IMA launches programme to sensitise doctors on sexual health, but fixation on male concerns does disservice to issue
When medical practitioners are fixated with sexual health issues faced by men, or view women's concerns only through the prism of their (male) partner's health, women and trans-people are even more unlikely to get an empathetic doctor to discuss these issues.
By Aashika Ravi
In October 2017, Mumbai-based gynaecologist Anamika Pradhan wrote a hilarious but worrying account 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 and patriarchal attitude she encountered from fellow doctors in her professional experiences, at seminars, and on doctors' WhatsApp groups.
But you don't need to be part of a doctors' WhatsApp group to glean what exactly Pradhan was referring to. We're all depressingly familiar with bad experiences with judgmental doctors when it comes to discussing matters of sexual health (so much so that women online even crowdsourced this list of non-judgmental gynecologists from across the country to tap into). Moral judgments 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.
Our hopes were raised when the Indian Medical Association announced a new initiative to raise sexual health awareness among doctors. The IMA, which is a nation-wide voluntary organisation of doctors, and the largest association of medical professionals and students in India, was quite well-placed to run an awareness campaign of this magnitude. The IMA's new programme is set to target around 3.5 lakh doctors across India to sensitise them and quash myths surrounding sexual health.
Finally, we thought that women won't have to lie or tell half-baked truths to their doctors simply to avoid a dressing down. It gave us the impression that 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.
We got in touch with Deepak Jumani, a doctor, professor and 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 Jumani, it felt like that might be the whole raison d'être for this movement to enlighten the medical practitioners. According to Jumani, doctors 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 patients who were not male, he did have something to say… but again, only in relation to the problems faced by the wives and partners of male patients suffering from erectile dysfunction, 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," Jumani said.
When the chairman of a sexual health initiative, which has such a wide outreach, speaks about women's sexual health entirely in relation to a man's, (also completely ignoring the existence of trans people, who face a completely 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 article 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 faced by 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 create understanding and awareness around it.
That being said, 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 Jumani himself. They will 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 and advocating about health and allied themes.
Rege 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 to 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 erectile dysfunction 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.
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