Krzysztof Nowosielski
None of us is born with knowledge of our sex life. Already this dominant sexual position is not the missionary position. Just the doggy position. And this issue of sex life in these patients is very important. But later on, when we get into the later stages of this relationship and we end up at this most advanced stage, which is commitment, when we really know each other strongly, this intimate contact is important, but it is not the most important part that binds the relationship together.

Monika Rachtan
What is this soreness most often due to?

Krzysztof Nowosielski
Looking at the statistics, we have more and more patients who suffer from endometriosis. And what the editor said is sad. But there continue to be gynaecologists who claim that menstruation is supposed to hurt.

Monika Rachtan
Hi, Monika Rachtan, I would like to welcome you very warmly to the next episode of Po Pierwsze Pacjent. Sex concerns the old and the young and is, in fact, our everyday reality. But what do Poles really know about sex? This is what I will be talking about today with my guest, Professor Krzysztof Nowosielski. Good morning, and a warm welcome, Professor.

Krzysztof Nowosielski
Good morning, Madam Editor, good morning to you.

Monika Rachtan
Mr Professor is a specialist in gynaecology and obstetrics, but also in sexology. It took me a long time on Instagram to find someone who deals with this particular field of medicine seriously, so I am very happy and very pleased that the professor accepted my invitation to the programme.

Krzysztof Nowosielski
Thank you very much for the invitation, as it is an honour to be able to share your knowledge with you and your editor.

Monika Rachtan
Professor, what does this look like in practice? Because you are, as I said, an obstetrician gynaecologist and a sexologist. If a patient comes in, this conversation about her intimate problems, about her reproductive health, is the start to a conversation about sex. Is it also the case that women come in and immediately say that they would like to talk about sex, because not everything that happens in this sphere is cool for them.

Krzysztof Nowosielski
Patients come with all sorts of problems and a conversation about intimate life will come up at some stage of the interview, regardless of the reason for coming to the gynaecological clinic. There are also female patients who come strictly with specific sexological problems. I, too, am a gynaecological oncologist and deal with a particular group of patients who are undergoing treatment for an oncological disease or living with an oncological disease. And this issue of sex life in these patients is very important. And indeed at every visit we raise this issue. We ask, we discuss what intimate life is like in the disease and after treatment of the disease.

Monika Rachtan
Professor, and do you have one? We all learn about sex at first probably from sources that we shouldn't learn from, which is films. Then we have different experiences in our lives, which are sometimes good and sometimes bad. We all know that things don't always go our way. Do you think, professor, that at some stage there should come a point when we are confronted with such factual knowledge, with a specialist who explains certain things to us, because recently there was a gynaecologist here on the sofa, who said that she had a patient who had a partner with whom she had sex for several years, but it turned out that she did not have a rupture of the hymen during intercourse, because it was simply not full intercourse and she did not have the foggiest idea about it. She was very surprised when she went to the gynaecologist and the doctor told her that she was still a virgin. So in your opinion, should this education appear at some stage?

Krzysztof Nowosielski
Questions of sex education have been raised in Poland for several years, but, in fact, this sex education has been in place all over the world, particularly in the United States and in other countries of the European Union, of this old Europe, for many, many years. Why is this happening? Because none of us is born with knowledge about our sex life. None of us knows our bodies at birth. We have to go through a process, which will be much easier if we get this basic amount of information about what human biology is like. What the physiology of sexuality looks like, And why is this important? Because sexual life is one of the elements of a good quality of life. If we are not able to adequately realise our sex life, whatever it may be, then our life is not quite complete. And now, in order to derive the greatest joy from intimate contact with another person, we need to know what we expect of ourselves and what we expect of the other person. Because if we have a couple, then sexual contact within a couple takes place on the basis that we get to know our own needs and these needs are met calmly, step by step, and then both parties to the sexual contact. It doesn't matter how many of those parties there are. They are happy and come out of the intimate contact satisfied. Well, let's take such average teenagers who have not received any education. Whether it be health education or family education, whatever you want to call it. How are they supposed to know what intimate zones are? What is the hymen? Is the hymen broken during sexual contact? Is oral sex already intimate contact? Can we contract sexually transmitted infections during kissing? These are all things we can receive by way of transmission during education, sex education. And it is physiological. It is the need of every human being and the right of every human being that, just as we know, just as we learn about history, just as we learn about biology, we learn about geography, we need to learn about our body, so that we can know this body better and in general, so that we can know it.

Monika Rachtan
If you found our conversation interesting and are looking for more valuable content. Subscribe to us on YouTube and Spotify. Monika Rachtan. You're invited. Well. And we get to know the slipper very well in biology, and unfortunately we don't know our body. And this core curriculum, which is implemented even in secondary school, unfortunately does not provide for such a comprehensive education. However, it also all depends on the teacher, because we can meet a teacher who will want to pass on more knowledge to us, and we can also meet a person who is totally closed-minded, who will simply be ashamed to talk, to talk to young people about sex and not get any information. And then it's very dangerous when a young girl who doesn't know that she just should have some needs, they should be fulfilled, That she not only in this intercourse is supposed to give herself, her body, but also is supposed to come out of it satisfied. And we have a boy who unfortunately didn't have parents who would talk to him frankly, and his sex life and his idea of sex life comes from the Internet and from certain films where the woman is treated very objectively. It can become a huge harm to both if they run into each other. What is more, they very often bump into each other and later such patients come to the professor's office and say that they were not ready, that perhaps they should have waited or known better in order to start playing around with sex life in the first place.

