By Aashika Ravi
In October 2017, Mumbai-based gynaecologist Dr Anamika Pradhan wrote a hilarious but worrying account in Agents of Ishq about her experiences with insensitive and ignorant fellow medical practitioners. She began by narrating how she was the only doctor that a local medical association could find to speak in favour of emergency contraceptive pills at a debate. As soon as she was done speaking (she lost the debate), she was veritably mobbed by the audience of doctors for being “against nature”. The essay went on to talk about the deeply worrying, deeply patriarchal attitudes she encountered from fellow doctors in her professional experiences, at seminars, and on doctors’ WhatsApp groups.
The thing is, you don’t need to be part of a doctors’ WhatsApp group to glean what exactly Dr Pradhan was referring to. We’re all depressingly familiar with bad experiences with judgemental doctors when it comes to discussing matters of sexual health (so much so that women online even crowdsourced this list of non-judgemental gynaecologists from across the country to tap into). Moral judgements seem to frequently hinder doctors from carrying out their professional responsibilities towards women patients effectively, and most of us don’t really need to think twice about whether doctors too need to be educated on how to respond correctly and professionally to sexually active patients.
Thankfully, a catalyst for change has come in the form of the Indian Medical Association’s new initiative to raise sexual health awareness among doctors. Now the IMA is pretty well placed to try something like this: It’s a nation-wide, voluntary organisation of Doctors of Modern Scientific System of Medicine, and the largest association of medical professionals and students in India. The IMA’s new programme will target 3.5 lakh doctors across India to sensitise them and quash taboos and myths surrounding sexual health.
Finally! Women won’t have to lie or tell quickly assembled half-baked truths to their doctors simply to avoid a dressing down because now, doctors will actually be actively taught how to respond sensitively to matters of sexual health in a way that doesn’t leave women patients feeling judged, shamed, or inadequately looked after.
Or at least, that’s what we thought they would be taught.
We got in touch with Prof. Dr Deepak Jumani, the chairman of this seemingly-promising initiative, with high hopes to see what he had to say about the IMA’s new plan. Unfortunately, we got close to nothing from him on this particular subject, but he did have a lot to say about… erectile dysfunction. In fact, on talking to Dr Jumani, it feels like that might be the whole raison d’etre for this Enlightenment movement happening over at the IMA.
According to Dr Jumani, we have to ask uncomfortable questions. About erectile dysfunction.
“Patients don’t talk about it and doctors don’t ask about it. We should remove the taboos so that we can talk about it, just like we talk about allergies, fissures or cancers. Everyone has bedroom woes which affect their relationships,” he said.
So, what about all the patients who don’t have erectile dysfunction, because of the minor reason of not having penises? When pressed about how the programme was going to help non-men, he did have something to say…but again, only in relation to the problems faced by the wives and partners of male patients of ED, plus a few throwaway lines on the woes of infertility.
“When men have erectile dysfunction, they stop having sex. If they don’t take any help, or get it fixed, they have no regard for their partners. Total disrespect for your partner.”
When the chairman of a sexual health initiative this ambitious and wide in reach speaks about women’s sexual health entirely in relation to a man’s, and primarily in terms of the “disrespect” accorded to those whose partners can’t have sex because of ED (also completely ignoring the existence of transpeople, who face a whole different set of obstacles when attempting to access medical care), what are we to understand about the interests and priorities of the medical community, and the direction in which it’s headed?
Unfortunately, this marginalisation of women to the discursive sidelines certainly isn’t a phenomenon restricted to medicine.
World over, women’s sexual pleasure and discomfort are often seen merely as inevitable byproducts of the sexual experience. Journalist Lili Loofbourow’s, writing in The Week, encapsulates this strange understanding of the female sexual experience perfectly when she says, “Women are enculturated to be uncomfortable most of the time. And to ignore their discomfort.” This affects how women think of their sexual pleasure, but more importantly, how they process and understand their own sexual health and medical conditions. Assuming that discomfort is part of the process makes it more difficult for women to explain their real symptoms properly without the help of a sensitive, knowledgeable and empathetic doctor.
Experts on reproductive and sexual health at Talking About Reproductive and Sexual Health Issues (TARSHI), a New Delhi based NGO, also warn of the possible repercussions of the limited perspective the IMA seems to be taking on this issue. “It’s great that the IMA is finally considering this long-overdue discussion on sexual health issues of men and women. All the same, there is a danger in looking at sexual issues purely from a medical lens, especially for women.”
They point us to an article by the New View Campaign, a network that attempts to challenge conventional views on sexuality. “A false notion of sexual equivalency between men and women” is one of the dangers of the medicalisation of sex. Women’s sexual disorders are very different from those of men and need a strong body of research to understand and create awareness around.
That being said, Dr Jumani does have big plans to raise sexual health awareness among doctors and prospective doctors through the IMA’s new (oddly unnamed) endeavour.
Every month, the IMA plans to send out e-bulletins with information about breaking the ice, how to talk to patients about sexual issues, information about sexual dysfunctions and how to diagnose them. Each branch of the IMA will conduct a monthly continuous medical education programme (CME) by speakers who will use educational material given by Dr Jumani himself, and also “adopt” a local school or college to conduct sexual health awareness trainings. The IMA plans to conduct a one-on-one dialogue with government authorities about how this is an important issue, and lobby to promote education in the field of sexual medicine.
We had an expert, Sangeeta Rege, co-ordinator at the Centre for Enquiry into Health and Allied Themes (CEHAT), weigh in on this initiative. CEHAT, a research centre, has worked closely in training, service and advocacy on health and allied themes.
She mainly questions the primary framework through which sexual health is looked at in this programme. “If you are only looking at the disease dimension, at least look at all aspects, both men and women. Why are they so fixated on penile penetration being the only source of pleasure?”
The illness model, she says, has its drawbacks. “There is an inability to look at sexual variation, even from birth. There’s also no scope to understand homosexuality or trans people’s sexual desires. Doctors aren’t even oriented on understanding sexual health of these diverse groups.”
On the IMA’s objective to educate children and parents, she puts forward an important point. Doctors need to look within their community first. “I would say before educating children or parents, start with your own community, by establishing comfort about sex and sexual health among doctors.”
With ED on our minds, we had to ask her what she thought of the IMA’s focus on it. “Erectile dysfunction is not always physiological, it can be a psychological issue too. But doctors aren’t trained to ask those questions.”
She suggests the Maharashtra government as a model to follow in engendering medical education. “They passed a directive in late 2017 to integrate gender into medical education. Now their curriculum is complemented by issues of sexuality and sexual health.”
TARSHI too has valuable advice for the IMA. “Sexual concerns are both common and natural experiences for people of all genders, and they need to be able to feel comfortable and free of stigma while discussing their sexual problems. We hope that IMA’s proposed programme will encourage more people to seek help without fear of being judged by medical service professionals. Not all sexual concerns need medical interventions (even if medical examination may be needed in some cases to diagnose the cause of some sexual problems). It would be encouraging if this programme on sexual health also includes sensitisation for medical professionals on the various ways society, cultural and sexual issues intersect. The last thing we need is for every sexual issue to be treated with pills!”
It seems that the IMA has a lot of ground to cover before they begin to preach about revolutionising the way doctors engage with the sexual health of their patients. That said, opening up a channel for expression of sexual health concerns and encouraging doctors to come out of the modesty closet is a big step forward in itself.
Co-published with Firstpost.