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M. Bonierbale (MD)a, J. Waynberg (MD, PhD)b
70 years of French sexology
Abridged version. Originally published in: Sexologies 16, 2007, pp. 238–258. Published here with permission of the copyright holders. a Servie du Professeur-Lancon, CHU Sainte-Marguerite, 13274 Marseille cedex 09, France b 57, rue Charlot, 75003 Paris, France
French sexologists from the post-war period until 1968 Objective and limitations of the associative movement Emergence of university courses
A school of thought promoting positive attitudes towards a secular and decriminalising approach to sexual behaviour was slow to emerge in France, and was for a long time limited to scattered and restricted initiatives. In contrast, German-speaking countries saw the advent of a scientia sexualis from the end of the 19th century, dramatically decapitated by the Nazis in 1933. At the time, France knew nothing of this, acquired no learning and, since 1920, the intellectual sphere seemed to be occupied in jousts between the Neo-Malthusians and family groups. Concerted action to achieve a renewed and educational view of sexuality was only achieved in the 1930s, and promoters of these ideas were still constrained by a repressive legislative framework and lukewarm public opinion. In the period immediately after the war, and until 1968, some authors still linked an educational activity to short-lived associations, but it was not until 1974 that a true associative movement began, fostered by indispensable North American support and promoted by legislative measures allowing access to contraception and legalising abortion. Around twenty more years were needed before a consensus appeared as to practices, teaching and research, thus succeeding in raising awareness among regulatory authorities. From 1995, on involvement of the academic world, through the French authorities (Ordre national des médecins – National Medical Association), opened a second stage in the history of French sexology, where there was some unity in terms of the actions undertaken, but even more importantly, a period of professional certification and recognition. It is in the face of this institutional challenge, and the globalisation of new concepts of public health, that the fifth generation of French sexologists is preparing for the future. Two associations in particular have played a major role in the contemporary history of French sexology: the SFSC (French Society of Clinical Sexology) and the AIHUS (University Hospitals Sexology Association). © 2007 Elsevier Masson SAS. Tous droits réservés.
The history of French sexology in the twentieth century is inextricably linked with an unjustly underestimated and insurmountable difficulty: the Great War of 1914–1918 and its demographic consequences. After the war, 10% of the male population of child-rearing age was missing at a time when France desperately needed to restore its marriage rate. The epidemics of typhoid fever in 1915 and Spanish influenza in 1918 caused infant mortality to soar, and the birth rate collapsed. Depopulation also aggravated the effects of venereal disease and abortion, estimated at between 100,000 and 400,000 per year, compared with 60,000 in 1913. In 1939, the promulgation of the Code de lafamille by the Daladier government even further tightened the already rigid legislative framework for sexuality. There were nevertheless numerous “proto-sexologists” on the scene, from various backgrounds, but they were dispersed and their ideas did not acquire any notable following. From both a literary and a clinical point of view, France considered itself after the war to be “the eldest daughter of psychoanalysis”, and in 1927 Marie Bonaparte founded the Paris Psychoanalysis Society. As a minority, sexologists only had a limited audience. A “hygienist” approach arose during the 1930s, seeking to educate, and which was eugenicist on sexual issues, a school of thought that was first expressed with the foundation by the reformist psychiatrist Edouard Toulouse (1986-1947) of the Association for Sexological Studies in July 1931.