Krzysztof Nowosielski
Let's start at the very beginning. This comparison with the slipper is quite apt, because the average primary and secondary school student knows all the life stages of the slipper and the life of the pine tree and can divide all the flowers into different species. And in fact, looking from a biological point of view a little bit he has too little knowledge of the anatomy of the genitals in man and woman and this implies the consequences of not knowing what will happen during sexual contact. This is on the one hand, but it is still quite important, and in fact probably the most important aspect of respecting the other person or respecting their rights. Also sexual rights. And this is what the editor was talking about. There are people who are not ready to start their sex life, and the pressure from their surroundings, friends, colleagues, colleagues is so great that they start their intimate life without being so willing and eager and at all eager to start it. This is also a little bit due to generational differences, because completely differently our generation, the millennial generation, approaches intimate life. Boomers approached gen z even differently, as the politicians say. They also approached it completely differently, there are slightly different laws operating there. There are other types of relationships, including situational relationships, which happen for a certain period of time and then disappear. And the alpha generation will approach it in a different way. I personally am most often approached by patients from Generation X or the millenial generation. For the most part, these are patients who were ready to start their sex life and relationship. But the relationship they are in is not always the ideal relationship they expect. This was shown very nicely by Professor Izdebski's research, which showed that two interesting things. The first one was a 2017 study, but it showed some generational changes and changes in a 10-15 year perspective. It showed that actually only 60% of people who are in a relationship would re-enter that relationship with the baggage of experiences they have. Perhaps they were not ready. Perhaps what they have encountered now is not ideal, but they are still in that relationship, they are continuing and they are happy to some extent. It also showed an interesting point that 10% people were a large range from 18 to 65. They have an additional relationship in addition to their regular relationship. This is one tenth, and in fact this thought is even allowed by 50% people who are in relationships. Patients who come afterwards of course come in couples, they come to solve problems that have arisen in their sexual life, but very often these problems are not biological, they are not caused by bodily dysfunctions, but the problems arise in the partner relationship, in that we work too much, that we don't have topics in common, that we focus on other things. We are workaholics and solving these problems is more difficult than biological problems. Because biological problems can be corrected, given a pill, operated on, get rid of the problem. But psychogenic problems, which are relational, require a lot of commitment and a lot of work, because you have to change something in yourself. You have to change something in the relationship. You have to give something more from yourself. And this is a problem that probably affects a whole generation. From the millennial generation to Generation X. We'll see what happens with generation Z and the alpha generation.

Monika Rachtan
Well, what's coming next may be even more difficult. That's because most young people get into relationships on social media. They even get stuck in a relationship on social media for a long time. There, everything is colourful, beautiful like on Instagram, and life is a bit different. And also relationships simply, no matter how much they love each other, how supportive the partners are of each other, come across various situations in life that are too much out of their control and some relationships simply cannot survive such situations, even if they seem to be the perfect couple. But Professor, what are the most common intimate problems that women come to your practice with, and does it happen that it is not just the woman who comes? Because it seems to me that we have a girl, such a greater lightness to come, however, Mr Professor is still a gynaecologist, and I will mention, maybe he will advise me something. And do solo men also come and talk about their problems?

Krzysztof Nowosielski
For female patients, probably the two most common reasons that are related to intimate, sexual life that push patients to come to the office. Firstly it is pain disorders, and secondly it is disorders of desire and arousal, or actually the desire for sexual intercourse. Pain disorders affect an increasing number of women. It used to be thought that it was more or less 5 to 7%, but now we are looking at that these pain disorders are increasing. That is, during sexual contact, the patient experiences soreness, independence regardless of position, regardless of the day of the cycle on which rapprochement occurs.

Monika Rachtan
What is this soreness most often due to?

Krzysztof Nowosielski
Looking at the statistics, we have more and more patients who suffer from endometriosis and this endometriosis affects very young women, that is, such 19-20 year old women who have endometriosis in the middle of the uterus. Just to clarify, so that our listeners know endometriosis is when there is a mucous membrane inside the uterus that is outside the uterus, for example, in the uterine muscle, in the pelvis, in the abdominal cavity it is on the intestines and it causes a lot of discomfort, which gets worse during menstruation. But these discomforts are very often constant, that is, they also occur outside the time when menstruation occurs, and when the patient feels pain during sexual contact there is such a self-perpetuating mechanism, a self-perpetuating inevitability of pain. That is, we know it is going to hurt. If we know it will hurt, we will avoid intimate contact at all costs. Even if it is a simple signal like a smile from the partner of the partner, waving, saying hello darling, nice to see you. Then this contact is already blocked and the painful symptoms appear. And this makes the treatment of this type of pain disorder incredibly long and very difficult, because it requires not just pain relief, but a change in the nervous system, so that information about an upcoming intimate contact, such as a smile or a kiss from the partner, does not cause an immediate pain reaction. And this requires a long rehabilitation process of desensitisation, as it is expertly termed.

