I comfortably sat in the referral OPD where we screen patients referred to Psychiatry from other departments of ‘real‘ Medicine and refer them to our Mental (read Mind) Health Center where we perform our Soul surgeries (not lobotomies) in secret.
My first referral came from Hepatology. A middle aged icteric man walked in trembling with his swollen parotids. An Alcoholic, of course! Though stable for now, the challenge would be finding out the reason why he chose alcohol (a depressant) to keep him happy. Referred.
The second referral came from Neurology. It was a young female having fainting spells whenever she faces ‘stress’. Looks like a seizure but not a seizure! Multiple ElectroEncephaloGrams were also normal. Hmm, Conversion Disorder. Needs time to delve into the subconscious. Referred to the mental health center, again.
The third referral came from Medicine. A young couple that recently got married walked in anxiously but seemed hesitant to talk about their problems. And just before we judged that they need help to save their marriage going, she nudged him, making him to whisper, “Doctor Saab, there is a small problem. We recently got married and when we’re trying, you know, it just happens too quickly. She is very upset with me doctor and her family wants her to divorce me. I came here on my wife’s insistence. I do love her, please help me doctor! Please.”
When I signed up for Psychiatry to study the mysteries of the mind, little did I realize that Sex would take such a huge place in it’s understanding. Well, we all know that Freud was a bit too obsessed about Sex but seriously, I did not expect to have encounters with successful otherwise healthy young men and women, shattered and broken asking me to fix their sex lives.
Marriages in conservative societies like India take a strange place. Marriage is well understood as a physical, emotional and sexual contract between two individuals but the challenges to ensure this comes in several forms.
First of all, since most marriages are arranged, the families involved at best can only make superficial guesses at how much the contract will be satisfied. Asking about a groom’s sexual health is a sure way to end the relationship even before it begins! Since most brides and grooms are virgins at the time of marriage, they themselves wouldn’t be aware of their sexual problems. Even after engagement, premarital sex isn’t remotely acceptable. So, please stop reflecting to your friends about the wisdom of ‘would you buy a car without test driving it?’
With this ignorance and building up anxiety, the young couple is expected to perform their best on their celebrated first night itself often on a white bed sheet as a proof of consummation. And if things don’t turn out well, sometimes, hell breaks loose with families’ involvement adding to the pressure and hot divorce notices being served the next day.
Therefore, lovely readers of Lexicon!
I present to you- Sexual dysfunction for dummies
Sex is one of the most intense physical and emotional reactions experienced by all living organisms. It is natural and need not really be taught.
It is okay to talk to your married friends, friends of opposite gender, friends in relationship and your partner regarding your anxieties as they too might be experiencing the same. Please confirm if you haven’t understood something well. It isn’t healthy to develop sexual myths/ misconceptions. We, Psychiatrists even diagnosis them and treat them!
Real sex isn’t remotely close to what you watch on TV or the other so-called sex educational films. Most pornographic videos are unreal, taken after a lot of preparation, makeup, medications involving a wide variety and often violate individual rights. Also, Asian men ejaculate faster than Caucasian and African men who mostly make the porn industry making us feel inferior.
It helps a little to get you a bit oriented about the basic sexual anatomy and physiology though theory alone is often insufficient. Even doctors who regular perform genital examinations report difficulty the first time they did it. There are several online resources that might be useful.
Not just books alone, it helps if you eat healthy, exercise regularly (especially Kegel’s pelvic floor exercises) , cut down on alcohol and have your Diabetes etc. under control. Even masturbation (especially an hour before sex) also helps.
All right now, before we get to work, make sure you and your partner are comfortable, have your private space and know about each other’s preferences. Performance anxiety and embarrassment of being found during the act also result in premature ejaculation and behavioral conditioning.
Foreplay cannot be emphasized enough. It is very important for adequate excitement and a great orgasm especially for the ladies. Take your sweet time to find the sensitive areas= erotic zones.
It is also common that for the first few times, things don’t happen the best way, (happened too early, parter isn’t satisfied or didn’t happen at all). Getting anxious about it only worsens it the next time. So, stay cool. Don’t make a fuss about it. It’s not that uncommon after all.
If things aren’t still working out even the next few times, don’t lash out. Ask your partner how you can help. Use a topical anesthetic cream or a double condom (avoid worry about unwanted pregnancy) to decrease the sensitivity. Change positions often and avoid positions that excessively stimulate the glans penis (Missionary puts more pressure than Woman on top). Taking a deep breath, pulling testes down before the ejaculatory reflex, distracting with lesser stimulating thoughts or mindfulness are other techniques!
Spontaneous erections not in intercourse settings, morning erections, good erections with masturbation or with other partners generally imply that his sex machinery is intact but may be because of psychological issues that need to be addressed.
It is informative to know that it is not just men alone but women too can suffer from sexual dysfunction such as not able to achieve orgasms or severe pain during sex.
If you have done everything for your end, don’t lose hope and find professional help (Andrologist/ Gynaecologist/ Psychiatrist). The doctor usually will maintain confidence, express empathy and will take a non- judgmental stance. He/ she will often be able to identify the problem that missed your eye and will help you address it without medicines initially usually though a PLISSIT model. Some couples find help with marriage counselors especially when the sexual problems are due to their troubled marriage.
Even if all of this fails, science has run far too ahead and has come up with pills such as to increase blood flow to the penis (Sildenafil, Tadalafil), increase the happy hormone Seratonin (antidepressants such as Dapoxetine, Sertraline), vacuum pumps, prostaglandin injections, testosterone boosters, surgical penile implants and African surgeons who have started penile transplants!
After all, with a greater percentages of sexual problems reported by magazines like India Today each year (More than 1 in every 10 Indian males is impotent), Infertility centers sprouting every nook and corner, it is important for us all to know to find simple solutions and try not run behind unrealistic sexual expectations.
Yours friendly spiritual- sexologist,
p.s. Do check out pornastherapy and Pea web app.
This article has been published in Lexicon’s 19th edition- SEXicon