Sexology is yet to gain same legitimacy as other medical fields, but Indians are now queuing up to discuss infertility, low sperm count or just dissatisfaction.
New Delhi: Dr Prakash Kothari’s patients want good sex, and they are not shy to admit it.
The Mumbai-based doctor, known as India’s top sexologist, says the field has undergone a sea change from the furtive encounters and hushed discussions of yore.
“When I started my practice [four decades ago], people were too shy to discuss their sex lives openly,” Kothari told ThePrint. “Today, they might not accept that they are visiting a sexologist, but they are discussing their problems openly with us.”
The women, too, he added. “Out of 10 patients at my clinic, four are female,” he said.
“They don’t shy away from telling me that they don’t feel satisfied, or that they may walk out of their marriage if I don’t treat their husband,” he added.
Sex is still considered taboo in India, but the covers are slowly coming off. More and more people are seeking out qualified sexologists for unabashed discussions about their sexual problems, be it infertility, masturbation addiction, or just the lack of satisfaction — problems that were once the exclusive preserve of anonymous advice columns.
As a result, sexology, a field of medicine that has struggled to attract the same reverence as its more conventional peers, is finding its place in the sun, spelling big bucks for practitioners who no longer seek the secrecy they prized in the early days of their career decades ago.
Dr Kothari, the former head of the sexual medicine department at Mumbai’s King Edward Memorial (KEM) Hospital, charges Rs 20,000 for a single consultation at his home clinic.
“When I started practising, my fee was just Rs 10,” he told ThePrint.
Additionally, he is paid Rs 5,000 for answering a single question under a weekly column, “Kaam Ka Column”, in a popular Hindi newspaper.
On ePsyclinic, a Gurgaon-based online mental health platform, seven to 10 people log in every day for Rs 900/hour video consultations on sexual concerns.
ePsyclinic also offers anonymous consultation, joining a range of app-based medical consultation apps helping those still resistant to open discussions reach out to professionals.
Sample this: On the online doctor-patient platform Lybrate, a Delhi-based company, queries on sexual health have risen 75 per cent in less than one year. Where Lybrate received 12 lakh queries on sexual health in 2017, the number stands at 21 lakh so far in 2018. It has 4,500 sexologists on board, against 5,000 cardiologists.
According to Docprime.com, an online medical consultation platform run by the Policybazaar Group, 10 per cent of the 2,000 daily chats on the app centre on sexual health and concerns.
Driven by an overwhelming response, online medical consultation app, DocsCall, is also planning to engage more sexologists.
“Surprisingly, the number of sexology cases far exceeds other cases, and amount to around 40 per cent of the total queries,” said Dr Bharat Kansal, the CEO of DocsCall. “Currently, we only have three sexologists handling the massive burden of these queries.”
Most of the consultation queries on the apps revolve around worries about addiction to masturbation, premature ejaculation, size of genitals, sexual weakness, erectile dysfunction and low sperm count.
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Who is a sexologist?
Across the world, sexual medicine still isn’t seen as an independent discipline. As a result, the comprehensive and recognised years-long training available in other medical specialties does not exist for sexual medicine.
Sexologists in India are a varied lot, coming from different branches of medicine such as urology, psychiatry, andrology (men-specific field), and genitor-urinary medicine, among others. Most reportedly ‘double’ as sexologists while pursuing their original discipline, with many homoeopaths and ayurveda doctors also dabbling in the field.
Although they largely have the image of sex-life counselors, sexologists also work with trauma victims and sex workers, besides helping design sex toys.
An array of foreign institutions such as the American Board of Sexology, Certified Supervisors of Sex Therapy, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) run certification courses for doctors with valid degrees like MBBS, Bachelor’s in homoeopathic medicine and surgery (BHMS), and Bachelor’s in ayurveda, medicine and surgery (BAMS).
Doctors who don’t hold a valid degree or prescribe medicines outside the purview of their degree are considered quacks.
“Having a certification from any reputed institute is an additional benefit, and patients must know the difference between a sexologist and a quack,” said Sanjay G. Deshpande of the Council of Sex Education and Parenthood International (CSEPI), an association of over 300 Indian doctors who also double as sexologists.
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‘Doctors don’t advertise’
There is no official estimate on the number of sexologists in India. “It is impossible to know because there are many quacks and many doctors doubling as sexologists,” said Deshpande.
“Our [CSEPI] members consist of doctors who have a valid medical degree in allopathic, Unani, ayurveda or homeopathy, and also practice sexology as part of their profession,” said Deshpande. “The majority of them are not exclusively sexologists.”