Monika Rachtan
Professor, but amazing what you are talking about. About the fact that such a small impulse as a smile and a kiss can cause pain, and shows how pain in women's intimate areas, in the abdominal area, pain associated with endometriosis, is not underestimated, but rather a neglected problem, because only a few years ago we would have said that menstruation has to hurt, that a woman's stomach sometimes has to hurt, that this is your beauty. The famous saying, which in Poland acquired great significance and caused those glasses to finally rub, that it does not have to be like that, that this pain is not something normal, but what the professor is talking about is in general a very global disorder in the sense of this patient, that endometriosis is not only the uterus, it is a disorder of the whole life, including sex life. And de facto it's not about intercourse itself, which, let's say, happens three times or used to happen three times a week, and now it doesn't happen at all. It's just that it's that normal functioning becomes impossible in a relationship.

Krzysztof Nowosielski
Exactly. We perceive, or the standard perception is that endometriosis is a disease that affects the uterus itself. And what the editor said is sad. But there are still gynaecologists who claim that menstruation is supposed to hurt and patients believe this. I remember a lot of patients who come in and have a slightly milder form of endometriosis, which is called adenomyosis, it involves the uterine muscle itself, and they have painful periods. And this period, a week and a half, when there's a couple of days before menstruation during menstruation and a couple of days of menstruation after menstruation they have severe pain, they can't function And the easiest way, which largely works, is to be prescribed and persuaded to take the contraceptive pill, which will make that these complaints will disappear and after a while patients come in after six months and say I'm sorry I waited so long because now I'm smiling, I'm having super sex, I'm happy with my life, I'm meeting my girlfriends, I'm dating my partner and my life has changed 180 degrees. This is the kind of life I expected, And it was just a regular contraceptive pill, nothing special, something any gynaecologist can prescribe, well you have to dare.

Monika Rachtan
Professor, but such myths have grown up about the contraceptive pill that it is sometimes difficult for women to make up their minds about contraception. Especially if, for example, they have not been exposed to the pill for many years as young girls. After all, it is said that the contraceptive pill causes thrombosis. It is said that the contraceptive pill wrecks the endocrine system. It is said that they cause weight gain and hair loss. I could go on with a whole list here. Is this not true?

Krzysztof Nowosielski
This cannot be judged zero-one. Every medicine, contraception is a medicine that we give to the patient. It can cause certain side effects. And we know very well that, indeed, the contraceptive pill increases the risk of cervical cancer, breast cancer, increases the risk of embolic and thrombotic incidents, those embolisms of which the editor spoke. Only we have to put this risk on the balance, and on the other arm of the scale put the gain that the patient can obtain. From the fact that we include this therapy under strict control. Because it's not like we prescribe the therapy and leave the patient alone. And she calls every six months just to get a prescription. We, as gynaecologists, gynaecologists, see the patient regularly and ask if she has improved, if anything has changed. We monitor the effects of this therapy and we would have to ask the patient if this risk is low, complications of contraception. We know that we have regular cytology, breast ultrasound, mammography. From the age of 45 we can detect certain things, and on the other hand we have the added effect of having a super life. In the sense you're not in pain, and I think we men have very little opportunity to see what it's like to live with pain. So someone who has had a root canal treated is a male milk tooth, a root canal tooth or an extracted tooth and they have a toothache for 2 days, you can imagine what it's like when for a whole month you just feel like that. You can't function at all. So if we improve the patient's quality of life, we rebuild their relationship and, above all, we improve the quality of life, including just the quality of sex life. And that is an effect that is, in a sense, priceless. Complications do happen, they are rare. We can monitor them, we can act before anything more serious happens.

Monika Rachtan
I also thought about the fact that the contraceptive pill, because it is a monitored therapy, puts the patient under the doctor's supervision. And this is what the professor said: you are not going to let a patient go without a cytology if she is on contraception. You will remind them that they need to have a breast ultrasound. When a patient reaches the age of 45, you will tell her about breast cancer screening, that she should have a mammogram. That it is a free examination and he will talk about what the patient, what a healthy woman should do. And that's super important too, looking at how many of us don't get screened. Although, on the other hand, now we're going to move a little bit to gynaecology. It seems to me, though, that in gynaecology there is a really good patient response to these regular examinations, because the National Health Fund figures say that we don't do this cytology under the National Health Fund, but we don't, because so far it's an examination that doesn't bring as much information as a liquid cytology, done in a private office, and again we don't know what the professor's experience is, but I don't know any woman. And one I know, she even listens to us, but I know well one woman who goes to a gynaecologist at the National Health Service. All my female friends go privately, so it's a bit different here. In gynaecology it's supposedly bad looking at the NFZ figures, but on the other hand I think there's a growing awareness of this taking care of your health and being in that contact with the gynaecologist.

