Byline: Om. Prakash, T. Sathyanarayana Rao
This review provides the available evidence on sexual dysfunctions in India. Most of the studies have concentrated on male sexual dysfunction and hardly a few have voiced the sexual problems in females. Erectile dysfunction (ED), premature ejaculation (PME) and combinations of ED and PME appear to be main dysfunctions reported in males. Dhat syndrome remains an important diagnosis reported in studies from North India. There is a paucity of literature on management issues with an emergent need to conduct systematic studies in this neglected area so that the concerns of these patients can be properly dealt with.
Human sexuality is inherently related to some of the social and public health problems in India. These problems may involve contraceptive use, child abuse, sex education, legal issues of homosexuality and AIDS. These health problems have a significant impact on existing health infrastructure and budget. These problems also need to look within the context of poverty, stressful living situations, diverse cultural belief systems, quackery, ignorance and inadequate health services. However, there is little recognition of how these health problems are related to human sexuality and their dysfunctions. There is a need to understand how sexual attitudes, beliefs, and values act and influence these problems. Our cultural perspective can also shape the experience and understanding of these disorders. [sup] There is a need to research sexual experiences and dysfunctions, which further influence adult behavior patterns in India.
In this review, our aim is to present sexual dysfunction from the Indian perspective. Available data, based clinical studies from India, are reviewed and important findings highlighted. Our presentation is limited to sexual dysfunction only and paraphilias will be not discussed.
Sexual dysfunction in males
One of the first literatures in male sexual dysfunctions was reported by Bagadia et al . (1959). [sup] They observed ignorance, superstitions, fears and guilt feelings about sex as major areas of concern, and developed a method of educational group therapy for minor sex disorders, which involved a psycho-education including anatomy, physiology and mind-body continuum related to sexual disorders.
Bagadia and his colleagues (1972) [sup] studied 258 male out patient of teaching hospital setting with sexual problems as main concerns. They found anxiety over nocturnal emission (65%) and passing semen in urine (47%) main problems in the unmarried group; while impotence (48%), premature ejaculation (34%) and passing semen in urine (47%) were common in married group. Anxiety state (57%), schizophrenia (16%) and reactive depression (16%) were common psychiatric diagnosable conditions in that sample.
Nakra and his colleagues (1977) [sup] studied sexual disorders in 150 males attending psychiatric unit of a teaching general hospital. They reported that 9.2% of all patients seen had potency disorders. The commonest psychosexual disorders were impotence (acute onset 11.3%; insidious onset 24%), premature ejaculation (PME) (acute onset 10%; insidious onset 15.3%), Dhat syndrome (with impotence/PME 10.7%; without 10%) and apprehension about potency (18%). The wives of these patients showed either helpful or indifferent attitudes towards the problem of sexual dysfunction. The authors also concluded that PME is a state of hyper-sexual arousal.
Using the same cohort, Nakra and his colleagues (1978) [sup] found that nearly 75% of the patients had practiced masturbation before developing potency disorders and nearly 43% had guilt associated with masturbation. The authors also found nocturnal emission and adolescent homosexual contacts in 95% and 16% of the subjects respectively and of these 69% and 39% respectively had associated guilt feelings. 64% of the subjects considered loss of semen harmful to health. …