Let’s talk about sex…

In India, a lot of prejudice and judgement is attached to talking about sex. But more often than not, a healthy discussion on the topic is necessary.

Once while I was on a conference abroad, one of my colleagues asked me how I addressed sexual issues in India. I explained that even though ours is a sensuous country – we are the land of Kama Sutra, we are home to UNESCO world heritage site in Central India, the temples of Khajuraho – our ode to sensuality and erotica (Thankfully, no political party has found the sculptors salacious yet!), we are very prudish when it comes to openly addressing the issue of sex.

There is also the general view of at least the government, if not people, that sex is only a means of procreation. So I explained to him that no Indian physician discusses sex with his patient unless the patient asks or wants to. Worse still, asking a female about her sexual history may upset her and would be a nonbailable and jailable offence if she complained. An observation from the University of Texas’ behavioral science department, tells us that every health care provider feels that it is not his job to discuss sexual issues with the patient, thus passing the buck to the doctor.

The WHO regards sexual health as an important point in human development. Despite this only 85 per cent patients get counseling advice about sexual activity only after suffering from heart attacks. Very few physicians offer advice about safe sex and many women with vaginal cancer have never discussed sexuality with their doctors. Many authorities feel that the doctor and patient are equally to blame for withholding discussions on sex. As a doctor, it makes sense to breach the subject with indirect questions about sexual health and also understand the sexual orientation of a patient. It is not uncommon in today’s times to find gay people in a practice. According to a report from Burd and his colleagues, doctors are most uncomfortable talking about sexual histories of those under the age of 18 or those above the age of 65 or with patients of the opposite gender. I think it is even more difficult in a country like India because of the stringent laws that make most doctors really hesitant in dealing with especially a woman’s sexual history. The American Medical Association recommends doctors take out dedicated time to discuss sexual health and counsel teens about sexual behavior and how to reduce risks of sexually transmitted diseases. Many adolescents do feel that the doctor is not the best person to discuss sex with. A study in Americam Family Physicians tells us that doctors spend not more than 36 seconds talking about sex in a 22-minute consultation. It is also important to encourage an adolescent to speak; his parents should be asked to wait in the next room. Even 48 per cent of medical resident’s day school programs feel uncomfortable to talk to the students about sex.

Research suggests that communication between health care workers provides patients with improved sexual health. Patient communication especially with regard to communicable and sexually transmitted diseases like AIDS has been effective in reducing these diseases considerably. Many health care providers avoid discussing this because they feel that they have not had any training in this. A study in the Journal of AMA tells us that 68 per cent of the patients surveyed, claim they do not bring up sexual issues because they feel embarrassed to talk about them. Many admit that if given the proper channel, they would have preferred to talk about it.

A common adolescent sex question has always been masturbation, often confounded by guilt, many religious and early eighteenth and nineteenth century thinking calling the act deplorable. It is a common practice and almost 93 per cent males and 80 per cent females masturbate. It is healthy and normal and no guilt should be attached to this. And it is the duty of a health care provider to explain all this to the confused adolescent. Masturbation has been documented in several animals as well.

Lastly, in this day and age, sexual health is an important part of your normal health and it will make it far easier for the doctor to address these issues if you raise the question.