Krzysztof Nowosielski
Because it doesn't quite work that way, because actually liquid cytology is slightly more sensitive, and it's a matter of 8-10% maximum. But the problem with screening in general is that we screen the same women all the time, that is, it is a specific group of women who go regularly, whether privately or on the National Health Service, and we will never achieve screening at a population level of 70-80%, because then it makes sense. That's how we screen the same women all the time.

Monika Rachtan
These are the ones that.

Krzysztof Nowosielski
And the ones we should examine will not go for an examination whether on the National Health Service or privately. It doesn't matter because they don't know about it, they don't want to, they are afraid. I live in a small town, they don't have access And so back to this topic of ours. Those women who live in small towns, they suffer, they don't have an intimate life quietly, because there nobody talks about the pain that a simple contraceptive pill for 3.50 can kill. Nobody talks about the fact that a woman is having intercourse but is in pain and doesn't want to have de facto intercourse, because it's not customary to talk about sexual topics in smaller localities, it's a big problem. And these patients also get hit, and convincing them that they can just buy this contraceptive pill that will work for, can work for their pain and they will have a really nice life and they will be smiling finally is sometimes difficult, well, because Clove didn't use Clove all their life.

Monika Rachtan
But it's your suggestion, Professor, that in general still in small towns this conversation about sex, about a woman being in pain, about, for example, telling her partner listen, Jacek, well unfortunately I can't make love to you because I'm in pain and I have to go to the doctor. That this is something that women are afraid to say in our country, in small towns?

Krzysztof Nowosielski
This may be the case. We don't have that data either, because those patients who come from smaller towns are not that many, because they just don't come simply in the world. More and more, there is a growing awareness of sexual rights in the big cities. And now back to this health education of ours, because there is a beautiful project Professor Izdebski was on the committee that prepared this education project.

Monika Rachtan
Yes, he was even a guest on my show.

Krzysztof Nowosielski
He was probably talking about this, about the background to the setting up of this project, which also involves talking about sexual rights, about what every sexual person, every person from birth to biological death, is entitled to. This is not being talked about in smaller towns. Again, we go back to the beginning of the conversation. How is a young person, woman or man, boy or girl supposed to know about their rights? Already in most schools I think, there are actions. Are there education on the fact that you can refuse sexual contact you have the right to refuse. That's the aftermath of the MeeToo action that's known all over the world. And it's really given such a booster to talk about the fact that if you don't want to have sexual contact you can say no at any time of a close-up, intimate relationship. It doesn't matter if you're a woman or a man. At any moment you can say no. And the other person has a responsibility to stop continuing sexual contact. How are they supposed to know this if there is no health education? This is something that we won't answer this question from. They won't learn it from the internet and if we don't do it, we don't educate, then we will have the problems that women then turn to gynaecologists, sexologists. That is to say, on the one hand, pain complaints, because there will be psychological trauma, and on the other hand, lack of interest and sexual excitement as the second reason with which these male and female patients come forward, because somewhere these sexual needs are high. One would like them to be high, but on the other hand the realisation of these needs is low. Well, because the patient comes home and does not feel like having sex.

Monika Rachtan
Well, exactly why doesn't she feel like having sex?

Krzysztof Nowosielski
It's a complex mechanism and it used to be thought of as just that. Maybe differently. It used to be thought that sex came very easily to men and that they were always ready and willing. Then it turned out in the course of research and running all sorts of patients that this is not quite the case. Both men and women can have problems, can lack the desire, the urge to have sex. It depends on a great many factors. And in understanding all of this, it is helpful to have such a model of the sexual response cycle by Rosemary Basson. She is a former American woman living in Quebec. In 2001, she presented an interesting concept of sexuality. It used to be that the Masters, Johnson, Kaplan model still works today, which is that it assumes this model that at first we feel like having sexual contact, then we get excited, then there's a super orgasm, and then there's a receding, arousal, and then we're back to the drab in inverted commas everyday life. It turns out that this is not quite the case. That's because there is a section of people around 30% or even more, depending on age groups, who are neutral at first. But if there is an external stimulus of a sexual nature and the cuddling starts, they get arousal first and then start to feel like having sex. That is, the mechanism is somewhat reversed. Later on, they feel excitement increasing and satisfaction from the sexual contact, which does not always end in orgasm. This model in particular sets women up for the fact that not every sexual contact has to be a climax to the max. One that we will never forget. There can be a satisfaction that we can be satisfied with sex. To say maybe it wasn't the way I remember it in my younger years, but it really was fun. I feel satisfied, content and it's this change in thinking that is causing some patients to start looking at their sexuality differently and opening up to new stimuli.

Monika Rachtan
Professor, only women have it so in this model. Do men also?

