Dr Jules S. Black, FRCOG, FRANZCOG, speaks about his life, his profession and the changing perceptions of sexology.

Born in Sydney on March 7, 1940 I went to Sydney Boys' High School and entered the Medical Faculty at Sydney University at age 16 - far too young. In retrospect, I had always been very curious about sex. This was triggered by the hush hush way in which it was discussed and by my parents' embarrassment when I made any allusion to it growing up. I carried this boyhood curiosity into my medical studies where my curiosity wasn't being satisfied, as the Faculty too was very coy about sexuality. Whereas we learned all about the anatomy, physiology, biochemistry and endocrinology of reproduction, the only real mention of sexual 'function' came in 4th year in our psychiatry lectures where we learned about bestiality and paedophilia, but not about the 'normal stuff', something I found deficient and downright weird. I had set about educating myself in the subject in 3rd year when I bought T.H. van de Velde's classic Ideal Marriage, which at the time was second only to The Holy Bible in worldwide book sales.

I graduated near the top of my class in early 1964. My marks meant I got the residency of my choice, St. Vincent's Hospital in Sydney. One always remembers that very first day as a doctor, resplendent in all-white coat, trousers and shoes. I was rostered on extra duty in the Emergency Ward that evening after my daytime work in the wards. Fired with enthusiasm and keenness I was fully expecting to make some brilliant diagnosis of an esoteric disease before the end of the evening. Far from it! A woman in her thirties came in with a cold or flu. What happened during the consultation was one of those 'Eureka moments' which helped shape the direction in which my career would take me. She must have sensed she could talk to me for suddenly she said, 'Doctor, I've never had an orgasm.' I know that no other resident, possibly most of the consultants at my hospital for that matter, could have handled that question without embarrassment or awkwardness, just like our parents. I know I would have helped her far more today than in 1964 but at least since I had forearmed myself through self-education because I had seen sexual function as being important, I was able to muddle through in a matter-of-fact, non-judgemental way and give her some kind of assistance.

Then the next lessons came. Whereas I may have seen sexuality as an important subject, no one listens to a resident. When I commenced my specialist training as an obstetrician and gynaecologist, I discovered no one listens to a registrar either, I had to be one of 'them' first. I trained at the now-closed Women's Hospital, Crown Street in Sydney, at the time Australia's largest maternity hospital. By sheer 'happenstance' around 1967 the hospital opened up Australia's first sexual dysfunction clinic, known by the euphemistic title of The Department of Gynaecological Psychiatry (this might be why years later Melbourne wrongly claimed to have opened the first sexual dysfunction clinic because they called it by its rightful title). Our clinic was started and run by the infamous psychiatrist, the late Dr Harry Bailey. His infamous deeds took place elsewhere and at another time and place. In the eyes of we registrars he was always most helpful with our puerperal psychoses and other psychological disturbances including the then compulsory psychological assessment of women seeking pregnancy termination. I found him to be one of the most intelligent and multitalented people I've ever met. I sat in with him in this clinic every week for 2-3 years and learned much. In early 1970 I was awarded the MRCOG and went to England for two years for postgraduate training.

In 1972, I returned to Australia from my postgraduate work. Finally I was 'one of them' and I started to raise the consciousness of my specialist colleagues and the profession at large towards our responsibilities regarding the sexual difficulties of our patients, male as well as female. After all, if there is no sexual function, there is no Obstetrics and Gynaecology. I'm not referring just to the obvious topic of childbirth, but there would be no miscarriages, abortions, sexually transmitted diseases (STDs), contraception and far fewer abnormal Pap smears and colposcopy procedures, hysterectomies and vaginal repairs, as examples. Our whole specialty depends on sexuality, but even to this day, so many of my colleagues do their best to avoid it.

Upon my return, there were snickers in the profession when they heard of my subspecialty, something experienced by many of my sexology colleagues around the world. I found there was the sense among my colleagues of this being something of a joke. It was summed up by one of my pathologist friends. We'd been together during high school and medical school and he was now the morbid anatomist at another major Sydney teaching hospital. He performed the post mortems among other duties. He wrote a nice reply to my commencement card, wished me all the best and finished with, 'You can have the frigid, I'll take the rigid'. Nevertheless, local doctors sent me their wives, husbands and sweethearts, even though I was called Dr Filth by some of them!

