MAJOR ISSUES IN SEXUAL MEDICINE THESE DAYS IN INDIA

Female sexual dysfunction and unconsummated marriages:

Despite the land of Kama sutra; the Indian society is still largely conservative about sexual issues. There is lack of proper sex education in Indian High schools and adolescents. The sex word is supposed to be a taboo in both urban and rural society. Although the concept of swayamvara (girl choosing her own groom) existed in Indian Vedic Literature some 4000 years ago; the arranged marriages are still prevalent in the Indian subcontinent. The Institution of arranged   marriages in India has been proved to be immune to the social, economic and educational progress what India has achieved. In rural background many a times the arranged marriages are forced on girls on the basis of caste and financial reasons.

Only 1.1% of marriages in India result in a divorce compared with over 45.8% in the United States, though the Indian figure appears to be rising. The remarkably low rate of divorce can also be because of female partner silently suffering in the forced marriages without voicing any discontent about physical/verbal abuse. They are also less likely to complain about dissatisfaction about sexual life.

The main problem with arranged marriage many a times is that there is no proper communication between the couple especially on the issues of sexual needs and preferences. This lack of sexual communication in the immediate post marriage life can lead to marital malaise and unconsummated marriage. Lack of privacy, system of combined family; orthodox society, and lack of sexual education during adolescence leads to a lot of sexual problems in newlywed couples. In Indian society that premarital relationship is not accepted so most of the girls are virgins till the marriage. So there is lot of fear and anxiety amongst the females after the marriage regarding the coital act.

Unconsummated marriages are the most commonly seen problem in sexology clinic. This is prevalent among 5 to 10 per cent of the marriage population in India. In most cases, the female partner does not allow the male to have an intercourse due to fear of pain.Vaginismus is the commonest reason; anxiety being the common reason. The vaginal muscles contract because of panic reaction leading to severe pain during insertion. Proper sexual counseling and dilatation is the answer for this problem.

In India there are very few systematic sex surveys conducted; so proper information about sexual dysfunction is not available. Female sexual dysfunction is highly prevalent to the extent of around 2/3 rd of married woman suffering from it. Singh et al presented one interesting paper regarding this problem and have highlighted the high prevalence of sexual problems in Indian women.

Average Indian woman has a tendency to neglect the body predisposition after marriage. Multiple child births most often by Dayas (synonym: midwifery in rural Indian set up), sedentary life style, lack of  exercise leads to problems like putting on weight and loose vagina.The lack of self esteem and culture of silence further aggravates the sexual dysfunction in them. Frigidity is common and many a times they just indulge in coital act for fear of verbal/physical abuse upon refusing it.

Male sexual dysfunction:

Khurana et al have shown in their study shown that around 1/3 rd of Indian men have metabolic syndrome in the form of dyslipidemia, and diabetes. The pandemic of diabetes in India has also led to increase in incidence of sexual dysfunction. As metabolic syndrome and endothelial dysfunction (hence erectile dysfunction) go hand in hand; the erectile dysfunction may be higher in India than the other countries in the world. In urban India with the advent of software and BPO companies, night duties and long stressful working hours have contributed to increased incidence of sexual dysfunction. Of late there has been increased awareness about sexual problems in Indian men due to mass media, newspapers, late night programs in TV channels and various web marketing programs. The proportion of couples seeking an appointment with the sexologist is on the rise. One of the welcome changes that is happening now-a-days is the couple coming together and visiting the doctors. The female counterparts are also forthcoming in their complaints especially in urban India. The general myths like Dhat syndrome (losing semen and hence energy) and guilt/misconceptions about the masturbation still continues to haunt the adolescents in India. The age old misconception about losing one drop of semen is equal to 40 drops of semen is still surprisingly high in adults because of lack of sex education. In certain rural areas, there is a general misconception that the sex with the virgins gives relief from venereal diseases. This only underscores the urgent need of starting sex education right at the high school age on a warfooting.   

Various sexual practices and problems with sexual orientation in India:

Different sexual practices in India are influenced by the social and religious laws (sexual morality).Anything other than conventional sexual practices are not encouraged and viewed with disgust. In fact, oral sex is listed as 'illegal' under Section 377 of the Indian Penal Code, stated as being 'carnal intercourse against the order of nature', which does not carry the potential for procreation. But with the exposure to internet and pornographic literature more and more young adults and couples are engaging in alternative sexual practices. Common trends what we see in sexology clinic is more and more couples are engaging in foreplay, oral sex and other sexual positions other than the routine missionary position.

The prevalence of lesbian, gay, bisexual and transgender life styles (LGBT) is not known but logically it must be the same as in any other countries. There is general reluctance on the part of people to talk and express their views about it. The Delhi High Court struck down the provision of Section 377 of the Indian Penal Code which criminalized consensual sexual acts of adults in private, holding that it violated the fundamental right of life and liberty and the right to equality as guaranteed in the Constitution. But there has not been any positive response from the Government on this issue; it remains to be ambivalent about this problem.

The last area of concern is HIV endemic in India. The National AIDS Control Program, with its focus on educating the general population about responsible sexual behavior, safer sex and condom use has had a significant impact. The reduction in the rate of HIV transmission in the country suggests success.