🔦 🩺🔍💬 Primary Care Sexology: a practical guide to better identify issues, avoid dead ends, and quickly direct to the right resources. It provides inclusive guidelines, care pathways, and resources that can be directly mobilised on the ground. #Prevention #Sexology #SexualHealth #HealthLiteracy #Inclusion #PublicHealth
📌 This guide is useful for general practitioners, midwives, physiotherapists, psychologists, nurses, and CCFs who receive sexual complaints without specialisation in sexology. It helps to ask the right questions, distinguish between organic, psychogenic, relational, and iatrogenic causes, and then direct without causing therapeutic wandering. It is also relevant for prevention actors who need to address sexuality without reducing the subject to STIs or contraception.
📜🔗LINK to the source
Since 2023, several texts and measures have reinforced the guidelines on intimate/affective life and sexual health, particularly for certain audiences (people in ESSMS, adolescents, LGBTQI+ communities, migrants, etc.).
Without rendering the guide obsolete, this justifies adding, in a future revision:
explicit references to the HAS 2025 recommendations on supporting intimate, emotional and sexual life in ESSMS; https://www.has-sante.fr/upload/docs/application/pdf/2025-02/accompagner_la_vie_intime_affective_et_sexuelle_des_personnes_en_essms._volet_1_socle_transversal_rbpp.pdf
links to recent updates from Santé publique France on sexual education and public brochures; https://www.santepubliquefrance.fr/sante-sexuelle/leducation-a-la-sexualite
1. Analytical summary
Context and issues
The document starts from a simple observation: sexual health is too often reduced to the prevention of STIs, HIV or unintended pregnancies. It reminds us that sexual disorders and dysfunctions are common, often under-evaluated, and that they do not always require medicalisation, but rather an acknowledgment of suffering and consent. The guide primarily aims to support primary care professionals who are not trained in sexology, in order to better identify complex situations. It also adopts an inclusive logic by moving away from strictly 'masculine' or 'feminine' classifications.
Operational contributions
The guide offers, for each disorder, a definition, possible causes, elements for clinical exploration, care options and recommended directions. It provides very usable benchmarks to distinguish somatic, iatrogenic, psychogenic and relational dimensions, which facilitates clinical sorting in consultation. It also offers orientation resources, directories, websites, brochures, podcasts and specialised accounts. Finally, it emphasises a posture of listening, contextualising questions and collaborating with professionals identified as safe.
2. Key points of the document
The guide aims to provide primary care providers with a framework to address sexuality, identify sexual suffering, and refer to sexology when necessary (p. 3, p. 39 to 40).
It reminds that the approach to gender, orientation, and sexual practices must be contextualised, useful for care provision, and designed to limit stereotypes and discrimination (p. 7, p. 11).
It recommends systematically searching for organic, iatrogenic, relational, and psychogenic causes in the face of a sexual complaint, rather than concluding too quickly to a single cause (p. 13).
It describes frequent and concrete consultation situations, such as dyspareunia, vaginismus, anismus, erectile dysfunction, premature ejaculation, lubrication disorders, desire disorders, and anorgasmia, with management guidelines (p. 14 to 36).
It offers a very rich directory of useful resources: professional directories, institutional resources, associations, podcasts, applications, Instagram, and books, which facilitates orientation in real practice (p. 41 to 47).
3. Local action pathways
Use the proposed inclusive anamnesis questions to open the exchange in consultation, particularly regarding sexual life, difficulties, and relational context (p. 11).
Establish a systematic identification of violence when the sexual complaint justifies it, relying on the guidelines from the dedicated chapter and on tools mentioned such as the violence meter (p. 10 to 11).
Structure a local referral circuit to gynaecologists, urologists, proctologists, midwives, physiotherapists, psychologists, and sexologists, according to the type of disorder encountered (p. 39 to 40).