Then, in 1973, another 'Eureka moment' occurred . A meeting was convened in the Barossa Valley in early September. An Adelaide obstetrician and gynaecologist, the late Dr Roger Wurm, had seen another deficiency in our training and I attended the inaugural scientific meeting of what became the Australian Society of Psychosomatic Obstetrics and Gynaecology. About a week later I had the opportunity to read a paper I had prepared for the Reunion Week of my old hospital, St. Vincent's, called, Sex in the Suburbs. It was the opportunity to meet many like-minded doctors from around our nation, many of whom became future stalwarts of the Australian Society of Sex Educators Researchers and Therapists (ASSERT) when we founded it. Coming back to that Reunion Week, this seminar had been organised by Dr Noel Wilton a staff psychiatrist from my own year. I knew him well. He, like me, was a maverick and 'stirrer' and broke new ground by having sexuality as a topic in this bastion of Catholic inhibition and tradition. The first two speakers were from the University of New South Wales' Department of Behavioural Psychology, an excellent unit. Then followed a priest/psychiatrist who with the aid of slides tried to show how advanced the Catholic School Sex Education Program had become. The slides were ones that were being used in the schools. Their background was green and very primitive line drawings thereon were pink. I had trouble making much out of what was being depicted. In the discussion time I criticised them as being difficult to relate to, 'Unless one was The Jolly Green Giant', (a cartoon figure at that time used to sell tinned peas). However, charitably, I conceded that what had been shown was streets ahead of anything audience members would have had when they went through Catholic schools.

Picture this - a packed, large lecture theatre. The first two speakers, the psychologist and sociologist wore casual clothing, the female sociologist with a very unbuttoned dress. At these Reunion Weeks, the front two or three rows are filled with the St. Vincent's nuns. I watched them from the stage during these first two talks. They just switched off. They perked up when their own priest/psychiatrist spoke. Similarly, I was one of their own. I had deliberately dressed up in my three-piece 'consultant suit' and wore my Vincent's tie. Being 'one of them' permitted me to get in under their 'radar' as it were and to then let the audience have it, both barrels. I heard subsequently that the nuns were doing the Rosary during my entire talk, and one of the organising doctors even left the lecture hall and went straight up to the corner church and lit candles for me. I'm pleased to say subsequently he became one of my referring GPs for sexual dysfunctions. The next Sunday Telegraph devoted a full page to this seminar with the sensational headline, Sex in the Suburbs, I'm sure thanks to a tip-off from Noel Wilton.

In 1974 I persuaded the Editor of the Australian and New Zealand Journal of Obstetrics and Gynaecology, one of the world's mainstream Obstetrics and Gynaecology journals, to accept its first article ever on sexuality. I had read that paper at a College meeting entitled Sex and the Gynaecologist. I have to state that in 2006 I was asked to write another paper on sexuality for one of our College Journals and was moved to observe that there had been maybe one other paper on the subject in all those intervening years!

The Royal Commission on Human Relationships started on 21 August, 1974, under Justice Elizabeth Evatt. I was the first witness and, from memory, that was in May the following year. How it came about is of interest; it was the first time ever TV cameras were allowed into an Australian courtroom. I made a submission to the Commission, possibly one amongst hundreds, maybe thousands. I was telephoned by the Judge's assistant, Jane Matthews, and told my submission was accepted and that they wanted me to give evidence in court. They were commencing in Sydney from a certain date, and when could I appear. It turned out I could appear on the first date offered. They said they'd put me in as first witness, and in turn that meant I would be the very first witness. Thus I was their first ever witness, not out of importance but merely by happenstance.

Unknown to me Justice Evatt permitted TV cameras in that first day to film a swearing-in plus the subsequent evidence I gave. Because I'm a medical consultant, they gave me the benefit of doubt that I therefore had some credibility. Because my evidence dealt with sexuality it attracted wide attention and probably got publicity for the Commission off to a good start. I still remember the smirk that evening on the face of the anchorman (Ian Findlay) for the ABC's 7:30 Report as he introduced my swearing-in and my evidence. 

In 1974 I badgered the Professor of Obstetrics and Gynaecology at Sydney University to include questions on sexuality in the final exam, which, for my sins, he made me construct. The late Professor Rodney Shearman was persuaded by my argument that the medical student will only learn something if it is examinable. Students have so much to learn that if a subject is not examined they perceive it as unimportant, and he agreed that sexuality was important. I did the same thing for the Membership of Royal Australian College of Obstretricians and Gynaecologists (MRACOG) exams. Sydney University's Professor Derek Llewellyn-Jones then sought the advice of Bettina Arndt and me in constructing a Human Sexuality course for the medical students, and the University of New South Wales Medical Faculty did likewise. Sydney University ran pilot schemes in 1974 and 1975 and thereafter the course formally entered the curriculum. These 45 years have taught me many things, and in this context, when it comes to tackling their patients' sexual dysfunctions and difficulties, I still find resistance amongst my colleagues. I have reached the conclusion that in the same way we can't all be equally comfortable with major gynaecological cancer surgery or microsurgery, IVF techniques or delivering babies, not everyone is comfortable with sexual counselling. The best example I ever had occurred about 25 years ago. One morning, in the car park of my medical centre in Sydney, I encountered a fellow obstetrician and gynaecologist with whom I had gone through medical school. We were friends and had even socialised in our student days. He asked me if I was, 'still doing..' he couldn't even get the word out after about three attempts, so I helped him by saying, 'Sex therapy?' and he said, 'Yes'. I said, 'I cannot see how one can divorce the whole of Obstetrics and Gynaecology from the sex act,' and he replied, 'I do my best to'.

