence of the patient in the therapist. Reaching areas of psychic and somatic intimacy and individual and marital intimacy achieves a kind of sexual intimacy, but it is of very different order than that which occurs in sexual or loving relationships..
It is no paradox to say that sex belongs to a forbidden area. It is here said. In a therapeutic session it is spoken, questioned, listened to, explained, dramatized, liberated in words and fantasies, but it is never "acted upon". And if doctors of sexology sometimes are led to undress their patients to examine for evidence of a physical anomaly, it is solely for the purpose of evaluation rather than to cause a sexual frisson in the sexologist¹s office. Health professionals are invested with a power by the nature of their work. It is for them to be the guarantors for their acts and not for patients to call those acts into question or to refuse to comply. To take advantage of the credulity of the patient would be to "solve" the problem by ignoring it instead of understanding and resolving it. Sensitivity and clear recognition rather than avoidance is the first step towards facing it and dealing with it. It is not a case of judging or condemning but of understanding and solving. A session listening to the reactions of counter-transference and counter-resistance, is often advantageous to the therapist who may have lost his bearings.
Medical practice is sometimes exposed to physical contact with sexual connotations (pelvic, breasts...) on unclothed patients. It is therefore a difficult exercise for the physician, and more so for the sexologist, to succeed in not adopting the ambiguous attitudes contained in certain gestures of examination or physical therapy. Fundamentally, that which characterizes the abuse is not the touch itself but the meaning behind it and its intention to provoke excitement. The act of sex, likened to an abuse of power, is an acting out and is dangerous to the continuation of therapy. The sexologist must not at any time yield to any kind of seduction from a patient, nor to their own sexual instincts towards them
Sexology goes beyond the strict field of psychotherapy, where nakedness and touch are not involved. If the sexologist is a medical doctor he is authorized, or even is obliged, to examine the genital areas to eliminate a physical cause. The act of sex can thus camouflage itself behind an allegedly justified medical gesture, which can confuse the patient. Should examination therefore be prohibited? To those who would be tempted to make this choice it is necessary to point out the need to continue research on sexual function, because it is this which has allowed sexology to exist.
Within the framework of defending the profession of sexologist, the SNMS is committed to the Council of the Order of physicians to establish a charter of ethics, drawn up by all of the learned societies. This common charter, accompanied by recommendations on sexological practice, would make it possible on the one hand to take into account the specific needs of this discipline and on the other hand to guarantee the personal commitment of the graduate sexologists having signed it.