Propose educational support tailored to painful disorders, vaginismus, lubrication difficulties, or orgasm disorders, to avoid wandering and reduce the anxiety of individuals (p. 15 to 19, p. 30, p. 34 to 35).
For medical-social or support teams, integrate guidelines on inclusive sexuality, trans identities, intersex individuals, and asexualities to adapt exchanges and not to presume practices or needs (p. 7 to 9, p. 16, p. 22 to 25, p. 35).
4. Additional references
🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of Affective and Sexual Education - Sexual Health ➡️🔗 https://pratiquesensante.odoo.com/4-1-education-affective-sexuelle
5. FAQ
Why was this guide written? To help professionals not trained in sexology to better identify, guide, and care for sexual suffering without reducing sexual health to the prevention of STIs (p. 3).
Should sexuality be discussed systematically in consultations? The guide recommends either systematic integration into the medical history or an opportunistic approach depending on the clinical context and the individual's request (p. 13).
What to do in the case of dyspareunia? Investigate vulvar, vaginal, and psychogenic causes, perform a gynaecological examination if relevant, then refer if the pain persists or resists treatment (p. 14 to 16).
Does vaginismus necessarily require management aimed at penetration? No, the guide emphasizes that one must start from the individual's actual request and not impose penetration if it is not their wish (p. 17 to 19).
How to address erectile dysfunction in the first line? By evaluating somatic, iatrogenic and psychogenic causes, with an appropriate clinical and biological assessment, then referring to a specialist if necessary (p. 22 to 27).
What to do in case of desire disorder? Check for organic, iatrogenic, psychological and relational causes, while reminding that the absence of desire is not a disorder in itself if it does not cause suffering (p. 31 to 32).
What orientation resources does the guide recommend? It cites directories, institutional websites, associations, applications, Instagram accounts and books to guide according to the need and the concerned audience (p. 41 to 47).
6. FALC Rewriting
Simple summary
The guide helps caregivers talk about sexuality.
It also helps to identify sexual disorders.
It explains possible causes, both simple and complex.
It provides care and orientation suggestions.
It offers an inclusive and respectful approach.
Simple key points
Sexuality is part of health.
A sexual complaint can have multiple causes.
One must seek the cause of the problem.
One must listen to the person's request.
Penetration is not mandatory to have a sexuality.
Violence must be identified when necessary.
There are many resources for guidance.
7. Cross-sectional analysis
Literacy: Yes, the document offers progressive explanations, simple definitions, and popularisation resources, which facilitates understanding for diverse audiences.
Empowerment : People are invited to express their requests, experiences, and relationship to pleasure, which strengthens their agency in clinical exchanges.
Participation : Co-construction is limited in the text, but the guide recommends involving the person in the referral letter and in the choice of intermediaries.
Community health : Yes, the collective dimension appears through self-support associations, speaking groups, and community resources.
Ethics : The text identifies normative biases related to gender, penetration, and heterosexuality, and proposes to limit them through a contextualised stance.
Human rights : The approach is generally consistent with equity and inclusion, particularly for trans, intersex, asexual individuals, and victims of violence.
Intersectorality : The document recommends links between general medicine, sexology, gynaecology, urology, proctology, physiotherapy, psychology, and health social work.
Partnership : Collaborations are presented concretely, but are not formalised in the form of protocols; the guide mainly emphasises the local referral network.
Combating discrimination : Yes, the text names the discriminations faced by marginalised populations and recommends useful, contextualised, and non-stigmatising questions.
8. Reliability of the resource
The scientific relevance is correct for a field practice guide: it relies on clinical benchmarks, known mechanisms, guidance recommendations, and several reference resources, but it is not a systematic review document. Its operational relevance is high, as it provides definitions, recommended actions, and concrete resources that can be immediately used in consultations. However, some cited resources are external and heterogeneous in their level of validation, which means they should be considered as aids to guidance and not as equivalent evidence. The publication date, April 2023, is recent for a field guide, but online resources need to be re-evaluated at the time of use.