The non-French-speaking Western world at the time was generally “Victorian” in its attitudes: misogynist, homophobic and retrograde. In Germany, in contrast, there was an urgent and imperious struggle to respect the right to be different. Prussian law was clearly the enemy of personal liberty. Its notorious article 175 outlawing homosexuals was the motive for the organisation of a protest movement, co-ordinated by politically engaged physicians. In France, it was not until 6 August 1942 that a law was signed by Marshal Philippe Pétain defining the “offence of homosexuality” when committed with anyone less than 21 years of age. In Germany, knowledge about sex was not synonymous with mere medicalised “marriage advice”, but was an enlightened contribution to political debate. It was authors such as Albert Moll (1862-1939) and Magnus Hirschfeld (1868-1935) who moved sexology leftwards into socialist ideas, with the aim of working towards recognition of universal human rights in matters of sexuality. Hirschfeld created, in 1897, an “International League for Sexual Reform”, founded the first sexology review in 1908, the Zeitchrift für Sexualwissenschaft, and founded his Institute for Sexology in 1919 in Berlin. Albert Moll organised the first International Sexology Conference at the Reichstag in 1926, and a second in London in 1930. The Nazis tragically brought the history of this period of competitive intellectual spirit and intense creativity to an abrupt halt at its height on 6 May 1933. A brown shadow fell on sexology, and sent its champions into exile.
French sexologists from the post-war period until 1968
Public opinion had not (yet) been mobilised by the question of segregation of sexual minorities, or by the legislature’s hold on individual liberties — illustrated by the notorious law of 13 April 1946, known as the “Marthe Richard law”, which imposed closure of brothels — nor by the brutality of literary censorship — but it was mobilised by the subject of birth-control. These close links with gynaecology are characteristic of the development of the field of sexology during this initial period, which involved around ten years of militant activism. In 1956, following in the footsteps of Simone de Beauvoir, a generation of intellectuals created La Maternité Heureuse (Happy Motherhood), an association which focused its activities on women’s rights to determine their own fertility and which became, in 1960, the MFPF (French Family Planning Movement). Free access to contraception and abortion comes across a being a kind of unavoidable compensation for the role women played during the war. A page was turned from this point on, with the legislature and medical profession forced to become involved. In the vanguard of sexology, sex information is a keystone of all the reformist zeal and the associated ethics. Dr Georges Valensin (1902-1987), a pioneer of what we could call a “popular” version of sexology from after the war, was a populariser of talented practitioners and produced a considerable journalistic output. On the eve of the key date of May 1968, the general picture that can be drawn of the premises of contemporary French sexology comprises three groups: a loose conglomeration of highly motivated but isolated intellectuals — for example Hélène Michel-Wolfromm (1914-1969) and Suzanne Képès (1918-2005), who were two emblematic figures of the period — associations with religious affiliations, and finally the political organisations, which had just federated the various family planning organisations and the first provisions for sex education in schools. The Family Planning Association was the icon of this movement until June 1973, the date on which the federation took a sharp move towards radical feminism and excluded physicians from its management. From October of that year, the “dissidents” created the Institute for information and research on sexuality (IFRES) in order to “undertake a global study of the problems linked with sexuality”. Chaired by Anne-Marie Dourlen-Rollier, this new Institute stated some particularly ambitious objectives: to form a pool of qualified teachers, to organise annual conferences, to create the review Contraception, fertilité, sexualité, to manage family planning centres in hospitals, etc. In parallel, various Churches, for example Catholic Centres for Preparation for Marriage, took other initiatives. All these influences converged on a single idea, marriage counselling, which was the precursor of the humanist-inspired sexology of the following decade: the French Association of Marriage Guidance Centres (AFCCC) was created in 1961, the Research Team Liaison Centre (CLER), which was linked to the Catholic church, in 1962, and the Couples’ and Families’ Federation in 1966.
Objective and limitations of the associative movement
Enter the American cousins At the end of the 1960s sexology was thriving in English-speaking countries. April 1966 saw the legendary publication of “Human Sexual Response” by William H. Masters and Virginia E. Johnson. The book was very successful in France, by comparison to the subdued reception given to the translation of the two “Kinsey reports” in collaboration with Wardell Pomeroy and Clyde Martin: Sexual Behavior in the Human Male, published in 1948, and Sexual Behavior in the Human Female in 1953. In France, the teaching of sexology and clinical practice started in the professional associations, since the university sector turned its back on a subject, which did not seem “serious” enough for them. Some universities were in favour, but did not dare to take responsibility publicly for teaching Sexology, and delegated the task with some circumspection to the pioneers of the subject who mostly came from private practice backgrounds, and who suddenly found themselves transported to senior positions as course directors for doctorate courses, with no real experience and no status. As was the case elsewhere in the world, French sexology teaching only developed thanks to the WHO guidelines in 1974 and 1975, to promote teaching of the concept of sexual health, and is often criticised for being more of a discussion panel than a science of research into treatments. As Ludwig Fineltain, one of the pioneers of the 1970s and 1980s recalls, French sexology could be described in the following terms: dogmatic conflicts, encyclopaedism and metasexology.