Krzysztof Nowosielski
Men too, I had the opportunity to be part of a research team that tested these models and it turned out that in men around 25% also falls into this model. Men's sexuality is a bit less talked about. We are a bit more secretive, there is less research I think we also don't want to talk about sexual health as much openly. And then there's the continued cult of the kind of man who's always, everywhere and anytime and in general super that sex will provide so that just everyone will see stars, And that's not the case. We all have better and worse days, both men and women. And now when patients come in saying that they don't feel like having sex, we do a whole sexological interview. We ask about the sexual experience, about what's going on, about relationships, about everything else. And a very large proportion of female patients would expect a doctor, a gynaecologist, a sexologist, a magic pill, right? Just as a man comes in with erectile dysfunction, we know that they are not psychogenic in origin. They are more organic. We have phosphodiesterase inhibitors, the blue pill, the pink pill. Whatever we can think of there, we give a tablet, it's better. With women, this path is not so easy, because this path is mainly about talking, psychotherapy, changing the mindset, changing the approach. Sometimes just explaining that this desire for sex doesn't always come first, it can come a little later, that there can be excitement first. This already allows you to get on a different track in such a relationship and allows you to achieve satisfaction, which is not always equal in women with orgasm and is not always necessary.

Monika Rachtan
I think that here, too, in women. Going back to that blue pill that the professor was talking about just now. In men it's like, he'll take this blue pill, he doesn't even have to tell anyone. Everything is great, all the pains are gone and we have good sex. And with a woman, even if she goes through that mechanism that the professor said, understands her needs, understands that there doesn't always have to be a desire, that there can be excitement at the beginning, she still has to go to the other side of the relationship and talk about her feelings, her needs, what it looks like for her. And then there's this man on the other side, who theoretically can always, always wants to and is always ready, and he has to accept that there's not always going to be these stars and fireworks. And here, I think, in the case of women, there is this additional difficulty, that the work is not only about her alone, but she de facto this psychotherapy that the sexologist still has to transfer to her partner, or persuade him to go with her to the sexologist and that they work on the problem together. And again in Poland, where we don't talk about sex, it may seem that, well, sorry, but it's not appropriate for a man to go to a sexologist, because after all he is healthy, he can always and always wants to.

Krzysztof Nowosielski
And here there is a conceptual error that we all assume, and even, and I would say even more, some inaccuracies. Because sex therapy is about couple therapy. If we have a tandem of man, woman, that is, women, two men and there is a problem in the relationship, it never involves one person. Even if, let's turn the situation around, erectile dysfunction occurs in the partner, over time it will generate disorders of just sexual interest and excitement in the woman. For various psychogenic reasons, because it will affect her self-esteem, she will be convinced that it is her partner who does not love her, who has someone on the side, and in fact he does not want to have intercourse because he has erectile dysfunction and he is ashamed to go to the doctor or he will buy the pill himself, but sometimes he is ashamed to buy the pill, especially in smaller towns, because he has to go to the pharmacy. Unless he orders on the internet, and you don't know what the quality is, what the quality is, so these problems pile up a lot. Yes, with women it's couples therapy too, and I wouldn't want our listeners to think that they have to carry us on their shoulders with this kind of therapy. If they go to sexologists, we treat couples, that is, they come together and we do classes, we explain, we educate and we solve these certain issues as a couple, because that is the only option that exists and that is the only option that gives a cure.

Monika Rachtan
Professor, but when there is a situation where a female patient comes to a gynaecologist, a sexologist, for the first time, she talks about her problems, the professor says that you have to come together, and she goes back to the house, asks her husband, says - Jacek, listen, tomorrow we are going. And Jacek says - no, I'm not weak, I always can. If you need it, come. But I won't go with you. And then what? And the professor refuses this Magda and says no, no, you have to come together.

Krzysztof Nowosielski
We adapt the therapy to the patient, not the other way around. This is a basic principle in medicine and then. We stick the therapy together with the bricks we have. There is no other option here. We cannot leave the patient. Then the situation is difficult. If you manage to ask this partner to come to the appointment, then the conversation will be completely different and it will be easier, even if it is a one-off visit. To explain what the therapy is really about, why this therapy came about, why we need to help, what needs to change? Because it is really about changing a lot of things. I have a lot of experience in treating patients and helping patients who are post cancer. The problems there are even greater, because the partner has to be involved in the treatment of pain after oncological treatment, after radiation. He is involved in this treatment process. At first, the patient herself makes the touching of her intimate area at all pleasant after the oncological treatment, but then the touching by the partner has to become pleasant. And this requires a lot of commitment. It can't, it can't be done without it. So we also have different options. We can explain to the patient, ask the partner to come, If he doesn't want to come, she instructs what to do and then they report back. And this also has an effect. patients, even after oncology, are really satisfied with their sex life and they return to their sex life. But all this we're talking about is a little bit, a little bit strange, because when we look at the results of studies, and now there was such a big study recently published of over a thousand people, when over 60% people are super satisfied with their sex life. But at the same time we see that these patients who have sexual problems, more and more. And at the same time, for all of us, sexual contact, intimate life is important, is an important, important part of life. There are some generational differences. As I said, the most important is sex life and the most satisfying is, surprisingly not in the generation 18-20 a few as if we thought, but 30-50, because then.

Monika Rachtan
We know each other a bit. We have experience, don't we? We already know what our needs are.

