A. Yes, certainly. For psychiatrists who’re also practicing sexologists, questions around sexual dysfunction are common.
I would say, that after depression, anxiety and alcohol-related problems; these are the most common problems we come across. And it is good to know that with increasing awareness in the community about the importance of a good sex life, people do come directly to us these days.
The prevalence of sexual disorders in the adult population ranges between 5-40% and till date, the majority of consultations in this area are by males. That’s not to say that females don’t have such problems, but due to the inhibitions our society places on women, these findings are incidental. It’s often while we’re evaluating the patient for depression or other psychiatric morbidity, that we realise her real reason for coming to us is for a sexual disorder.
Q. What are the most common factors, in your opinion, that contribute to a poor sex life?
A. Various factors can contribute to hampering one’s sex life. These can be broadly classified into 4 different types:
- Psychological factors – Work related stress and anxiety, concern over sexual performance, interpersonal issues, marital or relationship problems, any major psychiatric disorder, depression, feelings of guilt related to sex, lack of knowledge about the normal sexual cycle, previous significant negative sexual experience (e.g., forced intercourse or rape or childhood sexual abuse.), fear of pregnancy or fear of sexually transmitted diseases are some of the common psychological problems.
- Physical factors – Diabetes, heart and vascular diseases, neurological disorders, obesity, hormonal imbalance, kidney or liver failure, alcoholism and drug abuse can take a toll on a person’s sex life. Additionally, the side effects of certain medications may impact sexual function and desire. Pain or uneasiness due to a physical illness can also play spoilsport.
- Situational factors – Lack of privacy in the form of interruptions from children, parents, lack of a separate room in the house, feeling tired or “run down”, recent childbirth can affect one’s sex life.
- Partner specific problems – Sexual attractiveness, constant verbal criticism by partner, non-empathetic treatment by partner, preference for sexual activities (e.g. oral or anal) which are unappealing to the partner, alternate sexual preferences are some of the partner specific factors that inhibit a healthy sex life.
Q. Doctor Joshi, can you elaborate on why a good sex life is so important?
A. It’s a very important part of our lives. Because above all, what counts is our own self-esteem and we all need to feel wanted and needed.
Good sexual activities promote bonding in partners, as it releases oxytocin, the so-called “love hormone”, in both partners. It is a very effective way of communication where you show affection and care for your partner. It’s an excellent stress buster and good exercise.
Deprivation from physical intimacy and sexual connectedness can have a negative impact on one’s mental health and well-being. The best way to heal a problem in your sex life is to talk openly about it with your health professional or someone that you trust who will respect your confidentiality and support you in a non-judgmental way.
Q. There are lots of myths associated with sexual health in India, as it is still considered a taboo topic. Could you share some common myths that you have come across in your practice?
A. Oh yes, myths and misconceptions are definitely abounding in this area. Some common ones are:
1. The male partner should be the sexual leader.
2. Women should never initiate sex or never express their desire for sex.
3. All physical contact “must “ lead to sex.
4. Women should never say “no” to sex.
5. A happy couple should have sex many times in a week and have an orgasm “every time”.
6. Sex is the backbone of married life.
7. Respectable people should not indulge in sex as a routine and should certainly never masturbate.
Dr Pallavi Joshi has an MD in Psychiatry and currently practices at Vydehi Medical College, Bangalore
Photograph courtesy Dr Pallavi Joshi
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