Rise of professional corporatism On 17 May 1974, the French Society for Clinical Sexology was formed, under the dual influences of liberalisation of legal restrictions following 1968, and the popularity of new therapies emerging from the ideas of North American humanist psychology. Charles Gellman was the president, J. Waynberg the vice-president, G. Tordjman and G. Vallès were the secretaries and Guenkine was the treasurer. A close circle of nine people were the first board of directors: Jean Cohen, Ludwig Fineltain, Robert Gellman, Jacqueline Kahn Nathan, Michel Meignant, Emile Papiernik, Pierre Simon, Pierre Velay († 2007), and Gérard Zwang, R. Held, H. Klotz, C. Koupernik and P. Sivadon all approached the SFSC at the same time, and agreed to form the “honorary committee”. Their involvement was only brief, and following the withdrawal of their support the following year they were not replaced: this absence of university medical professionals was to profoundly affect the SFSC’s future. The SFSC’s articles of association were registered just before the 1st International Sexology Conference, which took place in Paris on 3-6 July 1974 at the Faculty of Pharmacy, avenue de l’Observatoire. This was a time of intellectual endeavour and meeting of minds, which would truly launch the association. The plan for the Paris conference emerged from the SSSS, the Society for the Scientific Study of Sex, which was founded in 1958 in New York, notably by Jack Lippes, who gave a brief welcome speech on behalf of the Society after the introductory speech by Professor Albert Netter. The choice of Paris was not just made by the French — as sexology was not yet a mature discipline in 1972, a relative of Albert Netter in New York, Robert Neuwirth, a cousin of Lucien Neuwirth, a member of the French parliament, had the idea of moving the annual meeting of the SSSS and forming an International Conference. Paris was chosen over venues in Italy because the adult gynaecology service at Necker hospital in Paris was the only such service to have a suitably high reputation, in their view. Professor Netter entrusted his assistant, Jacqueline Kahn-Nathan, a gynaecologist known for her militancy in favour of contraception and sex education, with the organisational tasks. Albert Netter showed little sympathy for the sexological approach to sexuality (and neither did the rest of the French university community). His opening speech ended with an invitation to create a university teaching programme for this “new and delicate discipline”. Despite his scepticism, he supported a teaching programme directed by Jacqueline Kahn-Nathan and Gilbert Tordjman at Necker hospital. The patronage of Minister Simone Veil, the International Federation of Obstetrics and Gynaecology, the Commissions for sex information, birth control and family information meant that this plan was fully embraced within the circles of gynaecology and family planning. The Conference’s programme was nonetheless interdisciplinary, and involved exploration of the areas that were being investigated and the treatments that were being researched at the time; the programme represents a highly documented summary of this work, already infused with the hegemonic trends from America. This meeting was not innovative; it just extended three decades of work that had been popularised by the Kinsey reports, and the writings of Masters, Richard Green and Helen Kaplan, among others.
