Integrating sexuality into gynaecological consultations: gynaecologists' perspectives

Abstract

There are currently few studies exploring doctors' personal perspectives on integrating sexuality into medical consultations. This study focuses on the views of gynaecologists on introducing, or not introducing, sexuality into their work. A total of 30 semi-structured interviews were conducted with gynaecologists in the French-speaking part of Switzerland. The thematic content analysis and computer-assisted lexical analysis (Alceste) on the interview transcripts highlighted four categories: perceptions and description of sexuality, patient's sexological history, training in sexology and perceived difficulties. It is observed that, above all, the ‘medical dimension’ characterises gynaecologists' perceptions. Of greater interest is our observation of disparities in gynaecologists' discussion of their practice, which is often the product of lay knowledge based on common sense and/or personal experience. Finally, the decision to integrate questions relating to sexuality seems to depend on non-medical factors such as the personal experience, interest or gender of the doctor.

À ce jour, peu d'études explorent les opinions personnelles des médecins sur l'intégration de la sexualité à leurs consultations. Cette étude examine comment les gynécologues se positionnent par rapport à l'introduction de la sexualité dans leur pratique médicale. 30 entretiens semi-structurés ont été conduits avec des gynécologues exerçant en Suisse francophone. L'analyse de contenu thématique et l'analyse lexicale assistée par ordinateur (logiciel Alceste) de la transcription des entretiens a fait émerger quatre catégories: les perceptions et les descriptions de la sexualité, l'histoire sexologique des patientes, les formations en sexologie et les difficultés perçues. L'étude révèle que par-dessus tout, la « dimension médicale » caractérise les perceptions des gynécologues. Plus intéressante est notre observation des disparités émergeant des discours des gynécologues sur leurs pratiques - qui est souvent le produit d'un savoir profane fondé sur le bon sens et/ou l'expérience personnelle. Enfin, la décision d'intégrer des questions relatives à la sexualité à leurs pratiques semble dépendre de facteurs non-médicaux tels que l'expérience ou l'intérêt personnels, ou le genre du médecin.

Actualmente, existen pocos estudios que analizan las opiniones personales de los médicos en relación a la integración de la sexualidad en sus consultas médicas. El presente estudio se centra en las opiniones de ginecólogos respecto a la introducción (o no introducción) de la sexualidad en su trabajo. Para ello, se realizaron 30 entrevistas semiestructuradas a ginecólogos de la región de habla francesa de Suiza. Tanto el análisis del contenido temático como el análisis computarizado del léxico (Alceste) de las entrevistas transcritas resaltaron cuatro categorías: percepciones y descripción de sexualidad, historia sexológica del paciente, formación en sexología y dificultades percibidas. Se observó que las percepciones de los ginecólogos son caracterizadas, sobre todo, por la “dimensión médica”. De mayor interés aún es la observación que las autoras realizan acerca de las disparidades existentes en la descripción que hacen los ginecólogos de su práctica médica, la cual a menudo es el resultado de conocimientos legos basados en el sentido común y/o en la experiencia personal. Por último, se constata que la decisión de integrar preguntas sobre la sexualidad parece depender de factores no médicos como la experiencia personal, el interés o el género del médico.

Keywords:

• gynaecologist
• sexuality
• perceptions
• practice
• Switzerland

Notes

^1. These studies do not define what women mean by sexuality or the themes to which they refer to (couple relationship, erotic fantasy and contraception).

^2. See http://www.unil.ch/cerpsa/page29553.html

^3. Thus, 6 out of 30 interviewed gynaecologists were trained in sexology. It is interesting to observe that their double specialisation was not specified in the directory.

^4. The acronym Alceste stands for Analyse des Lexèmes Co-occurrents dans les Enoncés Simples d'un Texte (translated as ‘Analysis of Co-occurring Lexemes in the Simple Wording of a Text’).

^5. Note that an independent inductive analysis was conducted one year ago by researcher CB on the 23 interviews addressing sexuality in a broader manner with less specific, but comparable, results.

^6. ‘Forms’ refers to words that correlated with their respective class.

^7. For our analysis, we retained only the words with χ² greater than 10.

^8. The Alceste software uses the terminology ‘elementary context units’ (ECUs). It consists of the most representative verbatim vocabulary of each of the classes.

^9. The Alceste analysis confirmed this result, as indicated by the χ² characteristic of the words associated with Class 2a: ‘check-up’ (91), ‘annual’ (83), ‘contraception’ (63).

^10. Basson's model of women's sexual response is circular in design, which allows for the overlapping of sexual phases, as well as variability of sequences. In this model, women's motivations for initiating or accepting sexual intercourse are much more complex than the simple presence or absence of sexual desire defined as sexual thoughts or fantasies. Some examples of motivations are: a desire to express love and to become closer to her partner, to receive and share physical pleasure or improve her own well-being and self-image (to feel attractive, feminine, or reduce feelings of anxiety) etc.

^11. Sexological consultations generally take place at the end of the day or in an afternoon specifically designed for these kinds of issues and last two or three times longer than gynaecological consultations.

^12. Alceste confirmed the two viewpoints highlighted by traditional TCA as indicated by the χ2 of the words associated with class 2b: ‘open’ (14), ‘request’ (16), ‘rapid’ (20). Alceste acts on lemmatisation, with the form ‘open’ referring to the manner of openness that we have described.

^13. The Alceste results confirm this result, as indicated by the χ²characteristic words of class 2b: ‘pain’ (40), ‘period’ (53), ‘cycle’ (37).

^14. Ruth Westheimer, born June 4, 1928, is a German-American sexologist with vast media coverage. She is popularly known as Dr Ruth.