Lebanon Pulse

Lebanon's first sexologist

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Article Summary
Sandrine Atallah is working to raise awareness of sexuality and sexual health in a country that often shies away from such topics.

In most of Lebanon’s obstetrics and gynecology clinics, a single question, only allowing for one of two ostensibly unambiguous answers, is used to elicit a woman’s sexual history — married or single?

A seemingly benign question, it alienates scores of women for whom marriage is not necessarily a prerequisite for engaging in sexual activity — creating an uncomfortable clinical environment in which patients might feel incapable of being forthright with their doctors about their needs and concerns. For not even the Lebanese medical community is free of the stigma shrouding the public discussion of sex in the country. But a handful of professionals such as Sandrine Atallah, the country’s first sexologist, are trying to remedy the lack of sexual health awareness that this reluctance has facilitated, and which has bred detrimental misconceptions about sex.

These include fallacies about safe sex, sexual infections, sexual performance and pleasure. From masturbation depleting an imagined, finite reservoir of sexual capacity to birth control pills causing infertility, Atallah has confronted a variety of sexual myths. She sees a high number of sexually transmitted infections (STIs), many of them the result of the erroneous assumption that familiars couldn’t possibly be carriers. “People think if they know a person, if they know their parents, they’re infection free,” Atallah explained.

Diana Abou Abbas, the manager of Marsa, one of Lebanon’s only sexual health centers, lists personal hygiene, education and family background as some of the irrelevant factors used to incorrectly determine whether a partner is carrying an STI. Both she and Atallah point to a widespread disdain for condom use, with men viewing them as barriers to intimacy and women reluctant to pressure their partners into wearing them.

Besides STIs, Atallah mentions sexual dysfunction as another consequence of inadequate sexual health awareness. Common problems include impotence in men, often as a result of performance anxiety, and vaginismus in women — an involuntary tightening of muscles that prevents penetration. Vaginismus is the most common ailment women describe when visiting Atallah. One reason for its frequency, she says, is a psychological fear of sex among women misinformed about the act.

Atallah has fewer female clients than male. Women, she explains, are less aware of their needs — that they are entitled to enjoy certain sensations. “If a man can’t get an erection, he can’t have intercourse. But a woman, if she doesn’t feel pleasure, can still continue to have intercourse. Men are more motivated to consult me, but that doesn’t mean they have more problems.” 

Unfortunately, Atallah explains that many medical practitioners in the country are not only uncomfortable addressing the issues subsumed within the dense, broad categories of sexual health and sexuality on a personal level, but also untrained to do so professionally. “When you do your medical studies [in Lebanon], you don’t have in-depth courses on sexuality or sexual health issues. You might have a two-hour session and then forget all the information it taught you.”

In 2009, Lebanon’s Ministry of Higher Education backed a reproductive health curriculum to be taught nationwide. But due to significant opposition from both teachers and parents, it was never implemented.

“It’s easy to teach sexual health,” said Rola Yasmine, a Lebanon-based reproductive and sexual health researcher. “But it’s tailoring it to the lives of people that makes a big difference.” She argues that the problem with the handful of existing sexual health awareness initiatives in Lebanon is that they are bound by a particular “heteronormative script.”

When it comes to women, the desire for motherhood and for being the "gentler" sex, for example, are assumed to be universal and natural. “There’s no room for people negotiating gender, pleasure, how to have safe sex and a variety of other things.”

According to Yasmine, there is also a tendency to isolate sexuality and sexual health from other issues with which they are intimately interconnected. Often used as a tool in the service of classism, racism, sectarianism and patriarchy, sexuality is one of the easiest ways to “character assassinate someone.”

For Yasmine, sexuality and sexual health cannot be adequately addressed without reference to these related issues. “When you talk about sexual health as a standalone field, for example, you’re talking about health but not thinking about who gets access to health care.”

In fact, STI testing is not covered by any insurance provider in Lebanon, leaving those unable to meet the costs at a dangerous disadvantage. Marsa offers HIV and Hepatitis B and C testing for free and medical consultations at a subsidized cost, but many are still unable to afford them. Additionally, the clinic is only known to a small community of mostly sexually active Beirutis. Many in Lebanon don’t even know they should be getting tested, let alone where.

While this all might paint a bleak picture of sexual health awareness in Lebanon, Atallah said that since she set up her practice in 2007, the situation has improved. Marsa, which has been operating since 2011, sees around 200 patients a month and, in addition to medical services, offers counseling on sexual health, sexual violence, gender and sexuality and living with HIV.

The Middle East Society for Sexual Medicine, of which Atallah is a member, runs the Arabic-language sexual health website yoursexualhealth.me. It’s popular throughout the region, from Saudi Arabia to Morocco. While obligated to respect religious sensibilities and, therefore, relatively limited in content, the site still manages to address many misconceptions and concerns, from "honeymoon impotence" to fear of intercourse while pregnant. 

But for far-reaching change to take place in Lebanon, Abou Abbas said that a national push is needed for sexual education from an early age — one that is supported by, not imposed on, parents.

Atallah elaborated that it’s very important in a more conservative society like Lebanon's to emphasize that sexual education doesn’t promote increased sexual activity. Sexual awareness, she pointed out, has actually been shown to delay the age of first intercourse. 

“In the end, people want what’s best for their kids,” Abou Abbas said. “It’s our job to show them that sexual health doesn’t have to be about sex.”

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Found in: women in society, women and islam, women's role, sexuality, sex in the muslim world, medicine, lebanon, health care, beirut

Sophie Chamas is a Beirut-based journalist and co-editor of Mashallah News, an online publishing platform for alternative stories from the Middle East. Her work has been featured in Al Jazeera English, CBC News, RTE, Reuters and Jadaliyya, among other publications. In 2012 she was awarded the Anna Lindh Mediterranean Journalism Award in the category of online media. 

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