Unity of action within the diverse associations When it returned to work in September 1974, the SFSC’s activities began again, with meetings almost every month in Paris, and with provincial professorial members who created associations affiliated to SFSC: in Bordeaux around Pierre Dallens, in Toulouse, in Tours, and in Grenoble, for example. In October the Society organised its first study trip, to New York and Philadelphia. Preparation for the globalisation of sexology was made by means of exchange visits. The SFSC organised several training trips to the United States. Gérard Vallès, a Lacanian psychoanalyst and former general practitioner — a pioneer who knew how to bring together the advantages of pragmatic adaptability and psychoanalytically inspired methodology. He became vice-president of the WAS (World Association for Sexology) — and this indicates how far medical training at the time neglected the body’s erotic capabilities and treatments for sexual disorders. The failure, or at least frustration, that professionals were feeling at the time was accentuated by the fact that newly legalised access to contraception and abortion generated new categories of treatment needs, requiring reimbursement by the national health system, for which qualitative as well as quantitative needs had to be assessed. The discovery that US treatment methods were so diverse gave rise to the hope of a true “sexological revolution”, for patients as well as for doctors — just the know-how remained to be acquired. Sexology was not, at this time, an opportunist field, and did not rely on issues dictated by profit-making organisations, but was part of a humanistic set of values. From 1976, a teaching programme was organised by the SFSC, initially for one year, but which was extended to three years, resulting in a Master’s degree in clinical sexology. Jacques Waynberg created “Sexography” in France, the first society for producing audiovisual sexological documents. This was the time when the films of the National Sex Forum (NSF), the Californian institute formed in 1968, were in the front line. Waynberg left the executive committee of the SFSC in 1976 and founded the Institute for Sexology on 21 May 1977. Over the years, the Institute for Sexology gave further life to the action in which Waynberg participated in America, “naturalising” it with the creation of original educational material, including computerised material, organisation of international meetings in the Disability field (1981) at the behest of teams piloting such activity in San Francisco, creation of a documentary fund and an ongoing training programme, inspired by links with the Kinsey Institute. The Journal of clinical sexology (Cahiers de sexologie clinique), the SFSC’s journal, was launched on 6 March 1975, with Gilbert Tordjman as the chief editor. This remained until 1991 the only practical sexology journal published in France. This was the heyday of associative efforts. The history of the SFSC illustrates the eclecticism of a reforming ideology that is open to the modern world. Around 1980, the Academy for Sexological Sciences was created; a small committee, which has since met each year to debate topics concerned with sexology itself, with the desire to maintain something of the innovative spirit of the founders of the SFSC. Links to the SFSC can be observed in the pedagogical choices made by the French School of Sexology, which was created in 1987 and directed by Claire and Robert Gellman, and the influence of the SFSC was also visible in the search for an international consensus on a code of ethics for the profession, broadly inspired by the French position which resulted from the work of Ludwig Fineltain. The same associative spirit meant that in every country there was a similar need to share experience and knowledge. In a few years an impressive number of associations, societies, institutes and corporate bodies of all kinds had developed throughout the world. The idea of a federation arose during the 3rd international congress, held in October 1978 in Rome: the WAS (World Association for Sexology) was founded there, and Gilbert Tordjman was its first elected president (at a later date, Marc Ganem, another French, became president of the WAS from 2001 until 2005). Later, the European Federation of Sexology (EFS) was founded in 1988 in Geneva, following efforts by Willy Pasini. This organisation, which brought together around fifty scientific societies, sought to co-ordinate the activities of these societies and encourage them to research and promote teaching of a European style of sexology. Willy Pasini was one of the driving forces behind this initiative (Porto et Bonierbale, 1993).