In 1975, Greta Goldberg approached me and several others to form the Australian Association of Sex Educators Counsellors and Therapists (AASECT), and eventually Australian Society of Sex Educators Researchers and Therapists (ASSERT), which we did. I was one of the founding directors. It was around this time that the sexual evolution was gearing up (I never use the commonly-used term 'revolution', as even today we're not there yet as regards a full understanding of sexual function, let alone dysfunction). Because I was a medical doctor, this gave me a certain credibility that enabled me to appear in the electronic media and use all 'those words', as well as in the print media. Initially people, such as Bettina Arndt, famously were banned from the airwaves for using 'those words'. They thought she was merely a public relations person. They didn't even bother to find out she was a highly qualified psychologist. I didn't like this prevailing attitude, but like wearing my Vincent's tie a couple of years before, I exploited this advantage, and was able to spread good, safe information about sexuality in the community. I appeared on national TV often, and as TV's second doctor, (James Wright was the first), I was regularly on The Mike Walsh Show, a major midday chat show that was live and nation-wide. I found out later that together Mike and I created TV history by demonstrating techniques such as the insertion of an Intrauterine Contraceptive Device (IUCD) and artificial insemination as well as discussing all sorts of hitherto taboo subjects. One thing was clear, wherever I spoke, whenever I appeared on TV or radio, whenever I was interviewed or wrote for the print media, I received letters and calls from people expressing gratitude for helping or asking for help with their particular problems. A lot of good was done by those shows. It got the whole subject of sexuality out in the open in a non-judgemental, un-embarrassing way that rubbed off on the public and on my medical practitioner audiences alike.

For a long period Bettina Arndt and I ran workshops together. In September 1976 I was a keynote speaker at a major conference in Rockhampton, along with Bettina. On the panel with us was a prominent Sydney psychiatrist who pulled me aside and said, 'Jules, two of my GP patients came to see me this week. They had attended your presentation last weekend. They said that the ease with which you and Bettina could talk about sexuality rubbed off on them and they already found themselves far more comfortable discussing sexuality with their patients.' That's what it's all about.

My practice started to build up, approximately one-third obstetrics, one-third gynaecology and one-third sexology. I saw men as well as women for counselling, since as the adage says, 'It takes two to tango'. In amongst all my cases, I started to amass a large number of unconsummated marriages due to vaginismus, and was successful in treating around 83% of them. At the peak of my career I had about the third largest series of cases, and had built up a worldwide reputation in relation to this condition.

On March 21, 1976, I was invited to speak in Adelaide as part of the Adelaide Festival. The South Australian Family Planning Association organised a seminar on Adult Sexuality open to the public and to health professionals. This had never been done before at the Festival and my topic was 'Management of Sexual Difficulties'. The late Dr Karl Ball, Medical Director of the Family Planning Association (SA) and a witty obstetrician, was in the chair. After introducing me to a packed lecture theatre at the Flinders Medical Centre he said, 'It is Sunday morning and I now invite Doctor Black to deliver the Sermon on the Mount!'

I had started to travel and meet world famous sexologists from 1977, and at the beginning of 1978 I passed another milestone when I visited the Department of Psychiatry and Behavioral Science, School of Medicine of the State University of New York at Stony Brook. This was during their heyday with so many famous sexologists on the one campus. Some had already heard of my work with apareunia due to vaginismus. It was wonderful to confer with them. New textbooks were being published and here was I meeting the various authors. An important book came out in 1979 that addressed finally some of the imbalance between conventional studies of hormones on behaviour and the less-studied and less-understood effects of behaviour on hormones. This opened new avenues of thought for me and the following years were very productive. I was involved in teaching, training and counselling, and in 1983, I was appointed to the Board of the Society for the Scientific Study of Sexuality (SSSS). In 1985 I was elected to the Board of the World Association for Sexual Health (WAS). I served on both Boards for several years. I have lectured or given workshops in countless countries to a myriad of organisations, and written a book, book chapters, scientific papers and articles.

I ended up being Australia's foremost gynaecological sexologist, and I am one of the few people who have lectured at several College expert advanced courses. Vaginismus was one subject, but more mainstream was my expertise with female pelvic pain in the absence of pathology. Academic professors and clinical colleagues have consulted me by telephone or correspondence over the years. I have had the privilege of knowing most of the worldwide sexologists of the past 40 years or so.