Dr Narayana Reddy of Chennai, the first medical professional to start an exclusive clinic for sexual problems in the Tamil Nadu capital, said there would be no more than 10 practitioners in India who only pursue sexology.
“There are just five to seven sexologists in India, including me, who treat just sex-related problems through medical science,” he added. “The rest are either doubling the profession or are quacks.”
Certified by the American College of Sexologists, Reddy is the elected president of the Asia Oceania Federation for Sexology (AOFS), an organisation that represents sexologists from Australia, Africa, Europe, Turkey, Israel, and Latin America.
His story echoes that of his colleague and contemporary Dr Thakur from Mumbai. When Reddy started practising sexology four decades ago, he did not get a single patient in the first six months. Today, getting an appointment at his clinic may take as long as a week, or after a reference from a senior doctor.
Reddy, however, rues that while he overcame many obstacles to establish the specialty of sexual medicine, the majority of Indian sexologists today remain quacks who issue advertisements with tall promises of magical cures.
“Anyone who advertises cannot be qualified as a doctor,” he said. “According to the rules of the Medical Council of India (MCI), doctors cannot advertise. I cannot advertise and I cannot guarantee.
“The profession is marred by quacks as they have high visibility,” Reddy added. “Since patients don’t know how to distinguish them from bona fide practitioners, they run to them.”
A Delhi-based patient agreed with this prognosis, telling ThePrint how he struggled to find a legitimate sexologist in light of a scare about sexually transmitted disease (STD).
“Recently, some rashes started developing on my body, which I feared were the result of an STD,” he said. “That is when my search for a sexologist started in Delhi. I came across a lot of doctors on the internet who claimed to be sexologists. But when I visited them in person, they didn’t appear legitimate.
“I finally found one in Uttam Nagar, 28 km from my house in Mayur Vihar, who confirmed I didn’t have an STD,” he added.
A long way to go
Dr Reddy said sexology had a long way to go before it was counted on a par with other field of medicine.
He remembers how, in his early days, people scoffed at his desire to become a sexologist.
“‘Pursue something like cardiology, it is respectable,’ everyone told me,” he added. “The hospital I joined designated me a reproductive biologist and not sexologist, what I actually was.
“Even my colleagues made fun of the profession,” he said. “They would wink while asking me about the cases I was dealing with.”
Choosing to become a sexologist is not very easy even today, Reddy added.
“We are still waiting for the day when the word ‘sex’ and ‘sexologist’ won’t be controversial at least in medical science,” he said. “Many young doctors want to become sexologists but succumb under family pressure to opt for some ‘respectable’ specialisation.”
Dr Rajinder Yadav of Fortis Hospital at Shalimar Bagh, a ‘doubler’, has seen his patients double over the past couple of years.
From the newly married to childless couples and individuals planning to undergo sex change surgery — everyone has made a beeline for the cabin of Dr Yadav, who is a urologist by qualification.
He said he encountered much stigma when he started out. “It was an issue with my parents and they felt uncomfortable with the fact that I also practised sexology,” he told ThePrint.
Dr Kothari did not tell his mother for almost a decade what he was practicing. “I wasn’t able to put a board outside my clinic because of the taboo related with the designation,” he said.
These sexologists feel that the profession hasn’t gained respect in the last four decades, even though it has gained a lot of customers.
“Any medical student who aspires to become a sexologist may face similar hurdles,” Kothari said. “The only thing that has changed is there are a lot many customers.”
Sweta Gupta, clinical director at IVF chain Medicover Fertility, said it would be better to call sexologists ‘relationship experts or therapists’ to disperse some of the stigma around the profession.
“In a few cases, the patient does not know how to do sex or are unable to fulfil their marriage,” she added. “In other cases, they are not sure if they are having sex the right way to conceive. For such cases, we might need the assistance of sexologists, but it is still a taboo and we might need to convince the patient first.”
The CSEPI, meanwhile, is leading efforts to get sexology recognised as an individual discipline medical students can specialise in.
To that end, the CSEPI had written to the MCI, the watchdog for medical practice in India. However, in September, the MCI was scrapped and is likely to be constituted as a new body, the National Medical Commission.
“We are waiting for the new body to begin its operations,” said Deshpande. “We will send a new letter demanding the attention of lawmakers to consider sexology as a separate branch of medical science.”
Meanwhile, he said, Tamil Nadu’s Dr MGR Medical University had agreed to introduce a recognised course on sexual medicine. “It will be launched in another six months.”
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