Emergence of university courses
In French university medical faculties, outside which there is no training (there is no sexology training in faculties of arts or human sciences), some diplomas, — sometimes short-lived — and credits in sexology began to appear during these “fertile” years. In Paris-XIII-Bobigny, in 1972, creation of an optional course in the field of human sexuality by Pierre Cornillot and Suzanne Képès for a sensitisation of the medical students. In Bordeaux, the creation of an optional certificate in sexology became part of the medical degree course in 1974 (30 hours), and was included for the first time in the medicine course. This was discontinued in the 1980s, and J. Tignol was to recreate a university diploma in sexology, which would be included with the other diplomas coordinated by AIHUS in 1993. Two meetings of the World Health Organisation, in September 1972 and February 1974, resulted in recommendations that teaching of human sexuality be integrated into the official syllabuses of universities, with the suggestion that sexology become a medical speciality. In Geneva, from 1969 onwards, the psychiatrist Willy Pasini (director of the Psychosomatic Gynaecology Unit) and Georges Abraham, a psychoanalyst, promoted a specialist course, under the supervision of William Geisendorf, which was integrated into the Geneva medical faculty’s courses in 1971. The Geneva School disseminated its learning style and educational resources gradually, in particular in Italy and in the University of Aix-Marseille, in co-operation with André Mattei (an endocrinologist working in CECOS) and Robert Porto, a psychiatrist and gynaecologist. A team formed around them, including the psychiatrist Mireille Bonierbale, who was to be one of its most prominent figures, establishing a solid area of coverage, taking in Marseilles, the SFSC and Geneva. In 1975, the first post-university teaching was created at the University of Aix-Marseille, supported by Willy Pasini and Georges Abraham. It was immensely successful. In 1976, the University Diploma (DU) in sexology was created. The experiment was soon repeated elsewhere. In Lyon in 1977, Jean-Claude Czyba, a professor of biology at the Université Claude-Bernard, assisted by Marie Chevret, a gynaecologist and psychiatrist, Jacques Cosnier, a psychiatrist, Albert Leriche, a urologist and Jacques Rollet, and endocrinologist, began a similar university course. The steady and productive links that were formed between Marseilles, Lyon and Geneva resulted in the creation, in 1983, of the University Hospitals Association for Sexology (AIHUS), of which Georges Abraham became the president, succeeded later by Willy Pasini, Albert Leriche, Henri Navratil and Pierre Costa. The resulting momentum swept up other universities in its path and caused something of a craze for sexology: in Bordeaux, Toulouse, Paris-XIII–Bobigny, Nantes, and in the faculties in the North-West and then in Paris, courses were progressively being set up, and their directors of studies came together within AIHUS. Generally speaking, these courses last three years and are open to medical students at the end of their studies, to doctors and to specialists, with parallel courses which have at least two years of common trunk. The titles of these diplomas vary from university from university and are open to non-physicians and healthcare professionals who are involved in issues of sexuality (clinical psychologists, midwives, marriage counsellors, nurses, physiotherapists, teachers, educators, etc.).
1995 marked a turning point for the SFSC, when the founding members retired and gave way to a team formed around Marc Ganem, Nicole Arnaud-Beauchamps, Gilles Formet and Michel Faruch. This team was to commit itself to preserving the specialist nature of the Society, whilst at the same time and working to federate the societies representing all the diverse areas of French sexology.
Transition from private training to universities In 1983 AIHUS (inter-university clinical sexology association, www.aihus.fr) was created by Georges Abraham, Mireille Bonierbale, Marc Bourgeois, Francois Charvet, Marie Chevret-Measson, Jean-Claude Czyba, Nadine Grafeille, André Mattei, Willy Pasini, Robert Porto and Jacques Rollet: its aim was to promote sexology within universities and to bring together university teachers, therapists and hospital researchers in the field. AIHUS played a leading role in establishing permanent lines of communication between the various constituent teams, encouraging new members and promoting teaching and information campaigns. The creation of AIHUS enabled teachers from various university courses to work together to harmonise course content, thereby establishing a strength in unity in co-ordinating university teaching in France, putting up a common front to the authorities responsible for changing old-fashioned prejudices towards sexology. AIHUS — propelled by characters such as Pierre Costa, Albert Leriche, Jean Tignol, Francis Pontonnier, Henri Navratil, François Giuliano, Alain Jardin, Christophe Lançon, Marie Chevret-Measson, Nadine Grafeille, Robert Porto, Mireille Bonierbale, Philippe Brenot and Marie Hélène Colson — played a major role in ensuring that clinical practice already approved abroad was recognised in France. Having set university teaching on the right track, AIHUS, which brought together all teachers from the various French university courses, worked to introduce a Council for Educational Co-ordination for the Interuniversity Diploma in Sexology (CCPIU), thus passing responsibility to universities. AIHUS could therefore now concentrate on research and increasing knowledge in specific fields, and the work of many members of AIHUS has achieved international renown. Finally, AIHUS, at the turn of the new century and having followed the course of university teaching, could start to implement a research plan for French sexology.
