Ashamed to ask for help

Russia and the USSR have never suffered from an excess of professional or academic discussion about sex. Quite the opposite: for the most part, the Soviet Union saw a catastrophic lack of sex education. The state was reluctant to develop this branch of medicine. Soviet citizens felt inhibited not only talking about their own sex lives, but also consulting doctors about intimate concerns.

Early Soviet doctors and researchers attempted to study people’s sex lives, with some advocating for a more open attitude towards sex. Stalin’s rise to power put an end to these attempts at a more open conversation. By the mid-1930s, public discourse on sex had virtually disappeared from newspapers and public life, while the subject itself became shrouded in silence and shame.

Under Stalin, there was simply no such profession as “sexologist” — a doctor specialising in sexual health. Sex education was virtually non-existent in schools, while academic research into sexuality was sparse and inaccessible to society at large.

As a result, ordinary people suffered. Many Soviet men were uneasy seeking medical assistance for sexual health problems. For women, the situation was even more difficult. Many resigned themselves to the fact that sex was a marital duty and not for pleasure. The lack of sexual satisfaction amongst women was rarely regarded as an issue worth consulting a doctor about. In contrast, erectile dysfunction was a far more visible problem and became a cause for concern. Discussions around the need to establish a separate branch of medicine dedicated to the sexual health of Soviet citizens began, therefore, with a focus on male sexual concerns.

Men rarely found the courage to seek a doctor’s advice on intimate issues. Those who did usually ended up with an appointment with a urologist. Finding no physiological abnormalities, doctors often threw their hands up. They sometimes prescribed treatments which only exacerbated patients’ conditions. They would give out testosterone or strong stimulants — both of which would prove ineffective.

Only in the early 1960s did the need to establish a specialised service focusing on sexual health become a topic for public discussion. In November 1963, renowned Soviet urologist Professor Ilya Porudominsky published an article in a highly influential state-run medical newspaper titled “Who Treats Sexual Disorders?” In it, he drew attention to the virtual absence of sexual healthcare in the Soviet Union. He argued that, rather than erectile dysfunction always being linked to physiological disorders, the cause often lay in a man’s psychological state; his anxiety or fear of a recurring inability to perform.

There were scarcely any medical professionals capable of addressing such issues in the USSR at the time. Porudominsky called for specialised sexual healthcare services to be established as soon as possible and for the training of doctors able to address both the physiological and psychological aspects of sexual disorders.

His appeal did not go unnoticed. A specialist department addressing issues of sex and sexual difficulties was established at the Moscow Research Institute of Psychiatry in 1965, staffed by just four doctors. They received hundreds of letters a week from patients about sexual problems they had been living with for decades. Appointments with these doctors could only be obtained via special referrals from the local authorities in each Soviet republic, and these were issued many years in advance. Demand for the expertise of this new department was enormous.

So-called “sexology clinics” gradually began to appear in various cities across the USSR in the 1970s. When discussing the slow but nonetheless noticeable development of intimate healthcare, doctors expressed relief that at least some of their patients had finally begun “to seek help regarding the most intimate aspects of human life, having overcome previous, entirely unfounded prejudices”. However, it was not always easy for specialists to communicate with patients. It proved difficult to find the right words which would neither offend nor upset. Moreover, not all patients were prepared to accept doctors’ advice, considering it indecent.

In the 1970s, one female patient went to see Dr. Mikhail Stern — an eminent Soviet sexologist — to complain about her sex life with her husband. The woman told the doctor that, right up until 1970, she and her two children had been crammed into a small room in a basement, but they had recently been given a small flat with a small bathroom. One day, her husband suggested sex in the bathroom.

Sexual health specialists helped not only men suffering from erectile dysfunction but also women who experienced no pleasure during sex. One woman, for instance, tried to explain her problem to Dr. Stern: “If I’m being honest, having sex with my husband is a chore, and not a particularly pleasant one at that. I find myself staring at the ceiling waiting for him to finish. I’ve had probably a dozen lovers and it’s always the same. A friend of mine told me that, if I closed my eyes, I’d be able to reach… what’s the name of it? An orgasm! Well, I gave it a go. I closed my eyes and moaned like a madwoman, but nothing happened!”

The study of sexual disorders continued to develop in the decades which followed, but remained shrouded in all sorts of prejudice, while doctors themselves often conceived of sexuality through the prism of norms and clinical understanding. Soviet doctors had to spend years convincing the state of the need for sexual healthcare, campaigning for the opening of specialist clinics, combating prejudices and explaining to people that there was nothing shameful about seeking specialist help.

Based on material from: Rustam Alexander, There Was Sex: The Intimate Life of the Soviet Union (Moscow: Individuum Books, 2025).