I mentioned previously how sexologists around the world had to grapple with the 'dirty joke' image of sexology among our peers. There is another way in which we have suffered around the world, and that is in professional promotion. Many of us found that our stated interest in sexual dysfunction prevented us from progressing to our maximum potential on our promotion paths. Professor Llewellyn-Jones had ensured our medical library received every issue of Forum Magazine. One day the Chairman visited the library, picked up some copies of Forum and perused the contents to which he took offence. He immediately had these magazines removed from the library shelves. That's the sort of ignorance I have had to battle my entire career in defence of Sexuality.

In the late 1970's I became the gynaecological consultant for Johnson and Johnson, the market leader in menstrual protection products. I enjoyed this interface between commerce and medical practice, principally because I was able to educate an audience of women far greater than that reached by the mass media. One of the things I have always tried to dispel is ignorance due to lack of factual information. This was rampant in my area of expertise - menstrual myths, poor knowledge of genital anatomy and bodily functions for example. A new marketing person at Johnson and Johnson approached me to rewrite all the package inserts of tampons and menstrual pads that were deemed outdated. When I read them I discovered here was a major source of menstrual myths and misinformation, quite physiologically and anatomically wrong as well as providing poor advice on behaviour and relationships. This is whence adolescent and older women were getting their information. I remembered growing up and seeing thinly veiled Johnson and Johnson advertisements in the women's magazines for menstrual products. The readers were invited to write in to 'Matron White' at Johnson and Johnson for additional information and samples, which they would receive in a 'plain brown envelope' (long before Playboy and Penthouse, who used the 'plain brown wrapper' ploy, ever existed). The trouble was that with the new consumer laws coming in, there had never been a 'Matron White' and to avoid accusations of faulty advertising, readers now had to write to Johnson and Johnson's newly-formed, euphemistically named, the Personal Products Division. So I was able to get good information out there in the public arena. As the years went by, I vetted many of their advertisements, booklets on male and female adolescence, and a 30-minute movie on the subject that went out to all the schools. I was also behind the scenes dispelling misinformation and educating the public when menstruation-related events such as the Toxic Shock Syndrome emerged.

In 1982, during one of my visits to Stony Brook, Professor Joe LoPiccolo made a videotape of my techniques in treating vaginismus. He had arranged for a female 'pseudo-patient' to be the subject upon whom to demonstrate my sexological examination and then management of vaginismus. Apart from the two of us, only Joe was in the room videotaping the session with a live feed going into their conference room where the faculty was assembled. Subsequently the three of us joined the faculty for discussion. I mention all of this because in 1986 during my time as President of the Australian Society of Sex Educators Researchers and Therapists (ASSERT), we had a very unfortunate, much-publicised incident where a GP member of ours was indulging in sexual contact with patients at his practice. He was bringing them to orgasm by hand or exploring if they had a G-spot, among other things, in order to help 'treat their infertility'. He claimed that what he was doing was in keeping with ASSERT's guidelines for a sexological examination, which was untrue - we didn't even have any official guidelines. I was subpoenaed as President and I produced this videotape showing what constituted a proper, ethical sexological examination. This videotape is now enshrined as reference evidence with the NSW Health Department and with the medical defence union involved. He was struck off the Medical Register.

With this kind of background in my post-graduate years, it is clear to me why I would be attracted to Psychosomatic Obstetrics and Gynaecology. I absorbed those concepts well known to psychotherapists, but absent from our mainstream specialist medical literature. To this day I am also still actively involved in obstetrics. I graduated at a time of major change in my specialty. Childbirth was no longer the dangerous pursuit it once genuinely used to be for mothers and babies. I met the new gurus such as the late Frédéric LeBoyer, Sheila Kitzinger and Michel Odent who showed us there was an effective, far gentler, less-invasive way to go. I was one of the pioneers in this country of what became known as 'Gentle Birth', with minimal interference where possible. I was also one of the pioneers of Birth Centres, helping to open the nation's first, again at Crown Street Hospital.

I have always contended that since, unlike any other doctors, we obstetricians and gynaecologists are responsible for managing problems associated with every major 'rite of passage' of women, ranging from childhood through adolescence, 'marriage', pregnancy up to the menopause and beyond how can the 'primary approach' to the management of such problems be with the knife or a 'magic bullet'?

I have acquired two mantras in my life:

(A) Some men see things as they are and ask, 'Why?'
I dream things that never were and ask, 'Why not?'
(George Bernard Shaw, Man and Superman II)

(B) There are no problems, only solutions. (Jules Black)