Can myths around sexuality cause distress?

The recent (2017) Hindi comedy-drama film Shubh Mangal Saavdhan, starring Ayushmann Khurrana (as Mudit Sharma) and Bhumi Pednekar (as Sugandha), revolves around a young couple’s intimate life. It depicts Mudit’s inability to sustain an erection and consummate the marriage. Funnily, it takes a veterinary doctor to convince him that he is ‘stressed’ and that the stress is creating performance anxiety.

In a conservative society like India, raising such taboo issues in popular media is a step forward. Schools do not have a curriculum on sexual and relationship issues. Sexual healthcare is an emerging field, with a severe dearth of qualified specialists. 

How common are these problems in India?

While there are no reliable statistics from India, even in a developed country like UK, one in six people reported having a sexual problem (The British National Surveys of Sexual Attitudes and Lifestyles, 2012). A group of sexual and relationship therapists from Bangalore (Aiyappa et al. Happy Relationships group, 2017) conducted an analysis of 500 questions that they received online. It was found that 97 per cent of queries were from men, a majority of them aged 20 to 35 years. Most of the questions were about the size of male genitals (concerns about having a ‘small penis’), ejaculating early (even though a large majority were in the average range of ejaculation time) and concerns about erections.

Why are young Indians presenting with sexual problems?

I often come across men who have a lot of myths and misconceptions about their sexuality. Sahil is an engineer who was married a year ago. He has only been able to have sexual intercourse about six times, since he complains of ‘extreme tiredness’ for two days after ejaculation. Sahil could have an anxiety-related condition specific to the Indian subcontinent called the ‘Dhat Syndrome’. Here, men harbor a false belief that loss of semen leads to physical weakness.

Rajat is a 35-year-old accountant who is married and has two children. He was referred to me for psychosexual counselling by a plastic surgeon, whom he consulted for a ‘penis enlargement’ surgery. He has been married for nine years and has had a satisfactory sexual relationship with his wife. However, a few weeks ago, when on a trip with his male friends, he was ridiculed by the others about the size of his penis, when they were bathing in a pool. Since then, he has been worried about his penis size, and has abstained from being intimate with his wife and is constantly preoccupied with the issue.

Young men like Rajat, with easy access to pornographic material online, have skewed ideas that sexual activity is intercourse-centric and penis-centric. In a study conducted by Happy Relationships – a social enterprise that works in the space of sexual health education – a young man queried, “Doctor, I have a small penis, it is six inches only. I need medication to increase its size." Unfortunately, there is a grey market, especially online, which sells counterfeit and spurious drugs, lotions, potions and oils, which perpetuate the myth that penis length can be increased.

Young Indian men are failing to acknowledge that intimacy, much like a couples' dance, needs both the partners to work in sync. Instead, many men view it as their sole responsibility to initiate sexual activity, to get a ‘great erection’, to be able to penetrate and carry on as long as possible. They ignore the role of their female partners in all of this. In doing so, when things go wrong, men often end up blaming themselves and are convinced that they are at fault. Sometimes, the stress of all this can lead to psychological problems such as anxiety and depressive illnesses. At a much deeper level, men develop doubts about being ‘man-enough’, which in some extreme cases, has driven them to contemplate suicide.

Take, for example, Geetha and Sharath, who have been married for under a year and are under pressure from their families to deliver the ‘good news’. She has an app that tells her when she is ovulating and the app commands the dates on which the couple should have intercourse for fertility. Sharath ‘had to have sex’ and Geetha, at times, would lose her patience and ask him to ‘just ejaculate’. This pressure to perform ended up causing erectile dysfunction in Sharath and consequently, disappointment in both. This led to relationship difficulties between them. I call this scenario ‘sex-on-demand’, where sexual activity is solely focused on procreation.

Sex-related issues and mental health are closely related, and this indicates an urgent need to understand sexual activity and its physical and emotional elements. As a sexologist, I often find myself repeating these statements in my clinic:

• Being in a relationship or being married is not just about sexual intimacy. There are other forms of intimacy such as emotional, recreational and couple time, which a person needs to focus on.

• Sex does not mean intercourse only. Penetrative sex is only one part of the intimacy spectrum.

• Erection does not function like a gadget that can be operated with an on/off button. Sexual arousal (erection in men and lubrication in women) is a process that originates in the mind and is processed by the body. People need to be relaxed and not get anxious at failures in achieving arousal, especially during the initial stages of their sexual exploration. Performance anxiety has spoiled the minds of many individuals and couples and has wreaked havoc in their relationship.

• Understand that there is a fine balance between giving and receiving pleasure with your partner. A person should approach it as a shared activity and not something that is one person’s task.

• If you are unsure, please go as a couple to a qualified sexologist. You could do this at any stage of your relationship, including a premarital counselling session.

There is an urgent need for everyone to talk about this problem: for parents to educate their children, for teachers to impart the right information, and for the society to remove taboos, myths and misconceptions about sex and sexuality.  

*Personal identities (names and other identifiable information) have been changed and details suitably anonymized.

Dr Sandip Deshpande is a Bangalore-based psychiatrist who specializes in sexual health and relationships.