Krzysztof Nowosielski
The editor said one very important thing. We know each other and we know each other's bodies. And it is no longer such love at the beginning, such infatuation and experimentation. Of course, experiments too, but we already know which way these experiments go. We already know what our needs are and we can find such a partner, a partner with whom we will create a tandem, something that works together, there is no possibility that they will separate and the sex will then be completely different. And actually statistically the people who are most satisfied with sex are the people who are 30-50. They have experience, they have a certain amount of baggage and then they can get from that sex what they want for themselves and for the other person, the person, the partner. And that's probably what's most so interesting. And we are just going back again to what we were saying at the beginning. If a person who doesn't have complete information about their sexuality, their biology, enters into a sexual life, that's the way for them to go into this area. When she knows herself, she will be satisfied. It will be 50-60 years. Well that's a bit of a shame. Let's make it so that we all have the same opportunities, because we may not have had this big, I'm talking about the millennial generation, this big sex education, but nevertheless at home sexuality was talked about, talked about. Now you don't talk about sexuality at all, because parents largely dump this sexuality on the school. They want the school to educate, and on the other hand they don't want the school to print. So where are young people supposed to learn about the biology of their bodies?

Monika Rachtan
Professor, how often do Poles have sex? How many times a week.

Krzysztof Nowosielski
The problem with the research is the research we have, because we now have a study that was recently published, Professor Izdebski's research. It is all declarative.

Monika Rachtan
So you don't check live? Okay.

Krzysztof Nowosielski
It is impossible to check.

Monika Rachtan
There are no cameras in the mattresses.

Krzysztof Nowosielski
I'm reminded of the Masters, Johnson study, because they actually, when they did their research to find out the cycle of sexual response, they would lock themselves in a wardrobe, peep at people who had intimate contact, then talk to them, ask them about those most intimate details related to the contact, but we don't do that. So this declarative frequency mostly 1-2 times a week. But as we look at the profile of the patients and that and our society in general. How long and how much we work, it seems that it's probably a bit, a bit of that wishful thinking though, that it's not just.

Monika Rachtan
Just a declaration.

Krzysztof Nowosielski
Such a declarative one.

Monika Rachtan
What does it look like in Europe, or is it just as common?

Krzysztof Nowosielski
Depending on the country and the generation the person comes from. On average 1-2 times a week, which is the European average. Here, if we look at all the studies we have at our disposal, Poles do not differ very much from the studies that have been conducted or from the results of studies from other nations. What I found interesting in the study I mentioned is that sexual behaviour is changing and the dominant sexual position is no longer the missionary position, but the doggy position. That's also interesting, but it's also individual, because again we're back to statistics with statistics. Everyone likes what they are used to and what gives them the most satisfaction. And that's what we need to get to know. We have to find our sexual scripts. This is also an interesting, interesting thing. Each of us builds up over the course of our lives the situation that gives us the most sexual satisfaction. This can relate to the appearance of the partner, the person of the partner, the smell, the way we dress, the way we behave, the place, the time, the circumstances, the time of year.

Monika Rachtan
Who doesn't dream of having sex on the beach?

Krzysztof Nowosielski
I think there are some people who don't dream of that. For example, people who immediately imagine a cold morning at the Baltic Sea, that is minus 5 plus the frozen, frozen Baltic or the Baltic in summer, that is +20 degrees and the water +3.

Monika Rachtan
But it's like the professor said these different factors matter. I asked the question how often, because I think of those conversations between two guys who meet in the pub in the evening and one says you know what? my wife doesn't want it at all. And how often do you do it? And he talks about once a week. And then we think. And the other one replies oh no, it's us every day. And then the first one who says once a week, he's so worried and he comes home and says Jesus, you don't seem to love me. You know, I was here with a friend at a meeting. He was telling me that 5 times a week with his wife, or preferably it's every day, and we only go once. And I have the impression that often we make this satisfaction with exactly what our sexuality looks like, what our relationship looks like in terms of sex, A little bit of it comes from the fact that we compare ourselves with others, that this declaration is often a little bit over the top and it seems to us that we would always want more, more, more. And what we actually have in our relationship, if it lives up to our expectations, well, maybe it's not as bad as others.

Krzysztof Nowosielski
That said, let's look at it from two perspectives. The first is one that I like a lot, which is Steinberg's theory of love. She puts the relationship into perspective and at the beginning of that relationship. This is the period where we are mega turned on by the partner person. And then, during those first two years, because this idyll can't last I don't know how long, it's the so-called intimacy period, then it lasts for about two years or so. This sexual contact is very frequent, but later on, when we enter the next stages of this relationship and we end up at this most advanced stage, which is commitment, when we really already know each other strongly, this intimate contact is important, but it is not the most important part that binds the relationship together. Because it's the relationality, spending time together, building something more than just sexual contact. So now we have these two guys, and let's ask ourselves if the one who said that every day, which stage of the relationship is he at, is he not at that initial stage of getting to know each other, or is the other one already at the stage of commitment, when there are other things as important as intimate contact. And the other issue is self-esteem. And each of us builds this sense of self-worth based on our experiences, our body image, what we have picked up from family, from friends, from contact with others. Each of us tends to compare ourselves when it comes to our intimate lives. This is a very individual issue. How often there is sexual contact is less important than how emotionally charged it is and the quality of the sexual contact. Because you can have sexual contact three times in a day, but the quality will be poor and it will not be there. The people involved in this wonderful sexual act will not be satisfied. And you can have sex once a month that will be really mega, mega, mega such that we will be thinking about it, dreaming about it and dreaming about it for the next few weeks. and I think that quality is the most important thing. You can see that from certain trends too, because it used to seem like we were all moving towards fast sex though, like fast food, fast sex. But these recent surveys show that more and more couples and people in general who were interviewed, which was more than 60% there, are moving towards slow sex, that is, that sex should be slower, give more sensations, and not be such a quick number.

