Neglected Sexual Health in India’s Medical Education and Regulation: Time for a Change

Abstract

India has given Kamasutra to the world and hosts temples which promote sexuality in Khajuraho, Konark, Belu, and Halebidu. Yet, sexuality education is a forbidden terrain, and its façade can be seen only in a few documents. Various organizations and leaders have put herculean efforts to bring it into the education system of India, but it is still missing, especially from the lives of people who are in need of it the most. The Adolescence Education Program was launched in India between 2003 and 2005 through collaboration between Ministry of Human Resource Development and National AIDS Control Organization, and was implemented in schools along with life skills training by Central Board of Secondary Education and Kendriya Vidyalaya Sangathan. However, in 2007, due to conflicts and opposition by the gatekeepers, only traces of the program can be found in the current curriculum. 1 This not only resulted in continued ignorance among the population but also increased the public's resistance to be educated in this essential subject. The importance of sexuality education in reducing the sexually transmitted infections/ HIV, teenage and unwanted pregnancies, sexual abuse, increased number of sexual partners, and early sexual activity are fairly neglected even now. 2 Sexual health is the most neglected part of an individual's health. Various studies in India have reported a wide range of sexual disorders among males and females. Sexual disorders can be related to desire, arousal, orgasm, and painful sexual intercourse. The common problems related to sexual health are premature ejaculation, delayed ejaculation, nocturnal emission, Dhat syndrome, erectile dysfunction, performance anxiety, guilt about masturbation, hypo-or hyper-active sexual desire, anorgasmia, vaginismus, dyspareunia, sexual aversion, and infections of the reproductive system. 3,4 To address these sexual disorders, India lacks trained professionals since there is no specific course for becoming a sexologist or a sex therapist. Currently in urban settings, various medical specialties like dermatology, obstetrics and gynecology, psychiatry, urology, and endocrinology attend to patients with sexual disorders. The lack of a sexual health specialist confuses patients regarding where to seek care. Patients may first consult their friends or may look on the Internet for self-help remedies, and eventually may land up with a quack or untrained professional. 5 Studies done in North India had found that 81% of men and 82% of women perceived themselves to have at least one sexual disorder. These patients were reluctant to seek care due to social stigma and lack of awareness. 6,7 A study done in rural areas in South India, which screened the population using validated and structured tools, found the prevalence of at least one (or more) sexual disorders among men and women to be 21.2% and 15.8%, respectively. 8 This difference in the prevalence of sexual disorders shows stigma and lack of sexuality education among the general population. Even in the absence of sexual health disorders, people feel they are suffering from it. This misinformation and stigma can be dealt with by community awareness and education programs enforced by schools, colleges, clinics, and media. There is a substantial prevalence of sexual health disorders in India. At least a primary care physician is expected to address the common sexual health problems, especially in a rural setting. It is disheartening to see that our medical graduates lack this basic knowledge. 9 The common sources of sexual health knowledge for our young doctors are friends, pornographic films, and magazines. 10 We would expect the source to be the medical textbooks which are based on scientific knowledge, which would also provide knowledge about diagnosis and management of sexual health disorders. Unfortunately, this topic is often ignored in the syllabus and training. How can we expect our physicians to address the sexual health disorders? Even in the syllabus of post-graduates' students of related specialties, topics like female sexual dysfunctions