Professionalization of medical sexology In 1995, a year in which there had been plenty of reviews, congresses, trips, studies and international conferences, the Conseil national de l’ordre des médecins (French medical association) planned three working sessions which brought together sexologists of all persuasions (SFSC, AIHUS, National Union of Sexologist Physicians (SNMS), Institute for Sexology). The minutes of the Sexology Study Committee, which were approved in a plenary session of the CNOM on 29 June 1995, aimed to harmonise the various university courses in sexology in order to create an Interuniversity Diploma in Sexology. Training was therefore officialised. But neither the codes for medical procedures nor the right to a title were tackled. The French medical association was a prudent and thrifty “sponsor”, and its mission only involved the teaching received, and not the qualification for a particular practice. The fundamental problems remained, in terms of refusal to grant the title “sexologist” and the right to charge more than the statutory medical fee, and the position of professionals who were trained at university level but who were not qualified physicians.
Co-ordination of university teaching Eight French universities were involved in the “Interuniversity” sexology diploma (DIU) and others were to join them at regular intervals; the DIU was co-ordinated by a national committee, the CCPIU (Council for Educational Coordination for the Inter-university Diploma in Sexology), which regularly monitors developments in the course and the national procedures for conferring the diploma, with collegial correction in the universities. The CCPIU provides a list of graduates to the CNOM each year; the era of secrecy and amateurism is over. A committee to study equivalence between diplomas was convened in 1998-1999. The CCPIU oversaw harmonisation of university courses within medical faculties that were involved in teaching the Sexology DIU.
In 2001, the vast majority of French sexologists were trained in France (A. Giami, P. de Colomby), around half in a university and the other half in private sexology training institutions. More physicians than non-physicians have university sexology training — 52% of general physicians and 58% of specialists have university training, while non-physicians (59% of psychologists and 57% of other non-physicians) are more often trained in private institutions (SFSC, Institute of Sexology, French School of Sexology). The many non-physicians who are trained at universities are not faced with the same administrative challenges as French physicians, and they have acquired the benefits of this extensive training, but it is important to remember that a French University diploma does not give the “right to practice”; instead it provides evidence of in-depth and extensive knowledge of a field. The “sexology profession” and right to practice is therefore initially dependant on qualifying diplomas, which determine who will enter the profession, whether in therapy, counselling or education, and this is accredited by various university courses and private institutions. A branch of non-physicians from AIHUS, in order to continue their own training, led by Claire Gellman-Barroux, created, in 1998 in Geneva, ASCLIF, the Association of French-speaking Clinical Sexologists (http://asclif.free.fr); a member of WAS and EFS, and whose current president is Ursula Pasini. In June 2001, the WAS organised the XVth World Congress of Sexology with the participation of EFS, SFSC, AIHUS, the French School of Sexology, ASS, at the behest of Marc Ganem, who was president at the time. AIHUS and the SFSC thus accepted, at the dawning of the year 2000, the legacy of a French tradition of striving to understand and treat intimate behaviour, and this led them, little by little, to combine their efforts. Faced with the globalisation of English-speaking sexology, the creativity of the French pioneers was a notable act of resistance: AIHUS, in collaboration with the European Sexology Federation, supported the publication of Sexologies, the only bilingual review of Sexual Health, which enables French-speaking authors to become better-known elsewhere. The SFMS (French-Speaking Sexual Medicine Society), which was created in June 2004 by Jacques Buvat (an endocrinologist, former president of ISSIR, which later became ESSM, the European Society of Sexual Medicine), aims to develop Sexual Medicine and to promote the use of the French language at international congresses.
French sexology has always been enriched by its multidisciplinary nature and its openness to an integrated approach. After the boom of the 1970s it needs to integrate the progress made possible by the arrival of medication for erectile dysfunction, without losing its originality or its humanism. A difficult balance needs to be found, and one of the tasks of the younger generation will be to redefine its identity for the future.
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