Monika Rachtan
Well, that's because maybe it's easier for us to take a little bit more time at a time, a greater number of minutes, hours, spend the whole day in bed and it brings us satisfaction. We are able to feel it realistically than doing something every day. Is it like the professor said three times a day for five minutes each? Immediately such a scene comes to mind with the secretary, which is not exactly cool for a woman and all that. I think that kind of sex just in terms of what a woman needs. However, we need a bit more time to get to that excitement, so I think it's good here, but still, it's just slow.

Krzysztof Nowosielski
Well, this trend is very, very nice, because we are sort of starting to see something other than just pure biology. Well, if you look at sexual contact purely from a biological point of view, well, we have the transfer of genetic material. But in the course of evolution, civilisation has developed sexual contact as something that gives great pleasure, tightens the bond, gives the possibility to relax, get to know the other person and is something that is most intimate and is such an act of entrusting one's body to the other person. Well, because we are naked during intimate contact. I'm talking literally biologically, but also mentally, because we give ourselves to the other person, we let ourselves go, we let our emotions go. We are ourselves and it also takes time, although there will be some people who don't need that much. They want it to be fast, strong and often they are entitled to that too. And this too is within the broad physiology. But this tendency is really to celebrate sex, so that it's not such a quick number, but that it's a preparation. But it's not about preparation in the sense. Just like we prepare for a wedding, it's so much more in inverted commas preparing ourselves, that it's just the mood, it's the atmosphere, it's, it's cool and it's cool ending up with cool sex I thought.

Monika Rachtan
I imagined this woman standing in the shower and getting her legs hot for her husband and saying no no no today because I have unshaven legs. I have to get ready. Professor, are Poles still at all ashamed to talk about sex? Is it still the case that it is a taboo subject? Is it still the case that sex is everywhere So much on the internet, on TV, in the newspapers, we see sex everywhere. And is that a bad thing, is that a good thing, is that we are becoming a bit more familiar with the subject and that maybe it is just ceasing to be a taboo subject, because sexuality is everywhere. What are your observations when it comes to us Poles? Do we still treat sex as a taboo subject?

Krzysztof Nowosielski
You have to see it from a broader perspective. Just talking about sex tames it a little, but it doesn't imply that we will open up and work on our sexuality. What we hear in the media, we think to ourselves gee, but they have it good. Then we go home and look at our lives and that sense of inferiority is switched on again. Well, because he, like the editor said, well because he has sex every day and I have sex once a week I am inferior. There's something wrong with me, and it's such a double-edged weapon, because we seem to lack such reliable information about human sexuality. And it's not about reading out loud clever books on TV or the radio, but it's about talking about sexuality precisely from the point of view of biology and from the point of view of something positive. And we are sometimes, even very often, bombarded with information about sexuality in a negative context, in the context that something has happened to someone, there have been sexual abuses around a person. And this is the moment when we start talking about sex. And all of us, sexologists, sexologists, want us to talk positively about sex, about the pleasures that sexual contact gives and what it gives, apart from the mere reduction of tension, precisely this closeness. The fact that we can be with someone, share ourselves with the other person. And that's the beautiful thing about sex, that it's not just about biology, it's about psychology, the psyche and creating some kind of coherent whole.

Monika Rachtan
That's right. This slow sex fits so well with what the professor said, because it's about being together, experiencing it together and talking about it. And I think this is also very important, and I think that many couples who decide to seek the help of a sexologist for therapy, notice that in the evening they start talking about it, that before they are in this bed, on the sofa, anywhere else, there is a conversation about what you would like, what you would like, what you expect, what you feel like, and that it is so opening. Because it's such tenderness and closeness and interest in that other person. It's very different from when we get into bed and just have five or seven minutes for each other. Nobody talks about needs and that partner doesn't even know if that partner, for example, is menstruating and wouldn't necessarily want to. That, however, this conversation and this kind of preparation, this shaving of my legs that I was talking about is cool and allows this sex to be enjoyed and experienced in a completely different way.

Krzysztof Nowosielski
The key is communication and communication. Because we all have a problem communicating our needs. Yes, in our personal life, in our professional life, as well as in our sexual life. Because it's difficult to tell a partner, a partner what we expect. Because I think there is a mechanism at work. Well, after all, he should guess, right?

Monika Rachtan
Or if I say he's not doing something, well he'll be angry that he's not doing it and say Why didn't you tell me about it for three years? Wasn't the sex satisfying for you for three years?

Krzysztof Nowosielski
Exactly, then the defence mechanisms kick in, Well, because we haven't actually talked about it for three years. So what has suddenly happened that we are talking? And that's what we should teach, that's what we should demand, even in inverted commas, of course, we should demand that young people are able to communicate their needs openly, that they are not afraid to talk about it, what their needs are, what they need, what they expect from their partner. And on that basis also, to make this sex life with them easier and one that is really interesting and appropriate for them, that meets their needs. That's what we see all the time in our practices, when patients come in and when asked if she has talked to her partner about it, well, she says, well, not really. Well because I don't know how to do it, how to talk about the fact that I have different expectations, or how to talk about the fact that it doesn't give me pleasure normally, or just sit down, discuss. Just like we discuss all sorts of other issues, family, problems, these issues should be discussed too and it takes time to do that. Again, we come back to what is probably the most important thing. In order to have a nice life at all, we need to have time for different elements. And also psychologists, psychologists divide that time into time spent on work is 20 para-30%. Time spent on family is 30 some %. But then we have time spent on yourself, on your development. This is also 30 some % and as if we don't have time for ourselves, we won't have time for our partner's partner. If we take the time to get to know ourselves and get to know our needs, then we can communicate what I expect. And let's go back to that patient you were talking about. You said that at the beginning she was not aware that she still had a hymen. The question is whether she is aware that clitoral stimulation can lead to orgasm. Has she ever obtained an orgasm? Does she know what an orgasm is? Does she know what in her body stimulated as an area will cause an orgasm. Will it be I don't know, the nipple, the earlobe, the inner surfaces of the thigh, or maybe the outer surfaces of the thigh? Or maybe the left buttock, the right buttock? Whatever, because if she doesn't know that, this sex is going to be a bit bland for her. She'll think the sex is just like that. He can be wonderful as long as we know what we want and the person with whom we share this sex allows us to fulfil our needs. We fulfil her needs because we direct each other what we want, what we want to achieve, which areas to stimulate, how to stimulate, What should the timing be? Should it be faster, slower, stronger, weaker? That's what we're not going to find out.

Monika Rachtan
When we don't try. The other person doesn't know it either, when she doesn't ask about it, when we don't tell her, because the fact that you have to take the rubbish out should be guessed by the husband, but it is also sometimes hard for him. And how a woman reaches orgasm can also change. Because I think to myself that today it may be pleasurable for me, but after some time it may all change and there will be something new, I will discover something. And that's what's worth sharing, because then we take care of this quality of the relationship, we take care of our sex together, which gives pleasure to one side, is satisfying to the other side. This conversation is the basis and the key to success here. We still our generation can educate ourselves from podcasts like ours today, from a profile like Mr Professor's profile on instagram. But I am most concerned about the youngest. What are we young adults, so to speak. But people who have a good sex life or who are trying to have a good sex life. What should we tell our children? What should we take care of? When should we do it? Should we bring our daughter to a gynaecologist? To a sexologist? Should we talk to our son about it? Or is it better for the husband to do it? Is there a prescription? Because I think a lot of parents, even though they are pushing this burden onto the school, are aware that the internet has taken over this burden and are a bit afraid of what will happen next.

Krzysztof Nowosielski
This is a difficult issue because it is, in a way, a bit individual. Just as we are different, we will have different ways of communicating about the intimate life of the house of the younger generation. And this is where a lot of problems arise. From the fact that the younger generation generally rebels against the older generation. On the other hand, they don't listen to authority figures, because now we have a kind of crisis of authority. YouTubers, who have appropriated the internet for themselves, are sometimes greater authorities than medical authorities And what they say is sacrosanct, and it's not always their knowledge and experience that allows them to speak up and shape the younger generations. On the other hand, it is always worth talking if the conversation is difficult. Seeing a sexologist will never be a bad idea. It will always be a good idea because we can go for advice. A sexologist will also help. There are sex educators Sexed.co.uk, great manuals, great websites, great actions. We have also produced such an app for the phone with my colleagues that facilitates sex education. Where there are ready-made scenarios, information prepared for young people, which will also allow us to take the burden of passing on information from parents, who do not always feel competent, for one thing. They sometimes don't have the courage to talk about sexual topics. Sometimes it's difficult for them to find a moment to sit down. And on the other hand, let's look at young people. They also might not always be so willing to sit down with their mum or their dad and talk about sex, because it's a sensitive, individual and very personal topic. And I think this school and apps made by professionals would be such a panacea and such a cure for the lack of knowledge. Because there you will be able to ask questions, you will be able to talk, but it has to be done by competent people. And it can't be on such a huge forum, because on a forum, however, we are a bit afraid. I think professional applications give the possibility that even asking a question will remain anonymous. And it's the answer that can save someone's life and make their sexual issues be seen very differently later on.

Monika Rachtan
Today we found out that not all good sex has to end in orgasm. It has also turned out that not all good sex has to start with desire. Excitement is very important and it is very important to find the answer to the question of what is pleasurable for us, what is pleasurable for our partner. And with that I leave you today. If you still don't know something about your sexuality, I cordially invite you to follow my guest on social media. My guest was Professor Krzysztof Nowosielski. Thank you very much, Professor, for today's meeting.

Krzysztof Nowosielski
Thank you, editor, thank you.

Monika Rachtan
And thank you for your attention. This was the programme First. Patient. My name is Monika Rachtan and I invite you to follow me on my social media. See you there.